Seroprevalencia contra agentes ToRCH en mujeres indígenas en edad fértil, estado Zulia, Venezuela / Prevalence of infectious agents in indigenous women of childbearing age in Venezuela

Introducción. El termino ToRCH comprende a los patógenos Toxoplasma gondii, virus de la rubéola, citomegalovirus y virus herpes simple 1 y 2. En mujeres embarazadas expuestas pueden ser causa de abortos y malformaciones congénitas en el neonato. Objetivo. Determinar la seroprevalencia de infección por los agentes causantes del síndrome ToRCH en mujeres en edad fértil de algunas comunidades indígenas yukpa de Venezuela. Materiales y métodos. En el año 2007 fueron seleccionadas 109 muestras de 151 mujeres, en edades comprendidas entre 14 y 40 años. La detección de anticuerpos se hizo por el método de inmunoensayo enzimático indirecto o ELISA de Smartest Diagnostics™. Resultados. El 85,5 % presentó anticuerpos contra T. gondii, el 95,4 % para rubéola, el 75,2 % para citomegalovirus y el 97,2 % para el virus herpes simple 1 y 2. Se observa que el 21,1 % y el 30,2 % presentaron relación entre la variable aborto y las infecciones por citomegalovirus y virus herpes simple 1 y 2, respectivamente. Conclusiones. Existe alta seroprevalencia de infecciones por los agentes causantes del síndrome ToRCH en mujeres en edad fértil de la etnia indígena yukpa. Las condiciones sanitarias precarias y el consumo de agua contaminada con ooquistes, favorecen la adquisición de la infección por T. gondii. El hacinamiento, el inicio a temprana de edad de la actividad sexual y el número de parejas, pueden incidir en la presencia de citomegalovirus y virus herpes simple 1 y 2.

Introduction. The ToRCH syndrome includes the following infectious pathogens: Toxoplasma gondii, rubella, cytomegalovirus and herpes simplex virus 1 and 2. In susceptible pregnant women, these pathogens can cause abortions and congenital malformation in the newborn babies. Objective. The seroprevalence of infection by ToRCH agents was determined in women of childbearing age in several Venezuelan Yukpa indigenous communities. Material and methods. In 2007, 109 samples were selected from 151 women with an age range of 14 to 40 years old. The determination of antibodies against ToRCH agents was carried out through the indirect enzyme immunoassay technique by ELISA´s technique of Smartest Diagnostics. Results. Of the 109 samples, 85.5% presented antibodies against T. gondii, 95.4% for rubella, 75.2% for cytomegalovirus and 97.2% for and herpes simplex virus 1 and 2. A relationship between abortion and infection by cytomegalovirus and herpes simplex virus 1and 2 was noted in 21.1% and 30.2% of women presented, respectively. Conclusions. The findings show a high prevalence of ToRCH agents in women in childbearing age in Yukpa indigenous communities in Venezuela. Poor sanitary conditions and consumption of water contaminated with oocysts may be an important way of transmission of T. gondii. Overcrowding in the communities, sexual activity at an early age and number of partners and may be related to the presence of cytomegalovirus and herpes simplex virus HSV-1 and 2.

Hepatitis C virus infection in hemodialysis patients in Maracaibo, Venezuela.

Over a two year period, the incidence of hepatitis C virus (HCV) infection was evaluated in 29 hemodialysis patients, aged between 15 and 75 years (mean ± SD: 45 ± 39.5 years), from the University Hospital Hemodyalisis Unit, Maracaibo, Zulia State, Venezuela. Anti-HCV antibodies were determined using a fourth generation ELISA (Innotest HCV Ab IV) kit and positive blood samples were tested using a recombinant assay kit (Inno-LIA HCV Ab III), both kits from Innogenetics N.V., Belgium. The findings indicate a lack of HCV seroconversion in the hemodialysis patients over the study period, confirmed by the recombinant assay. Risk factors for HCV infection were 0.3270 (95% confidence interval: 0.01323-8.080) in patients undergoing hemodialysis. The findings suggest a lack of significant sources for HCV infection due to the preventive measures to avoid its transmission in the hemodialysis unit.

Hepatitis C virus infection in hemodialysis patients in Maracaibo, Venezuela / Infecção pelo vírus da Hepatite C em pacientes em hemodiálise em Maracaibo, Venezuela

Over a two year period, the incidence of hepatitis C virus (HCV) infection was evaluated in 29 hemodialysis patients, aged between 15 and 75 years (mean ± SD: 45 ± 39.5 years), from the University Hospital Hemodyalisis Unit, Maracaibo, Zulia State, Venezuela. Anti-HCV antibodies were determined using a fourth generation ELISA (Innotest HCV Ab IV) kit and positive blood samples were tested using a recombinant assay kit (Inno-LIA HCV Ab III), both kits from Innogenetics N.V., Belgium. The findings indicate a lack of HCV seroconversion in the hemodialysis patients over the study period, confirmed by the recombinant assay. Risk factors for HCV infection were 0.3270 (95 percent confidence interval: 0.01323-8.080) in patients undergoing hemodialysis. The findings suggest a lack of significant sources for HCV infection due to the preventive measures to avoid its transmission in the hemodialysis unit.

Durante período de 2 anos, estudamos a incidência da infecção pelo vírus da hepatite C (VHC) em 29 pacientes em tratamento de diálise, com idades entre 15 e 75 anos (c ± DS; 45 ± 39,5 anos), procedentes da unidade de hemodiálise do Hospital Universitário de Maracaibo, Estado Zulia, Venezuela. Para a detecção dos anticorpos contra o VHC (anti-VHC) utilizamos a técnica de imunoensaio enzimático (ELISA, Innotest HCV Ab IV) e em amostras reativas por ELISA, utilizamos o método de immunoblot recombinante de terceira geração (Inno-LIA HCV Ab III), ambos da casa comercial Innogenetics N.V., Bélgica. Os resultados demonstram ausência de soroconversão ao VHC nos pacientes hemodializados durante o período estudado, o que foi confirmado pelo método de imunoblot recombinante. Os fatores de risco ao VHC foram 0,327 (95 por cento CI: 0,01323 - 8,080) nos pacientes submetidos ao tratamento de diálise. Nossos resultados sugerem ausência de fontes de infecção neste centro de hemodiálise e que as medidas universais de controle de infecção são cumpridas.

[Prevalence of infectious agents in indigenous women of childbearing age in Venezuela]. / Seroprevalencia contra agentes ToRCH en mujeres indígenas en edad fértil, estado Zulia, Venezuela.

INTRODUCTION: The ToRCH syndrome includes the following infectious pathogens: Toxoplasma gondii, rubella, cytomegalovirus and herpes simplex virus 1 and 2. In susceptible pregnant women, these pathogens can cause abortions and congenital malformation in the newborn babies. OBJECTIVE: The seroprevalence of infection by ToRCH agents was determined in women of childbearing age in several Venezuelan Yukpa indigenous communities. MATERIAL AND METHODS: In 2007, 109 samples were selected from 151 women with an age range of 14 to 40 years old. The determination of antibodies against ToRCH agents was carried out through the indirect enzyme immunoassay technique by ELISA´s technique of Smartest Diagnostics. RESULTS: Of the 109 samples, 85.5% presented antibodies against T. gondii, 95.4% for rubella, 75.2% for cytomegalovirus and 97.2% for and herpes simplex virus 1 and 2. A relationship between abortion and infection by cytomegalovirus and herpes simplex virus 1and 2 was noted in 21.1% and 30.2% of women presented, respectively. CONCLUSIONS: The findings show a high prevalence of ToRCH agents in women in childbearing age in Yukpa indigenous communities in Venezuela. Poor sanitary conditions and consumption of water contaminated with oocysts may be an important way of transmission of T. gondii. Overcrowding in the communities, sexual activity at an early age and number of partners and may be related to the presence of cytomegalovirus and herpes simplex virus HSV-1 and 2.

Cryptosporidium sp. y otros parásitos intestinales en niños menores de 5 años con diarrea y su relación con las pruebas coprocualitativas / Cryptosporidium sp. and other intestinal parasites in children under 5 years old with diarrhea and their relationship to coproquilitative tests

Para determinar la presencia de Cryptosporidium sp. y otros parásitos intestinales; así como su relación con las pruebas coprocualitativas, se analizaron 100 muestras fecales de niños de 3 meses a 5 años de edad, que asistieron al Laboratorio de Parasitología del Servicio Autónomo del Hospital Universitario de Maracaibo (SAHUM) con diagnóstico clínico de diarrea. Estas muestras fueron sometidas a un examen macroscópico y microscópico con SSF (0,85%) y lugol, coloración de Kinyoun para la detección de coccidios intestinales y las pruebas coprocualitativas: sangre oculta, azucares reductores y pH. Del total de muestras estudiadas, el 12% evidenció parásitos. Las especies encontradas fueron Cryptosporidium sp., Giardia lamblia y Blastocystis hominis con 4%cada uno, Trichuris trichiura (2%), Ascaris lumbricoides (1%), Pentatrichomonas hominis (1%). No se encontró correlación entre las pruebas coprocualitativas y las especies parasitarias identificadas, así como tampoco entre parasitosis y sexo. Cryptosporidium sp. y Giardia lamblia fueron los parásitos patógenos más frecuentes en niños < 2 años de edad

To determine the presence of Cryptosporidium sp. and other intestinal parasites, as well as their relation to coproqualitative tests, fecal samples were analyzed from 100 children ranging from 3 months to 5 years old, who attended the Autonomous Service Parasitology Laboratory at the University Hospital of Maracaibo (SAHUM) with a clinical diagnosis of diarrhea. These samples were subjected to macroscopic and microscopic examination with SSF (0.85%) and iodine, Kinyoun stain for the detection of intestinal coccidia, coproqualitative tests (occult blood, reducing sugars and pH). Of all the samples studied, 12% evidenced parasites. The species found were Cryptosporidium sp. (4%), Ascaris lumbricoides (1%), Trichuris trichiura (2%) Pentatrichomonas hominis (1%), Giardia lamblia and Blastocystis hominis at (4%). There was no correlation between the coproqualitative tests and the parasitic species identified, nor was there any relation ship between parasitosis and gender. Cryptosporidium sp. and Giardia lamblia were the most frequent pathogenic parasites in children < 2 years old

Diagnóstico diferencial de virus hepatótropos y no hepatótropos en pacientes atendidos en el laboratorio regional de referencia virológica: Maracaibo-Venezuela año 2007 / Differential diagnosis of hepatotropic and non-hepatotropic viruses in patients at the regional virological reference laboratory: Maracaibo-Venezuela 2007

La hepatitis viral representa un problema de salud pública a escala mundial, causada por diferentes agentes etiológico como el virus de la hepatitis A, B, C, D, E, F o G. Sin embargo, se han reportado casos relacionados con la enfermedad hepática causados por virus no hepatótropos como el Citomegalovirus (CMV) y el Virus Epstein Barr (VEB). El objetivo del presente estudio fue establecer el diagnóstico diferencial de virus hepatótropos y no hepatótropos en pacientes con síntomas y signos sugestivo de infección hepática, de la ciudad de Maracaibo-Venezuela. Año 2007. Se recolectaron 268 muestras de sangre de pacientes procedente de diferentes centros de salud de la ciudad de Maracaibo, que acudieron al Laboratorio regional de Referencias Virológica. La presencia de anticuerpos de tipo IgM, para el virus de hepatitis A (VHA), B (VHB), C (VHC), CMV y VEB fue detectada mediante la prueba de ELISA. Los resultados obtenidos indican una alta incidencia del VHA 118/268(44,03%), seguido del VHB 5/268(1,86%) y ausencia del VHC. Para virus no hepatótropos, el 4,48% (12/268) fueron positivos para el VEB y el 9,7% (26/268) para CMV. El 39,92% (107/268) son considerados negativos para los virus antes mencionados. En este estudio se señala que los virus CMV y VEB suelen estar comprometidos con daño hepático y deben ser consideradas como posibles agentes etiológicos ante cualquier caso de hepatitis

Viral hepatitis is a public health problem worldwide, caused by different etiologic agents,such as hepatitis A, B, C, D, E, F or G. However, cases have been reported related to liver disease caused by hepatotropic viruses, such as cytomegalovirus (CMV) and Epstein Barr Virus (EBV). The aim of this study was to establish the differential diagnosis of hepatotropic and non-hepatotropic viruses in patients with symptoms and signs suggestive of liver infection in the city of Maracaibo, Venezuela, 2007. 268 blood samples were collected from patients at different health centers in the city of Maracaibo, who recurred to the Regional Viral Reference Laboratory. The presence of IgM antibodies to hepatitis A virus (HAV), B (HBV), C (HCV), CMV and EBV was detected by ELISA. The results indicate a high incidence of HAV 118/268 (44.03%), followed by HBV 5/268 (1.86%) and the absence of HCV. For non-hepatotropic viruses, 4.48% (12/268) were positive for EBV and 9.7% (26/268) for CMV. For the above-mentioned viruses, 39.92% (107/268) are considered negative. This study suggests that CMV and EBV viruses are often involved with liver damage and should be considered as possible etiologic agents for any case of hepatitis

Incidencia de la infección por el virus de la hepatitis A diagnosticadas en la ciudad de Maracaibo estado Zulia Venezuela / Incidence of infection by the hepatitis A virus diagnosed in the city of Maracaibo state Zulia Venezuela

La infección por el virus de la hepatitis A (VHA) sigue siendo un problema de salud pública en los países en vías de desarrollo. El objetivo de la presente investigación fue determinar la incidencia de la infección por el VHA en individuos de la ciudad de Maracaibo, estado Zulia, Venezuela. Durante el periodo comprendido entre enero 2004 a diciembre 2007 se seleccionaron 1056 pacientes en edades de 1 a 60 años de ambos sexos (media ± DS: 27,48 ± 5,24), procedentes de los municipio Maracaibo y San Francisco ubicados en la ciudad de Maracaibo estado Zulia, Venezuela. La presencia de anticuerpos anti-IgM contra el virus de la hepatitis A se determinó mediante métodos convencionales de micro partículas enzimoinmunoanalisis (MEIA). Los resultados encontrados indican una seropositividad en 73 (35,1%), 76 (28%), 66 (24,3%), 35 (20,3%) individuos de las zonas Norte, Sur, Este, Oeste respectivamente, correspondientes al municipio Maracaibo y 31 (23,3%) correspondiente al municipio San Francisco. La mayor prevalencia fue observada en pacientes del sexo femenino menor de 20 años (47,3%), y en pacientes del sexo masculino menor de 10 años (53,7%), siendo el signo clínico más frecuente la ictericia (95,7%). Las deficientes medidas de saneamiento ambiental y sanitario fueron factores aparentemente determinantes en la diseminación del VHA

Hepatitis A virus (HAV) infection continues to be a public health problem in developing countries. The aim of this study was to determine incidence of the hepatitis A virus infection in a population from Maracaibo, Venezuela. From January, 2004 until December, 2007, this study was carried out on 1056 individuals, whose ages were between 1-60 years (average ± DS: 27.48 ± 5.24 years), coming from the Maracaibo and San Francisco municipalities, Venezuela. The IgM antibody against HAV was determined by the ELISA technique. The overall incidence was 26.6%. The North, South, East and West areas of the Maracaibo Municipality and the San Francisco Municipality in the city of Maracaibo showed incidences of 73 (35.1%), 76 (28%), 66 (24.3%), 35 (20.3%) and 31 (23.3%), respectively. The highest incidences were observed in females under 20 years (47.3%) and males under 10 years (53.7%). The most frequent clinical sign was jaundice in 95.7% of patients. Deficient sanitary conditions and hygiene habits seemed to be the main risk factors in spreading HAV infection

Helicobacter pylori: bacterial factors and the role of cytokines in the immune response.

Helicobacter pylori is a gram-negative micro-aerophilic bacterium that is widely distributed geographically and causes chronic gastritis, peptic ulcers, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. Bacterial virulence factors play an important role, since the virulent strains are more aggressive and increase the risk of developing severe clinical manifestations; in addition, other determinant factors are the nutritional state and the immune response of the host. Studies on humans, non-human primates, and rodents have reported that regulating proteins of the Th1 phenotype predominate in the immune response to the bacterial infection. The cytokines produced by this phenotype, are not very effective in eradicating the microorganism and furthermore, contribute to gastro-duodenal pathogenesis. Gastric inflammation in patients infected with H. pylori has been characterized by increased production of IL-1, IL-6, IL-12, IL-18, TNF-alpha, and IFN-gamma. Many prophylactic and therapeutic strategies have been researched using experimental animals. The utilization and effectiveness of vaccination on humans requires more study.

Baja prevalencia de la infección por el virus de la hepatitis C en una población de reclusos, Maracaibo, Venezuela / Low prevalence of hepatitis C virus infection in a prisoner population from Maracaibo, Venezuela

Introducción. Las conductas de alto riesgo presentes en los centros de reclusión incrementan la probabilidad de transmisión de la infección por el virus de la hepatitis C. En Venezuela no se han realizado estudios del virus en estos centros, por lo que se desconoce la relevancia de la infección en ellos. Objetivo. Estimar la prevalencia del virus de la hepatitis C y los posibles factores de riesgos involucrados en la transmisión del virus en reclusos de la cárcel de Sabaneta, Maracaibo, Venezuela. Material y métodos. Se seleccionó una población de 200 reclusos de un total de 1.000. Las edades estaban comprendidas entre 18 y 69 años (media ± DE: 31,629,93 a˜os). La detección de anticuerpos contra el virus de la hepatitis C se realizó por duplicado mediante el método inmunoenzimático ELISA de IV generación y por el método de inmunoblot INNO-LIA HCV®, ambos de Innogenetic Lab (Bélgica). El ARN viral se detectó por la técnica de reacción en cadena de la polimerasa, previa transcripción inversa, RT-PCR. Resultados. La frecuencia obtenida con el método ELISA fue de 5% (10/20) y 3/200 (1,5%) individuos fueron positivos, a la vez, con los métodos de INNO-LIA y RT-PCR. Conclusiones. La prevalencia de la infección por el virus de la hepatitis C en esta población fue baja, lo que evidencia la baja circulación del virus en el reclusorio. El principal factor de riesgo para la adquisición de la infección, al parecer, es el uso de drogas intravenosas.

Introduction. The high risk behaviors observed in prison centers have favored the transmission of hepatitis C virus infection. The main risk factor to acquire hepatitis C virus infection seems to be the use of intravenous drugs. In Venezuela, the prevalence of the infection in these centers is unknown since studies of the hepatitis C virus there are lacking. Objective. The aim of this study was to determine the prevalence of hepatitis C virus and the risk factors involved in the transmission in prisoner populations. Material and methods. A sample of 200 prisoners was studied from Sabaneta Jail, Maracaibo, Venezuela. The ages were between 18-69 years (average ± DS: 31.6±9.9 years). Serum samples were tested by a fourth generation enzyme-linked immunosorbent assay ELISA and a confirmatory assay INNO-LIA. Both kits were from Innogenetic Laboratories N.V. (Belgium). Viral RNA was tested by the reverse transcription polymerase chain reaction technique (RT-PCR). Results. The ELISA assay determined a hepatitis C virus prevalence of 5.0% (10/200); 3/200 (1.5%) individuals were positive by both INNO-LIA and RT-PCR tests. Conclusions. The observed prevalence of hepatitis C virus antibodies in this population was very low, suggesting a low circulation of the virus in this environment and a low level of associated risk behaviors.

[Low prevalence of hepatitis C virus infection in a prisoner population from Maracaibo, Venezuela]. / Baja prevalencia de la infección por el virus de la hepatitis C en una población de reclusos, Maracaibo, Venezuela.

INTRODUCTION: The high risk behaviors observed in prison centers have favored the transmission of hepatitis C virus infection. The main risk factor to acquire hepatitis C virus infection seems to be the use of intravenous drugs. In Venezuela, the prevalence of the infection in these centers is unknown since studies of the hepatitis C virus there are lacking. OBJECTIVE: The aim of this study was to determine the prevalence of hepatitis C virus and the risk factors involved in the transmission in prisoner populations. MATERIAL AND METHODS: A sample of 200 prisoners was studied from Sabaneta Jail, Maracaibo, Venezuela. The ages were between 18-69 years (average +/- DS: 31.6+/-9.9 years). Serum samples were tested by a fourth generation enzyme-linked immunosorbent assay ELISA and a confirmatory assay INNO-LIA. Both kits were from Innogenetic Laboratories N.V. (Belgium). Viral RNA was tested by the reverse transcription polymerase chain reaction technique (RT-PCR). RESULTS: The ELISA assay determined a hepatitis C virus prevalence of 5.0% (10/200); 3/200 (1.5%) individuals were positive by both INNO-LIA and RT-PCR tests. CONCLUSIONS: The observed prevalence of hepatitis C virus antibodies in this population was very low, suggesting a low circulation of the virus in this environment and a low level of associated risk behaviors.

[Viral loads in pediatric HIV patients with antiretroviral treatment]. / Carga viral en pacientes pediátricos VIH positivos con terapia antiretroviral.

BACKGROUND: Viral load in pediatric patients with HIV infections can help to make therapeutic decisions to modify the evolution of the disease. AIM: To evaluate viral load in positive HIV children with antiretroviral treatment. MATERIAL AND METHODS: Viral load was measured every six months during three years in fifty pediatric patients chosen randomly in aged 1 to 12 years, using the Test Monitor HIV-1 AMPLICOR, version 1.5. RESULTS: During the three years follow up, there was an increase in CD4 and CD8 lymphocyte count and decrease in the viral load. However, there was no significant relationship between lymphocyte subpopulation counts and viral loads. CONCLUSIONS: Viral load demonstrated to be an appropriate method to quantify plasma HIV-RNA. This tool can help to define the condition of a particular patient to predict clinical course of the disease and to assess the response to the treatment.

Carga viral en pacientes pediátricos VIH positivos con terapia antirretroviral / Viral loads in pediatric HIV patients with antirretroviral treatment

Background: Viral load in pediatric patients with HIV infections can help to make therapeutic decisions to modify the evolution of the disease. Aim: To evaluate viral load in positive HIV children with antiretroviral treatment. Material and methods: Viral load was measured every six months during three years in fifty pediatric patients chosen randomly in aged 1 to 12 years, using the Test Monitor HIV-1 AMPLICOR, versión 1.5. Results: During the three years follow up, there was an increase in CD4 and CD8 lymphocyte count and decrease in the viral load. However, there was no significant relationship between lymphocyte subpopulation counts and viral loads. Conclusions: Viral load demonstrated to be an appropriate method to quantify plasma HIV-RNA. This tool can help to define the condition of a particular patient to predict clinical course of the disease and to assess the response to the treatment.

[High prevalence of hepatitis B infection in Amerindians in Japreira, Zulia State, Venezuela]. / Alta prevalencia de la infección por el virus de hepatitis B en la comunidad indígena Japreira, Estado Zulia, Venezuela.

The aim of this study was to determine the prevalence of hepatitis B virus (HBV) infection in the Japreira indigenous community, Venezuela, and its relationship to age and gender. An intentional, non-probabilistic sample of 149 individuals was selected from a total of 300. All samples were studied for the presence of total HBV antibodies (total anti-HBc), and the positive samples were tested for HBV surface and "e" antigens (HBsAg, HBeAg). Overall prevalence rates of total anti-HBc were 72.9% in females and 81.1% in males. The highest prevalence of HBsAg was observed in males 26-35 years of age. Only four of the 44 HBsAg carriers were positive for HBeAg. The results showed a high endemic HBV infection rate and indicated that its spread begins at early ages. Sexual transmission may be the main route for spread of the virus. Crowding, close contact with bodily fluids, specific social practices, and features of the circulating viral strain among members of this community could be involved in the high chronicity observed in the Japreira indigenous community.

Alta prevalencia de la infección por el virus de hepatitis B en la comunidad indígena Japreira, Estado Zulia, Venezuela / High prevalence of hepatitis B infection in Amerindians in Japreira, Zulia State, Venezuela

A fin de conocer la prevalencia de la infección por el virus de hepatitis B (VHB) en la comunidad indígena Japreira, Venezuela, y determinar las pautas de su adquisición en función de la edad y sexo, se seleccionaron 149 individuos de un total de 300. Se detectó por métodos serológicos la presencia de anticuerpos totales del VHB (anti-HBc total), y en las positivas se investigó la presencia del antígeno de superficie (HBsAg) y del antígeno e del VHB (HBeAg). La prevalencia de anti-HBc total fue de 72,9 por ciento en el sexo femenino y 81,1 por ciento en el masculino, la prevalencia de HBsAg fue elevada (61,1 por ciento) en el sexo masculino, sólo cuatro de los portadores de HBsAg fueron positivos para HBeAg. Los resultados obtenidos indican un grado elevado de endemia para esta infección y que su diseminación comienza a temprana edad. El factor involucrado en la adquisición y diseminación del virus seria la vía sexual. Hacinamiento, contacto intercorpóreo con fluidos biológicos, prácticas sociales, y características de la cepa viral circulante podrían estar involucradas en la alta cronicidad observada en la comunidad indígena Japreira.

The aim of this study was to determine the prevalence of hepatitis B virus (HBV) infection in the Japreira indigenous community, Venezuela, and its relationship to age and gender. An intentional, non-probabilistic sample of 149 individuals was selected from a total of 300. All samples were studied for the presence of total HBV antibodies (total anti-HBc), and the positive samples were tested for HBV surface and e antigens (HBsAg, HBeAg). Overall prevalence rates of total anti-HBc were 72.9 percent in females and 81.1 percent in males. The highest prevalence of HBsAg was observed in males 26-35 years of age. Only four of the 44 HBsAg carriers were positive for HBeAg. The results showed a high endemic HBV infection rate and indicated that its spread begins at early ages. Sexual transmission may be the main route for spread of the virus. Crowding, close contact with bodily fluids, specific social practices, and features of the circulating viral strain among members of this community could be involved in the high chronicity observed in the Japreira indigenous community.

Low prevalence of hepatitis C virus infection in Amerindians from Western Venezuela.

Previous studies have not found hepatitis C virus (HCV) infection in Amerindians from Western Venezuela. A survey of 254 Bari and Yukpa natives aged 10-60 years (mean +/- SD age = 35 +/- 5.4 years) from four communities, two Bari and two Yukpa, in this area were studied to assess the prevalence of antibodies to HCV (anti-HCV) and HCV RNA among these indigenous populations. Serum samples were examined initially for anti-HCV by a four generation enzyme-linked immunosorbent assay (ELISA). Reactive samples were then tested using a third generation recombinant immunoblot assay (RIBA-3). Viral RNA was investigated in all immunoblot-reactive samples by a nested polymerase chain reaction (PCR) method. Six (2.3%) of 254 natives were positive by ELISA, one (2.2%) of these reactive samples were positive by RIBA, and four (1.5%) were indeterminate. Only two (0.8%) were positive by PCR, corresponding to 1 (2.1%) of 47 inhabitants of a Yukpa community and to 1 (2.2%) of 45 subjects of a Bari community. Iatrogenic is thought to play a role in acquisition of the infection. The findings indicate a HCV focus of low endemicity and are compatible with a low degree of exposures of the natives to the virus. Studies are necessary to assess the risk factors for infection in these Amerindians.

Low prevalence of hepatitis C virus infection in Amerindians from Western Venezuela

Previous studies have not found hepatitis C virus (HCV) infection in Amerindians from Western Venezuela. A survey of 254 Bari and Yukpa natives aged 10-60 years (mean ± SD age = 35 ± 5.4 years) from four communities, two Bari and two Yukpa, in this area were studied to assess the prevalence of antibodies to HCV (anti-HCV) and HCV RNA among these indigenous populations. Serum samples were examined initially for anti-HCV by a four generation enzyme-linked immunosorbent assay (ELISA). Reactive samples were then tested using a third generation recombinant immunoblot assay (RIBA-3). Viral RNA was investigated in all immunoblot-reactive samples by a nested polymerase chain reaction (PCR) method. Six (2.3 percent) of 254 natives were positive by ELISA, one (2.2 percent) of these reactive samples were positive by RIBA, and four (1.5 percent) were indeterminate. Only two (0.8 percent) were positive by PCR, corresponding to 1 (2.1 percent) of 47 inhabitants of a Yukpa community and to 1 (2.2 percent) of 45 subjects of a Bari community. Iatrogenic is thought to play a role in acquisition of the infection. The findings indicate a HCV focus of low endemicity and are compatible with a low degree of exposures of the natives to the virus. Studies are necessary to assess the risk factors for infection in these Amerindians.

[Immune evasion mechanisms of hepatitis C virus. Review]. / Mecanismos de evasión inmunitaria del virus de hepatitis C. Revisión.

Hepatitis Virus C (HCV) is a major worldwide health care problem. HCV infection usually tends to become chronic and can generate long-term hepatic cirrhosis and hepatocellular carcinoma. These affections frequently require a liver transplant to prolong the patients life. Maintenance of the chronic infection implies evasion of the host immune responses. Viral mechanisms involved in this evasion are being profusely studied in order to develop new and effective therapies and vaccines against HCV. An important HCV characteristic, its high genetic variability, has been proposed to contribute to immune evasion by means of antigenic change and variation. On the other hand, some studies suggest that genetic variability is not necessary to establish a chronic infection. Other studies related to immune responses in patients with spontaneous virus clearance and patients with chronic infection show a possible immunosuppression caused by some viral proteins, that may be essential to persist in the host. Specifically, it is believed that viral proteins NS5A, E2 and Core modulate some innate and specific immune mechanisms. The analysis of all data related to this topic suggests the existence of synergistic cooperation between viral variation and immunosuppression to overcome the immune defenses of the host.

Microsporidiosis in Venezuela: prevalence of intestinal microsporidiosis and its contribution to diarrhea in a group of human immunodeficiency virus-infected patients from Zulia State.

Microsporidia are recognized as a cause of morbidity among patients infected with the human immunodeficiency virus (HIV). Infection rates for intestinal microsporidiosis in HIV-infected patients from Venezuela are unknown. To determine the prevalence and pathogenic role of microsporidia in these patients in northwestern Venezuela, a case control study was conducted in 103 outpatients (mean +/- SD age = 37.3 +/- 5.6 years). Microsporidia were detected using unconcentrated formalin-fixed stools examined by Weber's chromotrope-based staining method. For identification of coccidia, modified Ziehl-Neelsen carbolfuchsin staining of formalin-ether concentrates were used, and for other pathogenic parasites, iron hematoxylin-stained smears and formalin-ether concentrates were examined. Microsporidial infections were detected in 14 (13.6%) of 103 patients and 39 (37.9%) had other parasitic pathogens. No significant difference was noted in the occurrence of the infection in patients with diarrhea (13 of 74, 17.6%) and controls (1 of 29, 3.4%) (P = 0.118). Nevertheless, this result may be due to the small sample size (n = 14) of infected individuals. The proportions of other pathogens in patients with or without diarrhea were not significantly different (P = 0.828). Microsporidiosis is common among the HIV-infected population in northwestern Venezuela. However, its pathogenic role in these patients is uncertain and warrants further investigation.

Mecanismos de evasión inmunitaria del virus de hepatitis C: revisión / Inmune evasion mechanisms of hepatitis C virus: review

El virus de Hepatitis C (VHC) constituye un problema de salud pública mundial. La mayoría de las infecciones se tornan crónicas, ocasionando con frecuencia cirrosis hepática y carcinoma hepatocelular a largo plazo, precisándose no pocas veces de transplantes hepáticos para prolongar la vida del individuo. El mantenimiento de una infección crónica implica la evasión al sistema inmunitario del hospedero. Los mecanismos virales involucrados en dicha evasión están siendo estudiados arduamente con el fin de desarrollar nuevas terapias preventivas y curativas efectivas contra el virus. Una característica importante, la extrema variabilidad genética del virus, se cree que contribuya al escape inmunitario al cambiar continuamente los epítopos expuestos a la detección; sin embargo, algunos trabajos sugieren que no es necesaria para el establecimiento de la cronicidad de la infección. Por otra parte, el estudio comparativo de la respuesta inmunitaria de los pacientes que se recuperan espontáneamente con la de aquellos infectados de manera crónica, señala que algunas proteínas virales podrían inducir cierta inmunosupresión indispensable para la persistencia en el hospedero. Concretamente, se cree que las proteínas NS5A, E2 y core modulan ciertos mecanismos de las respuestas innata y específica. El análisis de los hallazgos relacionados con el tópico permite sugerir la existencia de una sinergia entre la variación genética y la inmunosupresión para evadir de manera continua la detección y destrucción por parte del sistema de defensas del individuo

[Hepatitis C virus. Iatrogenic and nosocomial transmition?]. / Virus de hepatitis C. Transmisión iatrogénica y nosocomial?

The hepatitis C virus (HCV) infection constitutes an important, worldwide public health problem. Studies about the prevalence of HCV antibodies among surgical patients are few, and the involvement of surgery in the iatrogenic transmission of HCV remains a matter of controversy. Blood transfusions and other medical acts, have contributed to the spreading of HCV among the population. However, some HCV patients do not have antecedents of transfusions which suggest other mechanisms of transmission such as surgical acts, that continue facilitating the viral transmission. Some studies find an association between previous hospitalizations and the HCV infection, others report that such association does not exist. Several investigations suggest that the HCV infection risk does not reside in the surgery, but in the use of multidose containers, anesthetic products, saline solution, etc., administered during surgery. In Venezuela, the HCV overall prevalence is 1%. However, in poli-transfused, hemodialized or surgical patients is 10-22%. The studies carried out in surgery units, support the idea that surgical acts are not involved in the HCV spreading, although they can be responsible for this transmission in specific occasions. The HCV transmission due to surgical acts can happen in particular contexts of the sanitary environment and the study of this relationship is essential to adopt preventive measures that can help to eradicate or decrease this problem.