HIV infection and high-risk behaviours in a Paraguayan military population.

Between July 2005 and January 2006 we evaluated 1248 Paraguayan active duty military volunteers. Participants provided a blood sample for HIV testing and answered an anonymous survey. HIV seroprevalence was 0.4% (5 of 1248) among participants. The median age at first sexual intercourse was 16 years. Only 14.8% of participants reported condom use with every sexual encounter. Military students used condoms the most. Participants older than 45 years, compared with younger participants, had a fourfold (adjusted odds ratio 4.3) increased risk of not using condoms. Men were less likely to use a condom, more likely to practice anal intercourse, and had more sexual partners than women. Officers and non-commissioned officers were identified to have a twofold (as measured by adjusted odds ratio = 2.00 and 2.22, respectively) increased risk of having more than two sexual partners in the last month compared with students. Both officers and non-commissioned officers were twice as likely as students to practice anal intercourse. Despite the high-risk behaviours reported by those surveyed, HIV seroprevalence in active duty personnel was low. Future efforts should emphasize on the correct condom use keeping focus on the high-risk behaviours of groups at risk, and on routinely testing the military personnel for HIV.

Human parainfluenza virus in patients with influenza-like illness from Central and South America during 2006-2010.

BACKGROUND: Human parainfluenza viruses (HPIVs) are common viral causes of community-acquired pneumonia, particularly in children. The four types of HPIV have world-wide distribution; however, limited information exists about the epidemiological profile of HPIV in Latin-America. OBJECTIVE: Provide epidemiologic and phylogenetic information about HPIVs that circulated in Latin America between 2006 and 2010 to better characterize the extent and variability of this respiratory virus in the region. METHODS: Oropharyngeal swabs, demographic data and clinical characteristics were obtained from individuals with influenza-like illness in 10 Latin-American countries between 2006-2010. Specimens were analyzed with culture and molecular methods. RESULTS: A total of 30 561 individuals were enrolled; 991 (3·2%) were HPIV positive. Most infected participants were male (53·7%) and under 5 years of age (68·7%). The HPIV type most frequently isolated was HPIV-3 (403, 40·7%). In 66/2007 (3·3%) hospitalized individuals, HPIV was identified. The most frequent symptoms at enrollment were cough and rhinorrhea. We identified certain patterns for HPIV-1, -2 and -3 in specific cities. Phylogenetic analysis revealed a homogeneous distribution in the region. CONCLUSIONS: In the current scenario, no vaccine or treatment is available for this pathogen. Our results contribute to the scarce epidemiologic and phylogenetic information of HPIV in the region that could support the development of specific management.

Human rhinoviruses and enteroviruses in influenza-like illness in Latin America.

BACKGROUND: Human rhinoviruses (HRVs) belong to the Picornaviridae family with high similarity to human enteroviruses (HEVs). Limited data is available from Latin America regarding the clinical presentation and strains of these viruses in respiratory disease. METHODS: We collected nasopharyngeal swabs at clinics located in eight Latin American countries from 3,375 subjects aged 25 years or younger who presented with influenza-like illness. RESULTS: Our subjects had a median age of 3 years and a 1.2:1.0 male:female ratio. HRV was identified in 16% and HEV was identified in 3%. HRVs accounted for a higher frequency of isolates in those of younger age, in particular children < 1 years old. HRV-C accounted for 38% of all HRVs detected. Phylogenetic analysis revealed a high proportion of recombinant strains between HRV-A/HRV-C and between HEV-A/HEV-B. In addition, both EV-D68 and EV-A71 were identified. CONCLUSIONS: In Latin America as in other regions, HRVs and HEVs account for a substantial proportion of respiratory viruses identified in young people with ILI, a finding that provides additional support for the development of pharmaceuticals and vaccines targeting these pathogens.

Correlation of serotype-specific dengue virus infection with clinical manifestations.

BACKGROUND: Disease caused by the dengue virus (DENV) is a significant cause of morbidity throughout the world. Although prior research has focused on the association of specific DENV serotypes (DENV-1, DENV-2, DENV-3, and DENV-4) with the development of severe outcomes such as dengue hemorrhagic fever and dengue shock syndrome, relatively little work has correlated other clinical manifestations with a particular DENV serotype. The goal of this study was to estimate and compare the prevalence of non-hemorrhagic clinical manifestations of DENV infection by serotype. METHODOLOGY AND PRINCIPAL FINDINGS: Between the years 2005-2010, individuals with febrile disease from Peru, Bolivia, Ecuador, and Paraguay were enrolled in an outpatient passive surveillance study. Detailed information regarding clinical signs and symptoms, as well as demographic information, was collected. DENV infection was confirmed in patient sera with polyclonal antibodies in a culture-based immunofluorescence assay, and the infecting serotype was determined by serotype-specific monoclonal antibodies. Differences in the prevalence of individual and organ-system manifestations were compared across DENV serotypes. One thousand seven hundred and sixteen individuals were identified as being infected with DENV-1 (39.8%), DENV-2 (4.3%), DENV-3 (41.5%), or DENV-4 (14.4%). When all four DENV serotypes were compared with each other, individuals infected with DENV-3 had a higher prevalence of musculoskeletal and gastrointestinal manifestations, and individuals infected with DENV-4 had a higher prevalence of respiratory and cutaneous manifestations. CONCLUSIONS/SIGNIFICANCE: Specific clinical manifestations, as well as groups of clinical manifestations, are often overrepresented by an individual DENV serotype.

Enteric disease surveillance under the AFHSC-GEIS: current efforts, landscape analysis and vision forward.

The mission of the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) is to support global public health and to counter infectious disease threats to the United States Armed Forces, including newly identified agents or those increasing in incidence. Enteric diseases are a growing threat to U.S. forces, which must be ready to deploy to austere environments where the risk of exposure to enteropathogens may be significant and where routine prevention efforts may be impractical. In this report, the authors review the recent activities of AFHSC-GEIS partner laboratories in regards to enteric disease surveillance, prevention and response. Each partner identified recent accomplishments, including support for regional networks. AFHSC/GEIS partners also completed a Strengths, Weaknesses, Opportunities and Threats (SWOT) survey as part of a landscape analysis of global enteric surveillance efforts. The current strengths of this network include excellent laboratory infrastructure, equipment and personnel that provide the opportunity for high-quality epidemiological studies and test platforms for point-of-care diagnostics. Weaknesses include inconsistent guidance and a splintered reporting system that hampers the comparison of data across regions or longitudinally. The newly chartered Enterics Surveillance Steering Committee (ESSC) is intended to provide clear mission guidance, a structured project review process, and central data management and analysis in support of rationally directed enteric disease surveillance efforts.

Genetic analysis of influenza A/H1N1 of swine origin virus (SOIV) circulating in Central and South America.

Since the first detection of swine origin virus (SOIV) on March 28, 2009, the virus has spread worldwide and oseltamivir-resistant strains have already been identified in the past months. Here, we show the phylogenetic analysis of 63 SOIV isolates from eight countries in Central and South America, and their sensitivity to oseltamivir.

Arboviral etiologies of acute febrile illnesses in Western South America, 2000-2007.

BACKGROUND: Arthropod-borne viruses (arboviruses) are among the most common agents of human febrile illness worldwide and the most important emerging pathogens, causing multiple notable epidemics of human disease over recent decades. Despite the public health relevance, little is know about the geographic distribution, relative impact, and risk factors for arbovirus infection in many regions of the world. Our objectives were to describe the arboviruses associated with acute undifferentiated febrile illness in participating clinics in four countries in South America and to provide detailed epidemiological analysis of arbovirus infection in Iquitos, Peru, where more extensive monitoring was conducted. METHODOLOGY/FINDINGS: A clinic-based syndromic surveillance system was implemented in 13 locations in Ecuador, Peru, Bolivia, and Paraguay. Serum samples and demographic information were collected from febrile participants reporting to local health clinics or hospitals. Acute-phase sera were tested for viral infection by immunofluorescence assay or RT-PCR, while acute- and convalescent-phase sera were tested for pathogen-specific IgM by ELISA. Between May 2000 and December 2007, 20,880 participants were included in the study, with evidence for recent arbovirus infection detected for 6,793 (32.5%). Dengue viruses (Flavivirus) were the most common arbovirus infections, totaling 26.0% of febrile episodes, with DENV-3 as the most common serotype. Alphavirus (Venezuelan equine encephalitis virus [VEEV] and Mayaro virus [MAYV]) and Orthobunyavirus (Oropouche virus [OROV], Group C viruses, and Guaroa virus) infections were both observed in approximately 3% of febrile episodes. In Iquitos, risk factors for VEEV and MAYV infection included being male and reporting to a rural (vs urban) clinic. In contrast, OROV infection was similar between sexes and type of clinic. CONCLUSIONS/SIGNIFICANCE: Our data provide a better understanding of the geographic range of arboviruses in South America and highlight the diversity of pathogens in circulation. These arboviruses are currently significant causes of human illness in endemic regions but also have potential for further expansion. Our data provide a basis for analyzing changes in their ecology and epidemiology.

Molecular characterization of adenovirus circulating in Central and South America during the 2006-2008 period.

BACKGROUND: Human Adenoviruses are recognized pathogens, causing a broad spectrum of diseases. Serotype identification is critical for epidemiological surveillance, detection of new strains and understanding of HAdvs pathogenesis. Little data is available about HAdvs subtypes in Latin America. METHODS: In this study, we have molecularly characterized 213 adenoviruses collected from ILI presenting patients, during 2006-08, in Central and South America. RESULTS: Our results indicate that 161(76%) adenoviruses belong to subgroup C, 45 (21%) to subgroup B and 7 (3%) to subtype E4.

Impacto del Tratamiento Antirretroviral de Gran Actividad (TARGA) en la Supresión Viral en Niños Infectados por el Virus de Inmunodeficiencia Humana en Paraguay

Background: Clinical trials have shown that HAART is able to reduce HIV plasma viral loads to undetectable in 70%-90% of patients (pts). HAART in developing countries is reported to be much less effective. Objectives: To evaluate the virologic response to HAART in children with HIV infection and to determine the factors associated to sustained decrease in the viral load. Material and methods: Retrospective, observational study that included pts1.5 log reduction in viral load after week 12 of HAART initiation, which was maintained during the follow-up period. Results: 169 pts with HIV infection form the cohort of the institution, with a mean age of 7.5±3.8 years. 76 patients met the inclusion criteria. During the follow-up (85% of the pts with HAART =12 months), 48 pts (63%) achieved viral suppression whereas 28 (37%) do not. The viral load before the HAART were similar in both groups (50% and 43% of the pts with HIV-RNA >100.000 copies/ml) as well as in the CD4 count (35% vs. 43%). More pts in the non-responder group were female (60% vs.38%, p< 0.05). They were no differences between the age at HAART start, the current mean age, nutritional condition, percentage of orphans, and assistance to Day Care Center (DCC), between both groups. 42% in the responder-group were receiving protease-inhibitor vs. 8% of the non-responders (p< 0.05). Conclusions: The 37% of patients without HIV-1 suppression highlight need to be include a proteaseinhibitor based regimen as the first line treatment in developing countries

Resumen Los ensayos clínicos han demostrado que la TARGA es capaz de reducir la carga viral de VIH en plasma a niveles indetectables en el 70%-90% de los pacientes (pts). Sin embargo, se ha observado que la TARGA en los países en desarrollo podría ser menos efectiva. Objetivos: Evaluar la respuesta virológica a TARGA en niños con infección por VIH y determinar los factores asociados al descenso sostenido en los niveles de supresión viral. Materiales y métodos: Estudio retrospectivo y observacional que incluyó pts 100.000 copias/ml), así como el recuento de CD4 <25% (48% vs 43% de los pts). En el grupo no respondedor la mayoría eran mujeres (60% vs38%, p <0,05). No hubo diferencias entre la edad de inicio de TARGA, la edad media actual, el estado nutricional, el porcentaje de huérfanos, así como la asistencia a guarderías entre ambos grupos. El 42% en el grupo respondedor estaban recibiendo un inhibidor de la proteasa frente al 8% de los pacientes no respondedores (p<0,05). Conclusión:El 37% de los pacientes de la presente cohorte de niños con VIH-1 no alcanzaron supresión viral, la cual se ha correlacionado con la ausencia dentro del esquema de un inhibidor de proteasa. El presente estudio sugiere imperiosa la necesidad de incluir un inhibidor de la proteasa en el tratamiento de primera línea de niños con VIH en países en desarrollo.

Epidemiological and molecular characteristics of HIV-1 infection among female commercial sex workers, men who have sex with men and people living with AIDS in Paraguay.

An HIV seroprevalence and molecular study was conducted among 935 subjects: 723 female commercial sex workers, 92 men who have sex with men and 120 HIV-positive volunteers. The reported injection drug use rates were 0.7% in female commercial sex workers and 3% in men who have sex with men. Sexually transmitted infections were reported in 265 (37%) of the female commercial sex workers and 38 (41%) of the men who have sex with men. A total of 20 (2.8%) female commercial sex workers and 12 (13%) men who have sex with men became HIV infected during the study period. A history of sexually transmitted infection increased the risk of subsequent HIV infection twofold (adjusted odds ratio of 2.5) among the female commercial sex workers, while cocaine use had an adjusted odds ratios of 6.61 among men who have sex with men. From 130 samples, and based on heteroduplex mobility assaying for the env gene, with sequencing of part of pol and/or full genomes, subtype B was the predominant subtype identified (66%); followed by subtype F (22%) and subtype C (4%). Recombinant CRF12-BF strains were identified in 6% and CRF17_BF was identified in 2%.

Epidemiological and molecular characteristics of HIV-1 infection among female commercial sex workers, men who have sex with men and people living with AIDS in Paraguay / Características epidemiológicas e moleculares da infecção por HIV-1 entre as mulheres que trabalham no comércio do sexo, entre homens que mantém relações sexuais com homens e nas pessoas convivendo com AIDS no Paraguai

An HIV seroprevalence and molecular study was conducted among 935 subjects: 723 female commercial sex workers, 92 men who have sex with men and 120 HIV-positive volunteers. The reported injection drug use rates were 0.7 percent in female commercial sex workers and 3 percent in men who have sex with men. Sexually transmitted infections were reported in 265 (37 percent) of the female commercial sex workers and 38 (41 percent) of the men who have sex with men. A total of 20 (2.8 percent) female commercial sex workers and 12 (13 percent) men who have sex with men became HIV infected during the study period. A history of sexually transmitted infection increased the risk of subsequent HIV infection twofold (adjusted odds ratio of 2.5) among the female commercial sex workers, while cocaine use had an adjusted odds ratios of 6.61 among men who have sex with men. From 130 samples, and based on heteroduplex mobility assaying for the env gene, with sequencing of part of pol and/or full genomes, subtype B was the predominant subtype identified (66 percent); followed by subtype F (22 percent) and subtype C (4 percent). Recombinant CRF12-BF strains were identified in 6 percent and CRF17_BF was identified in 2 percent.

Um estudo de soroprevalência e de avaliação molecular do HIV foi realizado com 935 indivíduos: 723 mulheres que trabalhavam no comércio do sexo, 92 homens que mantinham relações sexuais com outros homens e com 120 voluntários HIV-positivos. O relato de uso de drogas injetáveis foi de 0,7 por cento nas mulheres que trabalhavam no comércio do sexo e de 3 por cento nos homens que mantinham relações sexuais com outros homens. Infecções sexualmente transmitidas foram relatadas por 265 (37 por cento) das mulheres que trabalhavam no comércio do sexo e em 38 (41 por cento) dos homens que mantinham relações sexuais com homens. Um total de 20 (2,8 por cento) mulheres que trabalhavam no comércio do sexo e 12 (13 por cento) homens que mantinham relações sexuais com homens se infectou com HIV durante o período do estudo. História prévia de infecção sexualmente transmitida aumentou em duas vezes o risco de infecção subseqüente por HIV (odds ratio ajustado de 2,5) entre as mulheres que trabalhavam no comércio do sexo, enquanto cocaína apresentou odds ratio ajustado de 6,61 entre os homens que mantinham relações sexuais com outros homens. De 130 amostras, com base no ensaio da mobilidade heteroduplex para o gene env, com sequenciamento de parte do pol e/ou genomas completos, o subtipo B foi o subtipo mais identificado (66 por cento); seguido pelo subtipo F (22 por cento) e subtipo C (4 por cento). Cepas recombinantes CRF12-BF foram identificadas em 6 por cento e CRF17_BF foi identificada em 2 por cento.

Prevalences, genotypes, and risk factors for HIV transmission in South America.

HIV cross-sectional studies were conducted among high-risk populations in 9 countries of South America. Enzyme-linked immunosorbent assay screening and Western blot confirmatory testing were performed, and env heteroduplex mobility assay genotyping and DNA sequencing were performed on a subset of HIV-positive subjects. HIV prevalences were highest among men who have sex with men (MSM; 2.0%-27.8%) and were found to be associated with multiple partners, noninjection drug use (non-IDU), and sexually transmitted infections (STIs). By comparison, much lower prevalences were noted among female commercial sex workers (FCSWs; 0%-6.3%) and were associated mainly with a prior IDU and STI history. Env subtype B predominated among MSM throughout the region (more than 90% of strains), whereas env subtype F predominated among FCSWs in Argentina and male commercial sex workers in Uruguay (more than 50% of strains). A renewed effort in controlling STIs, especially among MSM groups, could significantly lessen the impact of the HIV epidemic in South America.

Detecciòn de anticuerpos para el virus del Herpes simple tipo 1 y 2 (VHS 1 y 2), por el mètodo de Elisa en trabajadoras del sexo / Annual reports 1996 / detection of antibodies for herpes simplex virus 1 and 2 by the Elisa method in sex workers

Las tècnicas màs comùnmente utilizadas para el diagnòstico de la infecciòn por el virus del herpes simple (VHS) son: aislamiento del virus en cultivo de tejidos, examinaciòn citològica, ensayos serològicos como inmunofluorescencia indirecta, radioinmunoanàlisis, fijaciòn de complemento, hemaglutinaciòn indirecta y el mètodo de ELISA. Los ensayos serològicos mencionados podrìan distinguir infecciones por VHS-1 del 2. El objetivo de este trabajo fue determinar la presencia de anticuerpos de tipo IgG e IgM para el VHS-1 y 2, utilizando una tècnica de ELISA, en trabajadoras del sexo. Para tal efecto fueron estudiadas 56 trabajadoras del sexo, provenientes de las ciudades de Encarnaciòn, Edelira y Ayolas. El 78,5 por ciento de la poblaciòn en estudio presentò anticuerpos contra el virus VHS-1 y el 91 por ciento para el VHS-2. El 71 por ciento presentò anticuerpos del tipo IGG y el 74,1 por ciento del tipo IgM para ambos serotipos virales, respectivamente. Nuestros hallazgos podrìan indicar o una especificidad del mètodo de ELISA utilizado para la discriminaciòn del VHS-1 del 2 o la existencia de co-infecciòn en las mujeres estudiadas. Debido al alto porcentaje de anticuerpos contra VHS-2 detectados en las trabajadoras del sexo del Paraguay, consideramos de suma importancia ampliar el numero de pacientes y comparar el ELISA con otras tècnicas serològicas.

Detecciòn de anticuerpos para el virus del Herpes simple tipo 1 y 2 (VHS 1 y 2), por el mètodo de Elisa en trabajadoras del sexo / Annual reports 1996 / Detection of antibodies for herpes simplex virus 1 and 2 by the Elisa method in sex workers

Las tècnicas màs comùnmente utilizadas para el diagnòstico de la infecciòn por el virus del herpes simple (VHS) son: aislamiento del virus en cultivo de tejidos, examinaciòn citològica, ensayos serològicos como inmunofluorescencia indirecta, radioinmunoanàlisis, fijaciòn de complemento, hemaglutinaciòn indirecta y el mètodo de ELISA. Los ensayos serològicos mencionados podrìan distinguir infecciones por VHS-1 del 2. El objetivo de este trabajo fue determinar la presencia de anticuerpos de tipo IgG e IgM para el VHS-1 y 2, utilizando una tècnica de ELISA, en trabajadoras del sexo. Para tal efecto fueron estudiadas 56 trabajadoras del sexo, provenientes de las ciudades de Encarnaciòn, Edelira y Ayolas. El 78,5 por ciento de la poblaciòn en estudio presentò anticuerpos contra el virus VHS-1 y el 91 por ciento para el VHS-2. El 71 por ciento presentò anticuerpos del tipo IGG y el 74,1 por ciento del tipo IgM para ambos serotipos virales, respectivamente. Nuestros hallazgos podrìan indicar o una especificidad del mètodo de ELISA utilizado para la discriminaciòn del VHS-1 del 2 o la existencia de co-infecciòn en las mujeres estudiadas. Debido al alto porcentaje de anticuerpos contra VHS-2 detectados en las trabajadoras del sexo del Paraguay, consideramos de suma importancia ampliar el numero de pacientes y comparar el ELISA con otras tècnicas serològicas

Leucemia aguda megacarioblastica - LMA-M7: diagnóstico inmunocitoquimico en 2 casos / Annual reports 1994 / Acute megacarioblastic leukemia - LMA-M7: immunocitochemical diagnosis in two cases

La leucemia aguda megacarioblástica es una variedad reconocida desde 1985 y presenta el 10 por ciento de las leucemias agudas no linfoblasticas. Se presentan dos casos de leucemia aguda megacarioblastica, variedad M-7, cuyo diagnóstico diferencial se estableció por medio de la técnica de inmunocitoquimica. Representan los dos primeros casos de esta variedad diagnosticados en Paraguay. los casos corresponden a dos pacientes, uno de sexo masculino y uno de sexo femenino con anemia, pancitopenia, sin hepato-esplenomegalia y con blastos en médula osea y sangre periférica que fueron estudiados por medio de un panel de anicuerpos monoclonales para identificar la serie celular a la que pertenecían. Se obtuvieron resultados negativos con los anticuerpos anti-linfoblastos "B" y "T", anti-mieloblastos y anti-monociticos, mientras que el resultado fué positivo con el anticuerpo anti-glicoproteina plaquetaria para identificar precursores megacariocíticos, estableciéndose el diagnóstico de leucemia aguda megacarioblastica variedad M-7