Economic Costs of Chikungunya Virus in Colombia.

OBJECTIVE: The aim of the present study was to estimate the economic impact of chikungunya virus (CHIKV) infection in Colombia from a societal perspective. METHODS: We conducted a retrospective, bottom-up cost-of-illness study in clinically confirmed cases during the first chikungunya (CHIK) outbreak in Colombia in 2014. Direct and indirect costs were estimated per patient. Economic costs were calculated by the addition of direct costs (direct medical costs and out-of-pocket heath expenditures) and indirect cost as a result of loss of productivity. RESULTS: A total of 126 patients (67 children and 59 adults) with CHIK were included. The median of the direct medical cost in children was US$257.9 (interquartile range [IQR] 121.7-563.8), and US$66.6 (IQR 26.5-317.3) for adults. The productivity loss median expenditures reached US$81.3 (IQR 72.2-203.2) per adult patient. The median economic cost in adults as a result of CHIK was US$152.9 (IQR 101.0-539.6), of which 53.2% was a result of indirect costs. Out-of-pocket expenditures comprised 3.3% of all economic costs. CONCLUSIONS: Our study can help health decision makers to properly assess the burden of disease caused by CHIK in Colombia, an endemic tropical country. We recommend to strength the health information systems and to continue investing in public health measures to prevent CHIK.

Features of Dengue and Chikungunya Infections of Colombian Children under 24 Months of Age Admitted to the Emergency Department.

We aimed to assess clinical and laboratory differences between dengue and chikungunya in children <24 months of age in a comparative study. We collected retrospective clinical and laboratory data confirmed by NS1/IgM for dengue for 19 months (1 January 2013 to 17 August 2014). Prospective data for chikungunya confirmed by real-time polymerase chain reaction were collected for 4 months (22 September 2014-14 December 2014). Sensitivity and specificity [with 95% confidence interval (CI)] were reported for each disease diagnosis. A platelet count <150 000 cells/ml at emergency admission best characterized dengue, with a sensitivity of 67% (95% CI, 53-79) and specificity of 95% (95% CI, 82-99). The algorithm developed with classification and regression tree analysis showed a sensitivity of 93% (95% CI, 68-100) and specificity of 38% (95% CI, 9-76) to diagnose dengue. Our study provides potential differential characteristics between chikungunya and dengue in young children, especially low platelet counts.

Risk Factors for Severity of Chikungunya in Children: A Prospective Assessment.

Chikungunya appeared during the second half of 2014 in Colombia. A prospective cohort study was carried to detect differences and severity between neonates and older children. Of 54 children with chikungunya, neonates had a higher viral load and greater frequency of severe laboratory and clinical findings.

High frequency of Panton-Valentine leukocidin in Staphylococcus aureus causing pediatric infections in the city of Cartagena-Colombia.

Panton-Valentine leucocidin (PVL) is a pore-forming toxin that has been epidemiologically associated with CA-MRSA infections. However, its role in the pathogenicity of Staphylococcus aureus is still unclear. We evaluated the prevalence of PVL-coding genes in methicillin-resistant (MRSA) and methicillin-sensitive (MSSA) isolates that cause infections in pediatric patients in the city of Cartagena, Colombia. We obtained S. aureus isolates from patients at the Napoleon Franco Pareja Children's Hospital in Cartagena. Then, we evaluated the presence of the nuc, mecA, and PVL genes in these isolates by multiplex PCR and determined the antibiotic susceptibility profiles using CLSI standards. We further correlated methicillin susceptibility and the presence of PVL genes with clinical variables. Overall PVL prevalence in S. aureus isolates was 73.91%, with a frequency of 80.92% among MRSA isolates and 67.59% among MSSA. We found a correlation between erythromycin resistance and lack of PVL and found that PVL+ cases were more common in older patients. We found a high PVL prevalence in both MRSA and MSSA isolates, in concordance with previous regional reports.

Estrés oxidative-nitrosativo y dengue: revisión sistemática de estudios in vivo e in vitro / Oxidative-nitrosative stress and dengue disease: a systematic review of in vivo/in vitro studies

Objective: In this systematic review the aim was to summarise the in vivo/in vitro evidence on the role of oxidative-nitrosative stress in pathogenesis of dengue. Methods: We searched electronic databases (PubMed, EMBASE, The COCHRANE library, ScienceDirect, Scopus, SciELO, LILACS via Virtual Health Library, Google Scholar) using the term: dengue, dengue virus, severe dengue, oxidative stress, nitrosative stress, antioxidants, oxidants, free radicals, oxidized lipid products, lipid peroxides, nitric oxide, and nitric oxide synthase. Articles were selected for review by title and abstract excluding letter, review, epidemiological studies, and duplicates studies. Selected articles were reviewed for used animal model or cell cultures, original purposes, strain of virus or type of antibody, main outcomes, methods, and oxidative-nitrosative stress markers values. Results: In total, 4330 non-duplicates articles were identified from computerized searches of reference databases, of which 32 were eligible for full text searching. The results of in vivo studies were obtained from monkey and knockout and/or wild-type mice. Human peripheral blood mononuclear cells were cell cultures most commonly used in identified in vitro studies, following by human endothelial cells cultures. DENV-2 strains were most used. Conclusions: In conclusion, a large body of in vivo and in vitro evidences showed that oxidative/nitrosative stress can be related to production of pathogenesis-related protein, increased susceptibility of mice to DENV infection, hemorrhage development in mice, proinflammatory cytokines and transcriptional factor expression, and DENV replication in various cell cultures(AU)

Objetivo: sistematizar las evidencias in vivo/in vitro de la participación del estrés oxidativo-nitrosativo en el curso de la infección por virus del dengue. Métodos: revisión sistemática de estudios observacionales en las bases de datos (PubMed, EMBASE, The COCHRANE library, ScienceDirect, Scopus, SciELO, LILACS via Virtual Health Library, Google Scholar) utilizando las siguientes palabras clave: dengue, dengue virus, severe dengue, oxidative stress, nitrosative stress, antioxidants, oxidants, free radicals, oxidized lipid products, lipid peroxides, nitric oxide y nitric oxide synthase. La selección inicial fue realizada a partir del título y resumen excluyéndose: cartas para editor, revisiones, estudios con diseños epidemiológicos y estudios duplicados. A cada artículo seleccionado, se le revisó el objetivo o propósito, cultivos celulares o modelos animales utilizados, cepas víricas o tipo de anticuerpos utilizados, métodos y valores de los marcadores de estrés oxidativo-nitrosativo. Resultados: de 4330 publicaciones encontradas, 32 estudios cumplieron con los criterios de inclusión. Se utilizaron primates no humanos y ratones knockout o tipo salvaje para la obtención de las evidencias in vivo. Los cultivos celulares más utilizados fueron de células mononucleares de sangre periférica y de células endoteliales humanas. Las cepas más utilizadas en los ensayos correspondieron al serotipo 2 del virus dengue. Conclusiones: existen evidencias in vivo/in vitro que muestran la posible asociación entre el estrés oxidativo-nitrosativo con: producción de proteínas relacionadas con la patogénesis del dengue, incremento en la susceptibilidad de ratones por la infección por dengue, desarrollo de hemorragias en modelo de ratón, expresión de citoquinas proinflamatorias y replicación viral en varios cultivos de células tanto humanas como de origen animal(AU)

Mortalidad en un hospital pediátrico de referencia regional de Colombia: Hospital Infantil Napoleón Franco Pareja de Cartagena (Colombia) 2000 - 2010 / Infant mortality in a university pediatric hospital in Colombia, 2000 - 2010

Objetivo: Estimar la mortalidad intrahospitalaria como insumo para la planificación de la atención sanitaria en pediatría. Método: Se realizó un estudio descriptivo de la mortalidad intrahospitalaria del Hospital Infantil Napoleón Franco Pareja a partir del análisis de los registros de mortalidad de 969 niños fallecidos entre 2000 y 2010. Los casos fueron resumidos a partir de sus variables sociodemográficas y epidemiológicas. Resultados: La tasa de mortalidad hospitalaria media del periodo fue 8.5 muertes por mil egresos (Min= 2,6 y Max = 17,3). De los 969fallecimientos, 54,5 % fueron hombres. Dos de cada tres muertes fue en menores de un año y menos del 1 % en mayores de 15 años. Entre 2000 y 2004 la principal causa de muerte en ambos géneros fue la enfermedad diarreica (25 %), seguida por la neumonía (17,2 %) y la sepsis (12,3 %), y el 71.3 % de las causas estuvo asociado a infecciones. Entre 2005 y 2010 ocurrió el 26,2 % de las muertes totales, y sus principales causas se asocian a enfermedades crónicas. La tasa de mortalidad intrahospitalaria se redujo 6,7 veces, y en términos absolutos en 2010 se produjeron 10 veces menos muertes que en el 2000. Conclusiones: El Hospital Infantil Napoleón Franco Pareja ha impactado esencialmente la mortalidad infantil de Cartagena (pasó de aportar el 23 % en el 2000 al 7 % en 2010).

Objetive: To estimate in-hospital mortality in order to provide information for planning health care in pediatrics. Method: The mortality records of969 children whose death at Children's Hospital between years 2000 to 2010 in Cartagena Colombia, were analyzed. Results: The mean in-hospital mortality rate was 8.5 deaths for the period per thousand discharges (Min-Max = 2.6 -17.3). Of the 969 deaths 54.5 % was in men. Two out of three deaths were in children under one year and less than 1 % of deaths occurred in people over 15 years. Between 2000 and 2004 the leading cause of death in both genders was diarrheal disease (25 %) followed by pneumonia (17.2 %) and sepsis (12.3 %) and 71.3 % of the causes were associated infections. The 26.2 % of all deaths occurred between 2005 and 2010 and their causes are associated with chronic diseases. The hospital mortality rate was reduced 6.7 times and in 2010 there were 10 times fewer deaths than 2000. Conclusions: The Children's Hospital Napoleon Franco Pareja has impacted essentially Cartagena infant mortality (from 23 % to 7 % in the period).

Caracterización clínica del dengue en un hospital infantil de Cartagena (Colombia) / Clinical characterization of dengue in a children's hospital of Cartagena (Colombia)

Objetivo: Caracterizar las manifestaciones clínicas del dengue en pacientes pediátricos en una institución de salud de tercer nivel de Cartagena (Colombia). Materiales y métodos: Estudio descriptivo por revisión de historias clínicas de pacientes hospitalizados por dengue en el Hospital Infantil Napoleón Franco Pareja de la ciudad de Cartagena. Se evaluaron 136 niños con cuadros febriles agudos de etiología inaparente. Se utilizaron pruebas serológicas para confirmar la infección por el virus del dengue. Resultados: Se analizaron 98 casos de niños hospitalizados con diagnóstico de dengue. La edad osciló entre menores de 6 meses a 16 años, siendo el rango de edades con mayor frecuencia de la enfermedad de 10 a 16 años (33,7 %). Los signos y síntomas más frecuentes fueron: exantema (49,0 %), mialgia (35,7 %), cefalea (33,7 %), artralgia (33,7 %), anorexia (24,5 %), torniquete (19,4%), prurito (11,2 %), escalofrío (8,2 %), eritema facial (7,1 %) y dolor retroocular (6,1 %). Conclusiones: La edad continúa siendo el factor predominante en la gravedad intrahos-pitalaria del dengue. Por lo tanto, se necesitan con urgencia medidas preventivas en la población pediátrica.

Objective: To characterize the clinical manifestations of dengue in pediatric patients in a health institution tertiary Cartagena (Colombia). Materials and methods: Descriptive study by review of medical records of patients hospitalized for dengue at Children's Hospital Napoleon Franco Pareja of Cartagena. We evaluated 136 children with acute fever unapparent etiology. Serology to confirm infection by dengue virus tests was used. Results: 98 cases of children hospitalized with dengue diagnosis were analyzed. Age ranged from under 6 months to 16 years, with the age range with the highest frequency of the disease 10 to 16 years (33.7 %). The most common signs and symptoms were rash (49.0 %), myalgia (35.7 %), headache (33.7 %), arthralgia (33.7 %), anorexia (24.5 %), tourniquet (19.4 %), pruritus (11.2 %), chills (8.2 %), facial erythema (7.1 %) and ocular retro pain (6.1 %). Conclusions: Age remains the predominant factor in the severity of dengue. Therefore urgently needed preventive measures in the pediatric population.

Estimating costs associated with a community outbreak of meningococcal disease in a colombian Caribbean city.

Meningococcal disease is a serious and potentially life-threatening infection that is caused by the bacterium Neisseria meningitidis (N. meningitidis), and it can cause meningitis, meningococcaemia outbreaks and epidemics. The disease is fatal in 9-12% of cases and with a death rate of up to 40% among patients with meningococcaemia. The objective of this study was to estimate the costs of a meningococcal outbreak that occurred in a Caribbean city of Colombia. We contacted experts involved in the outbreak and asked them specific questions about the diagnosis and treatment for meningococcal cases during the outbreak. Estimates of costs of the outbreak were also based on extensive review of medical records available during the outbreak. The costs associated with the outbreak were divided into the cost of the disease response phase and the cost of the disease surveillance phase. The costs associated with the outbreak control and surveillance were expressed in US$ (2011) as cost per 1,000 inhabitants. The average age of patients was 4.6 years (SD 3.5); 50% of the cases died; 50% of the cases were reported to have meningitis (3/6); 33% were diagnosed with meningococcaemia and myocarditis (2/6); 50% of the cases had bacteraemia (3/6); 66% of the cases had a culture specimen positive for Neisseria meningitidis; 5 of the 6 cases had RT-PCR positive for N. meningitidis. All N. meningitidis were serogroup B; 50 doses of ceftriaxone were administered as prophylaxis. Vaccine was not available at the time. The costs associated with control of the outbreak were estimated at US$ 0.8 per 1,000 inhabitants, disease surveillance at US$ 4.1 per 1,000 inhabitants, and healthcare costs at US$ 5.1 per 1,000 inhabitants. The costs associated with meningococcal outbreaks are substantial, and the outbreaks should be prevented. The mass chemoprophylaxis implemented helped control the outbreak.