RESUMO
Objectives: This study aimed to ascertain which factors are associated with higher risk of mortality among hospitalized COVID-19 Bolivian patients. Methods: This retrospective observational study assessed risk factors associated with mortality in patients (n = 549) hospitalized for SARS-CoV-2 infection in a Bolivian hospital between April 6, 2020, and August 18, 2022. Results: The results provide evidence of association between male sex (odds ratio [OR] = 1.6, 95% confidence interval [CI] 1.06-2.6), older age, 51-61 years-old (OR = 5.2, 95% CI 2.2-12.6), 62-70 years-old (OR = 8.7, 95% CI 3.7-20.5), >70 years-old (OR = 16.9, 95% CI 7.1-39.9), and blood group A (OR = 1.9, 95% CI: 1.1-3.4) with higher mortality risk. The strong association between mortality and relatively young age, may be due to high frequency of undiagnosed comorbidities. Vaccination was associated with a reduction in mortality only when time period of hospitalization was not adjusted for. Conclusion: Among hospitalized patients in Bolivia male sex, older age, and blood group A are associated with higher mortality risk. Mortality risk increased markedly from a relatively young age and decreased in parallel to the uptake of the vaccination program. However, the gradual reduction in mortality can also be due to improved patient management and changes in natural immunity and virulence of circulating strains as the pandemic progressed.
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The standard of care for cutaneous leishmaniasis includes the intramuscular/intravenous administration of pentavalent antimonials that are toxic and poorly tolerated. Primary health care usually lacks trained health staff for the diagnosis and treatment of leishmaniasis in Cochabamba Bolivia. Taking these aspects into account, a Bolivian consortium set out to explore the intralesional administration of meglumine antimoniate to treat cutaneous leishmaniasis during primary care under programmatic conditions. A four-step strategy consisting of clinical training for intralesional treatment and the promotion and periodic follow-up of health staff was carried out. The training process was applied in situ to personnel of nine primary health care centres. The intralesional treatment was applied five times every other day. Clinical follow-up after six-months of treatment showed a 77% healing proportion and 5% of therapeutic failure among 152 enrolled patients. The drug volume used in the intralesional procedure was on average 1.7 mL/ulcer treated. In conclusion, the strategy used was successful and effective, accomplishing a healing proportion similar to the long standardized treatment with a reduced time of administration, no severe side effects, and it is feasible to conduct by trained health staff. Our study supports the current PAHO/WHO recommendation for the intralesional administration of pentavalent antimonials for the treatment of cutaneous leishmaniasis.
RESUMO
La COVID-19 clínicamente se presenta con síntomas gripales y dificultad respiratoria con o sin hipoxia que puede progresar en severidad, asociado a la presencia de variantes de SARS-CoV-2 que serían responsables de reinfecciones heterólogas. Este caso muestra una secuencia de cuatro infecciones en el mismo paciente con intervalos de tiempo entre cada infección de alrededor de 5 meses coincidente con los periodos en que se presentaron cuatro olas de la infección en Bolivia. La enfermedad por COVID-19, durante el tercer episodio, fue más severa que las anteriores, con compromiso pulmonar, incremento de la Proteína C Reactiva y daño hepático. Se asume que tal situación responde a una infección heteróloga con una variante diferente a las dos anteriores y la posibilidad de desarrollo del fenómeno ADE. Este caso constituiría al primer reporte documentado de infección recurrente por SARS-CoV-2 y debería servir para sensibilizar sobre la importancia de la vacunación a fin de reducir la posibilidad de reinfecciones.
Clinically COVID-19 presents with flu-like symptoms and respiratory distress with or without hypoxia that can progress in severity, which partially responds to the presence of SARS-CoV-2 variants that would be responsible for heterologous reinfections. This case shows a sequence of four infections with time intervals between each infection of around 5 months coinciding with the periods in which four waves of infection occurred in Bolivia. The Covid-19, during the third episode was more severe than the previous ones with lung involvement, increased C-Reactive Protein and liver damage. It is assumed that such a situation responds to a heterologous infection with a variant different from the previous two and the possibility of development of the ADE phenomenon. This case would constitute the first documented report of recurrent SARS-CoV-2 and should serve to raise awareness about the importance of vaccination in order to reduce the possibility of reinfections.
Assuntos
COVID-19RESUMO
Resumen Los anticuerpos neutralizantes (NAbs) contra el SARS-CoV-2 están siendo evaluados en humanos. Las respuestas adaptativas específicas de los sujetos asintomáticos o sintomáticos contra el antígeno de SARS-CoV-2, presentan una correlación positiva con la respuesta inmunitaria humoral. Objetivo: evaluar la presencia de anticuerpos contra la proteína específica de la espiga (RBD, dominio de unión al receptor de la proteína de espícula) y NP (nucleoproteína) del virus SARS-CoV-2 en personas que recibieron vacunas anti COVID-19 empleadas en Bolivia. Métodos: durante el año 2021 entre los meses de julio y agosto, se realizó un estudio observacional de tipo transversal, en 150 personas de ambos sexos que fueron reclutadas en los Hospitales: Caja de Seguro Social Militar y Caja Nacional de Salud, para detectar anticuerpos específicos contra las proteínas NP y RBD del virus SARS-CoV-2 responsable de la COVID-19, mediante una prueba inmunocromatográfica cualitativa. Resultados: la presencia de anticuerpos neutralizantes posterior a la aplicación de vacunas contra SARS-CoV-2, como esquema completo, primera dosis, y/o el antecedente de infección, se encontró en el 61 % de las personas agrupadas en la categoría "bajo riesgo laboral" de forma heterogénea en lo referente a anticuerpos RBD, NP o ambas juntas. Conclusiones: la producción de anticuerpos contra la proteína específica de la espiga RBD y NP del virus SARS-CoV-2 muestra una respuesta heterogénea por varios factores como ser, tipo de vacuna, numero de dosis, infección por el COVID-19, disminución de anticuerpo a largo del tiempo, sensibilidad del test y las propiedades intrínsecas de la persona evaluada.
Abstract Neutralizing antibodies (NAbs) against SARS-CoV-2 are being evaluated in humans. The specific adaptive responses of asymptomatic or symptomatic subjects against SARS-CoV-2 antigen show a positive correlation with the humoral immune response. Objective: To evaluate the presence of antibodies against spike specific protein (RBD, receptor binding domain of spike protein) and NP (nucleoprotein) of SARS-CoV-2 virus in people who received anti-COVID-19 vaccines used in Bolivia. Methods: During 2021 between July and August, a cross-sectional observational study was carried out in 150 persons of both sexes who were recruited in the Hospitals: Caja de Seguro Social Militar and Caja Nacional de Salud, to detect specific antibodies against the NP and RBD proteins of the SARS-CoV-2 virus responsible for COVID-19, by means of a qualitative immunochromatographic test. Results: The presence of neutralizing antibodies after the administration of vaccines against SARS-CoV-2, as complete scheme, first dose, and/or history of infection, was found in 61 % of the persons grouped in the category "low occupational risk" in a heterogeneous way regarding RBD antibodies, NP or both together. Conclusions: The production of antibodies against the specific protein of the RBD and NP spike of the SARS-CoV-2 virus shows a heterogeneous response due to several factors such as, type of vaccine, number of doses, infection by COVID-19, antibody decline over time, sensitivity of the test and intrinsic properties of the person evaluated.
RESUMO
Resumen La leishmaniasis tegumentaria en Bolivia es producida mayoritariamente por L. braziliensis. Las manifestaciones clínicas son ulceras, que pueden generar lesiones satélites próximas a la inicial. Las drogas de primera elección para el tratamiento son los antimoniales pentavalentes; aunque con una eficacia variable. La falta de respuesta a estas drogas, induce al empleo de otras, consideradas como de segunda elección. Sin embargo, en todos los casos existe la posibilidad de falla terapéutica. El presente caso muestra la remisión de las lesiones usando tratamiento combinado de pentamidina, miltefosina y paromomicina, en un paciente con antecedente de falta de respuesta a la monoterapia con Glucantime®. La remisión de la enfermedad alcanzada al final de la terapia, probablemente sea resultado de la acción lítica simultánea de las tres drogas utilizadas y a la restauración de la respuesta inmune del paciente. Hasta los 21 meses de control pos tratamiento, todas las lesiones se mantuvieron cicatrizadas y ausencia de otras nuevas.
Abstract The tegumentary leishmaniasis in Bolivia is mainly caused by L. braziliensis. The clinical manifestations are ulcerative lesions which can generate satellite lesions close to the initial one. The first choice drugs for treatment are pentavalent antimonials; although with variable effectiveness. Lack of response to these drugs leads to the use of other alternatives, considered as second-choice drugs. However, in all cases there is the possibility of therapeutic failure. The present case shows the remission of the lesions using a combined treatment of pentamidine, miltefosine and paromomycin, in a patient with a history of lack of response to monotherapy with Glucantime® The remission of the disease achieved at the end of combined therapy is probably the result of the simultaneous lytic action of the three drugs used and the restoration of the patient's immune response. Up to 21 months of post-treatment control, all the lesions remained healed and the absence of new ones.
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OBJETIVO: evaluar la seguridad a largo plazo frente al riesgo de complicaciones mucosas del uso intralesional de antimoniales pentavalentes en pacientes con leishmaniasis cutánea comparado con el uso sistémico de los mismos. MÉTODOS: estudio observacional, cuantitativo de tipo longitudinal retrospectivo. Se analizó un total de 66 registros clínicos de pacientes, con diagnóstico de Leishmaniasis cutánea del parque Isiboro Secure durante el periodo 2012 a 2016. Se evaluó un total de 46 tratamientos sistémicos y 20 intralesionales. RESULTADOS: la evaluación clínica realizada entre 4 y 7 años posteriores a la cicatrización de las lesiones cutáneas de Leishmaniasis mostró la ausencia de desarrollo de lesiones mucosas. Así mismo no se reportó fallas terapéuticas, recidivas ni efectos adversos a corto plazo. CONCLUSIONES: el tratamiento intralesional fue seguro y eficaz a largo plazo y es una opción confiable para el tratamiento de leishmaniasis cutánea evitando las complicaciones futuras de la enfermedad.
OBJECTIVE: to assess the long-term safety against the risk of mucosal complications of intralesional pentavalent antimonials (PA) in patients with cutaneous Leishmaniasis compared to the systemic use of PA. METHODS: retrospective longitudinal quantitative observational study. A total of 66 clinical records of patients diagnosed with cutaneous Leishmaniasis in Isiboro Secure Park were analyzed between 2012 and 2016. A total of 46 systemic and 20 intralesional treatments were evaluated. RESULTS: clinical evaluation 4-7 years after healing of Leishmaniasis skin lesions showed no development of mucosal lesions. Likewise, no therapeutic failures, relapses or short-term adverse effects were reported. CONCLUSIONS: intralesional treatment was safe and effective in the long term and is a reliable option for the treatment of cutaneous Leishmaniasis avoiding the future complications of the disease.
