Zika threatens to become a huge worldwide pandemic

The Aedes aegypti mosquito which transmits Zika virus (as well as dengue, chikungunya and yellow fever) represents a high risk for global transmission. This virus comes from Africa, the Zika forest in Uganda, where it was discovered in 1947 in a rhesus monkey. In May 2015, the first local cases were recorded in Brazil, surpassing 1.5 million cases in December of the same year. By March 2016, local transmission of Zika was recognized in 34 countries. Its clinical condition is similar to dengue febrile illness, although milder. The final geographical distribution area is constantly expanding. Recently, it has been associated with cases of Guillain-Barr ′e syndrome in Brazil, Colombia, El Salvador, Venezuela and Suriname. Microcephaly was documented in Brazil. This article discusses some factors that contributed to the spread of Zika virus in South America. Climate change associated with the events of the phenomenon of“El Ni?o”is also analyzed. The biggest concern is how quickly Zika is spreading around the world and that it could be far more dangerous than previously thought. Zika virus infection, by its explosive potential, has every chance of becoming a global pandemic.

Will there be a cure for HIV/AIDS? Making the dream a reality

It has been more than 30 years since AIDS was introduced in people's daily life, and it is a milestone that causes taboos, myths and prejudices. At that time, a patient told me his feelings, and he was very convincing:“I am horrified of living and afraid of dying.”Three decades later, AIDS infection is not a death sentence anymore. First, doctors could make that infected patients did not die from the disease;then, that the medication which kept them alive was not so toxic. And finally, that the treatments were more comfortable. And once at this point, the possibility that the virus may disappear from the body is a more realistic goal than ever. The story of AIDS has changed and, for the first time, we can foresee in the short term the beginning of the end of the pandemic. Now it is not about whether the cure is possible or not, but about when we will have it. This current mo-mentum, so hard to get, should be maintained. We have never been so close to achieving this goal. Although the end of the pandemic is close, this is not enough. It is worrying that some world leaders have absolved themselves of responsibility for not stopping or at least having understood the explosion of the pandemic as if it was a natural disaster. “Zero tolerance for HIV”requires a profound understanding of the stigma and discrimination of the infected people to finally get rid of the epidemic of fear and the devastation that the pandemic caused.

Giemsa and Grocott in the recognition of Histoplasma capsulatum in blood smears.

OBJECTIVE: To facilitate the recognition of intracellular yeasts of Histoplasma capsulatum and differentiate it from Leishmania amastigotes and other parasites, using the combination of Giemsa and a rapid modification of Grocott stains to peripheral blood smears in a hematological study. METHODS: The combination of both stains was applied consecutively (first Grocott and then Giemsa) to previously fixed peripheral blood smears. Microscopy was performed with 400× and 1 000×, the latter using immersion oil. RESULTS: The yeasts of Histoplasma capsulatum were observed into the cytoplasm of leukocytes as brownish oval elements, with 3-4 µm in diameter. CONCLUSIONS: The combination of both techniques is a simple and fast method to facilitate recognition of intracellular yeasts and it is different from intracellular parasitic elements. Moreover, it allows distinguishing the cell elements that are in the microscopic preparations. It may be very helpful in those cases in which the presumptive diagnosis of histoplasmosis has not been established yet and where other more sophisticated methods are not available.

Rapid and biosecure diagnostic test for tuberculosis.

Early and rapid detection of the causative organism is necessary in tuberculosis. We present here an integrated and dedicated molecular biology system for tuberculosis diagnosis. One hundred and eighty-nine (189) biologic specimens from patients strongly suspected by clinical parameters of tuberculosis were studied by Ziehl-Neelsen staining, cultivation on a solid medium, and by a balanced heminested fluorometric PCR system (Orange G3TB) that preserves worker safety and produces a rather pure material free of potential inhibitors. DNA amplification was carried out in a low cost using a tuberculosis thermocycler-fluorometer. The double stranded DNA produced is fluorometrically detected. The whole reaction is carried out in one single tube which is never opened after adding the processed sample, thus minimizing the risk of cross contamination with amplicons. The assay is able to detect 30 bacilli/ml of sample having a 99.8 % inter-assay coefficient of variation. PCR was positive in 36 (18.9 %) tested samples (33 of them were smear-negative). In our study, it yields a preliminary overall sensitivity of 97.4 %. In addition, its overall specificity is 98.7 %. The total run time of the test is 4 h with two and a half real working hours. All PCR-positive samples also had a positive result by microbiological culture and clinical criteria. The results obtained showed that it could be a very useful tool to increase efficiency in detecting the tuberculosis disease in low bacillus inoculum samples. Furthermore, its low cost and friendly usage make it feasible to be used in regions with poor development.

Adult female of Strongyloides stercoralis in respiratory secretions

Objective: To communicate the presence of adult females, rabditoid larvae and eggs of Strongyloides stercoralis (S. stercoralis) in the respiratory secretions obtained by tracheal aspirate from a HIV-negative patient who was suffering from polymyositis, and treated with corticoids and amethopterin and assisted by pneumonia. Methods: The respiratory secretions submitted to the Parasitology Laboratory of the Mu?iz Hospital were made more concentrated by centrifugation (1 500 r/min for 15 seconds). Wet mount microscopy was performed with the pellet. Results: It revealed adult females, rabditoid larvae and eggs of S. stercoralis. Further parasitological studies performed after the start of the treatment with ivermectin on fresh fecal samples, gastric lavages and tracheal aspirates showed scanty mobile filariform and rabditoid larvae of the same parasite. Conclusions: The presence of adult female S. stercoralis which has never been observed before in the clinical samples submitted to our Laboratory for investigation can be considered as an indirect marker of the severe immunosupression of the patient.

Adult female of Strongyloides stercoralis in respiratory secretions

<p><b>OBJECTIVE</b>To communicate the presence of adult females, rabditoid larvae and eggs of Strongyloides stercoralis (S. stercoralis) in the respiratory secretions obtained by tracheal aspirate from a HIV-negative patient who was suffering from polymyositis, and treated with corticoids and amethopterin and assisted by pneumonia.</p><p><b>METHODS</b>The respiratory secretions submitted to the Parasitology Laboratory of the Muñiz Hospital were made more concentrated by centrifugation (1 500 r/min for 15 seconds). Wet mount microscopy was performed with the pellet.</p><p><b>RESULTS</b>It revealed adult females, rabditoid larvae and eggs of S. stercoralis. Further parasitological studies performed after the start of the treatment with ivermectin on fresh fecal samples, gastric lavages and tracheal aspirates showed scanty mobile filariform and rabditoid larvae of the same parasite.</p><p><b>CONCLUSIONS</b>The presence of adult female S. stercoralis which has never been observed before in the clinical samples submitted to our Laboratory for investigation can be considered as an indirect marker of the severe immunosupression of the patient.</p>

Infections and inequalities: anemia in AIDS, the disadvantages of poverty.

OBJECTIVE: To study anemia in AIDS patients and its relation with socioeconomic, employment status and educational levels. METHODS: A total number of 442 patients who visited the Infectious Diseases University Hospital in Buenos Aires, Argentina were included in the study. Patients were dividied into two groups, i.e. one with anemia and the other without anemia. Anemia epidemiology and its relationship with educational level, housing, job situation, monthly income, total daily caloric intake and weekly intake of meat were evaluated. RESULTS: Anemia was found in 228 patients (54%). Comparing patients with or without anemia, a statistically significant difference was found (P<0.000 1) in those whose highest educational level reached was primary school, who lived in a precarious home, who had no stable job or were unable to work, whose income was less than 30 dollars per month, whose meat consumption was less than twice a week or received less than 8 000 calories per day. CONCLUSIONS: The high prevalence of anemia found in poor patients with AIDS suggests that poverty increases the risk to suffer from this hematological complication. The relationship between economic development policies and AIDS is complex. Our results seem to point to the fact that AIDS epidemic may affect economic development and in turn be affected by it. If we consider that AIDS affects the economically active adult population, despite recent medical progress it usually brings about fatal consequences, especially within the poorest sectors of society where the disease reduces the average life expectancy, increases health care demand and tends to exacerbate poverty and iniquity.

Pulmonary coinfection by Pneumocystis jiroveci and Cryptococcus neoformans

We communicate the diagnosis by microscopy of a pulmonary coinfection produced by Cryptococcus neoformans and Pneumocystis jiroveci, from a respiratory secretion obtained by bronchoalveolar lavage of an AIDS patient. Our review of literature identified this coinfection as unusual presentation. Opportunistic infections associated with HIV infection are increasingly recognized. It may occur at an early stage of HIV-infection. Whereas concurrent opportunistic infections may occur, coexisting Pneumocystis jiroveci pneumonia (PCP) and disseminated cryptococcosis with cryptococcal pneumonia is uncommon. The lungs of individuals infected with HIV are often affected by opportunistic infections and tumours and over two-thirds of patients have at least one respiratory episode during the course of their disease. Pneumonia is the leading HIV-associated infection. We present the case of a man who presented dual Pneumocystis jiroveci and cryptococcal pneumonia in a patient with HIV. Definitive diagnosis of PCP and Cryptococcus requires demonstration of these organisms in pulmonary tissues or fluid. In patients with < 200/microliter CD4-lymphocytes, a bronchoalveolar lavage should be performed. This patient was successfully treated with amphotericin B and trimethoprim sulfamethoxazole. After 1 week the patient showed clinical and radiologic improvement and was discharged 3 weeks later.

Infections and inequalities:anemia in AIDS, the disadvantages of poverty

Objective:To study anemia in AIDS patients and its relation with socioeconomic, employment status and educational levels. Methods:A total number of 442 patients who visited the Infectious Diseases University Hospital in Buenos Aires, Argentina were included in the study. Patients were dividied into two groups, i.e. one with anemia and the other without anemia. Anemia epidemiology and its relationship with educational level, housing, job situation, monthly income, total daily caloric intake and weekly intake of meat were evaluated. Results: Anemia was found in 228 patients (54%). Comparing patients with or without anemia, a statistically significant difference was found (P<0.000 1) in those whose highest educational level reached was primary school, who lived in a precarious home, who had no stable job or were unable to work, whose income was less than 30 dollars per month, whose meat consumption was less than twice a week or received less than 8 000 calories per day. Conclusions:The high prevalence of anemia found in poor patients with AIDS suggests that poverty increases the risk to suffer from this hematological complication. The relationship between economic development policies and AIDS is complex. Our results seem to point to the fact that AIDS epidemic may affect economic development and in turn be affected by it. If we consider that AIDS affects the economically active adult population, despite recent medical progress it usually brings about fatal consequences, especially within the poorest sectors of society where the disease reduces the average life expectancy, increases health care demand and tends to exacerbate poverty and iniquity.

Pulmonary coinfection by Pneumocystis jiroveci and Cryptococcus neoformans

We communicate the diagnosis by microscopy of a pulmonary coinfection produced by Cryptococcus neoformans and Pneumocystis jiroveci, from a respiratory secretion obtained by bronchoalveolar lavage of an AIDS patient. Our review of literature identified this coinfection as unusual presentation. Opportunistic infections associated with HIV infection are increasingly recognized. It may occur at an early stage of HIV-infection. Whereas concurrent opportunistic infections may occur, coexisting Pneumocystis jiroveci pneumonia (PCP) and disseminated cryptococcosis with cryptococcal pneumonia is uncommon. The lungs of individuals infected with HIV are often affected by opportunistic infections and tumours and over two-thirds of patients have at least one respiratory episode during the course of their disease. Pneumonia is the leading HIV-associated infection. We present the case of a man who presented dual Pneumocystis jiroveci and cryptococcal pneumonia in a patient with HIV. Definitive diagnosis of PCP and Cryptococcus requires demonstration of these organisms in pulmonary tissues or fluid. In patients with < 200/microliter CD4-lymphocytes, a bronchoalveolar lavage should be performed. This patient was successfully treated with amphotericin B and trimethoprim sulfamethoxazole. After 1 week the patient showed clinical and radiologic improvement and was discharged 3 weeks later.

A case report of cutaneous larva migrans in Argentina.

Cutaneous larva migrans (CLM) represents the most common tropically acquired dermatosis. CLM is caused by infection with hookworm larvae in tropical and sub-tropical areas, and people who have a history of foreign travel and of walking barefoot on sandy soil or beaches are at a high risk of getting infected with it. The diagnosis is usually made on the basis of the typical appearance of the lesion, intense itching and history of foreign travel. CLM is a common parasitic skin disease that can be easily prevented by wearing 'protective' footwear. A case of CLM is described in this article.

Diagnosis of Mycobacterium tuberculosis using molecular biology technology.

OBJECTIVE: To present an integrated molecular biology dedicated system for tuberculosis diagnosis. METHODS: One hundred and five sputum specimens from patients strongly suspected by clinical parameters of tuberculosis were studied by Ziehl-Neelsen staining, by cultivation on solid medium and by a balanced heminested fluorometric PCR system (Orange G3TB) that could preserve worker safety and produce a rather pure material free of potential inhibitors. DNA amplification was performed in a low cost tuberculosis termocycler-fluorometer. Produced double stranded DNA was flurometrically detected. The whole reaction was conducted in one single tube which would not be opened after adding the processed sample in order to minimize the risk of cross contamination with amplicons. RESULTS: The assay was able to detect 30 bacillus per sample mL with 99.8% interassay variation coefficient. PCR was positive in 23 (21.9%) tested samples (21 of them were smear negative). In our study it showed a preliminary sensitivity of 94.5% for sputum and an overall specificity of 98.7%. CONCLUSIONS: Total run time of the test is 4 h with 2.5 real working time. All PCR positive samples are also positive by microbiological culture and clinical criteria. Results show that it could be a very useful tool to increase detection efficiency of tuberculosis disease in low bacilus load samples. Furthermore, its low cost and friendly using make it feasible to run in poor regions.

Diagnosis of Mycobacterium tuberculosis using molecular biology technology

Objective:To present an integrated molecular biology dedicated system for tuberculosis diagnosis.Methods:One hundred and five sputum specimens from patients strongly suspected by clinical parameters of tuberculosis were studied by Ziehl-Neelsen staining, by cultivation on solid medium and by a balanced heminested fluorometricPCR system (OrangeG3TB) that could preserve worker safety and produce a rather pure material free of potential inhibitors. DNA amplification was performed in a low cost tuberculosis termocycler-fluorometer. Produced double stranded DNA was flurometrically detected. The whole reaction was conducted in one single tube which would not be opened after adding the processed sample in order to minimize the risk of cross contamination with amplicons.Results: The assay was able to detect30 bacillus per sample mL with99.8% interassay variation coefficient.PCR was positive in23 (21.9%) tested samples (21 of them were smear negative). In our study it showed a preliminary sensitivity of 94.5% for sputum and an overall specificity of98.7%.Conclusions:Total run time of the test is4 h with2.5 real working time. AllPCR positive samples are also positive by microbiological culture and clinical criteria. Results show that it could be a very useful tool to increase detection efficiency of tuberculosis disease in low bacilus load samples. Furthermore, its low cost and friendly using make it feasible to run in poor regions.

Enfermedades transmitidas por los alimentos: Análisis del riesgo microbiológico / Risk analysis of foodborne diseases: Microbial risk assessment

The basic goals of risk assessment include the following: to identify potentially hazardous situations and apply appropriate methods to estimate the likelihood that a hazard occurs. In The uncertainty in that estimate, to provide alternative solutions to reduce the risk, estimate the effectiveness of those solutions, provide information to base a risk management decision, and estimate the uncertainty associated with the analysis. Risk analysis provides the rational framework for assembling and then analysing the evidence relating to risk and presenting the results in a form that is easy to understand and then act upon fairly and effectively. Progress made is no excuse for arrogance. The present review is definitely not designed as the last word on risk analysis for foodborne diseases. Rather, this review has been designed to continue an evolving and necessary process and to provide a reference point that indicates the state of development in 2010.

Las metas básicas del análisis de riesgo incluyen las siguientes: identificar las situaciones potencialmente peligrosas, aplicar los métodos apropiados para estimar la probabilidad que un peligro ocurra, y en la incertidumbre en esa estimación, proporcionar las soluciones alternativas para reducir el riesgo, estimar la eficacia de esas soluciones, proporcionar la información sobre las que se base una decisión de la gestión de riesgos, y estimar la incertidumbre asociada a la evaluación. El análisis de riesgos constituye un sistema de referencia coherente para reunir y analizar indicios sobre los factores de riesgo, y también para presentar los resultados de modo inteligible y obrar después eficazmente. Pero los progresos realizados no pueden excusar la arrogancia. La presente revisión no pretende sentar cátedra sobre el análisis de riesgo microbiano, más bien está pensado como una etapa más de un proceso necesario y permanente, como un jalón que describe el estado de cosas en 2010.

Diagnóstico de criptococosis a partir de lesiones cutáneas / Diagnosis of cryptococcosis in cutaneous lesions

Se realizó el diagnóstico de criptococosis en un paciente con lesiones cutáneas de aspecto moluscoide, presentes en gran número en el rostro, sospechadas clínicamente de ser provocadas por Histoplasma capsulatum. El paciente, posteriormente diagnosticado como VIH positivo, presentó además Cryptococcus neoformans en el LCR y fue tratado con anfotericina B endovenosa. Con material obtenido por escarificación de las lesiones se realizaron extendidos y practicaron cultivos. Aplicadas a los extendidos, las coloraciones de Giemsa, Grocott y mucicarmín de Mayer, permitieron la observación de levaduras redondas y capsuladas que en los cultivos en agar semillas de girasol desarrollaron colonias de color pardo que correspondieron a Cryptococcus neoformans.

Diagnosis of cryptococcosis was performed in a patient with multiple cutaneous Muluscum contagiosumlike lesions in the face, clinically suspected as produced by Histoplasma capsulatum. The patient, after being diagnosed HIV positive, also showed Cryptococcus neoformans in the CSF, and was treated with intravenous amphotericin B. Clinical samples from the skin lesions were obtained and smears stained by Giemsa, Grocott and Mayer's mucicarmin were performed. Part of these samples, obtained by scrapping the ulcers, were suspended in isotonic saline solution and cultivated in Sabouraud dextrose agar and sunfloweragar; Cryptococcus neoformans colonies were identified.

[Risk analysis of foodborne diseases: microbial risk assessment]. / Enfermedades transmitidas por los alimentos: Análisis del riesgo microbiológico.

The basic goals of risk assessment include the following: to identify potentially hazardous situations and apply appropriate methods to estimate the likelihood that a hazard occurs. In The uncertainty in that estimate, to provide alternative solutions to reduce the risk, estimate the effectiveness of those solutions, provide information to base a risk management decision, and estimate the uncertainty associated with the analysis. Risk analysis provides the rational framework for assembling and then analysing the evidence relating to risk and presenting the results in a form that is easy to understand and then act upon fairly and effectively. Progress made is no excuse for arrogance. The present review is definitely not designed as the last word on risk analysis for foodborne diseases. Rather, this review has been designed to continue an evolving and necessary process and to provide a reference point that indicates the state of development in 2010.