Epidemiological Characteristics of Deaths from COVID-19 in Peru during the Initial Pandemic Response.

BACKGROUND AND AIM: Peru is the country with the highest mortality rate from COVID-19 globally, so the analysis of the characteristics of deaths is of national and international interest. The aim was to determine the epidemiological characteristics of deaths from COVID-19 in Peru from 28 March to 21 May 2020. METHODS: Deaths from various sources were investigated, including the COVID-19 Epidemiological Surveillance and the National System of Deaths (SINADEF). In all, 3851 deaths that met the definition of a confirmed case and had a positive result of RT-PCR or rapid test IgM/IgG, were considered for the analysis. We obtained the epidemiological variables and carried out an analysis of time defined as the pre-hospital time from the onset of symptoms to hospitalization, and hospital time from the date of hospitalization to death. RESULTS: Deaths were more frequent in males (72.0%), seniors (68.8%) and residents of the region of Lima (42.7%). In 17.8% of cases, the death occurred out-of-hospital, and 31.4% had some comorbidity. The median of pre-hospital time was 7 days (IQR: 4.0-9.0) and for the hospital time was 5 days (IQR: 3.0-9.0). The multivariable analysis with Poisson regression with robust variance found that the age group, comorbidity diagnosis and the region of origin significantly influenced pre-hospital time; while sex, comorbidity diagnosis, healthcare provider and the region of origin significantly influenced hospital time. CONCLUSION: Deaths occurred mainly in males, seniors and on the coast, with considerable out-of-hospital deaths. Pre-hospital time was affected by age group, the diagnosis of comorbidities and the region of origin; while, hospital time was influenced by gender, the diagnosis of comorbidities, healthcare provider and the region of origin.

Seroprevalence of Brucella canis in canines from a dog shelter in Bogotá, Colombia / [Seroprevalencia de Brucella canis en perros de un refugio para animales de compañía en Bogotá, Colombia].

Introduction: The risk of Brucella canis infection in humans and dogs has increased due to the permanent exposure to asymptomatic carrier dogs. In Colombia, there is evidence of B. canis infection in humans living with dogs. In the case of Bogotá, an additional concern is the lack of updated information related to the prevalence of the infection in dogs. Objective: To determine the seroprevalence of infection by B. canis in dogs intended for adoption programs in Bogotá. Materials and methods: By means of a descriptive cross-sectional study carried out in a dog shelter in Bogotá, anti-B. canis IgG antibodies were detected in the serum from 51 dogs 28 females and 23 males) using a lateral-flow immunochromatographic test. Additionally, seropositive animals were analyzed with PCR to detect Brucella spp DNA. Results: Brucella canis seroprevalence was 1.96% (1/51). The seropositive dog was an asymptomatic three-year-old she-dog in which no bacteria DNA was detected in the blood through PCR. Conclusions: The seroprevalence determined in this study represented by a single dog with anti-B. canis IgG can be considered a potential risk both for canine and human populations since this single dog could have a persistent infection capable of spreading the bacteria.

Introducción. El riesgo de infección con Brucella canis en humanos y perros aumenta con la exposición constante a perros portadores asintomáticos. En Colombia hay evidencia de infección con B. canis en personas que conviven con perros. Una preocupación adicional en Bogotá es la falta de información actualizada sobre la prevalencia de la infección en perros destinados a programas de adopción. Objetivo. Establecer la seroprevalencia de la infección por B. canis en perros de un refugio para animales de compañía destinados a la adopción en Bogotá. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal en un refugio ara animales de Bogotá. Se detectaron anticuerpos contra B. canis en el suero de 51 perros (28 hembras y 23 machos) mediante una prueba inmunocromatográfica de flujo lateral. Asimismo, los individuos positivos se analizaron con PCR para la detección del ADN de Brucella spp. Resultado. La seroprevalencia de B. canis fue del 1,96 % (1/51). El perro seropositivo correspondió a una hembra asintomática de tres años de edad en la cual no se detectó ADN bacteriano en sangre mediante la PCR. Conclusiones. La seroprevalencia representada por un solo perro con IgG anti-B. canis puede considerarse un riesgo potencial para las poblaciones de perros y humanos, ya que podría tratarse de un animal con infección persistente capaz de diseminar la bacteria.

Seroprevalencia de Brucella canis en perros de un refugio para animales de compañía en Bogotá, Colombia / Seroprevalence of Brucella canis in canines from a dog shelter in Bogotá, Colombia

Resumen | Introducción. El riesgo de infección con Brucella canis en humanos y perros aumenta con la exposición constante a perros portadores asintomáticos. En Colombia hay evidencia de infección con B. canis en personas que conviven con perros. Una preocupación adicional en Bogotá es la falta de información actualizada sobre la prevalencia de la infección en perros destinados a programas de adopción. Objetivo. Establecer la seroprevalencia de la infección por B. canis en perros de un refugio para animales de compañía destinados a la adopción en Bogotá. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal en un refugio para animales de Bogotá. Se detectaron anticuerpos contra B. canis en el suero de 51 perros (28 hembras y 23 machos) mediante una prueba inmunocromatográfica de flujo lateral. Asimismo, los individuos positivos se analizaron con PCR para la detección del ADN de Brucella spp. Resultados. La seroprevalencia de B. canis fue del 1,96 % (1/51). El perro seropositivo correspondió a una hembra asintomática de tres años de edad en la cual no se detectó ADN bacteriano en sangre mediante la PCR. Conclusiones. La seroprevalencia representada por un solo perro con IgG anti-B. canis puede considerarse un riesgo potencial para las poblaciones de perros y humanos, ya que podría tratarse de un animal con infección persistente capaz de diseminar la bacteria.

Abstract | Introduction: The risk of Brucella canis infection in humans and dogs has increased due to the permanent exposure to asymptomatic carrier dogs. In Colombia, there is evidence of B. canis infection in humans living with dogs. In the case of Bogotá, an additional concern is the lack of updated information related to the prevalence of the infection in dogs. Objective: To determine the seroprevalence of infection by B. canis in dogs intended for adoption programs in Bogotá. Materials and methods: By means of a descriptive cross-sectional study carried out in a dog shelter in Bogotá, anti-B. canis IgG antibodies were detected in the serum from 51 dogs (28 females and 23 males) using a lateral-flow immunochromatographic test. Additionally, seropositive animals were analyzed with PCR to detect Brucella spp DNA. Results: Brucella canis seroprevalence was 1.96% (1/51). The seropositive dog was an asymptomatic three-year-old she-dog in which no bacteria DNA was detected in the blood through PCR. Conclusions: The seroprevalence determined in this study represented by a single dog with anti-B. canis IgG can be considered a potential risk both for canine and human populations since this single dog could have a persistent infection capable of spreading the bacteria.

A silent public health threat: emergence of Mayaro virus and co-infection with Dengue in Peru.

OBJECTIVE: To describe frequency and clinical characteristics of MAYV infection in Piura, as well as the association of this pathogen with DENV. RESULTS: A total of 86/496 (17.3%) cases of MAYV were detected, of which 54 were MAYV mono-infection and 32 were co-infection with DENV, accounting for 10.9% and 6.4%, respectively. When evaluating monoinfection by MAYV the main groups were 18-39 and 40-59 years old, with 25.9% and 20.4% respectively. Co-infections were more common in the age group 18-39 and those > 60 years old, with 34.4% and 21.9%, respectively. The most frequent clinical presentation were headaches (94.4%, 51/54) followed by arthralgias (77.8%, 42/54). During the 8-month study period the most cases were identified in the months of May (29.1%) and June (50.0%).

Oropouche infection a neglected arbovirus in patients with acute febrile illness from the Peruvian coast.

OBJECTIVE: To evaluate the frequency of infection caused by the Oropouche virus (OROV) in 496 patients with acute febrile disease (AFI), whose samples were obtained for the analysis of endemic arboviruses in a previous investigation carried out in 2016. RESULTS: OROV was detected in 26.4% (131/496) of serum samples from patients with AFI. Co-infections with Dengue virus (7.3%), Zika virus (1.8%) and Chikungunya (0.2%) were observed. The most common clinical symptoms reported among the patients with OROV infections were headache 85.5% (112/131), myalgia 80.9% (106/131), arthralgia 72.5% (95/131) and loss of appetite 67.9% (89/131). Headache and myalgia were predominant in all age groups. Both OROV infections and co-infections were more frequent in May, June and July corresponding to the dry season of the region.

Identification of infection by Chikungunya, Zika, and Dengue in an area of the Peruvian coast. Molecular diagnosis and clinical characteristics.

OBJECTIVE: To assess the presence of Dengue, Chikungunya, and Zika in serum samples of patients with acute febrile illness in Piura, Peru and describe the most common clinical features. RESULTS: Dengue was the most common arbovirus detected in 170/496 (34.3%), followed by Zika in 39/496 (7.9%) and Chikungunya in 23/496 (4.6%). Among the 170 samples positive for Dengue, serotype 2 was the most predominant type present in 97/170 (57.1%) of samples, followed by the serotype 3 in 9/170 (5.3%). Headaches, muscle pain, and joint pain were the most common symptoms associated with fever in patients with Dengue and Zika. No symptoms predominance was observed in patients with Chikungunya.Dengue is considered the most frequent arbovirus in Peru and the number of cases has increased dramatically in the last 5 years. However, it is not the only arbovirus that circulates along the northern coast of Peru. It has also been determined the presence of Zika and Chikungunya in our population, which may suggest the circulation of other arboviruses that have not been detected.

Co-infection with Bartonella bacilliformis and Mycobacterium spp. in a coastal region of Peru.

OBJECTIVE: This study investigated an outbreak of Bartonellosis in a coastal region in Peru. RESULTS: A total of 70 (n = 70) samples with clinical criteria for the acute phase of Bartonellosis and a positive peripheral blood smear were included. 22.85% (n = 16) cases of the samples were positive for Bartonella bacilliformis by PCR and automatic sequencing. Of those positive samples, 62.5% (n = 10) cases were positive only for B. bacilliformis and 37.5% (n = 6) cases were positive to both Mycobacterium spp. and B. bacilliformis. The symptom frequencies were similar in patients diagnosed with Carrion's disease and those co-infected with Mycobacterium spp. The most common symptoms were headaches, followed by malaise and arthralgia.

Succinyl-CoA Synthetase: New Antigen Candidate of Bartonella bacilliformis.

BACKGROUND: Bartonella bacilliformis is the causative agent of Carrion's disease, a neglected illness with mortality rates of 40-85% in the absence of treatment. The lack of a diagnostic technique to overcome misdiagnosis and treat asymptomatic carriers is of note. This study aimed to identify new B. bacilliformis antigenic candidates that could lead to a new diagnostic tool able to be implemented in endemic rural areas. METHODOLOGY/PRINCIPAL FINDINGS: Blood (n = 198) and serum (n = 177) samples were collected in northern Peru. Clinical data were recorded. Specific 16S rRNA amplification by RT-PCR, IFA and ELISA for IgM/IgG with whole cells as antigens was done. Western blot analysis and N-terminal amino acid sequencing detected seroreactive proteins. ELISAs for IgM/IgG for the antigenic candidates were performed. Of the population 33.3% reported at least one symptom compatible with Carrion's disease; 25.4% (IFA), 27.1% (ELISA-IgG), 33.9% (ELISA-IgM) and 38.9% (RT-PCR) of samples were positive. Four proteins were considered potential antigenic candidates, including two new antigenic candidates, succinyl-CoA synthetase subunit α (SCS-α) and succinyl-CoA synthetase subunit ß (SCS-ß). On Western blot both Pap31 and SCS-α interacted with IgM, while GroEL and SCS-ß interacted with IgG. The presence of specific antibodies against the antigenic candidates varied from 34.5% (IgG against SCS-α) to 97.2% (IgM against Pap31). CONCLUSIONS/SIGNIFICANCE: RT-PCR and the high levels of positivity for specific ELISAs demonstrate high levels of B. bacilliformis exposure and asymptomatic carriers among inhabitants. The new antigens identified might be used as a new rapid diagnostic tool to diagnose acute Carrion's disease and identify asymptomatic carriers.

Easy and inexpensive molecular detection of dengue, chikungunya and zika viruses in febrile patients.

Dengue (DENV), chikungunya (CHIKV) and zika (ZIKV) are arthropod-borne viruses (arboviruses) sharing a common vector, the mosquito Aedes aegypti. At initial stages, patients infected with these viruses have similar clinical manifestations, however, the outcomes and clinical management of these diseases are different, for this reason early and accurate identification of the causative virus is necessary. This paper reports the development of a rapid and specific nested-PCR for detection of DENV, CHIKV and ZIKV infection in the same sample. A set of six outer primers targeting the C-preM, E1, and E gene respectively was used in a multiplex one-step RT-PCR assay, followed by the second round of amplification with specific inner primers for each virus. The specificity of the present assay was validated with positive and negative serum samples for viruses and supernatants of infected cells. The assay was tested using clinical samples from febrile patients. In these samples, we detected mono and dual infections and a case of triple co-infection DENV-CHIKV-ZIKV. This assay might be a useful and an inexpensive tool for detection of these infections in regions where these arboviruses co-circulate.