Improved detection of mixed P. falciparum-P. vivax infection at a rural health centre in Ethiopia using PCR.

This study aims to this study is to compare the co-infection Plasmodium falciparum + Plasmodium vivax and compare the detection of cases of mixed-species malaria using light microscopy versus semi-nested multiplex PCR (sPCR). Investigators collected 3060 samples at a rural health centre in Ethiopia from December 2010 to October 2011. Two capillary blood specimens were taken from each patient, one for diagnosis of Plasmodium infection by light microscopy and the other for sPCR-based diagnosis. LM detected 627 positive cases; these samples, together with 582 negatives by LM, were also subjected to sPCR testing. Of the 627 positive samples by LM, 68.4% were positive for P. vivax, 30.5% for P. falciparum, and 1.1% for P. falciparum + P. vivax co-infection. Using the sPCR technique, we identified 788 samples positive for Plasmodium: 33.0% for P. vivax, 26.5% for P. falciparum, 3.7% for P. falciparum + P. vivax co-infection, 2.0% for P. ovale and 0.8% for P. vivax + P. ovale co-infection. In the case of P. falciparum + P. vivax co-infection, light microscopy diagnosis showed a sensitivity of 11.1%, a specificity of 99.8%, a positive predictive value of 71.4% and a negative predictive value of 96.6%. The concordance rate for identifying P. falciparum + P. vivax co-infection (kappa statistic) with microscopy and sPCR was 0.184. The LM approach has low sensitivity for the detection of mixed-species infections, while sPCR is more useful.

Análisis coste-beneficio y coste-efectividad, de las nuevas alternativas de inmunización surgidas en el mercado para la prevención de la leishmaniosis canina en las Fuerzas Armadas / Cost-benefit and cost-effectiveness analysis of the new immunization alternatives for the prevention of canine leishmaniasis in the Armed Forces

Antecedentes y objetivos: La incorporación de estudios epidemiológicos y métodos de análisis de costes suponen herramientas de primer orden dentro de la Sanidad Militar. Permiten optimizar los recursos y estructuras disponibles, manteniendo así la eficacia y efectividad en la lucha frente a las enfermedades, una de ellas la Leishmaniosis. La epidemiología de campo, se nos presenta como una útil herramienta para alcanzar nuestro objetivo sanitario estratégico que es el de controlar esta enfermedad. La leishmaniosis canina es una de las parasitosis de mayor repercusión en las Fuerzas Armadas tanto desde el punto de vista de salud pública como de operatividad de nuestros perros de trabajo militar. El trabajo tiene como objetivo comparar el coste-beneficio (C-B) de dos tipos de vacunas con los costes que supondría la externalización de los servicios. Para ello se analiza el coste-efectividad (C-E), que supondría ampliar el actual programa de vacunación, con la incorporación de la nueva vacuna frente a LI (CaniLeish®), y analizar el coste-efectividad (C-E) que supondría ampliar el actual programa preventivo antivectorial con la adquisición de un nuevo medicamento preventivo frente a LI (Leisguard®). Material y Método: Se ha estimado mediante el análisis coste-beneficio y coste-efectividad, la eficiencia que supondría, teniendo en cuenta la seroprevalencia actual, el ampliar el existente programa preventivo con la adquisición de las nuevas alternativas de inmunización (vacunación y uso de domperidona) surgidas en el mercado frente a la leishmaniosis canina. Requiriéndose una valoración monetaria apropiada de los efectos sobre la salud de las alternativas evaluadas. Resultados: Se obtuvo que los costes globales de ambas alternativas son superiores al coste del tratamiento de la enfermedad, con relaciones coste-beneficio y coste-efectividad negativas (en términos de coste por mantenimiento de operatividad del efectivo canino), es decir, no se produce ahorro neto. Conclusiones: Derivado de los resultados obtenidos en estas técnicas analíticas concluimos que, el uso de recursos alternativos no reporta eficiencia frente a las actuaciones actuales. En este caso, cualquier medida preventiva nueva debe considerarse a medio/corto plazo, y siempre en función de los cambios epidemiológicos de la enfermedad en cuestión (AU)

Antecedents and objectives: Epidemiological studies and cost analysis methods are first-rate tools in the Medical Service. They allow to optimize the available resources and structures, maintaining efficacy and effectiveness in the fight against diseases, one of them the leishmaniasis. Field epidemiology is a useful tool to reach our health strategic goal of controlling this disease. Canine leishmaniasis is one the most important parasitic diseases in the Armed Forces, both from the point of view of public health and the operational capacity of our military working dogs. This study intends to compare the cost-benefit (C-B) of two types of vaccines with the costs of outsourcing the services. In order to do this the cost- effectiveness (C-E) of expanding the current immunization calendar, including a new vaccine against LI (CaniLeish®) and the cost-effectiveness (C-E) of expanding the current vector control program with the acquisition of a new preventive drug against LI (Leisguard®), are evaluated. Material and Method: the efficiency of expanding the existing preventive program with the new immunization alternatives (vaccination and the use of domperidone) appeared in the market against canine leishmaniasis, has been studied through a cost-benefit and cost-effectiveness evaluation, taking into account the current seroprevalence. An adequate monetary valuation of the impact on health of the studied alternatives is required. Results: The overall costs of both alternatives are higher than the cost of the treatment of the disease, with negative cost-benefit and cost-effectiveness relationships (in terms of cost per operational maintenance of the dogs), that is, there are no net savings. Conclusions: From the results obtained with these analytical techniques we conclude that the alternative resources are not more efficient that the current activities. In this case, any new preventive measure must be considered in the medium / short term and always bearing in mind the epidemiological changes of the disease concerned (AU)

Producción de una bacterina para inmunización de potros frente a Rhodococcus equi / A bacterine output for fouls immunization against Rhodococcus equi

Rhodococcus equi es un importante patógeno causante de neumonía piogranulomatosa muy grave en potros menores de tres meses. En este trabajo se describe un brote de la enfermedad en una Yeguada Militar. Tras el aislamiento e identificación del agente causal y la determinación de su sensibilidad a los antibióticos, se preparó una vacuna inactivada por calor y formaldehído para la inmunización de yeguas gestantes y potrillos de más de 6 semanas de vida. El resultado tras diez años de aplicación sistemática de la misma ha sido satisfactorio, no habiéndose dado ningún nuevo caso de esta patología ni presentado reacciones adversas locales o sistémicas (AU)

Rhodococcus equi is an important pathogen, causing quite serious piogranulomatous pneumonia within less than three months fouls. In this paper, an outbreak in a stud, Military livestock, is described. After isolation and identification of the causing agent, as much as its antimicrobial susceptibility determination, an inactivated vaccine, by heat and formaldehyde, was performed for immunization of pregnant mares and little fouls, with more than six weeks of life. The result, after ten years with systematic application of the vaccine was well satisfactory, without any new case of this pathology and without adverse reactions, local or systemic (AU)

Knockdown resistance mutations (kdr) and insecticide susceptibility to DDT and pyrethroids in Anopheles gambiae from Equatorial Guinea.

OBJECTIVES: To determine the frequency of knockdown resistance (kdr) mutations in the malaria vector Anopheles gambiae s.s. from continental Equatorial Guinea; and to relate kdr genotypes with susceptibility to DDT and pyrethroid insecticides in this vector. METHODS: Female mosquitoes were collected in two villages, Miyobo and Ngonamanga, of mainland Equatorial Guinea. Insecticide susceptibility tests were performed following WHO procedures. Anopheles gambiae complex specimens were identified to species and molecular form by PCR. Genotyping of the kdr locus was performed by allele-specific PCR and direct sequencing in a subset of samples. RESULTS: Both M and S molecular forms of A. gambiae were found in Ngonamanga whereas only the S-form was identified in Miyobo. The two kdr mutations were detected in S-form samples of both villages, with a higher frequency of the kdr-e (Leu-1014-Ser) allele (Miyobo: 16%; Ngonamanga: 40%). The kdr-w (Leu-1014-Phe) mutation was also detected in 3% of the M-form. All individuals tested for pyrethroids were susceptible. A mortality rate of 86% was obtained for DDT. An overall kdr allele frequency (i.e. kdr-e + kdr-w) of 22% was detected in DDT resistant individuals, whereas susceptible individuals had a kdr frequency of 6%. CONCLUSION: The co-occurrence of both kdr mutations and reduced susceptibility to DDT found in A. gambiae highlights the importance of implementing efficient surveillance of insecticide resistance in Equatorial Guinea.

Reactividad inmunohistoquímica frente a los antígenos humanos p53, c-erbB-2, Ki-67 y ER de los tumores mamarios de la perra / No disponible

No disponible