Susceptibility to endemic Aedes-borne viruses among pregnant women in Risaralda, Colombia.

OBJECTIVES: Aedes-borne viruses (ABV) affect humans on every inhabited continent and frequently cause epidemics. Recent epidemics of chikungunya and Zika viruses (ZIKV) highlight that preparedness for future epidemics requires assessment of susceptibility, particularly among high-risk groups. We sought to determine immunity against the three major circulating ABV among pregnant women in an ABV-endemic area of Colombia. METHODS: A cross-sectional seroprevalence study was performed, enrolling women presenting to Labor and Delivery. Cord blood and maternal peripheral blood samples were obtained. IgG seroprevalence to flaviviruses and chikungunya was determined by ELISA. An abbreviated neutralization test was used to estimate the frequency and magnitude of immunity to Zika and four dengue serotypes. Cluster analyses explored epidemiologic factors associated with seroprevalence. RESULTS: Most women exhibited high levels of neutralizing antibodies to one or more ABV; however, nearly 20% were seronegative for flaviviruses. Our research took place after the epidemic peak of the ZIKV outbreak in Colombia in 2016. However, only 20% of pregnant women had high levels of Zika-neutralizing antibodies consistent with likely protective immunity to ZIKV. CONCLUSION: Hence, a high proportion of pregnant women in Risaralda remain susceptible to one or more ABV including the teratogenic ZIKV, indicating a risk for future epidemics in this region.

Physical Growth and Neurodevelopment of a Cohort of Children after 3.5 Years of Follow-up from Mothers with Zika Infection during Pregnancy-Third Report of the ZIKERNCOL Study.

INTRODUCTION: In utero Zika virus (ZIKV) exposure has been related to a group of congenital structural abnormalities called the congenital Zika syndrome, which also has been related to neurodevelopment alterations even in normocephalic children. Physical growth has been less explored, and delayed growth and malnutrition have been reported. OBJECTIVE: The objective of this study is to describe the growth and neurodevelopment features of normocephalic infants born from a cohort of mothers with RT-PCR confirmed ZIKV during pregnancy in Risaralda, Colombia. METHODS: We conducted a retrospective cohort, including normocephalic children born from mothers with RT-PCR confirmed ZIKV infection during pregnancy in Risaralda, Colombia. Physical growth was measured using WHO standards, and neurodevelopment was measured with the abbreviated neurodevelopment scale 2 validated for Colombia. RESULTS: After verifying inclusion and exclusion criteria, 16 children were followed during a median time of 28 months (IQR 23-31 months); for a total of 116 visits, 87.5% (n = 14) of the patients developed a growth alteration. Five presented post-natal microcephaly, and among them, four presented malnutrition or low height. Six patients developed macrocephaly. Patients with a normal head circumference had normal neurodevelopment. Only one patient with microcephaly persisted with impairment of the neurodevelopment at the end of follow-up. All the patients with macrocephaly had normal neurodevelopment. DISCUSSION: Our study suggests that growth could be altered in infants with in utero Zika exposure. We found a high proportion of patients with overgrowth and macrocephaly. Future studies should consider endocrine follow-up of children born with in utero Zika exposure to explore these findings' possible aetiologies. CONCLUSION: We found a high proportion of growth alterations, particularly with overgrowth features and macrocephaly. Our study suggests that in addition to neurodevelopment impairment, growth could be altered in infants and children with in utero Zika exposure, even in those patients born without CZS.

Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis.

INTRODUCTION: An epidemic of Coronavirus Disease 2019 (COVID-19) began in December 2019 in China leading to a Public Health Emergency of International Concern (PHEIC). Clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews on COVID-19 have been published to date. METHODS: We performed a systematic literature review with meta-analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of COVID-19 confirmed cases. Observational studies and also case reports, were included, and analyzed separately. We performed a random-effects model meta-analysis to calculate pooled prevalences and 95% confidence intervals (95%CI). RESULTS: 660 articles were retrieved for the time frame (1/1/2020-2/23/2020). After screening, 27 articles were selected for full-text assessment, 19 being finally included for qualitative and quantitative analyses. Additionally, 39 case report articles were included and analyzed separately. For 656 patients, fever (88.7%, 95%CI 84.5-92.9%), cough (57.6%, 95%CI 40.8-74.4%) and dyspnea (45.6%, 95%CI 10.9-80.4%) were the most prevalent manifestations. Among the patients, 20.3% (95%CI 10.0-30.6%) required intensive care unit (ICU), 32.8% presented with acute respiratory distress syndrome (ARDS) (95%CI 13.7-51.8), 6.2% (95%CI 3.1-9.3) with shock. Some 13.9% (95%CI 6.2-21.5%) of hospitalized patients had fatal outcomes (case fatality rate, CFR). CONCLUSION: COVID-19 brings a huge burden to healthcare facilities, especially in patients with comorbidities. ICU was required for approximately 20% of polymorbid, COVID-19 infected patients and hospitalization was associated with a CFR of >13%. As this virus spreads globally, countries need to urgently prepare human resources, infrastructure and facilities to treat severe COVID-19.

Diagnosis and outcomes of pregnant women with Zika virus infection in two municipalities of Risaralda, Colombia: Second report of the ZIKERNCOL study.

BACKGROUND: Zika virus (ZIKV) infection has emerged as a significant threat for pregnant women and newborns in populations living in or visiting Latin America. We previously reported a preliminary analysis in Sucre, Colombia, as the first group of pregnant women with RT-PCR-confirmed ZIKV (ZIKa enEmbarazadas yReciénNacidos enCOLombia, ZIKERNCOL). METHODS: In this second report, findings of the first 86 pregnant women from La Virginia and Dosquebradas (municipalities), Risaralda, Colombia, with RT-PCR-confirmed ZIKV infection are reported. Clinical, demographical and obstetrical findings are described. RESULTS: All women reported ZIKV symptoms during pregnancy: 79.1% rash, 55.8% fever, among others. In addition to ZIKV, RT-PCR was positive for dengue in 18.6%; 45.3% Dengue IgM+; 5.8% RT-PCR positive for chikungunya; 3.6% Chikungunya IgM+. STORCH screening in mother: 11.6% IgG + anti-Toxoplasma gondii, 6% IgG + anti-rubella, 4.7% IgG + CMV. The rest of STORCH tests were negative. Microcephaly was observed in 2.4% of the newborns. No calcifications or other CNS alterations were detected. One newborn had cleft palate and one had bilateral renal ectopy. CONCLUSIONS: The rate of microcephaly in our cohort was consistent with other studies. Pregnant women in endemic areas should be followed and tested according to standard protocols, and asymptomatic ZIKV infection should be considered. Long-term follow-up of children is required in the congenital Zika syndrome (CZS) assessment.

Mapping Zika in the 125 municipalities of Antioquia department of Colombia using Geographic Information System (GIS) during 2015-2016 outbreak.

Not available.

Rasmussen aneurysm: A rare but not gone complication of tuberculosis.

This report describes the case of a 30-year-old homeless man from Pereira, Colombia with tuberculosis, who presented with massive hemoptysis and associated aneurysm of the left upper lobe (Rasmussen aneurysm). Computed tomography angiography with three-dimensional reconstruction confirmed the aneurysm, and embolization was performed successfully.

Mapping the ecoepidemiology of Zika virus infection in urban and rural areas of Pereira, Risaralda, Colombia, 2015-2016: Implications for public health and travel medicine.

OBJECTIVE: Geographical information systems (GIS) have been demonstrated earlier to be of great use to inform public health action against vector-borne infectious diseases. METHODS: Using surveillance data on the ongoing ZIKV outbreak from Pereira, Colombia (2015-2016), we estimated incidence rates (cases/100,000 population), and developed maps correlating with the ecoepidemiology of the area. RESULTS: Up to October 8, 2016, 439 cases of ZIKV were reported in Pereira (93 cases/100,000 pop.), with highest rates in the South-West area. At the corregiments (sub-municipalities) of Pereira, Caimalito presented the highest rate. An urban area, Cuba, has 169 cases/100,000 pop., with a low economical level and the highest Aedic index (9.1%). Entomological indexes were associated with ZIKV incidence at simple and multiple non-linear regressions (r2 > 0.25; p < 0.05). CONCLUSIONS: Combining entomological, environmental, human population density, travel patterns and case data of vector-borne infections, such as ZIKV, leads to a valuable tool that can be used to pinpoint hotspots also for infections such as dengue, chikungunya and malaria. Such a tool is key to planning mosquito control and the prevention of mosquito-borne diseases in local populations. Such data also enable microepidemiology and the prediction of risk for travelers who visit specific areas in a destination country.

Post-traumatic stress disorder in internally displaced people of Colombia: An ecological study.

BACKGROUND: Post-Traumatic Stress Disorder (PTSD) has been described as one of the most frequently reported mental condition among refugees and internally displaced populations (IDPs). Despite this, few has been reported about it in Latin America, even in Colombia, the country with the highest number of IDPs in the in the world. METHOD: This ecological study assessed incidence and differences of PTSD in general population and IDPs in Colombia and its departments (32) during 2009-2012. Epidemiological data was collected from the National Health Records System (RIPS), retrieving the ICD-10 code F43.1 in both populations. We estimated PTSD incidence rates on both populations (cases/100,000 pop), using reference population of the IDPs (SISDHES and the general population was taken from the (DANE). Incidence rates ratios were calculated comparing both populations. RESULTS: In general population, 6619 cases of PTSD occurred (14.5 cases/100,000 pop, 95%CI 14.0-15.0) while 177 among IDPs (73.8 cases/100,000 pop, 95%CI 63.0-85.0). PTSD was 5.1 times higher among IDPs than in general population. Ranging from 1.6 (Tolima) to 15.8 (Quindío) (median: 4.4). In departments with higher incidence, also it was in IDPs (r2 = 0.4899; p < 0.01). CONCLUSION: This study evidenced a significantly higher PTSD incidence among IDPs, when compared with general population in the same territories. This has relevant implications for screening, diagnosis and management of PTSD among IDPs, especially in high incidence areas. More studies are required to improve the understanding of this condition among vulnerable populations, as well to provide better medical and psychological interventions and for the development of public policies in countries, such as Colombia, with IDPs.

Influence of socio-economic inequality measured by the Gini coefficient on meningitis incidence caused by Mycobacterium tuberculosis and Haemophilus influenzae in Colombia, 2008-2011.

Bacterial meningitis is an important cause of infectious neurological morbidity and mortality. Its incidence has decreased with the introduction of vaccination programmes against preventable agents. However, low-income and middle-income countries with poor access to health care still have a significant burden of the disease. Thus, the relationship between the Gini coefficient and H. influenzae and M. tuberculosis meningitis incidence in Colombia, during 2008-2011, was assessed. In this ecological study, the Gini coefficient was obtained from the Colombian Department of Statistics, incidence rates were calculated (cases/1,000,000 pop) and linear regressions were performed using the Gini coefficient, to assess the relationship between the latter and the incidence of meningitis. It was observed that when inequality increases in the Colombian departments, the incidence of meningitis also increases, with a significant association in the models (p<0.01) for both M. tuberculosis (r²=0.2382; p<0.001) and H. influenzae (r²=0.2509; p<0.001). This research suggests that high Gini coefficient values influence the incidence of Mycobacterium tuberculosis and Haemophilus influenzae meningitis, showing that social inequality is critical to disease occurrence. Early detection, supervised treatment, vaccination coverage, access to health care are efficient control strategies.

Mapping Zika virus disease incidence in Valle del Cauca.

OBJECTIVE: Geographical information systems (GIS) use for development of epidemiological maps in tropical diseases is increasingly frequently utilized. Here, we apply this technique to map the current Zika virus (ZIKV) outbreak in Colombia. METHODS: Surveillance cases data of the ongoing epidemic of ZIKV in Valle del Cauca department and its capital, Cali (2015-2016), were used to estimate cumulated incidence rates (cases/100,000 population) to develop the first maps in the department and it municipalities. The GIS software used was Kosmo Desktop 3.0RC1®. Three thematic incidence rate maps were developed. RESULTS: Up to April 2, 2016, 9,825 cases of ZIKV were reported (15.15 % of the country cases). The burden of ZIKV infection has been concentrated in the North of the department. Valle del Cauca borders with other departments with incidence of ZIKV infection, such as Quindío (173 cases) and Risaralda (687 cases). Eleven municipalities of Valle del Cauca had cases in the range between 250 and 499 cases/100,000, all in the North and East of the department. Cali, the capital concentrates more than a third of the reported cases of ZIKV in Valle del Cauca. CONCLUSIONS: Use of GIS-based epidemiological maps allows to guide decision-making for prevention and control of diseases that constitute significant public health problems in the region and the country, such as exemplified by the emergence of ZIKV infection, particularly in departments such as Valle del Cauca with a high disease incidence.

Post-chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia.

OBJECTIVE: There are limited studies in Latin America regarding the chronic consequences of the Chikungunya virus (CHIK), such as post-CHIK chronic inflammatory rheumatism (pCHIK-CIR). We assessed the largest cohort so far of pCHIK-CIR in Latin America, at the municipality of La Virginia, Risaralda, a new endemic area of CHIK in Colombia. METHODS: We conducted a cohort retrospective study in Colombia of 283 patients diagnosed with CHIK that persisted with pCHIK-CIR after a minimum of 6 weeks and up to a maximum of 26.1 weeks. pCHIK cases were identified according to validated criteria via telephone. RESULTS: Of the total CHIK-infected subjects, 152 (53.7%) reported persistent rheumatological symptoms (pCHIK-CIR). All of these patients reported joint pains (chronic polyarthralgia, pCHIK-CPA), 49.5% morning stiffness, 40.6% joint edema, and 16.6% joint redness. Of all patients, 19.4% required and attended for care prior to the current study assessment (1.4% consulting rheumatologists). Significant differences in the frequency were observed according to age groups and gender. Patients aged >40 years old required more medical attention (39.5%) than those ≤40 years-old (12.1%) (RR=4.748, 95%CI 2.550-8.840). CONCLUSIONS: According to our results, at least half of the patients with CHIK developed chronic rheumatologic sequelae, and from those with pCHIK-CPA, nearly half presented clinical symptoms consistent with inflammatory forms of the disease. These results support previous estimates obtained from pooled data of studies in La Reunion (France) and India and are consistent with the results published previously from other Colombian cohorts in Venadillo (Tolima) and Since (Sucre).