Brucellosis in household members of Brucella patients residing in a large urban setting in Peru.

During home visits and using a point-of-care test for brucellosis, we screened the household members of adult patients found to have brucellosis by investigation at the Hospital Nacional Daniel Alcides Carrión in Callao, Peru. A total of 206 household members of 43 patients were screened, and 15 (7.3%) household members in 10 (23.3%) households tested seropositive. Brucellosis was diagnosed in 14 of them, all but 4 presenting with acute or subacute uncomplicated disease. Regardless of attempts to control brucellosis in Peru, the disease continues to be reasonably common among household members of brucellosis patients. Household members presumably remain the single most important identifiable risk group in an urban setting, and screening them provides an effective means for their early diagnosis. Although contact with livestock was rare, the consumption of unpasteurized dairy products was reported by almost all patients with brucellosis, their household members, and hospitalized non-brucellosis patients.

Evaluation of brucellosis by PCR and persistence after treatment in patients returning to the hospital for follow-up.

Polymerase chain reaction (PCR) was applied to confirm the diagnosis of brucellosis and to study its clearance in response to the standard treatment regimen with doxycycline and rifampin at hospitals in Callao and Lima, Peru. The PCR confirmed the diagnosis in 23 (91.7%) patients with brucellosis including 12 culture-confirmed cases. For patients treated at the hospital in Callao, PCR was positive for all samples collected during and at the conclusion of treatment and for 76.9% of follow-up samples collected on average 15.9 weeks after completion of treatment. For patients treated at the hospital in Lima, PCR tests were positive for 81.8% of samples collected during treatment, for 33.3% of samples collected at the conclusion of treatment, and for > or = 50% of samples collected at first, second, and third post-treatment follow-up. Thus, Brucella DNA may persist in the serum weeks to months after completion of the standard treatment regimen.

Risk factors for canine echinococcosis in an endemic area of Peru.

An epidemiological study was conducted in a highland rural community in Peru to determine risk factors for canine echinococcosis caused by Echinococcus granulosus. Dogs were diagnosed using a coproantigen enzyme-linked immunosorbent assay (ELISA). Dog owners were interviewed prior to stool collection and asked for attitudes, practices and beliefs likely to be associated with local patterns of E. granulosus transmission. Univariate and multivariate analysis were used to determine odds ratios (OR) and their 95% confidence intervals (CI). The main risk factors found to be significantly associated with canine echinococcosis by univariate analysis were dog age (3-25 months) (OR, 5.14; CI, 1.7-15.7), female sex (OR, 4.3; CI, 1.4-13.3) and having been fed hydatid infected offal (OR, 2.9; 95% CI, 1.0-8.6). There was complete lack of knowledge about echinococcosis transmission. In addition to periodic dog treatment, control programs need to emphasize education of the human population to increase knowledge of parasite transmission and to change human practices associated with high rates of infection.

Tuberculosis y embarazo: Infecciones clínico patológicas / Tuberculosis and pregnancy: clinical and pathological interactions

Objetivo: Valorar la infuencia de la tuberculosis (TBC) sobre la gestación parto y producto. Determinar los factores de reactivación y el curso de la TBC durante la gestación. Valorar la influencia del factor nutricional de la gestante tuberculosa sobre los resultados perinatales adversos: Diseño: Se realizó un estudio descriptivo retrospectivo de casos y controles, revisando correlativamente las historias clínicas de pacientes atendidos en el servicio de Gineco-obstetricia del Hospital Edgardo Rebagliati Martins durante los años de 1990-1995. Material: Se conformó un grupo con 31 gestantes con diagnóstico de tuberculosis y un grupo con 31 gestantes sin diagnóstico de tuberculosis: Resultados: El 90 por ciento de las reactivaciones de TBC se presentó durante la gestación. Un gran porcentaje de gestantes con TBC, tenía antecedentes de TBC (p < 0,08). En estas pacientes, el tratamiento específico para la TBC anterior a la gestación fue irregular y/o de corta duración, a diferencia del grupo de gestantes que no presentó tuberculosis durante el embarazo, pero que si tenía antecedentes de la enfermedad, recibió un tratamiento adecuado o completo ( p < 0,046 y p < 0.049 respectivamente). No se encontró diferencia significativas entre pacientes con TBC y sin TBC durante la gestación en relación a los resultados perinatales adversos: aborto (3 por ciento vs 0 por ciento), PBN (37 por ciento vs 33 por ciento), RIUC (27 por ciento vs 67 por ciento) y PEG (18 por ciento vs por ciento) (p > 0,05). Por el contrario, los resultados perinatales adversos están relacionados al MEN, peso bajo del embarazo, poca ganancia de peso en la misma, aunque con p > 0,05. Conclusiones: La gestación por sí sola no es factor de riesgo para la reactivación de la tuberculosis. La reactivación está asociada al antecedente de tuberculosis con tratamiento irregular y de corta duración. En nuestro estudio, la tuberculosis no alteró los resultados perinatales. Las madres con peso bajo antes del embarazo y/o poca ganancia de peso durante la gestación, tiene mayor porcentaje de PBN, RCIU y PEG. Palabras clave: tuberculosis, embarazo, puerperio.