Tropical splenomegaly in a migrant-in-transit crossing the Darien gap, Panamá: A probable case of hyper-reactive malarial splenomegaly.

Hyper-reactive malarial splenomegaly (HMS), or tropical splenomegaly syndrome, is a severe complication of chronic and recurrent infections caused by Plasmodium spp. This condition typically results in splenomegaly greater than or equal to 10 cm and a constellation of laboratory findings, including the absence of identifiable parasites in peripheral blood smears. However, patients with HMS demonstrate serological or molecular evidence of infection. Despite being a familiar entity in malaria holoendemic countries in Africa, and regions of Papua New Guinea, the pathophysiology, natural history, and treatment of the syndrome remains to be fully elucidated. Herein, we describe a highly suggestive case of HMS in a Senegalese patient migrating northbound to reach the U.S.-Mexico border and for whom we provided medical care during his crossing of the Darien Gap in Panama. We also reviewed the literature on diagnosing and treating HMS in-depth.

"You are the first person to ask me how I'm doing sexually": sexual and reproductive health needs and sexual behaviours among migrant people in transit through Panama.

Background: Unprecedented numbers of migrant people transiting through the Darién Gap at the Panama-Colombia border were recorded in 2021 and 2022. Data on sexual and reproductive health (SRH) needs and service provision among migrant people in transit is generally extremely sparse. This study aimed to collect personal accounts of sexual behaviours and SRH needs and access to services among migrant people in transit through Panama. Methods: We conducted a rapid-assessment qualitative study using semi-structured interviews during June-July 2022. Participants were migrant people in transit at three locations across Panama: (i) at the Migrant Reception Station (MRS) in Darién province at the Panama-Colombia border, (ii) in the city of David near the Costa Rica-Panama border, and (iii) at the Costa Rica-Panama border. Migrant peoples (>18 years) were invited to participate using purposive sampling. Results: Overall, 26 adult migrant people (16 men, 10 women) across the three sites participated in the study. We identified three overarching themes from the interviews: (1) increased need for SRH service provision, (2) experiences of sex, relationships, and transactional sex, and (3) vulnerability to exploitation and sexual violence. All accounts reported that no formal SRH care was present during the journey through the Gap and described as inconsistent at the MRS in Darién. Provision of gynaecological or genital examinations, laboratory testing for urinary tract or STI, and prenatal care were mentioned to be the most pressing needs. Participants reported a change in their sexual behaviour while travelling, whether a decline in sexual libido or preference towards short-term partners. Most female participants recounted constantly fearing sexual violence during the journey through the Gap and several respondents reported witnessing incidents of sexual and other forms of violence. Conclusion: There are significant unmet needs regarding SRH care during the journey of migrant people transiting through the Darién Gap, at the MRS in the Darién province, and across Panama. Provision of antenatal care, rapid testing for HIV/STI, condom distribution, and care for victims of sexual violence would significantly reduce adverse SRH outcomes and improve the well-being of migrant people, even when in transit.

Caterpillar Envenomation (Lepidopterism) in a Panamanian Jungle: About a Case.

Caterpillar venom has the potential to cause acute pain and systemic symptoms in individuals seeking medical attention in the jungles of Panama. Although this is not an obligatory notifiable disease, the hazards associated with exposure to this animal are widely recognized within the local community. Here, we present a case of a patient who sought medical attention after being rescued from a river in a Panamanian jungle after feeling acute pain in an upper extremity associated with shortness of breath and how tropical medicine teleconsult allowed for quick identification of the cause and assisted in the management. About his case, we examine the phenomenon of caterpillar envenomation and suggest that further research is needed to assess the potential impact of climate change on this disease. Of particular concern is the likelihood of an increase in contact accidents. We recommend that scientists and public health officials work together to understand the mechanisms of this disease better and to develop effective strategies for prevention and treatment. Our analysis underscores the importance of ongoing monitoring and surveillance to ensure we are prepared for future outbreaks.

Detection of Mansonella ozzardi in peripheral blood in two malaria-endemic areas in Panama.

Introduction: Studies conducted in 1984 demonstrated the presence of Mansonella ozzardi in the Darien and Colon provinces. Since then, there have not been further reports of this parasitic infection in Panama. Methodology: We conducted a cross-sectional assessment of peripheral blood samples of individuals across Panama over a 4-year period (2013-2016) as part of malaria surveillance activities. Results: We identified microfilaria in 96 cases. Most of these cases were found in East Panama (78%) followed by the Darien region (22%). Mansonella ozzardi was the filarial parasite identified by morphological features in all cases. Conclusion: After 36 years of epidemiological silence, we identified human cases of Mansonella ozzardi infection in Panama. This is, however, the first report of this filarial parasite's presence in the Eastern region of Panama. There is a need for further surveillance efforts to elucidate the epidemiology associated with Mansonella infections in Panama.

U.S. bound journey of migrant peoples InTransit across Dante's Inferno and Purgatory in the Americas.

Rapid rise of population migration is a defining feature of the 21st century due to the impact of climate change, political instability, and socioeconomic downturn. Over the last decade, an increasing number of migrant peoples travel across the Americas to reach the United States seeking asylum or cross the border undocumented in search of economic opportunities. In this journey, migrant people experience violations of their human rights, hunger, illness, violence and have limited access to medical care. In the 'Divine Comedy', the Italian poet Dante Alighieri depicts his allegorical pilgrimage across Hell and Purgatory to reach Paradise. More than 700 years after its publication, Dante's poem speaks to the present time and the perilious journey of migrant peoples to reach safehavens. By exploring the depths and heights of the human condition, Dante's struggles resonate with the multiple barriers and the unfathomable experiences faced by migrant peoples in transit across South, Central, and North America to reach the United States. Ensuring the safety of migrant peoples across the Americas and elsewhere, and attending to their health needs during their migratory paths represent modern priorities to reduce social injustices and achieving health equity.

Rapid health evaluation in migrant peoples in transit through Darien, Panama: protocol for a multimethod qualitative and quantitative study.

BACKGROUND: The world is currently unprepared to deal with the drastic increase in global migration. There is an urgent need to develop programs to protect the well-being and health of migrant peoples. Increased population movement is already evident throughout the Americas as exemplified by the rising number of migrant peoples who pass through the Darien neotropical moist broadleaf forest along the border region between Panama and Colombia. The transit of migrant peoples through this area has an increase in the last years. In 2021, an average of 9400 people entered the region per month compared with 2000-3500 people monthly in 2019. Along this trail, there is no access to health care, food provision, potable water, or housing. To date, much of what is known about health needs and barriers to health care within this population is based on journalistic reports and anecdotes. There is a need for a comprehensive approach to assess the health care needs of migrant peoples in transit. This study aims to describe demographic characteristics, mental and physical health status and needs, and experiences of host communities, and to identify opportunities to improve health care provision to migrant peoples in transit in Panama. STUDY DESIGN AND METHODS: This multimethod study will include qualitative (n = 70) and quantitative (n = 520) components. The qualitative component includes interviews with migrant peoples in transit, national and international nongovernmental organizations and agencies based in Panama. The quantitative component is a rapid epidemiological study which includes a questionnaire and four clinical screenings: mental health, sexual and reproductive health, general and tropical medicine, and nutrition. CONCLUSION: This study will contribute to a better understanding of the health status and needs of migrant peoples in transit through the region. Findings will be used to allocate resources and provide targeted health care interventions for migrant peoples in transit through Darien, Panama.

A new species of Atelopus (Amphibia: Bufonidae) from eastern Panama.

A new species of the genus Atelopus, Atelopus fronterizo sp. nov., from eastern Panama is described herein based on molecular, morphological, and bioacoustic evidence. The new species can be distinguished from its congeners occurring in the region by a combination of the following characters: (1) phalangeal reduction in thumb; (2) SVL (females only) (35.1-50.1; n=13), HW/SVL (0.23-0.34; n=59), EYND/HW (0.27-0.39; n=60), TIBL/SVL (0.41-0.56; n=58), and HAL/SVL (0.22-0.28; n=49); (3) dorsal color pattern with green or yellow background and extensive dark olive blotches forming transversal bands or mottling; (4) advertisement call duration 176-235 ms with 19-34 pulses, average pulse rate 131.69 pulses/s, and dominant frequency 2 422.50-2 606.50 Hz. The new species is nested within the Central American clade of Atelopus. The minimum Kimura-2-parameter (K2P) genetic divergence between Atelopus fronterizo sp. nov. and its most phylogenetically similar congeners ( A. certus and A. glyphus) is >2.6% for 16S and >4.9% for COI (Table 1). The phylogenetic relationship is strongly supported by ultrafast bootstrap values for the maximum-likelihood trees of both genetic markers (16S, 96; COI, 100, Figure 1A). Bayesian analysis of the concatenated sequences resulted in a tree with similar topology and high posterior probability support (0.99; Supplementary Figure S1). In addition, haplotype networks inferred from COI and 16S (Supplementary Figure S2) showed a well-separated clade containing the new species (two for COI, four for 16S). The number of mutational steps between haplotypes for the new species samples is very low (1-4 in 16S; one in COI), and the minimum number of mutational steps from the nearest species is nine for 16S (distance to A. certus) and 28 for COI (distance to A. glyphus).

A distinctive avian assemblage (Aves: Passeriformes) in Western Darién, Panama is uncovered through a disease surveillance program / Un conglomerado distinto de aves (Aves: Passeriformes) descubierto en el Darién occidental, Panamá por un programa de vigilancia de enfermedades

Basic knowledge about the distribution of flora and fauna is lacking for most tropical areas. Improving our knowledge of the tropical biota will help address contemporary global problems, including emerging tropical diseases. Less appreciated is the role that applied studies can have in improving our understanding of basic biological patterns and processes in the tropics. Here, I describe a novel avifauna assemblage uncovered in Western Darién province in the Republic of Panama that was uncovered during a vector-borne disease surveillance program. I compared the passerine bird species composition at 16 sites using records from recent ornithological expeditions sponsored by the Smithsonian Tropical Research Institute in Central and Eastern Panama. Based on the results of a Mantel test, geographic distance did not correlate with pairwise distinctiveness of sites. Instead, based on an index of distinctiveness modified from the Chao-Jaccard index, most sites were more or less similarly distinctive, with one site, Aruza Abajo, significantly more distinctive than the rest. I found that the distinctiveness of this site was due not only to the presence of several rare and range-restricted taxa, but also to the absence of taxa that are common elsewhere. This finding provides more evidence of high species composition turnover (beta-diversity) in the Panamanian biota, which appears to be driven by a combination of soil and climate differences over narrow distances. Rev. Biol. Trop. 62 (2): 711-717. Epub 2014 June 01.

El conocimiento básico sobre la distribución de la flora y fauna es escaso en la mayoría de las zonas tropicales. Mejorar el conocimiento de la biota tropical ayudará a enfrentar los problemas globales contemporáneos, incluyendo las enfermedades tropicales emergentes. Menos apreciado es el papel que los estudios aplicados pueden tener en mejorar nuestra comprensión de los patrones biológicos y procesos básicos en estas regiones. A continuación, describo un conglomerado distinto de aves encontrado en la provincia occidental de Darién en la República de Panamá, el cual fue descubierto durante un programa de vigilancia de enfermedades transmitidas por insectos vectores. En este estudio comparé la composición de especies de aves paseriformes de 16 sitios con registros de expediciones ornitológicas recientes en Panamá Central y Oriental patrocinadas por el Instituto Smithsonian de Investigaciones Tropicales. Basado en los resultados de la prueba de Mantel, el carácter distintivo de los sitios en comparaciones pareadas no se correlacionó con la distancia geográfica entre sitios. En cambio, con base a un índice de disimilitud modificado a partir del índice de Chao-Jaccard, la mayoría de los sitios presentaron grados de disimilitud más o menos equivalentes, sin embargo Aruza Abajo fue mucho más distintivo que el resto. Yo encontré que el carácter distintivo de Aruza Abajo fue la presencia de varias especies raras y de rango restringido, pero también existe ausencia de especies comunes en otros sitios. Este hallazgo proporciona evidencia del elevado reemplazo de especies de aves (diversidad beta) en la avifauna panameña, la cual parece estar determinada por una combinación de diferencias del suelo y clima en cortas distancias geográficas.

Distribución de los gasterópodos del manglar, Neritina virgínea (Neritidae) y Littoraria angulifera (Littorinidae) en la Ecorregión Darién, Caribe colombiano / Distribution of the mangrove gastropods Neritina virginea (Neritidae) and Littoraria angulifera (Littorinidae) within the Colombian Caribbean Darién Ecoregion

Distribution of the mangrove gastropods Neritina virginea (Neritidae) and Littoraria angulifera (Littorinidae) within the Colombian Caribbean Darién Ecoregion. Gastropods are one of the most abundant groups within the Caribbean mangroves, however, little is known about the distribution of particular species at a regional scale. With this aim, we studied the geographic distribution of Littoraria (Littorinopsis) angulifera and Neritina (Vitta) virginea within the Darién Ecoregion in the Caribbean coast of Colombia, from 77 sampling stations along 609km between the Colombian-Panamá border and Córdoba State, Colombia. The fieldwork was conducted in June-August 2009, and a total of 3 963 individuals of both species were hand-picked from the ground, prop-roots and trunks along 50m transects, and shell sizes were measured. The description of geographic patterns considered surface water salinity, mangrove cover and gastropod distribution within the Gulf of Urabá. In the outer-most part of the Gulf, L. angulifera was present in 84.8% of the stations, while N. virginea was only present in 15.2% of the stations. In this part, mangroves areas were patchily distributed, and the gastropods (mainly L. angulifera) were found on woody debris along the supralittoral zone in sandy shores. In the inner-most part, in contrast, N. virginea occurred in 84.6% of the stations, mostly in estuaries, deltas and river margins, while L. angulifera only appeared in Turbo Bay (15.4%). Mean shell size also exhibited a clear geographic pattern: size range was 6-22mm in L. angulifera, and 6-12mm in N. virginea. L. angulifera was found in open-water stations with water salinities >10PSU, but it was absent in sites with lower salinities like the Atrato River Delta and other small rivers. Its presence on coastal woody debris suggests that despite of the recruitment of small individuals from the nearshore stock of larvae, populations are unable to establish due to the absence of mangroves protection. Oppositely, N. virginea was found under estuarine conditions on mangrove roots and ground. Our results confirm that L. angulifera is an esteno-tolerant marine species, and N. virginea is an eury-tolerant estuarine species, thus their geographic distribution is strongly shaped by the large freshwater discharge of the Atrato River. We hypothesize that absence or limited distribution of gastropods in various areas of the Darién Ecoregion may be further explained by the poor conservation state of mangroves.

Aunque los gasterópodos son uno de los grupos más abundantes en los manglares del Caribe, poco se sabe del ámbito de especies particulares debido al enfoque comunitario de la mayoría de los estudios. El ámbito de las poblaciones de L. angulifera y N. virginea fue estudiado en la Ecorregión Darién, Caribe colombiano. El muestreo se realizó entre junio y agosto 2009, se recolectaron 3 963 individuos de ambas especies, a los cuales se les midió la talla de la concha. La Ecorregión presentó diferencias espaciales en el ámbito de la salinidad del agua a nivel superficial, la cobertura de manglar y el ámbito de las poblaciones. En la parte externa de la Ecorregión, L. angulifera presentó el mayor porcentaje de aparición (84.8%) en comparación a N. virginea (15.2%). En el interior N. virginea presentó el mayor porcentaje (84.6%), mientras L. angulifera apareció solo en bahía Turbo (15.4%). Se encontraron diferencias en el ámbito de tallas promedio de las conchas, donde L. angulifera varió entre 6 y 22mm y N. virginea entre 6 y 12mm dentro del Golfo. Se confirma que L. angulifera es una especie de carácter estenohalina y marina, mientras que N. virginea es eurihalina y estuarina.