A dengue outbreak in a rural community in Northern Coastal Ecuador: An analysis using unmanned aerial vehicle mapping.

Dengue is recognized as a major health issue in large urban tropical cities but is also observed in rural areas. In these environments, physical characteristics of the landscape and sociodemographic factors may influence vector populations at small geographic scales, while prior immunity to the four dengue virus serotypes affects incidence. In 2019, a rural northwestern Ecuadorian community, only accessible by river, experienced a dengue outbreak. The village is 2-3 hours by boat away from the nearest population center and comprises both Afro-Ecuadorian and Indigenous Chachi households. We used multiple data streams to examine spatial risk factors associated with this outbreak, combining maps collected with an unmanned aerial vehicle (UAV), an entomological survey, a community census, and active surveillance of febrile cases. We mapped visible water containers seen in UAV images and calculated both the green-red vegetation index (GRVI) and household proximity to public spaces like schools and meeting areas. To identify risk factors for symptomatic dengue infection, we used mixed-effect logistic regression models to account for the clustering of symptomatic cases within households. We identified 55 dengue cases (9.5% of the population) from 37 households. Cases peaked in June and continued through October. Rural spatial organization helped to explain disease risk. Afro-Ecuadorian (versus Indigenous) households experience more symptomatic dengue (OR = 3.0, 95%CI: 1.3, 6.9). This association was explained by differences in vegetation (measured by GRVI) near the household (OR: 11.3 95% 0.38, 38.0) and proximity to the football field (OR: 13.9, 95% 4.0, 48.4). The integration of UAV mapping with other data streams adds to our understanding of these dynamics.

Prevalence of Cryptococcal Antigen and Outcomes in People With Human Immunodeficiency Virus in Honduras: A Cohort Study.

BACKGROUND: Cryptococcal meningitis is a major cause of death among people with human immunodeficiency virus (PWH). Cryptococcal antigen (CrAg) testing of asymptomatic patients is an important public health measure to reduce mortality in high-incidence areas. However, limited data exist on CrAg prevalence in Central America. METHODS: We conducted a prospective cohort study at the 2 largest human immunodeficiency virus (HIV) clinics and hospitals in Honduras. Cryptococcal antigen in serum and cerebrospinal fluid was performed in individuals with HIV who had CD4 ≤100 cells/mm3 between 2017 and 2018. After CrAg testing, individuals were observed for 12 months to assess mortality using adjusted Cox proportional hazard models. RESULTS: A total of 220 PWH were tested for CrAg, 12.7% (n = 28) of which tested positive. Cryptococcal antigen prevalence was higher among hospitalized individuals in 40% (n = 10 of 25) of the cases. The proportion (35.8%) of individuals taking antiretroviral therapy was significantly (P < .01) lower among those who tested positive for CrAg. Overall mortality among the cohort was 11.4% (n = 25 of 220) by 12 months. Cryptococcal antigen-positive cases were at a significantly higher risk of death (adjusted hazard ratio, 2.69; 95% confidence interval, 1.07-6.84) compared with CrAg-negative participants. CONCLUSIONS: Cryptococcal antigen prevalence in Honduras was high among PWH. Moreover, individuals who tested positive for CrAg testing were at a higher risk of death. Systemic CrAg of PWH with a CD4 ≤100 cells/mm3 should be routinely performed in Central America.

Epidemiology, Outcomes, and Associated Factors of Coronavirus Disease 2019 (COVID-19) Reverse Transcriptase Polymerase Chain Reaction-Confirmed Cases in the San Pedro Sula Metropolitan Area, Honduras.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused substantial morbidity and mortality worldwide. Few reports exist in Latin America, a current epicenter of transmission. Here, we aim to describe the epidemiology and outcomes associated with coronavirus disease 2019 (COVID-19) in Honduras. METHODS: Baseline clinical and epidemiological information of SARS-CoV-2 reverse transcriptase polymerase chain reaction-confirmed cases detected between 17 March-4 May in the San Pedro Sula Metropolitan area was collected; for hospitalized cases, clinical data were abstracted. Logistic regression models were fit to determine the factors associated with hospitalization. RESULTS: We identified 877 COVID-19 cases, of which 25% (n = 220) were hospitalized. The 19-44-year age group (57.8%) and males (61.3%) were predominant in overall COVID-19 cases. Of the cases, 34% (n = 299) had at least 1 preexisting medical condition. Individuals aged 45-69 years (adjusted odds ratio [aOR] = 4.05; 95% confidence interval [CI], 2.85-5.76) or ≥70 years (aOR = 9.12; 95% CI, 5.24-15.86), of male sex (aOR = 1.72; 95% CI, 1.21-2.44), and those with a preexisting condition (aOR = 2.12; 95% CI, 1.43-3.14) had higher odds of hospitalization. Of inpatients, 50% were hospitalized more than 7 days. The median length of hospitalization was 13 days (interquartile range [IQR], 8-29) among individuals aged 19-44 years, and 17 days (IQR, 11-24.6) among those aged 45-69. Of the fatal cases, 42% occurred among adults under 60 years old. CONCLUSIONS: Our findings show that a high proportion of COVID-19 cases in Honduras occurred among younger adults, who also constituted a significant proportion of severe and fatal cases. Preexisting conditions were associated with severe outcomes independently from age and were highly prevalent in Honduran COVID-19 cases.

Perfil de sensibilidad a los antibióticos de las bacterias en infecciones del tracto urinario / Antibiotic sensitivity profile of bacteria in urinary tract infections

ResumenAntecedentes:las infecciones del tracto urinario representan motivo de consulta médica ambulatoria frecuentemente. Los altos y crecientes índices de resistencia antibiótica implican un reto para el médico tratante.Objetivo:obtener información epidemiológica del perfil de sensibilidad de las bacterias aisladas en los urocultivos.Metodología:entre febrero y junio de 2014, se recolectaron 602 resultados de urocultivos en diferentes laboratorios de las ciudades de San Pedro Sula y El Progreso, en Honduras. Las variables analizadas fueron sexo, edad y bacteria, y los antibióticos que presentaban mayor porcentaje de sensibilidad y resistencia en los urocultivos. Se utilizó el método de Kirby Bauer para valorar los perfiles de resistencia y sensibilidad en todos los laboratorios. Se elaboró una lista de 47 antibióticos de todos los laboratorios. Se correlacionaron las variables para describir los perfiles de resistencia y sensibilidad de la lista de antibióticos.Resultados:las bacterias aisladas fueron E. Coli (70,4%), Enterobacter spp (7,8%), Klebsiella spp (6,3%), Citrobacter spp (6,1%), Proteus spp (2,8%), Staphylococcus s spp (2,7%), Pseudomona aeruginosa (1,8%), Streptococcus spp (1,2%), Hafnia alveii (0,3%), Morganella morgagni (0,2%), Serratia marcenscens (0,2%), Neisseria gonorrhoeae (0,2%). De 602 muestras, la sensibilidad general reportada fue: fosfomicina (n=415, 68,9%), amikacina (n=412, 68,4%), nitrofurantoína (n=376, 62,4%), gentamicina (n=364, 60,4%) y ceftriaxona (n=307, 50%). Se reportó una resistência general a trimetoprim sulfametoxazol (n=302, 50,1%), ciprofloxacina (n=230, 38,2%), levofloxacina (n=221, 36,7%), norfloxacina (n=220, 36,5%) y amoxicilina+ácido clavulánico (n=204, 33,8%).Conclusiones:los resultados de este estudio revelan que por su buen perfil de sensibilidad, antibióticos como la fosfomicina y la nitrofurantoína pueden ser una opción terapéutica empírica viable en pacientes con infecciones del tracto urinario bajo no complicadas, previo a utilizar antibióticos de amplio espectro, evitando así el desarrollo de resistencia antibiótica.

AbstractBackground:Urinary Tract Infections represent a frequent reason of ambulatory medical consult.The high and increasing percentages of antibiotic resistance represent a challenge for the physician treating them.Aim:To obtain epidemiological information of the sensibility profile from bacteria isolated in urine cultures.Methods:Between February and June of 2014, 602 urine culture samples were collected from different laboratories in the cities of San Pedro Sula and El Progreso, Honduras. The variables analyzed were sex, age and bacteria, antibiotics with higher sensibility and with higher resistance in urine culture. The Kirby Bauer method was used to determine the sensitivity and resistance profiles of each urine culture. A total of 47 antibiotics were used in all the laboratories. The variables were correlated to describe the resistance and sensibility profiles of the list of antibiotics.Results:The bacteria isolated were E. Coli (70.4%), Enterobacter spp (7.8%), Klebsiella spp (6.3%), Citrobacter spp (6.1%), Proteus spp (2.8%), Staphylococcus s spp (2.7%), Pseudomona aeruginosa (1.8%), Streptococcus spp (1.2%), Hafnia alveii (0.3%), Morganella morgagni (0.2%), Serratia marcenscens (0.2%), Neisseria gonorrhoeae (0.2%). From 602 samples, the general sensitivity reported was: fosfomycin (n=415, 68.9%), amikacin (n=412, 68.4%), nitrofurantoin (n=376, 62.4%), gentamicin (n=364, 60.4%) y ceftriaxone (n=307, 50%). The resistance for all the samples reported was as follows trimetoprim sulfametoxazole (n=302, 50.2%), ciprofloxacin (n=230, 38.2%), levofloxacin (n=221, 36.7%), norfloxacin (n=220, 36.5%) y amoxicilin+clavulanic acid (n=204, 33.9%).Conclusions:The results in this research reveal that due to their good sensitivity profile, antibiotics like fosfomycin and nitrufurantoin can be a viable empiric therapy in patients with low urinary, or not complicated tract infection before using wide spectrum antibiotics, always personalizing according to the clinical state of the patient and trying to avoid the development of antibiotic resistance.