Kupffer cell diversity maintains liver function in alcohol-associated liver disease.

BACKGROUND AIMS: Liver macrophages are heterogeneous and play an important role in alcohol-associated liver disease (ALD) but there is limited understanding of the functions of specific macrophage subsets in the disease. We used a Western Diet Alcohol (WDA) mouse model of ALD to examine the hepatic myeloid cell compartment by scRNA seq and targeted Kupffer cell (KC) ablation to understand the diversity and function of liver macrophages in ALD. APPROACH AND RESULTS: In the WDA liver, KCs and infiltrating monocytes/macrophages (IMs) each represented about 50% of the myeloid pool. Five major KC clusters all expressed genes associated with receptor mediated endocytosis and lipid metabolism, but most were predicted to be non-inflammatory and antifibrotic with one minor KC cluster having a pro-inflammatory and extracellular matrix degradation gene signature. IM clusters, in contrast, were predicted to be pro-inflammatory and pro-fibrotic. In vivo diphtheria toxin based selective KC ablation during alcohol exposure resulted in a liver failure phenotype with increases in PT/INR and bilirubin, loss of differentiated hepatocyte gene expression, and an increase in expression of hepatocyte progenitor markers such as EpCAM, CK-7 and Igf2bp3. Gene set enrichment analysis of whole liver RNAseq from the KC ablated WDA mice showed a similar pattern as seen in human alcoholic hepatitis. CONCLUSIONS: In this ALD model, KCs are anti-inflammatory and are critical for maintenance of hepatocyte differentiation. IMs are largely pro-inflammatory and contribute more to liver fibrosis. Future targeting of specific macrophage subsets may provide new approaches to treatment of liver failure and fibrosis in ALD.

Heterogeneity in intrahepatic macrophage populations and druggable target expression in patients with steatotic liver disease-related fibrosis.

Background & Aims: Clinical trials for reducing fibrosis in steatotic liver disease (SLD) have targeted macrophages with variable results. We evaluated intrahepatic macrophages in patients with SLD to determine if activity scores or fibrosis stages influenced phenotypes and expression of druggable targets, such as CCR2 and galectin-3. Methods: Liver biopsies from controls or patients with minimal or advanced fibrosis were subject to gene expression analysis using nCounter to determine differences in macrophage-related genes (n = 30). To investigate variability among individual patients, we compared additional biopsies by staining them with multiplex antibody panels (CD68/CD14/CD16/CD163/Mac387 or CD163/CCR2/galectin-3/Mac387) followed by spectral imaging and spatial analysis. Algorithms that utilize deep learning/artificial intelligence were applied to create cell cluster plots, phenotype profile maps, and to determine levels of protein expression (n = 34). Results: Several genes known to be pro-fibrotic (e.g. CD206, TREM2, CD163, and ARG1) showed either no significant differences or significantly decreased with advanced fibrosis. Although marked variability in gene expression was observed in individual patients with cirrhosis, several druggable targets and their ligands (e.g. CCR2, CCR5, CCL2, CCL5, and LGALS3) were significantly increased when compared to patients with minimal fibrosis. Antibody panels identified populations that were significantly increased (e.g. Mac387+), decreased (e.g. CD14+), or enriched (e.g. interactions of Mac387) in patients that had progression of disease or advanced fibrosis. Despite heterogeneity in patients with SLD, several macrophage phenotypes and druggable targets showed a positive correlation with increasing NAFLD activity scores and fibrosis stages. Conclusions: Patients with SLD have markedly varied macrophage- and druggable target-related gene and protein expression in their livers. Several patients had relatively high expression, while others were like controls. Overall, patients with more advanced disease had significantly higher expression of CCR2 and galectin-3 at both the gene and protein levels. Impact and implications: Appreciating individual differences within the hepatic microenvironment of patients with SLD may be paramount to developing effective treatments. These results may explain why such a small percentage of patients have responded to macrophage-targeting therapies and provide additional support for precision medicine-guided treatment of chronic liver diseases.

Patients with fibrosis from non-alcoholic steatohepatitis have heterogeneous intrahepatic macrophages and therapeutic targets.

Background and Aims: In clinical trials for reducing fibrosis in NASH patients, therapeutics that target macrophages have had variable results. We evaluated intrahepatic macrophages in patients with non-alcoholic steatohepatitis to determine if fibrosis influenced phenotypes and expression of CCR2 and Galectin-3. Approach & Results: We used nCounter to analyze liver biopsies from well-matched patients with minimal (n=12) or advanced (n=12) fibrosis to determine which macrophage-related genes would be significantly different. Known therapy targets (e.g., CCR2 and Galectin-3) were significantly increased in patients with cirrhosis.However, several genes (e.g., CD68, CD16, and CD14) did not show significant differences, and CD163, a marker of pro-fibrotic macrophages was significantly decreased with cirrhosis. Next, we analyzed patients with minimal (n=6) or advanced fibrosis (n=5) using approaches that preserved hepatic architecture by multiplex-staining with anti-CD68, Mac387, CD163, CD14, and CD16. Spectral data were analyzed using deep learning/artificial intelligence to determine percentages and spatial relationships. This approach showed patients with advanced fibrosis had increased CD68+, CD16+, Mac387+, CD163+, and CD16+CD163+ populations. Interaction of CD68+ and Mac387+ populations was significantly increased in patients with cirrhosis and enrichment of these same phenotypes in individuals with minimal fibrosis correlated with poor outcomes. Evaluation of a final set of patients (n=4) also showed heterogenous expression of CD163, CCR2, Galectin-3, and Mac387, and significant differences were not dependent on fibrosis stage or NAFLD activity. Conclusions: Approaches that leave hepatic architecture intact, like multispectral imaging, may be paramount to developing effective treatments for NASH. In addition, understanding individual differences in patients may be required for optimal responses to macrophage-targeting therapies.

Serologic Evidence of Orientia Infection among Rural Population, Cauca Department, Colombia.

We assessed serum samples collected in Cauca Department, Colombia, from 486 persons for Orientia seroreactivity. Overall, 13.8% showed reactive IgG by indirect immunofluorescence antibody assay and ELISA. Of those samples, 30% (20/67) were confirmed to be positive by Western blot, showing >1 reactive band to Orientia 56-kD or 47-kD antigens.

Macrophage infection, activation, and histopathological findings in ebolavirus infection.

Macrophages contribute to Ebola virus disease through their susceptibility to direct infection, their multi-faceted response to ebolaviruses, and their association with pathological findings in tissues throughout the body. Viral attachment and entry factors, as well as the more recently described influence of cell polarization, shape macrophage susceptibility to direct infection. Moreover, the study of Toll-like receptor 4 and the RIG-I-like receptor pathway in the macrophage response to ebolaviruses highlight important immune signaling pathways contributing to the breadth of macrophage responses. Lastly, the deep histopathological catalogue of macrophage involvement across numerous tissues during infection has been enriched by descriptions of tissues involved in sequelae following acute infection, including: the eye, joints, and the nervous system. Building upon this knowledge base, future opportunities include characterization of macrophage phenotypes beneficial or deleterious to survival, delineation of the specific roles macrophages play in pathological lesion development in affected tissues, and the creation of macrophage-specific therapeutics enhancing the beneficial activities and reducing the deleterious contributions of macrophages to the outcome of Ebola virus disease.

Emerging Tickborne Bacteria in Cattle from Colombia.

Ehrlichia minasensis is a new pathogenic bacterial species that infects cattle, and Borrelia theileri causes bovine borreliosis. We detected E. minasensis and B. theileri DNA in cattle from southwestern Colombia by using PCR. E. minasensis and B. theileri should be considered potential etiologies of febrile syndrome in cattle from Colombia.

Genetic characterization of a novel Ehrlichia chaffeensis genotype from an Amblyomma tenellum tick from South Texas, USA.

Ehrlichia chaffeensis is the causative agent of human monocytotropic ehrlichiosis (HME), a disease that ranges in severity from mild to fatal infection. Ehrlichia chaffeensis is maintained in a zoonotic cycle involving white-tailed deer (Odocoileus virginianus) as the main vertebrate reservoir and lone star ticks (Amblyomma americanum) as its principal vector. Through complete genomic analysis from human ehrlichial isolates and DNA sequences obtained from deer and tick specimens, nine strains of E. chaffeensis have been characterized. Few studies have examined the genetic diversity of E. chaffeensis in ticks, and some of these investigations have identified that the genetic sequences coincide with the circulating strains reported so far. Here, we report the first evidence of E. chaffeensis DNA from an unfed Amblyomma tenellum (formerly Amblyomma imitator) collected in South Texas. We characterized the genetic variation of this E. chaffeensis genotype using conserved gene markers such as rRNA, dsb, and groEL. We also used gene targets useful to distinguish genotypes, such as the variable length PCR target gene (VLPT) and 120-kDa gene, encoding the tandem-repeat proteins TRP32 and TRP120, respectively. Our results suggest a novel E. chaffeensis genotype that exhibited greater variability than other genotypes of E. chaffeensis and highlights the role for A. tenellum as a potential vector of E. chaffeensis.

Prevalence of Ehrlichia canis and Hepatozoon canis in sheltered dogs in southern Aburrá Valley, Colombia

Background: Bacteria of the Anaplasmataceae family and canine hemoparasitic protozoans transmitted by ticks are common in Colombia due to circulation and biological adaptation of vector Rhipicephalus sanguineus sensu lato (s.l.). Objective: To detect the circulation of Ehrlichia canis and Hepatozoon canis in sheltered dogs in three municipalities in southern Aburrá Valley, province of Antioquia, Colombia. Methods: Primers were used to amplify the 16S rRNA associated with the Anaplasmataceae family, dsb for Ehrlichia sp. and 18S rRNA for Hepatozoon sp. Results: Of the 357 samples of venous blood obtained, representing all the sheltered dogs in the study zone, Ehrlichia canis DNA was detected in 2.2% of individuals, showing identity of 100% with previous sequences from the GenBank. Hepatozoon canis showed 8.7% (31/357) prevalence of infection, with 100% identity to genotypes from Japan, Brazil, and Spain. Only one sequence of H. canis exhibited a phylogenic divergence concerning H. canis previously reported in Brazil and the Old World. Conclusions: This study confirms the circulation of E. canis and H. canis in asymptomatic shelter dogs in the south-central zone of the Aburrá Valley, province of Antioquia, Colombia. The present study is the first molecular detection of H. canis in the Province of Antioquia and the third report of canine hepatozoonosis from Colombia, highlighting the importance of considering this agent in veterinary clinic.

Antecedentes: Los agentes patógenos transmitidos por garrapatas, tales como las bacterias de la familia Anaplasmataceae y los protozoos hemoparasitarios caninos, son comunes en Colombia debido a la circulación y la adaptación biológica del vector Rhipicephalus sanguineus sensu lato (s.l.). Objetivo: Detectar la circulación de Ehrlichia canis y Hepatozoon canis en perros protegidos en tres municipios del sur del Valle de Aburrá, departamento de Antioquia, Colombia. Métodos: Se usaron cebadores para amplificar el gen 16S rRNA asociado con la familia Anaplasmataceae y el gen dsb para Ehrlichia sp. y el 18S rRNA para Hepatozoon sp. Resultados: De las 357 muestras de sangre venosa obtenidas, que representan a todos los perros de albergues en la zona de estudio, 2,2% fueron positivas para Ehrlichia canis, con 100% de identidad con secuencias anteriores publicadas en todo el mundo. Hepatozoon canis mostró una prevalencia de infección del 8,7% (31/357), con una identidad del 100% con genotipos de Japón, Brasil y España. Solo una secuencia de H. canis exhibió divergencia filogénica en relación con H. canis previamente reportada en Brasil y el Viejo Mundo. Conclusiones: Este estudio confirma la circulación de E. canis y H. canis en perros asintomáticos de albergues en la zona centro-sur del Valle de Aburrá, departamento de Antioquia, Colombia. El presente estudio es la primera detección molecular en el Departamento de Antioquia y el tercer reporte de hepatozoonosis canina de Colombia destacando la importancia de considerar este agente en la clínica veterinaria.

Antecedentes: Agentes patogênicos transmitidos por carrapatos, como bactérias da família Anaplasmataceae e protozoários hemoparasitários caninos, são comuns na Colômbia devido à circulação e adaptação biológica do vetor Rhipicephalus sanguineus sensu lato (s.l.). Objetivo: Detectar Ehrlichia canis e Hepatozoon canis em cães abrigados em três municípios do sul do vale de Aburrá, departamento de Antioquia, Colômbia. Métodos: Os primers foram utilizados para amplificar o rRNA 16S associado à família Anaplasmataceae, o dsb para Ehrlichia sp. e o rRNA 18S para Hepatozoon sp. Resultados: Das 357 amostras de sangue venoso obtidas, representando todos os cães abrigados na zona de estudo, 2,2% foram positivas para Ehrlichia canis, com 100% de identidade com sequências anteriores publicadas em todo o mundo. Hepatozoon canis mostrou uma prevalência de infecção de 8,7% (31/357), com 100% de identidade com genótipos do Japão, Brasil e Espanha. Apenas uma sequência de H. canis apresentou divergência filogênica em relação a H. canis previamente relatados no Brasil e no Velho Mundo. Conclusões: Este estudo confirma a circulação de E. canis e H. canis em cães de abrigo assintomáticos na zona centro-sul do vale de Aburrá, departamento de Antioquia, Colômbia. O presente estudo é a primeira detecção molecular no Departamento de Antioquia e o terceiro relato de hepatozoonose canina na Colômbia, destacando a importância de considerar este agente na clínica veterinária.

Rickettsia parkeri with a Genetically Disrupted Phage Integrase Gene Exhibits Attenuated Virulence and Induces Protective Immunity against Fatal Rickettsioses in Mice.

Although rickettsiae can cause life-threatening infections in humans worldwide, no licensed vaccine is currently available. To evaluate the suitability of live-attenuated vaccine candidates against rickettsioses, we generated a Rickettsia parkeri mutant RPATATE_0245::pLoxHimar (named 3A2) by insertion of a modified pLoxHimar transposon into the gene encoding a phage integrase protein. For visualization and selection, R. parkeri 3A2 expressed mCherry fluorescence and resistance to spectinomycin. Compared to the parent wild type (WT) R. parkeri, the virulence of R. parkeri 3A2 was significantly attenuated as demonstrated by significantly smaller size of plaque, failure to grow in human macrophage-like cells, rapid elimination of Rickettsia and ameliorated histopathological changes in tissues in intravenously infected mice. A single dose intradermal (i.d.) immunization of R. parkeri 3A2 conferred complete protection against both fatal R. parkeri and R. conorii rickettsioses in mice, in association with a robust and durable rickettsiae-specific IgG antibody response. In summary, the disruption of RPATATE_0245 in R. parkeri resulted in a mutant with a significantly attenuated phenotype, potent immunogenicity and protective efficacy against two spotted fever group rickettsioses. Overall, this proof-of-concept study highlights the potential of R. parkeri mutants as a live-attenuated and multivalent vaccine platform in response to emergence of life-threatening spotted fever rickettsioses.

Ornithodoros puertoricensis (Ixodida: Argasidae) Associated With Domestic Fowl in Rural Dwellings From Córdoba Department, Caribbean Colombia.

Ticks of genus Ornithodoros are nidicolous parasites associated with a wide array of vertebrates. In humans, their bites cause hypersensitivity reactions and are capable to transmit pathogens of health concern. In the department of Córdoba, Caribbean region of Colombia, the first report of an Ornithodoros soft tick was made in 1980 by Betancourt, who described the collection of Ornithodoros talaje in human dwellings. Nevertheless, current the records of O. talaje made in South America have been questioned and likely correspond to misidentifications with morphologically similar species. Between October and December of 2020, we visited rural areas of four localities from three municipalities within the department of Córdoba: Cuero Curtido and Severá (municipality of Cereté), El Espanto (municipality of Planeta Rica), and Arroyo Negro (municipality of San Carlos). Search for soft ticks was performed in 46 human domiciles and peridomiciliary areas. We searched in areas frequented by domestic animals, inspecting cracks in the walls and fowl nests. Infestation by soft ticks was found in 13% (6/46) of visited houses. Overall, 215 ticks were collected (26 larvae, 144 nymphs and 45 adults) from nests of domestic birds or in the adjacent walls. Larvae, nymphs and adults were morphologically identified as Ornithodoros puertoricensis. Molecular identification of ticks was confirmed by sequencing the tick mitochondrial 16S gene of adults, pools of nymphs and larvae. Pairwise comparisons showed a 99% of identity with O. puertoricensis from Panama. This study reports for the first time O. puertoricensis associated with domestic fowl in rural dwellings in Colombia, and expands the geographical distribution of this tick species toward the Córdoba department. Importantly, local people described exposure to tick bites while sleeping in infested houses; therefore, the transmission of soft tick-borne pathogens is now of concern in the region.

Prescripción antibiótica de los médicos generales: impacto de la evaluación y retroalimentación en un hospital de tercer nivel en la ciudad de Medellín / Antibiotic prescription of general practitioner: impact of the evaluation and feedback in a tertiary care center in the city of Medellin

RESUMEN Objetivos: medir el impacto en la calidad de la prescripción antibiótica empírica en los médicos generales luego de la implementación de un sistema de evaluación y retroalimentación. Métodos: estudio cuasiexperimental con pre y postintervención en una clínica de tercer nivel en Medellín. Se revisó las prescripciones de un grupo de antibióticos por un médico internista, un epidemiólogo y un infectólogo. Se midió el consumo de antibióticos, las retroalimentaciones realizadas, el diagnóstico de la sepsis, tiempo de inicio de los antibióticos en el servicio de urgencias y la prevalencia de Escherichia coli productora de betalactamasa de espectro extendido. Resultados: el número de retroalimentaciones descendió de 10,9 a 2 %. Se redujo el consumo de ceftriaxona (p = 0,04), piperacilina tazobactam (p = 0,01), cefepime (p = 0,04) y ciprofloxacina (p = 0,01). Se evidenció una tendencia a la reducción en la prevalencia de E. coli BLEE (p = 0,3). La intervención no produjo un retraso en el inicio de antibióticos en el servicio de urgencias. Conclusión: una estrategia de auditoría y retroalimentación a los médicos generales, referente a la calidad de la prescripción antibiótica, reduce el consumo de antibióticos sin afectar la oportunidad del diagnóstico de sepsis o el inicio de su tratamiento y puede impactar favorablemente en el perfil de resistencia de la flora microbiana institucional.

SUMMARY Objectives: To measure the impact on the quality of the empirical antibiotic prescription in general practitioners, after the implementation of an evaluation and feedback system. Methods: Quasi-experimental study with pre- and post-intervention in a tertiary care center in Medellín. The prescriptions of a group of antibiotics were reviewed by an internist, an epidemiologist and an infectologist. When failures were found, prescribing doctors were informed. Subsequently, antibiotic consumption, feedbacks, sepsis diagnosis, start time of antibiotics in the emergency department and monthly incidence of Escherichia coli producing extended spectrum betalactamase were measured. Results: The numbers of feedbacks decreased from 10.9% to 2%. Consumption of ceftriaxone (p = 0.04), piperacillin tazobactam (p = 0.01), cefepime (p = 0.04) and ciprofloxacin (p = 0.01) was reduced. There was a tendency to reduce the prevalence of E. coli ESBL. The intervention did not cause a delay in the start of antibiotics in the emergency department. Conclusions: A strategy of continuous feedback to general practitioners regarding the quality of antibiotic prescription reduces consumption of antibiotics without causing changes in diagnosis opportunity or the beginning of antibiotics in sepsis and can impact favorably the resistance profile of the institutional microbial flora.

Detection of tick-borne rickettsial pathogens in naturally infected dogs and dog-associated ticks in Medellin, Colombia.

Tick-borne rickettsial pathogens (TBRP) are important causes of infections in both dogs and humans. Dogs play an important role as a biological host for several tick species and can serve as sentinels for rickettsial infections. Our aim was to determine the presence of TBRP in dogs and in dog-associated ticks and their potential risk to human diseases in Medellin, Colombia. DNA for E. canis (16S rRNA and dsb) and A. platys (groEl) was detected in 17.6% (53/300) and 2.6% (8/300) of dogs, respectively. Antibodies against Ehrlichia spp. 82 (27.3%) and Anaplasma spp. 8 (2.6%) were detected in dogs. Antibody reactivity against both agents were found in 16 dogs (5.3%). Eight dogs showed antibody for Rickettsia spp. with titers that suggest 3 of them had a probable exposure to R. parkeri. Rhipicephalus sanguineus s.l. (178/193) was the main tick in dogs, followed by R. microplus (15/193). The minimum infection rates (MIR) in R. sanguineus were 11.8% for E. canis and 3.4% for A. platys. E. canis and A. platys are the main TBRP infecting dogs and ticks and R. sanguineus s.l. is likely involved in the transmission of both agents. Interestingly, we found serological evidence of exposure in dogs for spotted fever group rickettsiae.

Ehrlichia canis TRP36 diversity in naturally infected-dogs from an urban area of Colombia.

Ehrlichia canis is the etiologic agent of a highly prevalent tick-borne disease, canine monocytic ehrlichiosis (CME). Four defined E. canis genotypes based on the trp36 gene sequences have been reported, three of them identified in North or South America. The diversity of E. canis has been investigated using genetic and serologic approaches based on distinct 36 kDa tandem repeat protein (trp36) gene sequences that have been reported. The main objectives of this study were to determine the prevalence of E. canis infection in dogs from Medellín, Colombia by PCR and determine the E. canis diversity using molecular and serologic approaches. Blood was collected from dogs (n = 300) with clinical signs of CME for PCR detection of E. canis 16S rRNA, dsb and trp36 DNA. Phylogenetic analysis of trp36 gene sequences was performed using MEGA. A serological evaluation was performed using immunofluorescence microscopy and ELISA with species-specific peptides from E. canis TRP19 and TRP36 (3 genotypes) and E. chaffeensis (TRP32). E. canis DNA (16S rRNA and/or dsb) was detected in 18 % (53/300) of dogs by PCR amplification. The trp36 gene was amplified and sequenced from 35/53 16S rRNA/dsb PCR positive samples revealing three genotypes: United States (US; n = 21), Costa Rica (CR; n = 11), and Brazil (BR; n = 3). Most dogs (33/35) with detectable trp36 DNA had anti-E. canis TRP19 and TRP36 peptide antibodies that corresponded to the genotype detected by PCR. Dogs that had antibodies to the TRP19 peptide (82/300; 38 %), also had antibodies to one or more genotype-specific TRP36 peptides. Based on TRP36 serology, the dogs exhibited highest frequency of infection with the US genogroup (US = 26), followed by the CR genogroup (CR = 19) and the BR genogroup (BR = 11). Notably, 26/53 trp36 PCR positive dogs had detectable antibodies to multiple E. canis genotypes (US/BR/CR = 8, BR/CR = 7, US/CR = 6 and US/BR = 5) suggesting coinfection or multiple sequential infections with different genotypes. Colombian dogs did not have antibodies to E. chaffeensis as determined by a TRP32 species-specific ELISA. Our results demonstrate the presence of three previously defined genotypes in North and South America in Colombian dogs (US, BR, CR). These results also demonstrate that TRP19 and TRP36 serology can provide valuable information regarding E. canis exposure and the potential genotype(s) involved in infection.

Detection of tick-borne rickettsial pathogens in naturally infected dogs and dog-associated ticks in Medellin, Colombia / Detecção de patógenos rickettsiais transmitidos por carrapatos em cães naturalmente infectados e carrapatos associados a cães em Medellin, Colômbia

Abstract Tick-borne rickettsial pathogens (TBRP) are important causes of infections in both dogs and humans. Dogs play an important role as a biological host for several tick species and can serve as sentinels for rickettsial infections. Our aim was to determine the presence of TBRP in dogs and in dog-associated ticks and their potential risk to human diseases in Medellin, Colombia. DNA for E. canis (16S rRNA and dsb) and A. platys (groEl) was detected in 17.6% (53/300) and 2.6% (8/300) of dogs, respectively. Antibodies against Ehrlichia spp. 82 (27.3%) and Anaplasma spp. 8 (2.6%) were detected in dogs. Antibody reactivity against both agents were found in 16 dogs (5.3%). Eight dogs showed antibody for Rickettsia spp. with titers that suggest 3 of them had a probable exposure to R. parkeri. Rhipicephalus sanguineus s.l. (178/193) was the main tick in dogs, followed by R. microplus (15/193). The minimum infection rates (MIR) in R. sanguineus were 11.8% for E. canis and 3.4% for A. platys. E. canis and A. platys are the main TBRP infecting dogs and ticks and R. sanguineus s.l. is likely involved in the transmission of both agents. Interestingly, we found serological evidence of exposure in dogs for spotted fever group rickettsiae.

Resumo As riquétsias transmitidas por carrapatos (RTC) são causas importantes de infecção em cães e humanos. Os cães exercem um papel essencial como hospedeiros biológicos para diversas espécies de carrapatos, assim como podem ser úteis como sentinelas de infecções por riquétsias. O intuito deste estudo foi determinar a presença de RTC em cães, assim como em seus carrapatos, para determinar o risco potencial de doença humana em Medellín, Colômbia. DNA de Ehrlichia canis (16S rRNA e dsb) e Anaplasma platys (groEl) foi detectado em 17,6% (53/300) e 2,6% (8/300) dos cães, respectivamente. Anticorpos contra Ehrlichia spp. (82; 27,3%) e Anaplasma spp. (8; 2,6%) foram detectados nos cães. Reatividade de anticorpos contra ambos patógenos (Ehrlichia e Anaplasma) foi detectada em 16 cães (5,3%). Oito animais apresentaram anticorpos contra Rickettsia spp., e 3 deles sugerem uma provável exposição a Rickettsia parkeri. Rhipicephalus sanguineus s.l. (178/193) foi a principal espécie de carrapatos, seguida de R. microplus (15/193). A taxa de infecção mínima em R. sanguineus foi 11,8% para E. canis e 3,4% para A. platys. E. canis e A. platys são as principais RTC que infectam cãese R. sanguineus s.l. provavelmente está envolvido na transmissão de ambos os agentes. É evidente, porém, a exposição sorológica dos cães a riquétsias do grupo da febre maculosa.

Aislamiento e identificación de bacterias con potencial nosocomial procedentes de ambientes y superficies de una clínica veterinaria Universitaria del Área Metropolitana del Valle de Aburrá, Antioquia-Colombia / Isolation and identification of bacteria with nosocomial potential from environments and surfaces of a veterinary university clinic of Metropolitan area of Aburra Valley Antioquia-Colombia

Introducción: Las infecciones nosocomiales son aquellas adquiridas por los pacientes durante la hospitalización. Son de gran importancia en medicina humana pero aún se desconoce cuál es su papel en medicina veterinaria. Objetivo: Identificar la presencia de bacterias asociadas a infecciones hospitalarias en ambientes y superficies en una clínica veterinaria. Materiales y métodos: Se realizaron dos muestreos, se determinó a través de sedimentación y torunda la presencia de bacterias en el ambiente y las superficies de las 8 unidades de la clínica veterinaria. La presencia de nosocomiales se determinó por el crecimiento y purificación en medios diferenciales, la identificación se hizo por descripción macroscópica de las colonias y tinción de Gram y posteriormente se realizó una caracterización bioquímicamente por medio del API20E y API50 CH/E y un antibiograma en las cepas relacionadas con resistencia a antibióticos. Resultados: Se obtuvo 95 aislados y se logró determinar la presencia de 28 agentes potencialmente nosocomiales, donde se destaca la presencia de Pseudomonas aeruginosa, Proteus sp. y Staphylococcus sp. microorganismos relacionados con infecciones asociadas a hospitales veterinarios. Conclusiones: Se realiza la primera aproximación a este tipo de infecciones en hospitales veterinarios en Antioquia, y se evidencia la circulación en ambiente y superficies de potenciales bacterias nosocomiales en la clínica veterinaria.

Introduction: Care associated infections are of importance in human medicine but few is known in veterinary medicine. Aims: To identify pathogenic bacteria in surfaces of veterinary clinics. Materials and methods: Two samples with cotton hissops were obtained in inert surfaces from 8 veterinary clinics. The presence of pathogenic bacteria was established by growth in agar media, identification of species was performed through colonies morphology and Gram stain and biochemistry identification with API20E and API50 CH/E system and antibiogram. Results: 95 isolates were characterized and within them 28 were pathogenic. The most prevalent were Pseudomonas aeruginosa, Proteus sp. and Staphylococcus sp. Conclusions: This is the first description of pathogenic microorganisms present in veterinary clinics in Antioquia that have potential for clinical consequences for personnel working at this veterinary centers.

[First evidence of lymphocytic choriomeningitis virus (Arenavirus) infection in Mus musculus rodents captured in the urban area of the municipality of Sincelejo, Sucre, Colombia].

INTRODUCTION: The lymphocytic choriomeningitis virus is an Old World arenavirus that infects Mus musculus, and can cause congenital hydrocephalus, chorioretinitis and multisystemic failure in transplant human recipients. Although the disease has not been clinically diagnosed in Colombia yet, there have been reports of infection with the Pichindé virus in rodents from Cauca and Valle del Cauca departments, and with the Guanarito virus in rodents from Córdoba department. OBJECTIVE: To identify the lymphocytic choriomeningitis virus from Mus musculus captured in the municipality of Sincelejo. MATERIALS AND METHODS: We evaluated 80 samples of plasma by ELISA using antigen from lymphocytic choriomeningitis virus. Additionally, a nested RT-PCR was performed to seropositive and seronegative samples for the S-segment. RESULTS: We found a 10% seroprevalence (8/80) and the viral genome was detected in 16 brain samples; the alignment (BLAST) and the phylogenetic analysis (MrBayes, version 3.2.2) confirmed the presence of the lymphocytic choriomeningitis virus. CONCLUSION: The results indicated that human infection with the lymphocytic choriomeningitis virus in humans could occur in the urban area of Sincelejo, although no cases have been reported so far.

Primera evidencia de infección por el virus de la coriomeningitis linfocítica (arenavirus) en roedores Mus musculus capturados en la zona urbana del municipio de Sincelejo, Sucre, Colombia / First evidence of lymphocytic choriomeningitis virus (Arenavirus) infection in Mus musculus rodents captured in the urban area of the municipality of Sincelejo, Sucre, Colombia

Resumen Introducción. El virus de la coriomeningitis linfocítica es un arenavirus del Viejo Mundo que se hospeda en el ratón casero (Mus musculus), y puede causar infecciones congénitas, hidrocefalia, coriorretinitis y falla orgánica múltiple en pacientes receptores de trasplantes. En Colombia aún no se ha reportado la enfermedad mediante diagnóstico clínico, pero en estudios serológicos se ha detectado la infección por el virus Pichindé en roedores en los departamentos del Cauca y Valle del Cauca, y por el virus Guanarito, en roedores en Córdoba. Objetivo. Detectar el virus de la coriomeningitis linfocítica en M. musculus en el municipio de Sincelejo. Materiales y métodos. Se evaluaron 80 muestras de plasma mediante la prueba ELISA usando antígeno del virus de la coriomeningitis linfocítica. Además, se empleó la reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR) anidada en muestras de animales seropositivos y seronegativos para la detección del segmento S. Resultados. Se encontró una seroprevalencia de 10% (8/80) y se detectó el genoma viral en 16 muestras de cerebro; el alineamiento (en la Basic Local Alignment Search Tool, BLAST) y el análisis filogenético (mediante el programa MrBayes, versión 3.2.2) confirmaron que correspondía al virus de la coriomeningitis linfocítica. Conclusión. Los resultados indicaron que la infección por el virus de la coriomeningitis linfocítica en humanos podría ocurrir en el área urbana de Sincelejo, aunque hasta la fecha no se hayan reportado casos.

Abstract Introduction: The lymphocytic choriomeningitis virus is an Old World arenavirus that infects Mus musculus, and can cause congenital hydrocephalus, chorioretinitis and multisystemic failure in transplant human recipients. Although the disease has not been clinically diagnosed in Colombia yet, there have been reports of infection with the Pichindé virus in rodents from Cauca and Valle del Cauca departments, and with the Guanarito virus in rodents from Córdoba department. Objective: To identify the lymphocytic choriomeningitis virus from Mus musculus captured in the municipality of Sincelejo. Materials and methods: We evaluated 80 samples of plasma by ELISA using antigen from lymphocytic choriomeningitis virus. Additionally, a nested RT-PCR was performed to seropositive and seronegative samples for the S-segment. Results: We found a 10% seroprevalence (8/80) and the viral genome was detected in 16 brain samples; the alignment (BLAST) and the phylogenetic analysis (MrBayes, version 3.2.2) confirmed the presence of the lymphocytic choriomeningitis virus. Conclusion: The results indicated that human infection with the lymphocytic choriomeningitis virus in humans could occur in the urban area of Sincelejo, although no cases have been reported so far.

Etiología y caracterización epidemiológica del síndrome febril no palúdico en tres municipios del Urabá antioqueño, Colombia / Etiology and epidemiological characterization of non-malarial febrile syndrome in three municipalities of Urabá (Antioquia), Colombia

Introducción. La región de Urabá es endémica para varias enfermedades febriles agudas de origen infeccioso. Sin embargo, solo los pacientes con malaria pueden acceder a un diagnóstico oportuno y rápido, motivo por el cual muchos síndromes febriles no palúdicos quedan sin diagnóstico etiológico claro. Objetivo. Establecer la etiología, describir las manifestaciones clínicas y explorar algunos posibles factores de riesgo relacionados con los síndromes febriles agudos no palúdicos en pacientes procedentes de los municipios de Necoclí, Turbo y Apartadó. Materiales y métodos. Se tomaron muestras de suero en fase aguda y de convalecencia de 220 pacientes febriles negativos para malaria, provenientes de zonas rurales y urbanas de Necoclí, Turbo y Apartadó en los años 2007 y 2008. Se practicaron pruebas para diagnóstico de dengue (detección de anticuerpos IgM por ELISA), leptospirosis (detección de anticuerpos IgM e IgG por IFI), rickettsiosis (detección de anticuerpos IgG por IFI), hantavirus y arenavirus (detección de anticuerpos IgG por ELISA). Resultados. Se encontraron frecuencias de dengue, leptospirosis, rickettsiosis y arenavirus de 37,3 %, 14,1 %, 2,7 % y 0,5 %, respectivamente. Se presentaron 12 casos de coinfección de leptospirosis-dengue y uno de leptospirosis-rickettsiosis-dengue. El sexo masculino y la humedad relativa media, fueron factores de riesgo para dengue. El inicio de signos clínicos en febrero de 2008, se asoció tanto con la infección por dengue como por leptospirosis. Conclusión. Se reafirma la importancia del virus del dengue, Rickettsia spp. y Leptospira spp., como agentes causantes del síndrome febril en la región del Urabá.

Introduction: Urabá, a region on the northern coast of Colombia, is endemic to several acute febrile illnesses of infectious origin; however, only patients with malaria may have access to quick and effective diagnosis. For this reason, many non-malarial febrile patients go without a clear etiologic diagnosis. Aim: To establish the etiology and clinical signs of acute febrile non-malaria syndromes and explore some of the likely risk factors in patients originating in the municipalities of Necocli, Turbo and Apartado who exhibit these symptoms. Materials and methods: We obtained acute and convalescent sera from 220 non-malarial febrile patients from the rural and urban zones of Necocli, Turbo and Apartado during 2007 and 2008. Serologic tests for dengue (IgM by ELISA), leptospirosis (IgM and IgG by IFA), rickettsiosis (IgG by IFI), hanta and arenavirus (IgG by ELISA) were performed. Results: We found that the frequency of infection for dengue, leptospirosis, rickettsiosis and arenavirus, was 37.3%; 14.1%; 2.7% and 0.5%, respectively. There were 12 co-infection cases of leptospirosis-dengue and one of leptospirosis-rickettsiosis-dengue. Male gender and relative humidity were considered risk factors for dengue, and the beginning of clinical signs in February of 2008 was associated with the infection of dengue and leptospirosis. Conclusion: This study confirms previous records that underline the importance of Rickettsia spp, dengue virus and Leptospira spp as causal agents of febrile syndrome in this region of Colombia.

[Etiology and epidemiological characterization of non-malarial febrile syndrome in three municipalities of Urabá (Antioquia), Colombia]. / Etiología y caracterización epidemiológica del síndrome febril no palúdico en tres municipios del Urabá antioqueño, Colombia.

INTRODUCTION: Urabá, a region on the northern coast of Colombia, is endemic to several acute febrile illnesses of infectious origin; however, only patients with malaria may have access to quick and effective diagnosis. For this reason, many non-malarial febrile patients go without a clear etiologic diagnosis. AIM: To establish the etiology and clinical signs of acute febrile non-malaria syndromes and explore some of the likely risk factors in patients originating in the municipalities of Necocli, Turbo and Apartado who exhibit these symptoms. MATERIALS AND METHODS: We obtained acute and convalescent sera from 220 non-malarial febrile patients from the rural and urban zones of Necocli, Turbo and Apartado during 2007 and 2008. Serologic tests for dengue (IgM by ELISA), leptospirosis (IgM and IgG by IFA), rickettsiosis (IgG by IFI), hanta and arenavirus (IgG by ELISA) were performed. RESULTS: We found that the frequency of infection for dengue, leptospirosis, rickettsiosis and arenavirus, was 37.3%; 14.1%; 2.7% and 0.5%, respectively. There were 12 co-infection cases of leptospirosis-dengue and one of leptospirosis-rickettsiosis-dengue. Male gender and relative humidity were considered risk factors for dengue, and the beginning of clinical signs in February of 2008 was associated with the infection of dengue and leptospirosis. CONCLUSION: This study confirms previous records that underline the importance of Rickettsia spp, dengue virus and Leptospira spp as causal agents of febrile syndrome in this region of Colombia.

Primera evidencia genética de hantavirus en roedores capturados en colombia y correlación serológica en humanos

Introducción: desde mayo de 1993 se reconoció el primer hantavirus en el continente americano, asociado con la presentación del síndrome cardiopulmonar por hantavirus, en la región conocida como Four Corners en Norte América(1,2). Desde entonces, se han identificado virus similares circulando en roedores de la subfamilia Sigmodontinae, a lo largo de Sur y Centro América.En el año 2004, Mattar et al (3), publicaron la primera evidencia serológica demostrando la circulación de hantavirus en trabajadores rurales sanos del norte de Colombia, y dos años más tarde Alemán et al (4), reportaron la primera evidencia serológica en roedores capturados en Córdoba y Sucre.