The Camino Verde intervention in Nicaragua, 2004-2012.

Camino Verde (the Green Way) is an evidence-based community mobilisation tool for prevention of dengue and other mosquito-borne viral diseases. Its effectiveness was demonstrated in a cluster-randomised controlled trial conducted in 2010-2013 in Nicaragua and Mexico. The Nicaraguan arm of the trial was preceded, from 2004 to 2008, by a feasibility study that provided valuable lessons and trained facilitators for the trial itself. Here, guided by the Template for Intervention Description and Replication (TIDieR), we describe the Camino Verde intervention in Nicaragua, presenting its rationale, its time and location, activities, materials used, the main actors, modes of delivery, how it was tailored to encourage community engagement, modifications made from the feasibility study to the trial itself, and how fidelity to the process originally designed was maintained. We also present information on costs and discuss the place of this study within the literature on implementation science. TRIAL REGISTRATION: ISRCTN27581154 .

Mobilising communities for Aedes aegypti control: the SEPA approach.

Camino Verde (the Green Way) is an evidence-based community mobilisation tool for prevention of dengue and other mosquito-borne viral diseases. Its effectiveness was demonstrated in a cluster-randomised controlled trial conducted in 2010-2013 in Nicaragua and Mexico. The common approach that brought functional consistency to the Camino Verde intervention in both Mexico and Nicaragua is Socialisation of Evidence for Participatory Action (SEPA). In this article, we explain the SEPA concept and its theoretical origins, giving examples of its previous application in different countries and contexts. We describe how the approach was used in the Camino Verde intervention, with details that show commonalities and differences in the application of the approach in Mexico and Nicaragua. We discuss issues of cost, replicability and sustainability, and comment on which components of the intervention were most important to its success. In complex interventions, multiple components act in synergy to produce change. Among key factors in the success of Camino Verde were the use of community volunteers called brigadistas, the house-to-house visits they conducted, the use of evidence derived from the communities themselves, and community ownership of the undertaking. Communities received the intervention by random assignment; dengue was not necessarily their greatest concern. The very nature of the dengue threat dictated many of the actions that needed to be taken at household and neighbourhood levels to control it. But within these parameters, communities exercised a large degree of control over the intervention and displayed considerable ingenuity in the process. TRIAL REGISTRATION: ISRCTN27581154 .

Introduction and Establishment of Aedes albopictus (Diptera: Culicidae) in Managua, Nicaragua.

Aedes aegypti (L.) is the main vector of dengue virus and more recently chikungunya virus in Latin America. However, the Asian tiger mosquito Aedes albopictus (Skuse, 1894) is expanding its global range and increasing its role in transmission of these diseases. In this report, we suggest that Ae. albopictus was introduced to the Department of Managua, Nicaragua, in 2010 via two independent routes and demonstrate its dissemination and establishment in urban neighborhoods by 2012. The coexistence of two competent vector species could alter the epidemiology of dengue and chikungunya as well as indicate the need for new strategies aimed at vector control.

Serological reactivity of different antigenic preparations of Leishmania (Leishmania) amazonensis and the Leishmania braziliensis complex.

Total antigen from Leishmania (Leishmania) amazonensis and isolates from the Leishmania braziliensis complex, along with their respective antigenic fractions obtained by affinity chromatography on concanavalin-A-Sepharose and jacalin-agarose columns evaluated using immunoenzymatic ELISA assay. For this, serum samples from 229 patients were used, grouped as American tegmental leishmaniasis (n masculine=58), visceral leishmaniasis (n masculine=28), Chagas disease (n masculine=49), malaria (n masculine=32), tuberculosis (n masculine=13) and healthy volunteers (n masculine=49). Samples from American tegmentary leishmaniasis showed higher reactivity with antigens isolated from the Leishmania braziliensis complex than with antigens from Leishmania amazonensis (p<0.001). ELISA assays showed a sensitivity range from 60% to 95% with antigens isolated from the Leishmania braziliensis complex. There was marked nonspecific reactivity among serum samples with the use of antigenic fractions binding with concanavalin-A and jacalin from both Leishmania complexes, in comparison with other antigens (p<0.001). The results presented in this study suggest that the use of homologous antigens increases the efficiency of anti-Leishmania immunoglobulin detection, which may be very valuable for diagnostic purposes.

Serological reactivity of different antigenic preparations of Leishmania (Leishmania) amazonensis and the Leishmania braziliensis complex / Reatividade sorológica frente a diferentes preparações antigênicas de Leishmania (Leishmania) amazonensis e do complexo Leishmania braziliensis

Total antigen from Leishmania (Leishmania) amazonensis and isolates from the Leishmania braziliensis complex, along with their respective antigenic fractions obtained by affinity chromatography on concanavalin-A-Sepharose and jacalin-agarose columns evaluated using immunoenzymatic ELISA assay. For this, serum samples from 229 patients were used, grouped as American tegmental leishmaniasis (nº=58), visceral leishmaniasis (nº=28), Chagas disease (nº=49), malaria (nº=32), tuberculosis (nº=13) and healthy volunteers (nº=49). Samples from American tegmentary leishmaniasis showed higher reactivity with antigens isolated from the Leishmania braziliensis complex than with antigens from Leishmania amazonensis (p<0.001). ELISA assays showed a sensitivity range from 60 percent to 95 percent with antigens isolated from the Leishmania braziliensis complex. There was marked nonspecific reactivity among serum samples with the use of antigenic fractions binding with concanavalin-A and jacalin from both Leishmania complexes, in comparison with other antigens (p<0.001). The results presented in this study suggest that the use of homologous antigens increases the efficiency of anti-Leishmania immunoglobulin detection, which may be very valuable for diagnostic purposes.

Antígeno total de Leishmania (Leishmania) amazonensis e isolado do complexo Leishmania brazilienis, assim como suas respectivas frações antigênicas obtidas por cromatografia de afinidade em coluna de concanavalina-A ligada a sepharose e Jacalina ligada a agarose foram avaliadas por ensaio imunoenzimático ELISA. Para tanto, foram utilizadas amostras de soros de 229 pacientes agrupadas em leishmaniose tegumentar americana (nº=58), leishmaniose visceral (nº=28), doença de Chagas (nº=49), malaria (nº=32), tuberculose (nº=13) e voluntários saudáveis (nº=49). Houve maior reatividade das amostras de leishmaniose tegumentar americana com a utilização dos antígenos obtidos do isolado do complexo Leishmania braziliensis quando comparado com antígenos de Leishmania amazonensis (p<0,001). Observou-se ainda que a sensibilidade do teste ELISA variou de 60 a 95 por cento entre os antígenos obtidos do isolado do complexo Leishmania braziliensis. Houve acentuada reatividade inespecífica das amostras de soros com a utilização das frações antigênicas ligantes de Concanavalina-A e Jacalina de ambos os complexos Leishmania em comparação aos demais antígenos (p<0,001). Os resultados apresentados no presente trabalho sugerem que a utilização de antígenos homólogos aumentam a eficiência de detecção de imunoglobulina anti-Leishmania o que pode ser de grande valia para o propósito de diagnóstico.

Detección de anticuerpos contra trypanosoma cruzi en Somoto, Nicaragua, medianta ELISA indirecto e IFI en muestras de sangre en papel de filtro / Trypanosoma cruzi antibody detection in eight rural communities of Somoto, Nicaragua, through indirect ELISA and indirect immunofluorescence in blood samples collected on filter paper

Se estandarizó un inmunoensayo enzimático en fase sólida (ELISA) para estudiar la presencia de anticuerpos contra Trypanosoma cruzi en personas asintomáticas que viven en un área endémica de enfermedad de Chagas en Nicaragua. El ensayo fue estandarizado para el análisis de muestras de sangre colectadas en papel de filtro como método simple de transporte de muestras de sangre. Se realizó un estudio previo en el que se estudiaron por ELISA 18 muestras de suero total y 18 eluidos de sangre de pacientes con enfermedad de Chagas crónica, 30 muestras de suero y 30 eluidos de sangre de personas sanas que se utilizaron como controles negativos y 14 muestras de suero y 14 eluidos de sangre de pacientes con leishmaniasis cutánea o visceral que se utilizaron para los estudios de reacciones cruzadas. Tanto con el suero total como con los eluidos de sangre, la prueba de ELISA proporcionó una sensibilidad de 100 por ciento y una especificidad de 90 porciento; solo se observaron reacciones cruzadas con las muestras de pacientes con leishmaniasis visceral. El estudio poblacional incluyó a ocho comunidades rurales de Somoto, Nicaragua. Mediante un muestreo al azar se colectaron muestras de sangre en papel de filtro a 2 434 personas (1 335 del sexo masculino y 1 099 del sexo femenino) de las comunidades de Aguas Calientes, La Manzana, Los Canales, Santa Rosa, Las Playas, El Brocal, Santa Isabel y Santa Teresa. Las muestras fueron estudiadas por ELISA e inmunofluorescencia indirecta (IFI) encontrándose un total de 260 seropositivos por ELISA (10,7 por ciento), 207 de los cuales.....(AU)

We standardized a solid-phase enzyme-linked immunosorbent assay (ELISA) in order to study the presence of Trypanosoma cruzi antibodies in asymptomatic persons who live in an area of Nicaragua endemic for Chagas' disease. The test was standardized to analyze filter-paper blood samples, which are easy to transport. In the first phase of our investigation, ELISA was used to study 18 samples of total serum and 18 eluates of blood from patients with chronic Chagas' disease; 30 samples of serum and 30 eluates of blood from healthy people, used as negative controls; and 14 samples of serum and 14 eluates of blood from patients with cutaneous or visceral leishmaniasis, which were used to study cross-reactions. Both with the total-serum and the blood-eluate samples, the ELISA test provided 100 percent sensitivity and 90 percent specificity. Cross-reactions in the patient samples were observed only with visceral leishmaniasis. The second phase of our investigation was a population study that included eight rural communities in the area of Somoto, Nicaragua. Through random sampling, filter-paper blood samples were collected from 2 434 people (1 335 men and 1 099 women) from the communities of Aguas Calientes, El Brocal, La Manzana, Las Playas, Los Canales, Santa Isabel, Santa Rosa, and Santa Teresa. Studied by ELISA and by indirect immunofluorescence (IIF), the samples included 260 found seropositive by ELISA (10.7 percent), of which 207 were positive according to IIF (8.5 percent). With both techniques, the majority of seropositives were among women, but the difference between men and women was not statistically significant.....(AU)

Evaluación de la respuesta inmune en enfermos con Leishmaniasis cutánea localizada en Nicaragua / Evaluation of the immune response in patients with cutaneous leishmaniasis located in Nicaragua

Se estudió la respuesta inmune en 16 enfermos con Leishmaniasis cutánea localizada (LCL) en fase crónica y activa de la enfermedad. Se observó que los niveles de IgG sérica de los enfermos se encuentran significativamente elevados en relación con los valores de referencia de los controles normales (p < 0,001), no así los niveles séricos de IgM, los niveles de inmunocomplejos circulantes y la actividad de la vía clásica del completamiento, que se mantienen dentro de los valores de referencia. Se observó inmunodeficiencia celular en los enfermos, caracterizada por la disminución significativa de los linfocitos CD3,CD4 y el índice CD4/CD8 (p < 0,001) en relación con los valores de referencia de los controles normales, se discute la importancia de estas alteraciones en la evaluación clínica de la enfermedad(AU)

Evaluación de la respuesta inmune en enfermos con Leishmaniasis cutánea localizada en Nicaragua / Evaluation of the immune response in patients with cutaneous leishmaniasis located in Nicaragua

Se estudió la respuesta inmune en 16 enfermos con Leishmaniasis cutánea localizada (LCL) en fase crónica y activa de la enfermedad. Se observó que los niveles de IgG sérica de los enfermos se encuentran significativamente elevados en relación con los valores de referencia de los controles normales (p < 0,001), no así los niveles séricos de IgM, los niveles de inmunocomplejos circulantes y la actividad de la vía clásica del completamiento, que se mantienen dentro de los valores de referencia. Se observó inmunodeficiencia celular en los enfermos, caracterizada por la disminución significativa de los linfocitos CD3,CD4 y el índice CD4/CD8 (p < 0,001) en relación con los valores de referencia de los controles normales, se discute la importancia de estas alteraciones en la evaluación clínica de la enfermedad

Evaluación de la respuesta inmune en enfermos con leeishmaniasis cutáneas localizadas en Nicaragua

Se estudio la respuesta inmune en 16 enfermos con Leishmaniasis cutánea localizada (LCL) en fase crónica y activa de la enfermedad. Se observo que los niveles de IgG sérica de los enfermos se encuentran significativamente elevados en relación con los valores de referencia de los controles normales (P<0.001), no así los niveles séricos de IgH, los niveles de inmuno-complejo circulantes y la actividad de la vía clásica del complemento, que se mantienen dentro de los valores de referencia. Se observo inmunodeficiencia celular en los enfermos, caracterizada por la disminución significativa de los linfocitos CD3, CD4 y el índice CDH/CD8, los controles normales se discute la importancia de estas alteraciones en la evaluación de la enfermedad