A new species of Cosmetocleithrum (Monogenea, Dactylogyridae) from the gills of Auchenipterichthys coracoideus (Siluriformes, Auchenipteridae) from the Peruvian Amazonia / Una nueva especie de Cosmetocleithrum (Monogenea, Dactylogyridae) de las branquias de Auchenipterichthys coracoideus (Siluriformes, Auchenipteridae) de la Amazonía peruana

Abstract In this study, a new species of Monogenoidea, Cosmetocleithrum amazonensis n. sp., parasitizing the gills of the silurid Auchenipterichthys coracoideus (Eigenmann & Allen, 1942), is documented. Cosmetocleithrum amazonensis n. sp. is distinguished from all other congeners by possessing an elongated, sclerotized, and sinuous male copulatory organ (MCO) with poorly defined spirals, a sclerotized border at the base, and the distal region supported by the accessory piece. The accessory piece is a single, robust, and non-articulated plate with the MCO. This study presents the third record of a Monogenoidea species in an Auchenipteridae (Siluriformes) host from Peru.

Resumen En este trabajo se registra una nueva especie de Monogenoidea, Cosmetocleithrum amazonensis n. sp., parasitando las branquias del silurido Auchenipterichthys coracoideus (Eigenmann & Allen, 1942). Cosmetocleithrum amazonensis n. sp. se distingue de todas las demás especies congéneres por poseer un órgano copulador masculino (OCM) tubo alargado, esclerotizado y sinuoso, con espirales poco definidos, base con borde esclerotizado y con la región distal apoyada sobre la pieza accesoria. La pieza accesoria es una placa única, robusta y no articulada con el OCM. En este estudio se presenta el tercer registro de una especie de Monogenoidea en un hospedero Auchenipteridae (Siluriformes) del Perú.

Genomic resistant determinants of multidrug-resistant Campylobacter spp. isolates in Peru.

OBJECTIVES: Antimicrobial resistant (AMR) Campylobacter is a global health threat; however, there is limited information on genomic determinants of resistance in low- and middle-income countries. We evaluated genomic determinants of AMR using a collection of whole genome sequenced Campylobacter jejuni and C. coli isolates from Iquitos, Peru. METHODS: Campylobacter isolates from two paediatric cohort studies enriched with isolates that demonstrated resistance to ciprofloxacin and azithromycin were sequenced and mined for AMR determinants. RESULTS: The gyrA mutation leading to the Thr86Ile amino acid change was the only gyrA mutation associated with fluoroquinolone resistance identified. The A2075G mutation in 23S rRNA was present, but three other 23S rRNA mutations previously associated with macrolide resistance were not identified. A resistant-enhancing variant of the cmeABC efflux pump genotype (RE-cmeABC) was identified in 36.1% (35/97) of C. jejuni genomes and 17.9% (12/67) of C. coli genomes. Mutations identified in the CmeR-binding site, an inverted repeat sequence in the cmeABC promoter region that increases expression of the operon, were identified in 24/97 C. jejuni and 14/67 C. coli genomes. The presence of these variants, in addition to RE-cmeABC, was noted in 18 of the 24 C. jejuni and 9 of the 14 C. coli genomes. CONCLUSIONS: Both RE-cmeABC and mutations in the CmeR-binding site were strongly associated with the MDR phenotype in C. jejuni and C. coli. This is the first report of RE-cmeABC in Peru and suggests it is a major driver of resistance to the principal therapies used to treat human campylobacteriosis in this setting.

Antibiotic Use and Stewardship Practices in a Pediatric Community-based Cohort Study in Peru: Shorter Would be Sweeter.

BACKGROUND: There is a need to evaluate antibiotic use, duration of therapy, and stewardship in low- and middle-income countries to guide the development of appropriate stewardship programs that are global in scope and effectively decrease unnecessary antibiotic use. METHODS: We prospectively collected information on illness occurrence and antibiotic use from a cohort of 303 children. We evaluated the incidence, duration of therapy, and appropriateness of antibiotic prescriptions by 5 main antibiotic prescribers (physicians and nurses, pharmacists, nursing assistants, self-prescriptions, and neighbors or family members). RESULTS: Ninety percent of children received an antibiotic during follow-up, and on average, by the end of follow-up a child had spent 4.3% of their first 5 years of life on antibiotics. The most frequent prescribers were physicians/nurses (79.4%), followed by pharmacists (8.1%), self-prescriptions (6.8%), nursing assistants (3.7%), and family or neighbors (1.9%). Of the 3702 courses of antibiotics prescribed, 30.9% were done so for the occurrence of fever, 25.3% for diarrhea, 2.8% for acute lower respiratory disease, 2.7% for dysentery, and 38.2% for an undetermined illness. Courses exceeding the recommended duration were common for the principal diseases for which treatment was initiated, with 27.3% of courses exceeding the recommended length duration, representing a potential reduction in 13.2% of days on which this cohort spent on antibiotics. CONCLUSIONS: Stewardship programs should target medical personnel for a primary care stewardship program even in a context in which antibiotics are available to the public with little or no restrictions and appropriate duration should be emphasized in this training.

Heterogeneity of Dengue Illness in Community-Based Prospective Study, Iquitos, Peru.

Measuring heterogeneity of dengue illness is necessary to define suitable endpoints in dengue vaccine and therapeutic trials and will help clarify behavioral responses to illness. To quantify heterogeneity in dengue illness, including milder cases, we developed the Dengue Illness Perceptions Response (IPR) survey, which captured detailed symptom data, including intensity, duration, and character, and change in routine activities caused by illness. During 2016-2019, we collected IPR data daily during the acute phase of illness for 79 persons with a positive reverse transcription PCR result for dengue virus RNA. Most participants had mild ambulatory disease. However, we measured substantial heterogeneity in illness experience, symptom duration, and maximum reported intensity of individual symptoms. Symptom intensity was a more valuable predicter of major activity change during dengue illness than symptom presence or absence alone. These data suggest that the IPR measures clinically useful heterogeneity in dengue illness experience and its relation to altered human behavior.

Using full chloroplast genomes of 'red' and 'yellow' Bixa orellana (achiote) for kmer based identification and phylogenetic inference.

BACKGROUND: Full chloroplast genomes provide high resolution taxonomic discrimination between closely related plant species and are quickly replacing single and multi-locus barcoding regions as reference materials of choice for DNA based taxonomic annotation of plants. Bixa orellana, commonly known as "achiote" and "annatto" is a plant used for both human and animal foods and was thus identified for full chloroplast sequencing for the Center for Veterinary Medicine (CVM) Complete Chloroplast Animal Feed database. This work was conducted in collaboration with the Instituto de Medicina Tradicional (IMET) in Iquitos, Peru. There is a wide range of color variation in pods of Bixa orellana for which genetic loci that distinguish phenotypes have not yet been identified. Here we apply whole chloroplast genome sequencing of "red" and "yellow" individuals of Bixa orellana to provide high quality reference genomes to support kmer database development for use identifying this plant from complex mixtures using shotgun data. Additionally, we describe chloroplast gene content, synteny and phylogeny, and identify an indel and snp that may be associated with seed pod color. RESULTS: Fully assembled chloroplast genomes were produced for both red and yellow Bixa orellana accessions (158,918 and 158,823 bp respectively). Synteny and gene content was identical to the only other previously reported full chloroplast genome of Bixa orellana (NC_041550). We observed a 17 base pair deletion at position 58,399-58,415 in both accessions, relative to NC_041550 and a 6 bp deletion at position 75,531-75,526 and a snp at position 86,493 in red Bixa orellana. CONCLUSIONS: Our data provide high quality reference genomes of individuals of red and yellow Bixa orellana to support kmer based identity markers for use with shotgun sequencing approaches for rapid, precise identification of Bixa orellana from complex mixtures. Kmer based phylogeny of full chloroplast genomes supports monophylly of Bixaceae consistent with alignment based approaches. A potentially discriminatory indel and snp were identified that may be correlated with the red phenotype.

Lack of Evidence of Sylvatic Transmission of Dengue Viruses in the Amazon Rainforest Near Iquitos, Peru.

Dengue viruses (DENV) are currently responsible for more human morbidity and mortality than any other known arbovirus, and all four DENV are known to exist in sylvatic cycles that might allow these viruses to persist if the urban (Aedes aegypti) cycle could be controlled. To determine whether DENV were being maintained in a sylvatic cycle in a forested area about 14 km southwest of Iquitos, Peru, a city in which all 4 serotypes of DENV circulate, we placed 20 DENV seronegative Aotus monkeys in cages either in the canopy or near ground level for a total of 125.6 months. Despite capturing >66,000 mosquitoes in traps that collected some of the mosquitoes attracted to these monkeys, blood samples obtained once a month from each animal were tested and found to be negative by an enzyme-linked immunosorbent assay for IgM and IgG antibodies to dengue, yellow fever, Venezuelan equine encephalitis, Oropouche, and Mayaro viruses. Although all four DENV serotypes were endemic in nearby Iquitos, the findings of this study did not support a DENV sylvatic maintenance and transmission cycle in a selected area of the Amazon rainforest in northeastern Peru.

Antibiotic Resistance of Campylobacter Species in a Pediatric Cohort Study.

The objective of this study was to determine the phenotypic patterns of antibiotic resistance and the epidemiology of drug-resistant Campylobacter spp. from a low-resource setting. A birth cohort of 303 patients was followed until 5 years of age. Stool samples from asymptomatic children (n = 10,008) and those with diarrhea (n = 3,175) were cultured for Campylobacter Disk diffusion for ciprofloxacin (CIP), nalidixic acid (NAL), erythromycin (ERY), azithromycin (AZM), tetracycline (TE), gentamicin (GM), ampicillin (AMP), amoxicillin and clavulanic acid (AMC), ceftriaxone (CRO), chloramphenicol (C), and trimethoprim-sulfamethoxazole (TMS) was determined. Antibiotic resistances in Campylobacter jejuni and non-C. jejuni isolates from surveillance and diarrhea samples were compared, and the association between personal macrolide exposure and subsequent occurrence of a macrolide-resistant Campylobacter spp. was assessed. Of 917 Campylobacter isolates, 77.4% of C. jejuni isolates and 79.8% of non-C. jejuni isolates were resistant to ciprofloxacin, while 4.9% of C. jejuni isolates and 24.8% of non-C. jejuni isolates were not susceptible to azithromycin. Of the 303 children, 33.1% had been diagnosed with a Campylobacter strain nonsusceptible to both azithromycin and ciprofloxacin. Personal macrolide exposure did not affect the risk of macrolide-resistant Campylobacter Amoxicillin and clavulanic acid (94.0%) was one of the antibiotics with the highest rates of susceptibility. There is a high incidence of quinolone- and macrolide-resistant Campylobacter infections in infants under 24 months of age. Given the lack of association between personal exposure to macrolides and a subsequent Campylobacter infection resistant to macrolides, there is a need to evaluate the source of multidrug-resistant (MDR) Campylobacter This study provides compelling evidence to propose amoxicillin/clavulanic acid as a treatment for campylobacteriosis.

Arsenic, manganese and aluminum contamination in groundwater resources of Western Amazonia (Peru).

This paper presents a first integrated survey on the occurrence and distribution of geogenic contaminants in groundwater resources of Western Amazonia in Peru. An increasing number of groundwater wells have been constructed for drinking water purposes in the last decades; however, the chemical quality of the groundwater resources in the Amazon region is poorly studied. We collected groundwater from the regions of Iquitos and Pucallpa to analyze the hydrochemical characteristics, including trace elements. The source aquifer of each well was determined by interpretation of the available geological information, which identified four different aquifer types with distinct hydrochemical properties. The majority of the wells in two of the aquifer types tap groundwater enriched in aluminum, arsenic, or manganese at levels harmful to human health. Holocene alluvial aquifers along the main Amazon tributaries with anoxic, near pH-neutral groundwater contained high concentrations of arsenic (up to 700µg/L) and manganese (up to 4mg/L). Around Iquitos, the acidic groundwater (4.2≤pH≤5.5) from unconfined aquifers composed of pure sand had dissolved aluminum concentrations of up to 3.3mg/L. Groundwater from older or deeper aquifers generally was of good chemical quality. The high concentrations of toxic elements highlight the urgent need to assess the groundwater quality throughout Western Amazonia.

Landscape-scale consequences of differential tree mortality from catastrophic wind disturbance in the Amazon.

Wind disturbance can create large forest blowdowns, which greatly reduces live biomass and adds uncertainty to the strength of the Amazon carbon sink. Observational studies from within the central Amazon have quantified blowdown size and estimated total mortality but have not determined which trees are most likely to die from a catastrophic wind disturbance. Also, the impact of spatial dependence upon tree mortality from wind disturbance has seldom been quantified, which is important because wind disturbance often kills clusters of trees due to large treefalls killing surrounding neighbors. We examine (1) the causes of differential mortality between adult trees from a 300-ha blowdown event in the Peruvian region of the northwestern Amazon, (2) how accounting for spatial dependence affects mortality predictions, and (3) how incorporating both differential mortality and spatial dependence affect the landscape level estimation of necromass produced from the blowdown. Standard regression and spatial regression models were used to estimate how stem diameter, wood density, elevation, and a satellite-derived disturbance metric influenced the probability of tree death from the blowdown event. The model parameters regarding tree characteristics, topography, and spatial autocorrelation of the field data were then used to determine the consequences of non-random mortality for landscape production of necromass through a simulation model. Tree mortality was highly non-random within the blowdown, where tree mortality rates were highest for trees that were large, had low wood density, and were located at high elevation. Of the differential mortality models, the non-spatial models overpredicted necromass, whereas the spatial model slightly underpredicted necromass. When parameterized from the same field data, the spatial regression model with differential mortality estimated only 7.5% more dead trees across the entire blowdown than the random mortality model, yet it estimated 51% greater necromass. We suggest that predictions of forest carbon loss from wind disturbance are sensitive to not only the underlying spatial dependence of observations, but also the biological differences between individuals that promote differential levels of mortality.

Emergence of Human Arboviral Diseases in the Americas, 2000-2016.

In addition to individual or clusters of cases of human infections with arboviruses, the past 15 years has seen the emergence of newly recognized arboviruses and the re-emergence of others. Mentioned in this brief summary are Bourbon, Cache Valley, chikungunya, Heartland, Itaqui, Mayaro, Oropouche, Powassan, and Zika viruses, the latter being a remarkable occurrence.

In vitro Antimicrobial Activity of Traditional Plant Used in Mestizo Shamanism from the Peruvian Amazon in Case of Infectious Diseases.

CONTEXT: Our survey was performed near Iquitos (Peruvian Amazon) and its surroundings and leads us to consider Mestizo ethnomedical practices. The plant species reported here are traditionally used for ailments related to microbial infections. Inhabitants of various ethnic origins were interviewed, and 52 selected plants extracts were evaluated for their antimicrobial properties against a panel of 36 sensitive and multi-resistant bacteria or yeast. The study aimed at providing information on antimicrobial plant extract activities and the ethnomedical context of Mestizo riverine populations from Loreto (Peru). MATERIAL AND METHOD: The minimum inhibitory concentrations (MICs) of the plant crude extracts were carried out using the agar dilution method and ranged between 0.075 and 5.0 mg/ml. RESULTS: Of the 40 plants analyzed, 9 species showed MIC ≤0.3 mg/ml (Anacardium occidentale, Couroupita guianensis, Croton lechleri, Davilla rugosa, Erythrina amazonica, Jacaranda copaia subsp. Spectabilis, Oenocarpus bataua, Peperomia macrostachya, and Phyllanthus urinaria) for one or several of the 36 microorganisms and only 6 drug extracts were inactive. Among the 40 plants, 13 were evaluated for the first time for an antibacterial activity. CONCLUSION: This evaluation of the antimicrobial activity of 40 plants using an approved standard methodology allowed comparing those activities against various microbes to establish antimicrobial spectra of standardized plant extracts, and give support to the traditional use of these plants. It may also help discovering new chemical classes of antimicrobial agents that could serve against multi-resistant bacteria. SUMMARY: This study leads us to consider Mestizo ethnomedical practices near Iquitos (Peruvian Amazon) and its surroundings. The plant species reported here are traditionally used for ailments related to microbial infections. 52 selected plants extracts were evaluated for their antimicrobial properties against a panel of 36 sensitive and multi resistant bacteria or yeast. The study aimed at providing information on antimicrobial plant extract activities and the ethnomedical context of Mestizo riverine populations from Loreto.

Brote de fiebre de oropuche en Bagazán, San Martín Perú: evaluación epidemiológica, manifestaciones gastrointestinales y hemorrágicas / Oropuche fever outbreak in Bagazan,San Martín, Peru: epidemiological evaluation, gastrointestinal and hemorrhagic manifestations

INTRODUCCIÓN: En Perú, el primer brote de fiebre de Oropuche (OROF) fue en Iquitos en 1992, como diseminación del virus oropuche (OROV) desde Brasil. La OROF produce gastos en recursos de salud, pérdida laboral, inasistencia académica y sufrimiento social. OBJETIVO: Contribuir a evaluar el brote de OROF en el pueblo Bagazán del Departamento San Martín, comparar las manifestaciones gastrointestinales (MGI) y hemorrágicas con las del brote de Iquitos y los de Brasil. MÉTODOS: En Bagazán, con 1,082 habitantes, se produjo bruscamente en mayo de 2010 un síndrome febril agudo en muchos habitantes. La información fue registrada en formatos estandarizados. Muestras sanguíneas fueron enviadas al Instituto Nacional de Salud de Lima. RESULTADOS: En 108 pacientes se confirmó el diagnóstico. La mayoría presentó fiebre > 38ºC, cefalea, dolores musculares, artralgias, inyección conjuntival, dolor abdominal, náuseas, vómitos, diarrea. En pocos casos epistaxis, sangrado gingival, menorragia. Las MGI fueron más frecuentes que en el de Iquitos. CONCLUSIONES: El brote demostró la persistente diseminación del OROV al Perú. El brote ocurrió al producirse una conjunción de situaciones propicias. Se discuten hipótesis del incremento de MGI y hemorrágicas, incluyendo razones ecológicas, inmunitarias, individuales y virales.

INTRODUCTION: In Peru, the first outbreak of Oropuche fever (OROF) occurred in Iquitos during 1992, as dissemination of oropuche virus from Brazil. The OROF causes expenses in public health, loss of labour and academic activities and social suffering. OBJECTIVE: Evaluation of the outbreak of OROF in Bagazan community of San Martin Department, and comparison of the gastrointestinal and hemorrhagic clinical manifestations with those occurred in Iquitos and Brazil. METHODS: The sudden onset of an acute fever syndrome in many people of Bagazan, little village with 1082 residents, happened in may 2010. The symptoms and signs were registered in a standardized pattern. Blood samples were sent to the laboratory of the National Health Institute in Lima. RESULTS: The diagnosis was confirmed in 108 patients. The clinical manifestations were fever of 38º C, headache, muscle and joint pains, congestion of conjunctiva, nausea, vomiting, and diarrhea. Some cases presented nose, gum and/ or vaginal bleeding. The gastrointestinal manifestations were more frequent than those of the Iquitos cases. CONCLUSIONS: The outbreak showed the dissemination of OROF to Peru, because of various favorable conditions. We discuss the hypothesis of the increase of gastrointestinal and hemorrhagic manifestations, including ecological, immunity, individual and viral characteristics.

Seroprevalencia de anticuerpos contra el virus de hepatitis C (VHC) en trabajadoras sexuales que acuden a un Centro de Referencia de Infecciones de Transmisión Sexual (CERITSS) de la ciudad de Iquitos, Perú / Seroprevalence of antibodies against hepatitis C virus in Female sex workers patients from the sexually transmitted Infections Reference Center in Iquitos, Peru

Introducción: los principales factores de riesgo descritos para contraer la infección por el virus de la hepatitis C (VHC) son antecedentes de transfusión sanguínea y uso de droga endovenosa; el riesgo por transmisión sexual es controversial. Existen pocos estudios de VHC en trabajadoras sexuales (TS) en el Perú, encontrando bajas prevalencias de VHC (0-1%). El presente estudio se ha realizado en Iquitos, una ciudad en la selva peruana, en donde existe gran comercio sexual y la prevalencia de HIV/SIDA y otras Infecciones de Transmisión Sexual (ITS) es alta. Objetivo: determinar la seroprevalencia de anticuerpos contra el VHC en TS de la ciudad de Iquitos atendidas en un Centro Especializado de Referencia de Infecciones de transmisión sexual (CERITSS) e identificar los factores de riesgo asociados a esta. Material y métodos: es un estudio de corte transversal en TS quienes acudieron a su control periódico al CERITSS San Juan entre mayo 2003 a enero 2004. Una encuesta clínica-epidemiológica fue utilizada para determinar la frecuencia de factores de riesgo para adquirir la infección por VHC. Para determinar la presencia de anticuerpos contra el VHC, se utilizó la prueba de enzima inmunoensayo (EIA); todos los resultados positivos fueron confirmados con la prueba inmunoblot recombinante (RIBA). Resultados: cuatro de las 200 TS enroladas en el estudio fueron positivos para la prueba EIA, todas ellas tuvieron resultados positivos de RIBA (prevalencia de 2%, IC95% 0,06-3,94%). Estas 4 TS reportaron ser naturales de Iquitos, tener mas de 5 años de trabajo sexual, reportaron un bajo uso de condón (<50%). Tres de ellas reportaron haber tenido mas de 9 parejas/ día, realizar trabajo sexual bajo efecto del alcohol y tener sexo anal frecuentemente. Ninguna refirió transfusiones sanguíneas, antecedente de tatuajes o uso de drogas endovenosas. Solo una de las 4 VHC positivas tuvo serología positiva para sífilis co-existentemente y ninguna para VIH. Una de las 200 TS enroladas tuvo infección por VIH. Conclusiones: la seroprevalencia de anticuerpos contra el VHC en TS es mayor que la reportada en poblaciones similares en otras ciudades del Perú. Esta población se caracterizó por tener una conducta sexual de alto riesgo y no tener antecedentes de transfusión sanguínea ni consumo de droga endovenosa.

Introducction: the principal described risk factors to contract the hepatitis C virus (HCV) are blood transfusion antecedents and intravenous drug use; sexual transmission risk is controversial. In Peru there exist few studies whose female sex worker (FSW) HCV prevalence oscillates between 0-1%. The present study is based in Iquitos, a Peruvian jungle city with high sexual commerce and HIV/AIDS prevalence. Objetive: determine the HCV serological prevalence in Iquitos FSWs attending the STI/ HIV specialist center (CERITSS) and identify associated risk factors. Material and methods: cross-sectional study in FSWs who attended periodic San Juan CERITSS examinations from May 2003 to January 2004. Epidemical questionnaires where used to evaluate the risk factors. To determine HCV antibodies presence, the immunoassay enzyme (EIA) positive results were confirmed by the recombinant immunoblot assay (RIBA) test. Results: 4/200 FSWs enrolled in the study were EIA test positive; all had confirmed positive RIBA results, representing 2%(95%IC 0,06%-3,94%) prevalence. the 4 FSWs referred to be were born in Iquitos, to having been a sex worker for five years and stated condom use was <50%. Three to having had 9 sexual clients daily; to heavy alcohol consumption and to frequent anal sex . None declared intravenous drug use; having had tattoos and blood transfusions. Only one of 4 HCV positives had syphilis serology and none had HIV infections. 1/200 was diagnosed with HIV. Conclusion: the antibody against HCV seroprevalence in Iquitos FSWs is greater than reported in similar populations or the general population of other Peruvian cities. This population was characterized by having high risk sexual behavior and no blood transfusion antecedent nor intravenous drug user.

Sistemática de las plantas medicinales de uso frecuente en el área de Iquitos / Systematics of medicinal plants often used in the Iquitos area

En éste artículo, se reporta la existencia de 105 especies de plantas medicinales, que los habitantes de Iquitos y alrededores usan frecuentemente en el tratamiento de ciertas dolencias; la idea de esta contribución es aclarar ciertos nombres científicos que erróneamente se vienen usando para las plantas medicinales de uso folklórico.