Clinical Manifestations of Dengue in Children and Adults in a Hyperendemic Region of Colombia.

Dengue is the most common arboviral disease in the world. Traditionally, it has affected more adults, but the incidence in children has increased in recent years. Colombia is no stranger to this change; therefore, we aimed to find the differences in signs, symptoms, and clinical, hematological, and hemogram characteristics between children under 12 years old and individuals aged 12 years and older in an endemic region of Colombia in 2020-2022. The analyses were conducted with baseline data, corresponding to a cross-sectional design. Multiple correspondence analysis was used for general, dermatological, and clinical symptom profiles. Discriminant analysis was used for laboratory profiles. Multiple correspondence analysis was applied to nominal categorical data, employing Euclidean distances to analyze age groups. Discriminant analysis was applied to a training sample and validated on a test sample. The overall agreement of the model's discrimination, sensitivity, specificity, and fit indicators was calculated. The results indicated that individuals under 12 years exhibited distinct dermatological and clinical features, including rash, pruritus, hypotension, lymphocyte count, and platelet count, compared with those aged 12 years and older. In contrast, those 12 years and older were profiled for general and clinical symptoms such as pain (back pain, retro-orbital pain, headache), dizziness, chills, hematuria, tachypnea, and elevated/high hematocrit, hemoglobin, and basophil values. These findings are crucial to understanding the high incidence in children; they also facilitate rapid understanding of the disease in clinical care settings and differentiate it from other febrile outbreaks. This will affect disease control, particularly in severe cases, and reduce mortality.

Immune system gene polymorphisms associated with severe dengue in Latin America: a systematic review.

One of the main challenges in the clinical management of dengue is the early identification of cases that could progress to severe forms of the disease. A biomarker that may enable this identification is the presence of genetic polymorphisms in genes associated with immune responses. The objective of this study was to perform a systematic review of the Latin American literature on these genes. An electronic literature search was carried out in PubMed, Scopus, Lilacs, and the Virtual Health Library, and reference lists of systematic reviews in the area. Case-control studies conducted in Latin American countries examining at least one form of genetic polymorphism related to immune responses against severe dengue were included. In total, 424 articles were identified and 26 were included in this systematic review. Of the 26 selected articles, 16 reported polymorphisms associated with the risk of developing severe dengue (Risk); Similarly, 16 articles reported polymorphisms associated with a decreased risk of severe dengue (Protective). The final analysis revealed that multiple polymorphisms in immune system genes were early markers of the progression of dengue in Latin Americans and found that polymorphisms of the TNF-alpha gene may have a critical role in dengue pathogenesis.

Immune system gene polymorphisms associated with severe dengue in Latin America: a systematic review

ABSTRACT One of the main challenges in the clinical management of dengue is the early identification of cases that could progress to severe forms of the disease. A biomarker that may enable this identification is the presence of genetic polymorphisms in genes associated with immune responses. The objective of this study was to perform a systematic review of the Latin American literature on these genes. An electronic literature search was carried out in PubMed, Scopus, Lilacs, and the Virtual Health Library, and reference lists of systematic reviews in the area. Case-control studies conducted in Latin American countries examining at least one form of genetic polymorphism related to immune responses against severe dengue were included. In total, 424 articles were identified and 26 were included in this systematic review. Of the 26 selected articles, 16 reported polymorphisms associated with the risk of developing severe dengue (Risk); Similarly, 16 articles reported polymorphisms associated with a decreased risk of severe dengue (Protective). The final analysis revealed that multiple polymorphisms in immune system genes were early markers of the progression of dengue in Latin Americans and found that polymorphisms of the TNF-alpha gene may have a critical role in dengue pathogenesis.

Multicentric study of cervical cancer screening with human papillomavirus testing and assessment of triage methods in Latin America: the ESTAMPA screening study protocol.

INTRODUCTION: Human papillomavirus (HPV) testing is replacing cytology in primary screening. Its limited specificity demands using a second (triage) test to better identify women at high-risk of cervical disease. Cytology represents the immediate triage but its low sensitivity might hamper HPV testing sensitivity, particularly in low-income and middle-income countries (LMICs), where cytology performance has been suboptimal. The ESTAMPA (EStudio multicéntrico de TAMizaje y triaje de cáncer de cuello uterino con pruebas del virus del PApiloma humano; Spanish acronym) study will: (1) evaluate the performance of different triage techniques to detect cervical precancer and (2) inform on how to implement HPV-based screening programmes in LMIC. METHODS AND ANALYSIS: Women aged 30-64 years are screened with HPV testing and Pap across 12 study centres in Latin America. Screened positives have colposcopy with biopsy and treatment of lesions. Women with no evident disease are recalled 18 months later for another HPV test; those HPV-positive undergo colposcopy with biopsy and treatment as needed. Biological specimens are collected in different visits for triage testing, which is not used for clinical management. The study outcome is histological high-grade squamous intraepithelial or worse lesions (HSIL+) under the lower anogenital squamous terminology. About 50 000 women will be screened and 500 HSIL+ cases detected (at initial and 18 months screening). Performance measures (sensitivity, specificity and predictive values) of triage techniques to detect HSIL+ will be estimated and compared with adjustment by age and study centre. ETHICS AND DISSEMINATION: The study protocol has been approved by the Ethics Committee of the International Agency for Research on Cancer (IARC), of the Pan American Health Organisation (PAHO) and by those in each participating centre. A Data and Safety Monitoring Board (DSMB) has been established to monitor progress of the study, assure participant safety, advice on scientific conduct and analysis and suggest protocol improvements. Study findings will be published in peer-reviewed journals and presented at scientific meetings. TRIAL REGISTRATION NUMBER: NCT01881659.

Genetic diversity of Leptospira in northwestern Colombia: first report of Leptospira santarosai as a recognised leptospirosis agent.

The region of Antioquia in northeastern Colombia has the highest number of reported leptospirosis cases in the country. It also shows high seroprevalence indexes in the general population and socio-environmental conditions favourable for the transmission of the disease between humans and animals. In this study, 25 Leptospira isolates from Colombia's Antioquia department were identified to the species level as L. santarosai (12), L. interrogans (9) and L. meyeri (4) using phylogenetic analysis of the Amidohydrolase gene. Typing at the serovar level was performed using multilocus sequence typing (MLST) and monoclonal antibodies. The serovars Canalzonae, Babudieri, Alice, Beye, and Copenhageni have been identified as causing human or animal infections in Antioquia, Colombia. The four environmental isolates were not identified to the serovar level. L. santarosai serovar Canalzonae and Alice were identified as new etiologic agents of human leptospirosis in Antioquia, Colombia. This paper reports species and serovars that were previously unknown in the region.

Genetic diversity of Leptospira in northwestern Colombia: first report of Leptospira santarosai as a recognised leptospirosis agent

The region of Antioquia in northeastern Colombia has the highest number of reported leptospirosis cases in the country. It also shows high seroprevalence indexes in the general population and socio-environmental conditions favourable for the transmission of the disease between humans and animals. In this study, 25 Leptospira isolates from Colombia’s Antioquia department were identified to the species level as L. santarosai (12), L. interrogans (9) and L. meyeri (4) using phylogenetic analysis of the Amidohydrolase gene. Typing at the serovar level was performed using multilocus sequence typing (MLST) and monoclonal antibodies. The serovars Canalzonae, Babudieri, Alice, Beye, and Copenhageni have been identified as causing human or animal infections in Antioquia, Colombia. The four environmental isolates were not identified to the serovar level. L. santarosai serovar Canalzonae and Alice were identified as new etiologic agents of human leptospirosis in Antioquia, Colombia. This paper reports species and serovars that were previously unknown in the region.

Situación de la leptospirosis en el Urabá antioqueño colombiano: estudio seroepidemiológico y factores de riesgo en población general urbana / Leptospirosis in Uraba, Antioquia, Colombia: a seroepidemiological and risk factor survey in the urban population

Leptospirosis es una zoonosis de gran incidencia en regiones tropicales. Su prevalencia es desconocida en la región del Urabá colombiano. Entre marzo y octubre del año 2000 se realizó un estudio descriptivo de corte para determinar la seroprevalencia de anticuerpos contra Leptospira spp. y describir algunos factores de riesgo en nueve municipios del Urabá. La población incluida fue de 582 personas a las cuales se les tomó una muestra de sangre y se le aplicó una encuesta sobre factores de riesgo. La detección de anticuerpos contra Leptospira spp. fue realizada por inmunofluorescencia indirecta y por microaglutinación. La seroprevalencia general en la zona fue 12,5 por ciento (IC95 por ciento: 10,01-15,5). No hubo diferencias en cuanto al sexo, raza, oficio, edad, años de residencia en la zona y características de la vivienda. L. interrogans serovar Grippotyphosa fue la especie más prevalente, identificándose en 53 de los seropositivos. En 38 seropositivos los títulos detectados fueron iguales o mayores a 1:400. En conclusión, existe alta prevalencia de anticuerpos contra Leptospira spp. Es necesario orientar las medidas de control para disminuir el riesgo de exposición ambiental a leptospirosis por parte de los habitantes de la zona.

Leptospirosis is a widespread zoonosis in tropical regions. The prevalence is unknown in the Colombian region of Uraba. A cross sectional study was conducted from March to October 2000 in order to determine the prevalence of Leptospira spp. antibodies and describe risk factors in nine counties in the region. The sample consisted of 582 individuals, who answered a questionnaire and had blood samples drawn to determine risk factors. Detection of Leptospira spp. antibodies was based on indirect inmunofluorescence and microagglutination. Seroprevalence was 12.5 percent (95 percentCI: 10.01-15.5). No differences were observed according to race, gender, occupation, age, living conditions, or time of residence in the area. L .interrogans serovar Grippotyphosa was the most prevalent species, identified in 53 individuals. Titers were > 1:400 in 38 seropositive individuals. In conclusion, there is a high prevalence of Leptospira spp. antibodies in the area, where it is thus necessary to establish control measures to decrease the risk of environmental exposure to leptospirosis.

[Characterization of two typhoid fever outbreaks in Apartadó, Antioquia, 2005]. / Caracterización de dos brotes de fiebre tifoidea en Apartadó, Antioquia, 2005.

INTRODUCTION: The characterization of typhoid fever outbreaks is important because it is necessary to find the source of the infection and development control measures. OBJECTIVE: A typhoid fever outbreak is described from Apartadó and the Salmonella Typhi isolates characterized by phenotypic and genotypic methods. MATERIALS AND METHODS: From 44 patients, 15 blood cultures and 7 stools cultures were recovered. Phenotypic identification of isolates was done by biochemical and serological tests, and antibiotic susceptibility was tested. Genes hilA, invA and the IS200 marker were evaluated by polymerase chain reaction; pulsed field gel electrophoresis was used for the XbaI gene. Eight water samples were examined by polymerase chain reaction and culture methods in order to isolate Salmonella spp. RESULTS: Fifteen patients were confirmed for typhoid fever, 13 by blood cultures and two by stools cultures. All S. Typhi isolates were susceptible to the antimicrobials tested. The presence of hilA, invA and IS200 were confirmed by polymerase chain reaction in all isolates. The pulsed field gel electrophoresis method grouped 10 isolates in COINJPP.X01.0035 pattern, three in COINJPPX01.0002, one in COINJPP.X01.0012 and one in COINJPPX01.0037. Water isolates were negatives for Salmonella spp. CONCLUSIONS: Pulsed field gel electrophoresis discriminated the isolates in two outbreaks. Initially the cases were described as only one outbreak, by epidemiological criteria and phenotypic test. Additionally two isolates with different clonal origin were discriminated, indicating that they were unrelated to the other cases. It was not possible to confirm the infection source from water samples.

[Leptospirosis in Uraba, Antioquia, Colombia: a seroepidemiological and risk factor survey in the urban population]. / Situación de la leptospirosis en el Urabá antioqueño colombiano: estudio seroepidemiológico y factores de riesgo en población general urbana.

Leptospirosis is a widespread zoonosis in tropical regions. The prevalence is unknown in the Colombian region of Uraba. A cross sectional study was conducted from March to October 2000 in order to determine the prevalence of Leptospira spp. antibodies and describe risk factors in nine counties in the region. The sample consisted of 582 individuals, who answered a questionnaire and had blood samples drawn to determine risk factors. Detection of Leptospira spp. antibodies was based on indirect inmunofluorescence and microagglutination. Seroprevalence was 12.5% (95%CI: 10.01-15.5). No differences were observed according to race, gender, occupation, age, living conditions, or time of residence in the area. L .interrogans serovar Grippotyphosa was the most prevalent species, identified in 53 individuals. Titers were > 1:400 in 38 seropositive individuals. In conclusion, there is a high prevalence of Leptospira spp. antibodies in the area, where it is thus necessary to establish control measures to decrease the risk of environmental exposure to leptospirosis.

Caracterización de dos brotes de fiebre tifoidea en Apartadó, Antioquia, 2005 / Characterization of two typhoid fever outbreaks in Apartadó, Antioquia, 2005

Introducción. La caracterización de los brotes de fiebre tifoidea es importante epidemiológicamente, debido a que esto permite la búsqueda de la fuente y el desarrollo de medidas de control. Objetivo. Describir un brote de fiebre tifoidea en el municipio de Apartadó y caracterizar fenotípica y genotípicamente los aislamientos de Salmonella Typhi relacionados con él. Materiales y métodos. Se estudiaron 44 pacientes, a 15 de ellos se les tomaron muestras para hemocultivos y a 7, muestras para coprocultivos. Los aislamientos bacterianos se estudiaron con pruebas bioquímicas y serotipificación y se determinó el perfil de susceptibilidad a antibióticos. Los aislamientos se evaluaron fenotípicamente por reacción en cadena de la polimerasa para los genes hilA, invA e IS- 200, y por electroforesis en campo pulsado con XbaI. Se estudiaron ocho muestras de agua asociadas al brote por reacción en cadena de la polimerasa y cultivo para la búsqueda de Salmonella. Resultados. A 15/44 pacientes se les confirmó el diagnóstico clínico de fiebre tifoidea, a 13 por hemocultivos y a 2 por coprocultivos positivos para S. Typhi. Todos los aislamientos de S. Typhi fueron sensibles a los antibióticos probados. La reacción en cadena de la polimerasa confirmó la presencia de los genes hilA y invA e IS-200 en todos los aislamientos estudiados. La electroforesis en campo pulsado agrupó 10 aislamientos en el patrón COINJPP.X01.0035, tres en el patrón COINJPPX01.0002, uno COINJPP.X01.0012 y uno COINJPPX01.0037. El estudio de aguas fue negativo para Salmonella spp. Conclusiones. La electroforesis en campo pulsado estableció la presencia de dos brotes, que inicialmente, por epidemiología y pruebas fenotípicas del patógeno, habían sido descritos como uno solo. Además, permitió diferenciar dos aislamientos de origen clonal diferente, que indicaron casos aislados. No se pudo corroborar la fuente de infección en el agua.

Introduction. The characterization of typhoid fever outbreaks is important because it is necessary to find the source of the infection and development control measures. Objective. A typhoid fever outbreak is described from Apartadó and the Salmonella Typhi isolates characterized by phenotypic and genotypic methods. Materials and methods. From 44 patients, 15 blood cultures and 7 stools cultures were recovered. Phenotypic identification of isolates was done by biochemical and serological tests, and antibiotic susceptibility was tested. Genes hilA, invA and the IS200 marker were evaluated by polymerase chain reaction; pulsed field gel electrophoresis was used for the XbaI gene. Eight water samples were examined by polymerase chain reaction and culture methods in order to isolate Salmonella spp. Results. Fifteen patients were confirmed for typhoid fever, 13 by blood cultures and two by stools cultures. All S. Typhi isolates were susceptible to the antimicrobials tested. The presence of hilA, invA and IS200 were confirmed by polymerase chain reaction in all isolates. The pulsed field gel electrophoresis method grouped 10 isolates in COINJPP.X01.0035 pattern, three in COINJPPX01.0002, one in COINJPP.X01.0012 and one in COINJPPX01.0037. Water isolates were negatives for Salmonella spp. Conclusions. Pulsed field gel electrophoresis discriminated the isolates in two outbreaks. Initially the cases were described as only one outbreak, by epidemiological criteria and phenotypic test. Additionally two isolates with different clonal origin were discriminated, indicating that they were unrelated to the other cases. It was not possible to confirm the infection source from water samples.