Resistencia antimicrobiana y factores de virulencia en aislados de Vibrio cholerae O1. Cuba, 2012-2015 / Antimicrobial resistance and virulence factors in Vibrio cholerae O1 isolates. Cuba, 2012-2015

Introducción: El cólera es una infección intestinal aguda causada por cepas toxigénicas de Vibrio choleare. La rápida diseminación y emergencia de la multirresistencia que caracteriza a este patógeno, podría interferir en el éxito de la terapia antimicrobiana, por lo que constituye una prioridad monitorear los cambios en los patrones de susceptibilidad, como parte trascendental de la política de control de la resistencia antimicrobiana. Objetivo: Determinar el comportamiento de la resistencia antimicrobiana frente a los antimicrobianos de interés empleados en el tratamiento, la presencia de factores de virulencia enzimáticos y si existe relación entre ambos. Métodos: Se realizó un estudio descriptivo de corte transversal durante julio de 2012 a diciembre de 2015. Se estudiaron 500 aislamientos pertenecientes al cepario del Laboratorio Nacional de Referencia de Enfermedades Diarreicas Agudas del Instituto de Medicina Tropical Pedro Kourí, procedentes de brotes de enfermedades diarreicas agudas de la red nacional de laboratorios de Microbiología de Cuba. Se aplicaron métodos convencionales fenotípicos para determinar el comportamiento de la resistencia antimicrobiana, la presencia de factores enzimáticos y la relación de estos con la resistencia antimicrobiana. Resultados: Los mayores porcentajes de sensibilidad se obtuvieron frente a azitromicina (98 por ciento), doxiciclina (96 por ciento) y ciprofloxacina (93 por ciento) y de resistencia frente a ampicilina (100 por ciento) y trimetoprim-sulfametoxazol (99,4 por ciento). Se encontraron 44 aislados (8,8 por ciento) multirresistente. Todos los aislamientos poseían al menos dos enzimas extracelulares como factores de virulencia, las más frecuentes: gelatinasa (96 por ciento) y lecitinasa (95 por ciento). Conclusiones: Se evidencia una relación directa y proporcional entre la presencia de los factores de virulencia y resistencia antimicrobiana, sinergismo que surgiere mayor patogenicidad de los aislados estudiados procedentes de brotes epidémicos(AU)

Introduction: Cholera is an acute intestinal infection caused by toxigenic strains of Vibrio choleare. The rapid dissemination and emergence of the multiresistance that characterizes this pathogen could interfere with the success of antimicrobial therapy, so it is a priority to monitor changes in susceptibility patterns, as a transcendental part of the resistance control policy antimicrobial. Objective: To determine the behavior of antimicrobial resistance against the antimicrobials of interest used in the treatment, the presence of enzymatic virulence factors and whether there is a relationship between them. Methods: A descriptive cross-sectional study was conducted during July 2012 to December 2015. Where 500 isolates belonging to the cepary of the National Reference Laboratory for Acute Diarrheal Diseases of the Institute of Tropical Medicine Pedro Kourí, from outbreaks of EDA of the national network of Microbiology laboratories in Cuba. Conventional phenotypic methods were applied to determine the behavior of antimicrobial resistance, the presence of enzymatic factors and their relationship with antimicrobial resistance. Results: The highest percentages of sensitivity were obtained against azithromycin (98 percent), doxycycline (96 percent) and ciprofloxacin (93 percent) and resistance to ampicillin (100 percent) and trimethoprim-sulfamethoxazole (99.4 percent). 44 isolated (8.8 percent) multi-resistant were found. All isolates had at least two extracellular enzymes as virulence factors, the most frequent: gelatinase (96 percent) and lecithinase (95 percent). Conclusions: There is a direct and proportional relationship between the presence of virulence factors and antimicrobial resistance, synergism that arises greater pathogenicity of the isolates studied from epidemic outbreaks(AU)

Infección por Angiostrongylus cantonensis (Nematoda: Metastrongylidae) en Rattus rattus (Rodentia: Muridae) en una localidad de La Habana, Cuba / Infection by Angiostrongylus cantonensis (Nematoda: Metastrongylidae) in Rattus rattus (Rodentia: Muridae) in a locality of Havana, Cuba

Introducción: La meningoencefalitis eosinofílica producida por Angiostrongylus cantonensis (Chen, 1935), es una zoonosis emergente presente en Cuba. En el país existen escasos estudios de prevalencia de infección en los hospederos definitivos, que puedan determinar sitios de riesgo para el establecimiento de medidas efectivas en la prevención de la enfermedad. Objetivo: Determinar la prevalencia de infección por A. cantonensis en una población natural de R. rattus, su relación con la estructura poblacional y la época del año en una finca que pertenece al Programa de la Agricultura Urbana y Suburbana de Cuba. Material y Métodos: Se realizó un estudio descriptivo en el municipio La Lisa, La Habana. Se hicieron capturas de roedores mensuales durante los períodos lluvioso y poco lluvioso. Se examinaron las arterias pulmonares de los roedores capturados en búsqueda de parásitos adultos. El índice parasitológico de prevalencia fue calculado y comparadas las frecuencias entre los períodos del año y la edad ecológica. Resultados: Se capturaron 63 roedores identificados como Rattus rattus, de ellos 46,03 por ciento estuvo infectado con A. cantonensis, con un incremento de la infección en los individuos adultos (59,46 por ciento) y en el período lluvioso (55,88 por ciento). Conclusiones: Se demuestra por primera vez en Cuba la infección de A. cantonensis en R. rattus. La presencia de individuos adultos, la alta abundancia de roedores y la temporada lluviosa son los factores que incidieron en una mayor infección de A. cantonensis, y que aumentan la probabilidad de transmisión a los hospederos intermediarios y, por ende, el riesgo de transmisión al humano(AU)

Introduction: Eosinophilic meningitis caused by Angiostrongylus cantonensis (Chen, 1935) is an emergent zoonosis present in Cuba. In the country, few studies about the prevalence of infection in definitive hosts, which can determine risk sites for the establishment of effective measures to prevent the disease, have not been carried out so far. Objective: To determine the prevalence of infection with Angiostrongylus cantonensis in a natural population of Rattus rattus, its relationship with the population structure, and the season of the year in an urban farm field belonging to the Programme of Urban and Suburban Agriculture of Cuba. Material and Methods: A descriptive study was conducted in La Lisa Municipality, Havana, Cuba. The rats were collected monthly during the rainy and dry seasons. The pulmonary arteries of the captured rodents were examined for adult worms. The prevalence of parasitological indices was calculated. The frequencies of infection were compared between the seasons of the year and ecological ages. Results: A total of 63 rodents identified as Rattus rattus were captured. Of the total of individuals captured, 46.03 percent were infected with A. cantonensis, with an increase of infection in adult individuals (59.46 percent) and during the rainy season (55.88 percent). Conclusions: The infection of A. cantonensis in its definitive host R. rattus, and its circulation in the study area in the analyzed period was demonstrated for the first time in Cuba. The presence of adult rats, the high quantity of rodents and the rainy season were the factors that contributed to a greater infection of A. cantonensis, which increase the probability of transmission to intermediate hosts, and consequently, the risk of transmission to humans(AU)

Prevalence of Giardiaduodenalis among children from a central region of Cuba: molecular characterization and associated risk factors.

Giardia duodenalis is one of the most frequent intestinal parasitic infections in children worldwide. To date, eight main assemblages of G. duodenalis have been described, but only A and B genetic groups are known to infect humans. A cross-sectional study was conducted to determine the prevalence and risk factors of Giardia duodenalis infection in 417 preschool children from the Fomento municipality in the central region of Cuba between January and June 2013. The overall prevalence of Giardia infection was 10.79 %. Assemblage identification was carried out by the amplification of a fragment of the triose phosphate isomerase (tpi) gene. DNA from 36 of 45 (80 %) samples was successfully amplified by PCR-tpi. Assemblage B and mixed assemblages A + B represented 52.78 and 36.11 % respectively, of genotyped samples. Assemblage A accounts for only 11.11 %. Children who were cared for at home were associated with diarrhea caused by assemblage B. No associations were found between other clinical variables with infecting assemblage of Giardia. Univariate analysis identified the use of unsafe water resources (OR 2.9; CI 1.2-6.8) and-even more interestingly-keeping dogs indoor (OR 2.5; CI 1.2-5.4) were significant risk factors associated with Giardia infection among children. Multivariate analysis using introduction test logistic regression ratified the association of these two risk factors: kept dogs indoor (OR 2.8, CI 1.1-5.3), and untreated water (OR 1.4, CI 1.4-4.9) with Giardia infection. This information may be useful for an effective prevention and control programme of giardiasis in this population.

Molecular analysis of Giardia duodenalis isolates from symptomatic and asymptomatic children from La Habana, Cuba.

Giardiasis is considered the most common intestinal parasitic disease in humans worldwide. In Cuba, this infection has particularly a strong clinical impact on the child population. Giardia duodenalis is a highly diverse protozoan, which comprises a complex of eight morphologically identical genetic assemblages, further divided into sub-assemblages. The present study used triose phosphate isomerase (tpi) and small-subunit ribosomal RNA (SSU rRNA) genes as genetic markers for the identification of G. duodenalis assemblages and sub-assemblages in correlation with clinical and epidemiological data in children attended at the Paediatric Hospital "William Soler" and at Pedro Kouri Institute, between 2015 and 2016. A prevalence of 8% of G. duodenalis infection was recorded in stool samples after concentration techniques from 68 children out of 847 analysed. A 100% detection of Giardia DNA was achieved by a SSU-rRNA PCR, whereas DNA from 63 of 68 (92.6%) was successfully amplified by tpi-PCR. By this assemblage-specific tpi-PCR 32 (50.8%) assemblage B, 17 (27.0%) assemblage A and 14 (22.2%) mixed infection (A + B) were identified. Assemblage B was significantly (P < 0.02) more frequently found in children with diarrhoea. Sequence analysis of the tpi gene of Giardia isolates from symptomatic children showed that assemblage A belonged to the sub-assemblage AII, and 4 sub assemblages BIV and 1 sub assemblage BIII were also recorded. Only 2 discordant genotyping results were observed by phylogenetic comparison of SSU-rRNA and tpi sequences. Further studies with novel molecular tools for a better discrimination at the sub-assemblage level are needed to identify the dynamics of spread of giardiasis and to verify possible correlations between Giardia genetic diversity and clinical manifestation.

Prevalence of intestinal parasites and molecular characterization of Giardia duodenalis from dogs in La Habana, Cuba.

Giardia duodenalis is a worldwide protozoan parasite that infects humans and other mammals including dogs. Due to the risk of zoonotic transmission between dogs and humans, we aimed in this study to determine the prevalence of the intestinal parasites and the distribution of assemblages of G. duodenalis among dogs analysed. A descriptive cross-sectional study was carried out in La Habana from June 2014 to March 2015 in the Zoonosis Unit of La Lisa municipality. A total of 98 dogs were analysed by three different techniques (microscopy with faecal concentration, Enzyme-Linked ImmunoSorbent Assay, and Polymerase Chain Reaction) in order to detect Giardia in stool samples. Out of 98 dogs studied, 43 (43.9%) were infected with intestinal parasites. The zoonotic parasites Ancylostoma caninum (21.4%), Trichuris vulpis (16.3%) and the protozoan Giardia duodenalis (11.2%) were the most prevalent parasites. In regards to the G. duodenalis, seven dogs were positive by microscopy after faecal concentration, nine by NOVITEC® Giardia Microplate Assay, and ten and eleven samples were amplified by the ß-giardin and SSU-RNA PCRs, respectively. After PCR sequence analysis of both genes only zoonotic assemblages (A and B) were detected. The SSU-RNA sequence results revealed a distribution of 8 assemblage A and 4 assemblage B, whereas only assemblage A were identified by the ß-giardin analysis. Among subassemblage classification by ß-giardin phylogenetic tree, four isolates showed an AI pattern and one isolate displayed an AII distribution. Mixed infections were detected in three isolates. These findings highlight the risk of zoonotic transmission of Giardia duodenalis between dogs and humans.

Low prevalence of Vibrio cholerae O1 versus moderate prevalence of intestinal parasites in food-handlers working with health care personnel in Haiti.

Food-handlers with poor personal hygiene working in food-service establishments could be potential sources of infection due to pathogenic organisms. In May 2011, a cross-sectional study was undertaken to determine the prevalence of bacteria and intestinal parasites among food-handlers working with Cuban health personnel in Haiti. Stool specimens were collected from 56 food-handlers and samples were examined using standard procedures. Of the food handlers, 26.8% had one bacterial or intestinal parasite. The most prevalent species of organism found were Blastocystis spp. (9%), followed by Vibrio cholerae O1 serotype Ogawa, Aeromonas spp. and Giardia intestinalis, each one with 4%. The prevalence of intestinal parasites was 19.7%. Five out of 56 food handlers had diarrhea at the time the study was conducted. It was found that there was a lower prevalence of V. cholerae O1 serotype Ogawa in comparison to intestinal parasites. The study highlights the importance of the precautions that must be taken in cholera-affected countries by medical teams and their organizations, with emphasis on the preparation, processing, and serving of meals. The recommendation is to intensify continuing education programs, periodical laboratory examinations to detect carriers and food-handlers reporting sick, and to observe strict adherence to hygienic food-handling practices. In addition, food handlers with diarrhea should refrain from preparation or delivery of food.

Molecular Characterization and Risk Factors of Giardia duodenalis among School Children from La Habana, Cuba.

Giardia duodenalis is considered the most common protozoan infecting humans worldwide. Molecular characterization of G. duodenalis isolates has revealed the existence of eight groups (assemblages A to H) which differ in their host distribution. A cross-sectional study was conducted in 639 children from La Habana between January and December 2013. Two assemblage-specific PCRs were carried out for the molecular characterization. The overall prevalence of Giardia infection was 11.9%. DNA from 63 of 76 (82.9%) samples was successfully amplified by PCR-tpi, while 58 from 76 (76.3%) were detected by PCRE1-HF. Similar results by both PCRs were obtained in 54 from 76 samples (71%). According to these analyses, assemblage B and mixed assemblages A + B account for most of the Giardia infections in the cohort of children tested. Our current study identified assemblage B as predominant genotype in children infected with Giardia. Univariate analysis indicated that omission of washing hands before eating and keeping dogs at home were significant risk factors for a Giardia infection. In the future, novel molecular tools for a better discrimination of assemblages at the subassemblages level are needed to verify possible correlations between Giardia genotypes and symptomatology of giardiasis.

Impact of periodic selective mebendazole treatment on soil-transmitted helminth infections in Cuban schoolchildren.

OBJECTIVE: To evaluate the impact of periodic selective treatment with 500 mg mebendazole on soil-transmitted helminth (STH) infections in Cuban schoolchildren. METHODS: We followed up a cohort of 268 STH-positive schoolchildren, aged 5-14 years at baseline, at six-month intervals for two years and a final follow-up after three years. Kato-Katz stool examination was used to detect infections with Ascaris lumbricoides, Trichuris trichiura and hookworm. Common risk factors related to STHs were assessed by parental questionnaire. RESULTS: A significant reduction in the number of STH infections was obtained after three years with the highest reduction for T. trichiura (87.8%) and the lowest for hookworm (57.9%). After six months, cure rates (CRs) were 76.9% for A. lumbricoides, 67.4% for T. trichiura and 44.4% for hookworm. After two treatment rounds, more than 75% of all STH-positive children at baseline were cured, but with important differences between STH species (95.2% for A. lumbricoides, 80.5% for T. trichiura and 76.5% for hookworm). At the end of the study, these cumulative CRs were almost 100% for all three STHs. Risk factors for STHs were sex, sanitary disposal and habit of playing in the soil. CONCLUSIONS: Our results indicate that periodic selective treatment with 500 mg mebendazole is effective in reducing the number of STH infections in Cuban schoolchildren. Although important differences were found between helminth species, two rounds of treatment appeared sufficient to obtain substantial reductions.

Correlation of Giardia duodenalis assemblages with clinical and epidemiological data in Cuban children.

Giardia duodenalis is one of the most frequent intestinal parasitic infections in children worldwide. To date, eight main assemblages of G. duodenalis have been described, but only A and B genetic groups are known to infect humans. In Cuba, this parasite has most clinical impact on children. The aim of this investigation was genetic characterization of G. duodenalis isolated from children with giardiasis diagnosed at the Paediatric Hospital "William Soler" between 2010 and 2011, and to compare the genetic results with clinical and epidemiological data. A total of 103 stool samples from 452 children were positive for G. duodenalis and co-infections with other parasites were noted in 5 cases. Assemblage identification was carried out by the amplification of a fragment of the triosephosphate isomerase (tpi) gene. Sub-assemblages of assemblage A (AI and AII) were identified by a nested PCR using the intergenic spacer (IGS) region of ribosomal deoxyribonucleic acid gene as a target. DNA from 90 of 103 (87.4%) samples was successfully amplified by PCR-tpi. The prevalence of assemblages A and B was 40% and 42%, respectively. Infections with both assemblages were reported in 16 cases. No associations between epidemiological information and assemblage was detected, but assemblage B was significantly (P<0.01) more frequently found in children with diarrhea, flatulence or abdominal pain than assemblage A. Sub-assemblage AII accounted for the majority of cases (86.5%).

Parasitosis intestinales en niños hospitalizados: distribución por edad y aspectos clínicos / Intestinal parasites in hospitalized children: age distribution and clinical aspects

Objetivo: Estimar la prevalencia de enteroparásitos y su comportamiento por edades en niños ingresados durante un periodo de cinco meses (enero-mayo) en el hospital Pediátrico Universitario del Cerro, en La Habana, Cuba. Métodos: Se realizó un estudio observacional descriptivo de corte transversal en el que se recogieron tres muestras de heces para exámenes coproparasitológicos y datos de interés clínico y epidemiológico por cuestionarios. Resultados: Giardia lamblia fue el protozoo más frecuente (31,7%), especialmente en los servicios de Gastroenterología (p0,05). Conclusiones: Se recomienda la búsqueda sistemática de estos agentes parasitarios en los niños ingresados con diarreas, para un mejor conocimiento de las enteroparasitosis en la población pediátrica, y la implementación oportuna de medidas de control.

Objective: To estimate the prevalence of intestinal parasitic infections and their behavior according to age. Methods: Adescriptive cross sectional survey was carried out in admitted patients and three faecal samples were collected for each child and were examined by parasitological techniques. Clinical and epidemiological data were too collected with questionnaires. Results: Giardia lamblia was the most frequent parasite isolated (31,7%), in special in diarrhea wards (p<0.05). Parasitic and commensal infections increased with age (p<0.01); and children aged more than five years showed the higher percentages (45,6%) (p<0.01). G. lamblia and Blastocystis spp. were found with a major frequency in preschool and school children; while Cryptosporidium spp. was found only in preschoolers. Abdominal pain was found in higher frequency in children infected with parasites (p<0,01), followed by anal itching, antecedents of shedding parasites (p<0,01), and anorexia (p<0,05). No statistical differences were found with the rest of symptoms. Conclusions: The systematic searching of these parasitic agents is recommended in children admitted with diarrhea, and this action would increase the knowledge of parasitic infections in our pediatric population and the implementation of opportune measures for the control.

[Clinical features of giardiasis in different age groups of pediatric in-patients]. / Variaciones en las manifestaciones clínicas de la giardiosis en pacientes pediátricos hospitalizados, según grupos de edades.

INTRODUCTION: It has been suggested that the clinical features of giardiasis might vary in patients of different age groups. OBJECTIVE: To compare clinical presentation of giardiasis in children less than 5 years of age and older children. METHODS: A retrospective study of patients hospitalized with giardiasis during 2007 was performed. The clinical features of the two age groups were compared. Additionally, length of stay was analyzed. RESULTS: In total, 170 patients were included. In children ≥ 5 years of age, abdominal pain and urticaria were significantly more frequent (OR=9.46; 95%CI: 4.35-20.52,P5=0.000+ and OR=11.0; 95%CI: 1.205-101.11, P=0.023, respectively). Diarrhoea was more frequently found in children younger than 5 years (OR=6.45; IC 95%: 3. 12-13.37, P=0.000+). The frequencies of other symptoms were similar. Length of stay was significantly higher in children under 5 years of age. DISCUSSION AND CONCLUSIONS: Clinical presentations differed in some aspects among the examined age group of our paediatric patients. Our finding might be of importance for an early recognition of giardiasis, which is essential for an accurate diagnosis and a prompt treatment.

Variaciones en las manifestaciones clínicas de la giardiosis en pacientes pediátricos hospitalizados, según grupos de edades / Clinical features of giardiasis in different age groups of pediatric in-patients

It has been suggested that the clinical features of giardiasis might vary in patients of different age groups. Objective: To compare clinical presentation of giardiasis in children less than 5 years of age and older children. Methods: A retrospective study of patients hospitalized with giardiasis during 2007 was performed. The clinical features of the two age groups were compared. Additionally, length of stay was analyzed. Results: In total, 170 patients were included. In children ≥ 5 years of age, abdominal pain and urticaria were significantly more frequent (OR=9.46; 95%CI: 4.35-20.52,P5=0.000+ and OR=11.0; 95%CI: 1.205-101.11, P=0.023, respectively). Diarrhoea was more frequently found in children younger than 5 years (OR=6.45; IC 95%: 3. 12-13.37, P=0.000+). The frequencies of other symptoms were similar. Length of stay was significantly higher in children under 5 years of age. Discussion and conclusions: Clinical presentations differed in some aspects among the examined age group of our paediatric patients. Our finding might be of importance for an early recognition of giardiasis, which is essential for an accurate diagnosis and a prompt treatment.

La giardiosis es una enfermedad frecuente a escala internacional. Se ha sugerido por algunos autores que su presentación clínica puede variar con la edad. Objetivo: Comparar las manifestaciones clínicas de la giardiosis en los niños hospitalizados bajo 5 años de edad con las de niños de 5 años o más. Métodos: Estudio retrospectivo realizado en el Hospital Pediátrico de Centro Habana durante el año 2007. Las manifestaciones clínicas fueron extraídas utilizando un formulario prediseñado y separadas de acuerdo a los grupos de edades estudiados. Adicionalmente, se extrajo la estadía hospitalaria. Resultados: Se incluyeron 170 pacientes. Los niños de 5 y más años de edad manifestaron con mayor frecuencia dolor abdominal (OR = 9,46; IC 95%: 4,35-20,52, p = 0,000+) y urticaria (OR = 11,0; IC 95%: 1,205-101,11, p = 0,023), mientras que la diarrea se encontró más frecuentemente bajo 5 años de edad (OR = 6,45; IC 95%: 3,12-13,37, p = 0,000+). En el resto de las manifestaciones clínicas no se encontraron diferencias significativas en sus frecuencias entre ambos grupos de edades (p > 0,05). La estadía hospitalaria fue significativamente más prolongada entre los pacientes bajo 5 años de edad. Discusión y conclusiones: Las manifestaciones clínicas pueden variar en algunos aspectos entre los diferentes grupos de edades pediátricas. Su rápido reconocimiento es esencial con el fin de arribar a un diagnóstico preciso y al tratamiento oportuno.

Abdominal pain and asthenia as common clinical features in hospitalized children for giardiasis.

Giardiasis is a disease with worldwide distribution, although its prevalence differs from country to country. In order to investigate the clinical pattern of giardiasis in in-patient children, a case-control study was carried out. In-patient children who had Giardia lamblia infection were compared with non Giardia-infected children, focusing only on 4 clinical manifestations: diarrhoea, abdominal pain, asthenia and vomiting. In multivariable analysis, abdominal pain (odds ratio [OR] 4.71, 95% confidence intervals [CI] 2.66-8.32) and asthenia (OR 3.30, 95% CI 1.16-9.37) had positive and independent associations with Giardia infection. The present study supports the potential role of G. lamblia in abdominal pain in children who attend- and are admitted- to a hospital in Havana City, and highlights the importance to keep abdominal pain and asthenia in mind in hospital admitted children in the event of an association with an evocative epidemiological context.

[Aeromonas spp asociated to acute diarrheic disease in Cuba: case-control study]. / Aeromonas spp asociada a enfermedad diarreica aguda en Cuba: estudios de casos y controles.

The members of the genus Aeromonas are currently considered important gastrointestinal pathogens in different geographical areas. From February 1985 to January 2005 several case-control studies were coordinated by the National Reference Laboratory for Diarrheal Diseases from the Pedro Kouri Institute. The study purpose was to analyze a possible pathogenic role for Aeromonas spp in Cuban children with acute diarrhea. In that period 2,322 children less than 5 years old with acute diarrhea were studied for diarhoeal pathogens and another group of 2,072 non hospitalized children without diarrhea during the similar time from the same geographical areas and matched by ages were recruited. In the group of children with diarrheas (cases), Aeromonas spp. was isolated in 166 (7.15%) and in the control group the microorganism was found in only 35 (1.76%). When Aeromonas isolation rates were compared between both groups, we found that probability to isolate this specie was significantly higher in cases than in controls (OR = 4.48, 95% IC: 3.05-6.60; P < 0.001). The Aeromonas species more frequently isolated were A. caviae, A. hydrophila, and A. veronii bv sobria. Other enteric pathogens detected in children with diarrhea were: Shigella spp in 418 (18%) (P < 0.0001), Salmonella spp in 53 (2.3%) (P < 0.01), and enteropathogenic E. coli in 58 (2.49%) (P < 0.05).

Toxocariasis in Cuba: a literature review.

Human toxocariasis (HT) is a zoonotic disease caused by infection with the larval stage of Toxocara canis, the intestinal roundworm of dogs. Infection can be associated with a wide clinical spectrum varying from asymptomatic to severe organ injury. While the incidence of symptomatic human toxocariasis appears to be low, infection of the human population is widespread. In Cuba, a clear overview on the status of the disease is lacking. Here, we review the available information on toxocariasis in Cuba as a first step to estimate the importance of the disease in the country. Findings are discussed and put in a broader perspective. Data gaps are identified and suggestions on how to address these are presented. The available country data suggest that Toxocara infection of the definitive dog host and environmental contamination with Toxocara spp. eggs is substantial, but information on HT is less conclusive. The availability of adequate diagnostic tools in the country should be guaranteed. Dedicated studies are needed for a reliable assessment of the impact of toxocariasis in Cuba and the design of prevention or control strategies.

Aeromonas spp asociada a enfermedad diarreica aguda en Cuba: estudios de casos y controles / Aeromonas spp asociated to acute diarrheic disease in Cuba: case-control study

The members of the genus Aeromonas are currently considered important gastrointestinal pathogens in different geographical areas. From February 1985 to January 2005 several case-control studies were coordinated by the National Reference Laboratory for Diarrheal Diseases from the Pedro Kouri Institute. The study purpose was to analyze a possible pathogenic role for Aeromonas spp in Cuban children with acute diarrhea. In that period 2,322 children less than 5 years old with acute diarrhea were studied for diarhoeal pathogens and another group of 2,072 non hospitalized children without diarrhea during the similar time from the same geographical areas and matched by ages were recruited. In the group of children with diarrheas (cases), Aeromonas spp. was isolated in 166 (7.15%) and in the control group the microorganism was found in only 35 (1.76%). When Aeromonas isolation rates were compared between both groups, we found that probability to isolate this specie was significantly higher in cases than in controls (OR = 4.48, 95% IC: 3.05-6.60; P < 0.001). The Aeromonas species more frequently isolated were A. caviae, A. hydrophila, and A. veronii bv sobria. Other enteric pathogens detected in children with diarrhea were: Shigella spp in 418 (18%) (P < 0.0001), Salmonella spp in 53 (2.3%) (P < 0.01), and enteropathogenic E. coli in 58 (2.49%) (P < 0.05).

Los miembros del género Aeromonas son considerados patógenos importantes del tracto gastrointestinal en diferentes áreas geográficas. De febrero de 1985 a enero de 2005 se realizaron estudios de casos y controles en el Laboratorio Nacional de Referencia de Enfermedades Diarreicas Agudas del Instituto Pedro Kourí con el objetivo de conocer el comportamiento de los microorganismos pertenecientes al género Aeromonas en niños con diarreas en Cuba. La muestra estuvo constituida por 2.322 niños bajo 5 años de edad, ingresados por enfermedad diarreica aguda y como grupo control se estudió un total de 2.072 niños con edades y áreas geográficas similares que acudieron a los hospitales correspondientes en ese mismo período de tiempo. En el grupo de niños que presentaron diarreas, Aeromonas spp fue aislada en 166 (7,15%), y en los controles fue encontrada en 35 (1,76%). Al comparar la positividad para Aeromonas entre ambos grupos, la probabilidad de diagnosticar este microorganismo fue 4,28 veces mayor en los casos que en los controles (OR = 4,28; IC al 95%: 2,96-6,20; P < 0,001). Las especies más frecuentemente aisladas fueron A. caviae, A. hydrophila, y A. veronii bv sobria. Otros enteropatógenos aislados en niños que presentaban diarrea fueron: Shigella spp. en 418 (18%) (P < 0,0001, Salmonella spp en 53 (2,3%) (P < 0,01),) y E. coli enteropatógena en 58 (2,49%) (P < 0,05).

[Phenotypic characteristics and virulence factors in Aeromonas strains isolated from patients with diarrheic disease in Cuba]. / Caracterización fenotípica y factores de virulencia en cepas de Aeromonas aisladas de pacientes con enfermedad diarreica aguda en Cuba.

Fifty four strains of Aeromonas spp were isolated from patients with acute diarrheic episodes by using Aerokey II and Aeroesquema methods. In vitro antimicrobial susceptibility and virulence factors were analyzed. The most frequently isolated specie was Aeromonas caviae. Over 75% of strains exhibited resistance to penicillins and ce-phalosporins; for the other antibiotic groups resistance was under 20%. Twenty six strains (48.1 %) were multiresist-ant. At least one virulence factor among those evaluated in the study was present in 53 (98.1%) of the 54 strains.

Caracterización fenotípica y factores de virulencia en cepas de Aeromonas aisladas de pacientes con enfermedad diarreica aguda en Cuba / Phenotypic characteristics and virulence factors in Aeromonas strains isolated from patients with diarrheic disease in Cuba

Fifty four strains of Aeromonas spp were isolated from patients with acute diarrheic episodes by using Aerokey II and Aeroesquema methods. In vitro antimicrobial susceptibility and virulence factors were analyzed. The most frequently isolated specie was Aeromonas caviae. Over 75 percent of strains exhibited resistance to penicillins and ce-phalosporins; for the other antibiotic groups resistance was under 20 percent. Twenty six strains (48.1 percent) were multiresist-ant. At least one virulence factor among those evaluated in the study was present in 53 (98.1 percent) of the 54 strains.

Se identificaron 54 cepas de Aeromonas aisladas de pacientes con enfermedad diarreica aguda mediante los métodos Aerokey II y Aeroesquema. Se determinó la susceptibilidad antimicrobiana y algunos factores de virulencia. La especie encontrada en mayor frecuencia fue Aeromonas caviae. Se observaron valores de resistencia por sobre 75 por ciento para penicilinas y cefalotina; para el resto de los antimicrobianos estos valores se encontraron bajo 20 por ciento>; 26 cepas (48,1 por ciento) presentaron multi-resistencia. Al menos un factor de virulencia de los investigados estuvo presente en 53 (98,1 por ciento) de las 54 cepas analizadas.

Caracterización microbiológica de cepas de Vibrio cholerae no-O1 aisladas en Cuba / Microbiological characterization of non-01 Vibrio cholerae isolated in Cuba

Se estudiaron 422 cepas de Vibrio cholerae no-O1 procedentes de 9 provincias del país, de ellas 9 aisladas de un brote de enfermedad de transmisión hídrica. En la totalidad de las cepas se determinó la susceptibilidad antimicrobiana y la presencia de factores de virulencia. En las 9 cepas procedentes del brote, se realizó además, el estudio de macrorrestricción de ADN mediante la técnica de electroforesis de campo pulsado. Se demostró por primera vez en Cuba y el Caribe, la circulación de cepas de V. cholerae no-O1 atípicas (resistentes al compuesto vibriostático O129 y al trimetoprim-sulfametoxazol). El comportamiento de la susceptibilidad antimicrobiana demostró por primera vez la circulación en Cuba de 2 patrones diferentes de resistencia (ampicilina, trimetoprim/sulfametoxazol, sulfonamida y tetraciclina, trimetoprim/sulfametoxazol, sulfonamida). La frecuencia de cepas resistentes al trimetoprim-sulfametoxazol se mantuvo similar en todo el período de estudio. Sin embargo, se produjo un decrecimiento de la resistencia a la ampicilina y un aumento de la resistencia a la tetraciclina. Los principales factores de virulencia que se encontraron fueron la gelatinasa, la hemolisina, la elastasa y la adherencia a células HEp-2. Sin embargo, las cepas del brote mostraron mayores porcentajes que el resto, para la presencia de la toxina termoestable y la presencia de fimbrias. Los resultados de los estudios molecular y epidemiológico permitieron dar una respuesta acelerada y precisa sobre la etiología del primer brote de enfermedad de transmisión alimentaria.

The study of 422 non-01 Vibrio cholerae strains from nine provinces, 9 of them isolated from a water-borne disease outbreak, was performed. All the strains exhibited antimicrobial susceptibility and virulence factors. The nine strains from the outbreak were subjected to a DNA macrorestriction study based on the pulsed field electrophoresis technique. For the first time in Cuba and the Caribbean, the circulation of atypical non-01 V. Cholerae strains (resistent to vibriostatic compound 0129 and trimethoprim/sulfamethoxazole). The behavior of antimicrobial susceptibility evinced for the first time the circulation of two different resistence patterns in Cuba (ampicilline, trimethoprim/sulfamethoxazole, sulfonamide and tetracycline, trimethoprim/sulfamethoxazole, sulfonamide). The frequency of trimethoprim/sulfamethoxazole-resistent strains was similar during the whole period of study. However, resistance to ampicilline decreased whereas resistance to tetracycline increased. The main found virulence factors were gelatinase, hemolysine, elastase and adherence to Hep-2 cells. On the other hand, the outbreak strains showed higher percentages than the others due to the presence of heat-liable toxin and fimbriae. The results of the molecular and epidemiological studies allowed giving a speedy and accurate response that explained the etiology of the first food-borne disease outbreak.

Caracterización microbiológica de cepas de Vibrio cholerae no-O1 aisladas en Cuba / Microbiological characterization of non-01 Vibrio cholerae isolated in Cuba

Se estudiaron 422 cepas de Vibrio cholerae no-O1 procedentes de 9 provincias del país, de ellas 9 aisladas de un brote de enfermedad de transmisión hídrica. En la totalidad de las cepas se determinó la susceptibilidad antimicrobiana y la presencia de factores de virulencia. En las 9 cepas procedentes del brote, se realizó además, el estudio de macrorrestricción de ADN mediante la técnica de electroforesis de campo pulsado. Se demostró por primera vez en Cuba y el Caribe, la circulación de cepas de V. cholerae no-O1 atípicas (resistentes al compuesto vibriostático O129 y al trimetoprim-sulfametoxazol). El comportamiento de la susceptibilidad antimicrobiana demostró por primera vez la circulación en Cuba de 2 patrones diferentes de resistencia (ampicilina, trimetoprim/sulfametoxazol, sulfonamida y tetraciclina, trimetoprim/sulfametoxazol, sulfonamida). La frecuencia de cepas resistentes al trimetoprim-sulfametoxazol se mantuvo similar en todo el período de estudio. Sin embargo, se produjo un decrecimiento de la resistencia a la ampicilina y un aumento de la resistencia a la tetraciclina. Los principales factores de virulencia que se encontraron fueron la gelatinasa, la hemolisina, la elastasa y la adherencia a células HEp-2. Sin embargo, las cepas del brote mostraron mayores porcentajes que el resto, para la presencia de la toxina termoestable y la presencia de fimbrias. Los resultados de los estudios molecular y epidemiológico permitieron dar una respuesta acelerada y precisa sobre la etiología del primer brote de enfermedad de transmisión alimentaria(AU)

The study of 422 non-01 Vibrio cholerae strains from nine provinces, 9 of them isolated from a water-borne disease outbreak, was performed. All the strains exhibited antimicrobial susceptibility and virulence factors. The nine strains from the outbreak were subjected to a DNA macrorestriction study based on the pulsed field electrophoresis technique. For the first time in Cuba and the Caribbean, the circulation of atypical non-01 V. Cholerae strains (resistent to vibriostatic compound 0129 and trimethoprim/sulfamethoxazole). The behavior of antimicrobial susceptibility evinced for the first time the circulation of two different resistence patterns in Cuba (ampicilline, trimethoprim/sulfamethoxazole, sulfonamide and tetracycline, trimethoprim/sulfamethoxazole, sulfonamide). The frequency of trimethoprim/sulfamethoxazole-resistent strains was similar during the whole period of study. However, resistance to ampicilline decreased whereas resistance to tetracycline increased. The main found virulence factors were gelatinase, hemolysine, elastase and adherence to Hep-2 cells. On the other hand, the outbreak strains showed higher percentages than the others due to the presence of heat-liable toxin and fimbriae. The results of the molecular and epidemiological studies allowed giving a speedy and accurate response that explained the etiology of the first food-borne disease outbreak(AU)