Exploring the latency period in Chagas disease: duration and determinants in a cohort from Colombia.

BACKGROUND: Chagas disease has a varying latency period, the time between infection and onset of cardiac symptoms, due to multiple factors. This study seeks to identify and understand these factors to enhance our knowledge of the disease. METHODS: A retrospective follow-up study was conducted in Colombia on patients with indeterminate chronic Chagas disease. Medical files were examined to evaluate the disease latency time using time ratios (TRs) and the AFT Weibull model. RESULTS: The study followed 578 patients, of whom 309 (53.5%) developed cardiac disease, with a median latency period of 18.5 (95% CI 16 to 20) y for the cohort. Those with the TcISyl genotype (TR 0.72; 95% CI 0.61 to 0.80), individuals who lived 5-15 y (TR 0.80; 95% CI 0.67 to 0.95), 15-30 y (TR 0.63; 95% CI 0.53 to 0.74) or >30 y (vs 5 y) in areas with high disease prevalence had shorter latency periods. On the other hand, undergoing treatment increased the latency period (TR: 1.74; 95% CI 1.52 to 1.87). CONCLUSIONS: The latency period of Chagas disease was found to be independently related to male gender, receipt of etiological treatment, length of time spent in an endemic area and the TcISyl genotype. The implications of these findings are discussed.

Comparison of 1-year healthcare resource utilization and related costs for patients with heart failure in the Chagas and non-Chagas matched cohorts.

Background: Chagas disease is one of the leading causes of heart failure (HF) in Latin Americans, and there are limited data available that examine related costs of care for patients with HF. This study aimed to compare healthcare resource utilization and related costs for patients with HF, with and without Chagas disease. Methods: A prospective matched-cohort study comparing the healthcare costs for patients with HF with Chagas disease and care costs for patients with HF without Chagas disease was conducted between January 2019 and December 2019. Only direct costs have been estimated, including hospitalization costs, medications and other cardiovascular interventions, and clinical and laboratory follow-up for up to 1 year. Results: A total of 80 patients with chronic HF were included in the study. Of the 80 patients, 40 patients in the Chagas cohort and 40 patients in the non-Chagas cohort were matched for age, insurer and sex. From a social security system perspective, the total costs for the two cohorts during the study period were U$970,136. Specifically, the healthcare costs for the Chagas cohort were greater than the total healthcare costs for the non-Chagas group (U$511,931 versus U$458,205; p = 0.6183) Most costs were associated with hospitalizations (65.5% versus 59.6%), with averages of U$12,798.5 and U$11,455.1 per person in the Chagas and non-Chagas groups, respectively. In both the Chagas (51.6%) and non-Chagas cohorts (54.5%), causes of readmission unrelated to HF outweighed causes of readmission related to HF. High incidences of hospital admissions were observed during the rainy (cold) season for both cohorts. Conclusions: Over a 12-month follow-up period, patients with chronic HF and Chagas consume as many healthcare resources as those with chronic HF and without Chagas. These data highlight the considerable and growing economic burden of HF on the Colombian health system.

Seroprevalence of SARS-CoV-2 Antibodies in Children and Adolescents: Results From a Population-Based Survey in 10 Colombian Cities.

Background. Understanding COVID-19 dynamics in Colombia during the first pandemic year (2020) gives important insights surrounding population's exposure risk and specific susceptibilities. Seroprevalence studies can aid in having a broader understanding of the disease, offering a more inclusive view of the pandemic's impact across the population. Methods. A population-based cross-sectional study to assess antibodies against SARS-CoV-2 in 10 Colombian cities was developed between September and December 2020. Cities were grouped according development typology (Robust (RD), Intermediate (ID) and Incipient (InD)). Detection of total antibodies (IgM + IgG) against SARS-CoV-2 was employed. Univariate Odds Ratios (OR) were estimated for antibody results and selected variables. Results. About 3124 children aged between 5 and 17 years were included. Factors related to lower seropositive results were affiliation to the employer-based health insurance in RD and ID cities (OR: 0.579, 95% CI 0.477-0.703, OR: 0.648, 95%CI 0.480-0.874 respectively) and living in a household with adequate access to public services only for ID cities (OR: 0.679. 95% CI 0.491-0.939). Higher seropositivity rates in RD and ID cities were seen in children belonging to the low socioeconomic stratum (RD: OR: 1.758, 95% CI 1.427-2.165; ID: OR: 2.288, 95% CI 1.599-3.275) and living in an overcrowded household (RD: OR: 1.846, 95% CI 1.467-2.323; ID: OR: 2.379, 95% CI 1.769-3.199). Conclusions. Children and adolescents showed substantial impact from the COVID-19 pandemic. Disadvantageous living conditions were found to be significantly related to having a positive SARS-CoV-2 antibody test. These results highlight the need to prioritize vulnerable populations in the context of health emergencies.

Comparison of methodologies for microscopic malaria diagnosis

Introduction: As part of the pre-elimination plan for malaria in Colombia, it has been proposed to develop activities within the line of work: "Improve access and quality of malaria diagnosis". Objective: To compare the methodology recommended by PAHO/WHO with that used in Colombia for the diagnosis of malaria. Materials and methods: Samples were collected and 88 slides were prepared for malaria diagnosis, under different scenarios according to the parameters to be evaluated. After duplicate mycroscopic reading, the respective variance calculations were performed for all possible staining comparisons with the two methods used (thick smear, combined thick smear), according to the staining (modified Romanowsky or Giemsa), with the result variable being the parasite density (500, 1,000, 5,000 and 10,000 parasites/µl of blood). Results: A Cohen kappa index of inter-rater agreement of 0.923 (95% CI: 0.768-1.078) was obtained. None of the factors (A: stain, B: methodology) or interactions (AB) had a statistically significant effect on the results with a 95% confidence level. Conclusion: Based on the results of the study, the preparation of two thick smears in the same slide stained with the modified Romanowsky stain is a suitable methodology for the diagnosis of malaria in Colombia, due to its technical characteristics, of storage, low cost, use and care.

Enfermedad de Chagas y su seroprevalencia en tres departamentos de la Amazonia colombiana / Chagas disease and its seroprevalence in three departments of the Colombian Amazon

Objetivo. Determinar la seroprevalencia de la enfermedad de Chagas en población general procedente de tres departamentos de la Amazonía colombiana: Vaupés, Amazonas y Guaviare y analizar variables de riesgo para la enfermedad. Métodos. Para determinar la seropositividad se analizaron 3429 muestras de suero obtenidas mediante previo consentimiento informado durante los años 2009 y 2010 a través de un muestreo probabilístico, de conglomerados, estratificado y trietápico para cada departamento, con probabilidades finales desiguales. Fueron analizadas en el Laboratorio de Parasitología del Instituto Nacional de Salud de Bogotá mediante dos técnicas de diagnóstico, Inmunoensayo enzimático (Elisa) e Inmunofluorescencia indirecta (IFI) empleando como antígeno una cepa de Trypanosoma cruzi colombiana previamente caracterizada como linaje TcI. Resultados. Se encontró una seroprevalencia general de 0,99%, 2,07% para el departamento del Guaviare, 0,79% para el departamento de Vaupés y 0,09% para el departamento de Amazonas. Estos resultados permitirán establecer una línea de base epidemiológica que contribuya a las estrategias de control de la enfermedad en esta zona.

Objective. To estimate the prevalence of Chagas disease in population from Vaupés, Amazonas and Guaviare, three departments of the Colombian amazon. Risk factors were also assessed. Methods. For estimating seroprevalence, 3429 serum samples were taken according to a three-stage conglomerate sampling for each department. Those samples were analyzed in the Parasitology Laboratory of the National Health Institute (INS), through ELISA and IFAT techniques. Results. The prevalence for Amazonas, Guaviare and Vaupés departments was 0,09%, 2,07% and 0,79%, respectively. Those results will allow health policy makers towards prevention of Chagas disease.

Risk factors associated with Chagas disease in pregnant women in Santander, a highly endemic Colombian area.

OBJECTIVE: To determine the prevalence and risk factors associated with Chagas disease in pregnant women in an endemic area of Santander, Colombia. METHODS: Cross-sectional study included 23 municipalities of Santander, Colombia. Serological IFAT and ELISA tests were undertaken to detect IgG anti- Trypanosoma cruzi. A questionnaire was conducted for assessing the risk factors of each participant. Newborns were evaluated at birth and followed up to 1 year of age to determine congenital infection. RESULTS: An overall prevalence of 3.2% (95% CI 2.4-4.2) among 1518 pregnant women was detected. Prevalences by provinces were as follows: Guanentina: 6.0% (95% CI 4.1-8.5), García Rovira: 2.9% (95% CI: 1.5-4.8) and Comunera: 0.4% (0.4-2.3). The main risk factors identified were age >32 years old (OR: 2.1; 95% CI: 1.1-3.9); currently having a thatched roof (OR: 11.8; CI95% 2.2-63.2) and a thatched roof during childhood (OR: 3.0; 95% CI: 1.4-6.6); having below primary school education level (OR: 4.6; 95% CI: 2.2-9.5); and a history of a close contact with the vector (triatomine bugs) at least once during their lifetime (OR: 6.9; 95% CI: 3.7-12.9). No congenital cases were detected by parasitological or serological techniques. CONCLUSIONS: Prevalence of Chagas disease in pregnant women is a potential source of infection in this Colombian endemic area. The main risk factors associated with seropositivity were related to conditions favouring the contact with the vector. The results show that it is necessary to continue an active surveillance in order to offer diagnosis and treatment to mothers and their newborns in addition to screening to pregnant women from endemic areas.

Cisticercosis en Colombia. Estudio de seroprevalencia 2008 – 2010 / Cysticercosis in Colombia. Seroprevalence study 2008 – 2010

IntroduccIón: el complejo Taeniasis / Cisticercosis (T/C) es una infección parasitaria que en Colombia como en otros países constituye un gran problema de Salud Pública. La prevalencia de cisticercosis en la población general Colombiana no ha sido determinada a la fecha. objetIvo: determinar la prevalencia de cisticercosis en la población general de Colombia e identificar los principales riesgos ambientales, socioeconómicos, culturales y estilos de vida relacionados con la cisticercosis. MaterIales y Métodos: mediante técnica ELISA investigamos la prevalencia de sero positividad de anticuerpos IgG anti cistiercos en población general de 23 departamentos Colombianos incluyendo la ciudad capital. Se analizaron 23.960 muestras sanguíneas. El proceso se realizó en la sección de parasitología del Instituto Nacional de Salud, Bogotá Colombia. resultados: la seroprevalencia general fue de 8.55%, la más alta se presentó en el departamento de Vaupés (40,19%) y la menor en el departamento de Caldas (0,53%). El análisis multivariado de factores de riesgo mostró riesgo incrementado de seropostividad para Mujeres (OR=1,60 IC 1,40 – 1,90) p <0,05, y para personas quienes consumían alimentos sin cocción (OR = 44,80 IC 5,00 – 401,40) p <0,05. No lavarse las manos después de ir al baño y haber utilizado el sanitario (OR = 1,37 IC 0,70 – 2,70) no mostró significancia estadística. conclusIones: Colombia tiene un rango variable de prevalencia de seropositividad de cisticercosis en población general (0.53% to 40.19%). Los principales factores de riesgo fueron el género femenino y el no lavado de manos después de ir al baño.

Cisticercosis en Boyacá, Colombia: estudio de seroprevalencia / Cisticercosis in Boyacá, Colombia: seroprevalence study

Introducción. La cisticercosis humana es una infección producida por la forma larval de la Taenia solium, quepresenta múltiples manifestaciones clínicas de acuerdo a los órganos y tejidos que afecte, la neurocisticercosis(NC) es la forma más grave. En Colombia se desconoce la prevalencia de la cisticercosis en la población general.Objetivo. Estimar la prevalencia de la cisticercosis en el departamento de Boyacá en población general, a travésde pruebas serológicas.Materiales y Métodos. La metodología utilizada, teniendo en cuenta que se trata de una encuesta departamentalcon proyección nacional, se basó en tres fases, una primera correspondiente a su diseño estadístico y planteamiento metodológico, una segunda etapa dada por la ejecución en campo para obtener información a través de instrumentosde recolección de datos, toma de muestras de sangre y procesamiento de las mismas en el Laboratorio de Parasitología del Instituto Nacional de Salud mediante la técnica de Elisa y una última fase de consolidación, análisisy divulgación de los resultados. El diseño muestral fue probabilístico, trietápico, de conglomerados y estratificado. Resultados. La prevalencia general de anticuerpos anti-cisticerco en el departamento de Boyacá fue de 4,02%.Entre hábitos de aseo no realizar el lavado de manos después de ir al sanitario configura un riesgo muy importante(RP=4,63 I.C 95% 4,50 – 4,76 p <0,05) junto con otros hábitos como la eliminación de excretas al aire libre o enletrina sin pozo (RP=1,27 I.C 1,24 – 1,31) p <0,05.Conclusiones. Se logró conocer la seroprevalencia de la cisticercosis determinada en población general deldepartamento de Boyacá y algunos factores epidemiológicos determinantes de esta patología, todo ello puedeestablecerse como una línea base para dar inicio al proceso de la vigilancia epidemiológica, control y prevenciónde esta patología.

Introduction. Human cysticercosis is an infection caused by the larval form of Taenia solium, which has many clinicalmanifestations according to the organs and tissues affected, being the neurocysticercosis (NC) the most severe form. In Colombia, the prevalence of cysticercosis is unknown in the general population and habits exist in our population. Objective. To estimate the prevalence of the cysticercosis in Boyaca Department in general population through serologicaltests. Materials and Methods. The methodology used, taking into account that this is a survey at the departmental level with national projection was based on three phases, an initial design for statistical and methodological approach, a second stage performance given by its field to obtain information through data collection instruments, blood sampling and processing them in the Laboratory of Parasitology, National Institute of Health by ELISA and a final phase of consolidation, analysis and dissemination of results. The sample design was probabilistic, three-stage, stratified cluster. Results. The overall prevalence of anti-cysticercus antibodies in the department of Boyacá was 4.02%. Hygiene habitswere a group of factors which are found not to hand washing after using the bathroom set up a very significant risk (RP = 4.63 CI 4.50 to 4.76) p <0.05 with other habits, such as excreta or in outdoor pit latrine without (RP = 1.27 CI 1.24 to 1.31) p <0.05. Conclusions. Understanding was reached on the status of cysticercosis seroprevalence determined by the general populationof the department of Boyacá and some determinants of this disease, constituting a baseline you can start the process of epidemiological surveillance, control and prevention of this disease in this department.