Chlamydia psittaci seropositivity in workers exposed to birds and review of the literature: Evidence of circulation in Antioquia / Seropositividad de Chlamydia psittaci en trabajadores expuestos a aves y revisión de la literatura: evidencia de circulación en Antioquia.

Introduction: Psittacosis is a zoonotic disease caused by Chlamydia psittaci, a bacterium classified as an agent with bioterrorist potential. It has caused multiple outbreaks in exposed poultry workers around the world. Colombia has no epidemiological follow-up of the infection and a big knowledge gap. Objectives: To determine the antibodies' frequency against C. psittaci in workers with occupational exposure to birds and to review the literature on studies conducted in Colombia. Materials and methods: We conducted a cross-sectional descriptive study with analytical intent on workers in contact with birds and reviewed the related literature in Colombia. IgM and IgG serum antibodies against C. psittaci were detected by microimmunofluorescence. The sociodemographic and exposure characteristics were expressed as frequencies and summary measures. Associated factors were explored by bivariate and multivariate analysis. The scientific and gray literature review was done with a structured search. Results: We analyzed 54 workers in contact with birds. Antibody prevalence was 31.5%. Slaughtering and evisceration by non-veterinarians was a risk factor for antibody presence. There are only four previous studies on C. psittaci in Colombia. Conclusions: Here, we present the first evidence of C. psittaci circulation among workers exposed to birds in Antioquia and the second report in the country. These findings contribute to the "One Health" public health strategy.

Introducción: La psitacosis es una enfermedad zoonótica causada por Chlamydia psittaci. Esta bacteria es catalogada como un agente con potencial bioterrorista y ha causado múltiples brotes en trabajadores con exposición laboral a aves en diferentes lugares del mundo. En Colombia, no se hace seguimiento epidemiológico de la infección y existe una gran brecha en el conocimiento. Objetivos: Determinar la frecuencia de anticuerpos contra C. psittaci en trabajadores con exposición laboral a aves y sus factores asociados. Además, revisar la literatura en relación con los estudios sobre el tema realizados en Colombia. Materiales y métodos: Se llevó a cabo un estudio descriptivo, transversal, con intención analítica, en trabajadores en contacto con aves y se revisó la literatura científica relacionada en Colombia. Se detectaron anticuerpos IgM e IgG contra C. psittaci en suero por microinmunofluorescencia. La descripción de las características sociodemográficas y de exposición se hizo con frecuencias y medidas de resumen. Se exploraron factores asociados por análisis bivariados y multivariados. La revisión de la literatura científica y gris se hizo con búsqueda estructurada. Resultados: Se analizaron 54 trabajadores en contacto con aves y se encontró una prevalencia de anticuerpos del 31,5 %. El ejercer funciones de sacrificio y faenado de las aves sin ser médico veterinario fue un factor de riesgo para la presencia de anticuerpos. Solo se encontraron cuatro estudios previos sobre C. psittaci hechos en Colombia. Conclusiones: Este estudio constituye la primera evidencia de la circulación de C. psittaci en trabajadores en contacto con aves en Antioquia y el segundo reporte en el país. Estos hallazgos aportan desde la salud pública a la estrategia One Health.

Seropositividad de Chlamydia psittaci en trabajadores expuestos a aves y revisión de la literatura: evidencia de circulación en Antioquia / Chlamydia psittaci seropositivity in workers exposed to birds and review of the literature: Evidence of circulation in Antioquia

Introducción. La psitacosis es una enfermedad zoonótica causada por Chlamydia psittaci. Esta bacteria es catalogada como un agente con potencial bioterrorista y ha causado múltiples brotes en trabajadores con exposición laboral a aves en diferentes lugares del mundo. En Colombia, no se hace seguimiento epidemiológico de la infección y existe una gran brecha en el conocimiento. Objetivos. Determinar la frecuencia de anticuerpos contra C. psittaci en trabajadores con exposición laboral a aves y sus factores asociados. Además, revisar la literatura en relación con los estudios sobre el tema realizados en Colombia. Materiales y métodos. Se llevó a cabo un estudio descriptivo, transversal, con intención analítica, en trabajadores en contacto con aves y se revisó la literatura científica relacionada en Colombia. Se detectaron anticuerpos IgM e IgG contra C. psittaci en suero por microinmunofluorescencia. La descripción de las características sociodemográficas y de exposición se hizo con frecuencias y medidas de resumen. Se exploraron factores asociados por análisis bivariados y multivariados. La revisión de la literatura científica y gris se hizo con búsqueda estructurada. Resultados. Se analizaron 54 trabajadores en contacto con aves y se encontró una prevalencia de anticuerpos del 31,5 %. El ejercer funciones de sacrificio y faenado de las aves sin ser médico veterinario fue un factor de riesgo para la presencia de anticuerpos. Solo se encontraron cuatro estudios previos sobre C. psittaci hechos en Colombia. Conclusiones. Este estudio constituye la primera evidencia de la circulación de C. psittaci en trabajadores en contacto con aves en Antioquia y el segundo reporte en el país. Estos hallazgos aportan desde la salud pública a la estrategia One Health.

Introduction. Psittacosis is a zoonotic disease caused by Chlamydia psittaci, a bacterium classified as an agent with bioterrorist potential. It has caused multiple outbreaks in exposed poultry workers around the world. Colombia has no epidemiological follow-up of the infection and a big knowledge gap. Objectives. To determine the antibodies' frequency against C. psittaci in workers with occupational exposure to birds and to review the literature on studies conducted in Colombia. Materials and methods. We conducted a cross-sectional descriptive study with analytical intent on workers in contact with birds and reviewed the related literature in Colombia. IgM and IgG serum antibodies against C. psittaci were detected by microimmunofluorescence. The sociodemographic and exposure characteristics were expressed as frequencies and summary measures. Associated factors were explored by bivariate and multivariate analysis. The scientific and gray literature review was done with a structured search. Results. We analyzed 54 workers in contact with birds. Antibody prevalence was 31.5%. Slaughtering and evisceration by non-veterinarians was a risk factor for antibody presence. There are only four previous studies on C. psittaci in Colombia. Conclusions. Here, we present the first evidence of C. psittaci circulation among workers exposed to birds in Antioquia and the second report in the country. These findings contribute to the "One Health" public health strategy.

Sexual Behaviors and Factors Associated with Condomless Sexual Practice in Colombian Men Who Have Sex with Men at High Risk of HIV Transmission.

Men who have sex with men (MSM) have a disproportionate burden of HIV infection worldwide. In Colombia, the prevalence of HIV in MSM is ~ 43 times higher than in the general population (17% vs. 0.4%). This study determined the sexual behaviors, HIV serostatus, and associated factors with condomless sexual practice with both regular and casual partners in 92 MSM from Medellín, Colombia. The subjects were recruited through a community-based approach, and the data were collected by a structured survey and in-depth interviews. Participants were classified into three groups according to the number of sexual partners in the last three months, to compare the sociodemographic conditions and sexual behaviors. Univariate analysis was described by absolute and relative frequencies; bivariate analysis and multivariate logistic regression were used to compare the groups and to explore the associated factors with condomless sexual practice. The overall HIV estimated prevalence was 4.3%, while the estimated prevalence for MSM with > 10 sexual partners in the last three months was 14.8%. This last group showed higher average age, higher percentage of subjects who have had sex with people living with HIV, and increased frequency of previous sexually transmitted infections. Having condomless sex with casual partners was associated with the number of sexual partners in the last three months. This study demonstrates that Colombian MSM continue to have a high risk of HIV infection/transmission and reinforce the need to implement adequate prevention programs, PrEP and guarantee access to treatment for people living with HIV.

NK Cell Activity and CD57+/NKG2Chigh Phenotype Are Increased in Men Who Have Sex With Men at High Risk for HIV.

Introduction: The HIV-exposed seronegative (HESN) status is for individuals who remain seronegative despite repeated exposure to HIV. One of the main cohorts within this group is men who have sex with men (MSM). Studies of this cohort have revealed different immunological and genetic mechanisms that can explain the phenomenon of natural HIV resistance. NK cells' higher effector capacity is related to natural resistance to HIV. Besides, a new population of NK cells with adaptive features was described recently. These cells are increased in some HESN cohorts and appear to be involved in better control of viral replication in primarily HIV-infected subjects. The present study evaluated the role of NK cells in the natural resistance to HIV-1 infection in MSM. Methodology: Phenotypic and functional features were evaluated in NK cells from two groups of MSM, at different risks of HIV infection, according to the number of sexual partners. The production of IFN-γ and ß-chemokines was included in the analysis, as well as the cytotoxic capacity and adaptive NK cell frequency. Genetic features, such as HLA and KIR allele frequencies, were also explored. Results: High-risk MSM exhibit an increased frequency of fully mature and CD57+/NKG2Chigh NK cells. These individuals also show higher cytotoxic capacity and IFN-γ production in response to K562 stimuli. NK cells with a CD107a+/IFN-γ+ functional profile were found more frequently and displayed higher IFN-γ production capacity among high-risk MSM than among low-risk MSM. The protective allele HLA-B∗18 was only present in the high-risk MSM group as well as HLA-B∗ 39. The protective phenotype KIR3DL1/S1-HLA-B∗Bw4, in a homozygous state, was particularly abundant in the high-risk population. Notably, some of these functional features were related to higher frequencies of mature and CD57+/NKG2Chigh NK cells, which, in turn, were associated with a higher number of sexual partners. Conclusion: The changes observed in the NK cell compartment can be driven by the magnitude of sexual exposure and immunological challenges of high-risk individuals, which could influence their resistance/susceptibility to HIV infection.

Prevalencia de Corynebacterium spp. y factores asociados en mujeres del Valle de Aburrá / Prevalence of corynebacterium spp. and associated factors in women of Valle de Aburrá

Introducción: Corynebacterium spp. está presente en flujo vaginal de mujeres asintomáticas, perose ha encontrado asociado a procesos patológicos, generando confusión al momento de clasificarlo como microbiota o microorganismos patógenos. Nuestro objetivo fue determinar la prevalencia de Corynebacterium spp. y explorar su asociación con características clínicas y hábitos sexuales. Material y métodos: estudio descriptivo transversal en 511 mujeres del Valle de Aburrá durante 2012 y 2013. Los datos demográficos, clínicos y de comportamiento sexual se obtuvieron mediante encuestas; la información sobre el perfil microbiológico genital se obtuvo de muestra de flujo vaginal. El análisis descriptivo se hizo con frecuencias y medidas de resumen; para el análisis bivariado se usó χ cuadrado, prueba exacta de Fisher, U de Mann Whitney y se usó regresión logística para el análisis multivariado; los análisis se realizaron en el programa estadístico IBM SPSS Statistics versión 22. Resultados: la prevalencia de Corynebacterium spp fue 59%. Referente al comportamiento sexual durante el último mes previo a la toma de muestra, encontramos que las participantes tuvieron sexo con una persona en promedio (rango de 0 - 3 personas distintas); respecto a las prácticas durante el coito en el mismo mes, se observó que 58% de las mujeres tuvo sexo sin preservativo, a 61% le practicaron sexo oral y a 10% sexo anal. Se encontró asociación de Corynebacterium sppcon reacción leucocitaria. Conclusiones: la prevalencia de Corynebacterium spp. fue 59% y se encontró asociado a reacción leucocitaria; no se asoció a comportamientos sexuales específicos ni sintomatología ginecológica. (Acta Med Colomb 2015; 40: 234-240).

Introduction: Corynebacterium spp. is present in vaginal fluid of asymptomatic women, but it has been found associated with disease processes, creating confusion when classified as normal or pathogenic flora. Our objective was to determine the prevalence of Corynebacterium spp. and explore its association with clinical characteristics and sexual habits. Materials and Methods: descriptive cross-sectional study in 511 women of Valle de Aburrá in 2012 and 2013. Demographic, clinical and sexual behavioral data were obtained through surveys; information about genital microbiological profile was obtained from sample of vaginal discharge. Descriptive analysis was done with frequencies and summary measures; for bivariate analysis χ square, Fisher exact test and Mann Whitney U test were used, and logistic regression was used for multivariate analysis; analysis were performed in the statistical program SPSS Statistics version 22. Results: The prevalence of Corynebacterium spp was 59%. Regarding sexual behavior during the last pre-sampling month, we found that participants had sex with a person on average (range from 0-3 different people); regarding practices during intercourse in the same month, it was observed that 58% of women had sex without a condom, to 61% oral sex was practiced and to 10% anal sex. Association of Corynebacterium spp with leukocyte reaction was found. Conclusions: The prevalence of Corynebacterium spp was 59% and was found associated with leukocyte reaction; it was not associated to specific sexual behaviors or gynecological symptoms. (Acta Med Colomb 2015; 40: 234-240).

[Risk factors for multidrug-resistant Pseudomonas aeruginosa infection, in a tertiary hospital in Colombia]. / Factores de riesgo para infección por Pseudomonas aeruginosa multi-resistente en un hospital de alta complejidad.

INTRODUCTION: multi-resistant Pseudomonas aeruginosa (MR) is frequently associated with healthcare infections. Its epidemiology is complex and few studies help to understand it. A study about risk factors associated with this type of bacteria is needed. OBJECTIVE: To determine risk factors associated with MR P. aeruginosa infection in hospitalized patients from the Hospital Universitario San Vicente Foundation-Medellin. MATERIALS AND METHODS: case-control study to identify risk factors associated with infection by MR P. aeruginosa. RESULTS: 140 patients were included, 70 in each group. Bivariate analysis found association with previous use of carbapenems (OR 3.12 - IC 1.21 to 8.03, p = 0.02), aminoglycosides (OR 5.09 - CI: 1.38 to 18, 77, p = 0.01) and days of stay prior to isolation of the organism (OR 1.03 - CI: 1.01-1.05, p = 0.01). In multivariate analysis MR P. aeruginosa infection was associated with hospital stay (OR 1.03 - IC 1.01 to 1.05), use of aminoglycosides (OR 1.30 to 19.28) and treatment with two or more antimicrobials in the last 30 days (OR 3.09 - CI: 1.26 to 7.58). The risk of developing infection was 3% per day of hospital stay prior to isolation of the agent. CONCLUSION: Developing MR P. aeruginosa infection was associated with prior use of antimicrobials and prior hospital stay.

Factores de riesgo para infección por Pseudomonas aeruginosa multi-resistente en un hospital de alta complejidad / Risk factors for multidrug-resistant Pseudomonas aeruginosa infection, in a tertiary hospital in Colombia

Introduction: multi-resistant Pseudomonas aeruginosa (MR) is frequently associated with healthcare infections. Its epidemiology is complex and few studies help to understand it. A study about risk factors associated with this type of bacteria is needed. Objective: To determine risk factors associated with MR P. aeruginosa infection in hospitalized patients from the Hospital Universitario San Vicente Foundation-Medellin. Materials and Methods: case-control study to identify risk factors associated with infection by MR P. aeruginosa. Results: 140 patients were included, 70 in each group. Bivariate analysis found association with previous use of carbapenems (OR 3.12 - IC 1.21 to 8.03, p = 0.02), aminoglycosides (OR 5.09 - CI: 1.38 to 18, 77, p = 0.01) and days of stay prior to isolation of the organism (OR 1.03 - CI: 1.01-1.05, p = 0.01). In multivariate analysis MR P. aeruginosa infection was associated with hospital stay (OR 1.03 - IC 1.01 to 1.05), use of aminoglycosides (OR 1.30 to 19.28) and treatment with two or more antimicrobials in the last 30 days (OR 3.09 - CI: 1.26 to 7.58). The risk of developing infection was 3% per day of hospital stay prior to isolation of the agent. Conclusion: Developing MR P. aeruginosa infection was associated with prior use of antimicrobials and prior hospital stay.

Introducción: Pseudomonas aeruginosa multi-resistente (MR) es causa frecuente de infecciones asociadas al cuidado de la salud, su epidemiología es compleja y hay pocos estudios que permiten comprenderla. El estudio de los factores de riesgo asociados a este tipo de bacterias es necesario para la implementación de estrategias de control de las mismas. Objetivo: Determinar factores de riesgo asociados a infección por P. aeruginosa MR en pacientes hospitalizados en el Hospital Universitario de San Vicente Fundación-Medellín. Materiales y Métodos: Estudio analítico con abordaje como casos y controles para determinar factores de riesgo asociados a infección por P. aeruginosa MR. Resultados: Se incluyó un total de 140 pacientes, 70 en cada grupo. En el análisis bivariado se encontró asociación con el uso previo de carbapenémicos (OR 3,12- IC 1,21-8,03; p: 0,02), aminoglucósidos (OR 5,09- IC: 1,38-18,77; p: 0,01) y el tiempo por día de estancia previo al aislamiento (OR 1,03- IC: 1,01-1,05; p: 0,01). En el análisis multivariado hay asociación entre la estancia hospitalaria (OR 1,03- IC 1,01-1,05), el uso de aminoglucósidos (OR 1,30-19,28) y el uso de dos o más antimicrobianos en los últimos 30 días (OR 3,09- IC: 1,26-7,58) con el desarrollo de infecciones por P. aeruginosa MR. El riesgo de desarrollar una infección por esta bacteria fue de 3% por cada día de estancia hospitalaria previo al aislamiento. Conclusión: El desarrollar infección por P. aeruginosa MR se asoció con el uso previo de antimicrobianos y con el tiempo previo de estancia hospitalaria.

Asbesto en Colombia: un enemigo silencioso / Asbestos in Colombia: A silent enemy

El asbesto es un grupo de minerales no metálicos fibrosos, compuestos de silicatos de doble cadena que poseen gran resistencia a la tensión y la degradación química y conductividad térmica baja. A pesar de la evidencia experimental y poblacional de que dichos minerales son agentes cancerígenos y de su reconocimiento como tales por la Organización Mundial de la Salud, aún se los sigue usando en muchos países, Colombia incluida, a costa de la salud de los trabajadores, lo que se ha convertido en un problema mundial por el desarrollo de enfermedades asociadas a estos minerales en individuos expuestos. En este artículo se hace una revisión sobre el asbesto, las enfermedades asociadas a él y la normatividad mundial y colombiana frente al mismo; además, se plantea la conveniencia de evaluar la utilidad de la monitorización genética como complemento para el seguimiento de los individuos expuestos, que permita mejorar la vigilancia en nuestro país del desarrollo de cáncer de pulmón, mesotelioma y otras enfermedades asociadas con el asbesto.

Asbestos is a group of fibrous non-metallic minerals, composed of double chain silicates, that shows high resistance to tension and chemical degradation and low thermal conductivity. Despite being recognized as carcinogenic agents by the World Health Organization (WHO), based on experimental evidences and population studies, asbestos are still used in many countries at the expense of the health of workers. This has become a worldwide problem associated with the increase of asbestos-related diseases in exposed persons. In this article, we review asbestos and their associated diseases; the use, exposure and existing regulations on asbestos both in Colombia and in other countries. Finally, we raise the possibility of evaluating the usefulness of genetic monitoring in addition to following-up exposed individuals. This would enable a better surveillance in our country with respect to lung cancer, mesothelioma and other asbestos-related diseases.

Autoinmunidad y receptores tipo Toll / Autoimmunity and toll-like receptors

La respuesta inmune innata está conformada por un conjunto de mecanismos que permiten reconocer los componentes propios del organismo y diferenciarlos de los microorganismos invasores para generar una primera línea de defensa. Este reconocimiento está mediado por diferentes receptores presentes en la superficie y en el interior de células inmunes y no inmunes; entre ellos se encuentran los siguientes: receptores tipo Toll (RTT), receptores de lectinas tipo C, receptores tipo GIR (genes inducibles por ácido retinoico) y receptores tipo Nod y NALP, que reconocen patrones moleculares asociados a microorganismos (PMAM). Gracias a esta capacidad de discriminación, adquirida evolutivamente por la inmunidad innata, se ha aceptado tradicionalmente que los procesos autoinmunes no están relacionados con esta sino con la inmunidad adquirida. Sin embargo, varios estudios han demostrado que esa teoría no es totalmente cierta y que algunos mecanismos efectores de la inmunidad innata participan en la generación de las enfermedades autoinmunes o en la potenciación de su fisiopatología. En esta revisión se estudia la contribución de la inmunidad innata a la autoinmunidad con énfasis en el papel de los receptores tipo Toll.

Autoimmunity and toll-like receptors Innate immune response consists of a set of mechanisms allowing the body to recognize its own components and to differentiate them from invasive microorganisms in order to generate a first line of defense. Such recognition is mediated by several receptors present both on the surface and inside immune and non-immune cells, among them: Toll-like receptors, C-type lectin receptors, RIG receptors (retinoic acid induciblegenes), and Nod-like and NALP receptors, all of which recognize microbe-associated molecular patterns (MAMP). Due to this discriminative ability, acquired by innate immunity in the course of evolution, it has been traditionally accepted that autoimmune processes are not related to innate immunity but to the acquired one. However, several studies have demonstrated that this theory is not entirely true and that some mechanisms of innate immunity either participate in the generation of autoimmune diseases or enhance its physiopathology. This review examines the contribution of innate immunity to autoimmunity emphasizing on the role of Toll-like receptors.

Correlación entre la vacunación y lapresencia de anticuerpos protectorescontra el virus de la hepatitis B en personas de la Facultad de Medicina, Universidad Cooperativa de Colombia, Medellín, 2011 / Correlation among vaccination and the presence of protector antibodies anti-hepatitis B virus in the personnel of Universidad Cooperativa de Colombia Medical School-Medellín, 2011

Introducción: El personal de la salud es uno de los principales grupos en riesgo de infeccióncon el virus de la hepatitis B y aunque existe una vacuna recombinante basada en el antígeno desuperficie del virus, no todos los individuos vacunados logran el título de anticuerpos protectores.Objetivo: determinar la relación entre los títulos de anticuerpos contra el antígeno de superficiedel virus de la hepatitis B y el número de dosis de vacuna contra la hepatitis B, en personal dela Facultad de Medicina de la Universidad Cooperativa de Colombia, sede Medellín, en 2011. Materiales y Métodos: se realizó un estudio descriptivo transversal en una muestra probabilísticade 162 personas. La recolección de la información fue a partir de fuente primaria. El análisisestadístico se realizó con base en proporciones, medidas de resumen, estadística paramétrica y noparamétrica. Resultados: el 80% del grupo de estudio presentó anticuerpos en un nivel protector,el promedio del título de anticuerpos fue 396 mUI/mL, éste presentó asociación estadística conel número de dosis y no se observó asociación estadística con el sexo ni la edad. Conclusión: la protección hallada contra el virus de la hepatitis B fue menor a la reportada internacionalmentepara vacunas recombinantes (aproximadamente del 90% al 95% en adultos jóvenes). Esto sepodría atribuir a la inclusión de personas con esquemas de vacunación incompletos o con pobrerespuesta inmunológica a la vacuna, como los hombres, los individuos con alto índice de masacorporal, la edad adulta, la presencia de tabaquismo o los individuos con HLA DR3-DQ2.

Introduction: Health personnel is one of the main risk groups for infection with Hepatitis B virus, andalthough there is a vaccine based on recombinant surface antigen of the virus, not all vaccinatedindividuals reach protective antibody titers. Objective: to establish the relationship between serumtiters of anti-Hepatitis B Virus and the number of doses of vaccine against hepatitis B, in staff of the Medical School at Universidad Cooperativa de Colombia, Medellin, in 2011. Materials and methods:a cross-sectional study in a probability sample of 162 people was conducted. The data collectionwas from primary source. Statistical analysis was made based on proportions, summary measures, parametric and nonparametric statistics. Results: 80% of the study group had protective antibodies, the average antibody titer was 396 mIU/mL, it was statistically associated with the number of doses,and there was no statistical association with sex or age. Conclusion: the protection found againsthepatitis B virus was lower than that reported internationally for recombinant vaccines (approximately 90-95% in young adults). This could be attributed to the inclusion of people with incompletevaccination schedules or poor immune response to the vaccine, such as men, individuals with highbody mass index, adulthood, smoking status, and individuals with HLA DR3-DQ2.