Seropositivity to Shiga toxin 2 among Argentinian urban and rural residents. Association with sociodemographic and exposure factors.

BACKGROUND: Shiga toxin-producing Escherichia coli (STEC) are enteric pathogens that cause hemolytic-uremic syndrome (HUS). Ruminants, especially cattle, are their main reservoir. This study describes the seroepidemiology of STEC in rural and urban populations in Argentina, a country with a high HUS incidence. METHODS: A cross-sectional study was performed in patients without gastrointestinal symptoms. IgG antibodies against Stx2 were detected by western blotting. RESULTS: Anti-Stx2 antibodies were detected in 14.56% of serum samples, more frequently in rural (19.38%) than urban residents (12%). Seropositivity was associated with lower socioeconomic status (SES). Among the other variables considered, thawing homemade hamburgers before cooking them, and the lack of knowledge about HUS were also associated with seropositivity. A multivariate logistic regression analysis performed with the variables that were statistically significant showed that only the SES index remained significant. As SES was measured based on several variables, we further analyzed each one of them and found that the lack of a high education level was statistically associated with seropositivity. CONCLUSIONS: The present findings have implications for STEC prevention efforts, highlighting the importance of considering SES and risks factors linked to different SES levels when targeting consumer-level public health interventions.

Seroprevalence of human leptospirosis in a rural community from Tandil, Argentina. Assessment of risk factors and spatial analysis.

Leptospirosis is a neglected zoonosis that is widely distributed in the world. Although it is endemic in Argentina, prevalence remains unknown. The aims of the study were: (i) to determine the prevalence of leptospirosis in humans from a rural community in Tandil Argentina, (ii) to identify infecting Leptospira spp. serogroups, (iii) to identify factors associated with the infection, (iv) to estimate the population attributable fraction (PAF) of the risk factors and (v) to determine the spatial patterns of disease presentation and related risk factors. Blood samples from 202 participants were collected. A survey was conducted to obtain clinical and epidemiological data. Serological testing was performed by the microscopic agglutination test (MAT). Univariate and multivariate methods were applied to evaluate associations. Spatial clusters were investigated for seroprevalence and risk factors. Antibodies were found in 32.2% of participants (95% CI: 25.8-39.1). The most prevalent serogroup was Hebdomadis followed by Sejroe; Icterohaemorrhagiae; Tarassovi and Canicola. Living at lower altitudes (OR: 13.04; 95% CI: 2.60-65.32); not having access to water supply network (OR: 2.95; 95% CI: 1.30-6.69); living close to flooded streets (OR: 2.94; 95% CI: 1.14-7.69) and practicing water sports (OR: 3.12; 95% CI: 1.12-8.33) were associated with seropositivity. Factors related with housing characteristics, services and infrastructure had the higher PAF (from 17% to 81%). A spatial cluster with higher rates of positivity and of the main risk factors was determined. This work contributes useful data for specific preventive measures that should be implemented for the control of the disease.

Microscopic agglutination test: Variables that affect the time of serological confirmation of human leptospirosis cases.

Leptospirosis is considered an endemic disease in Buenos Aires province, Argentina, with human cases reported annually from rural and urban areas. The aim of the study was to describe the variables that influence the delay in the serological confirmation of leptospirosis in human cases (period 2006-2014) from Buenos Aires province. Sixty-four percent (64%) of cases could be confirmed by microscopic agglutination test (MAT) with the first sample. The time of confirmation of the human leptospirosis cases was on average 21 days from the onset of the first clinical signs, and varied depending on the distance of the different sanitary regions. The geographical distribution of the confirmed leptospirosis human cases, in addition to the high number of suspected cases and probable cases (which could not be confirmed by MAT), demonstrate that leptospirosis is endemic and underreported in Buenos Aires province, and that distance and lack of resources could be determinant factors of this situation.

Trichinella Infection in Culled Wild Boar (Sus scrofa) from El Palmar National Park, Argentina, and Exposure Risk in Humans and Dogs Consuming Wild Boar Meat.

Trichinellosis is a foodborne disease caused by ingestion of raw or undercooked meat containing Trichinella spp. larvae. Consumption of wild boar (Sus scrofa) meat represents an important source of human trichinellosis worldwide. In El Palmar National Park (EPNP), Argentina, invasive alien wild boars are controlled and meat from culled animals is released for public consumption following on-site artificial digestion (AD) testing. Meat trimmings and offal from the control program are often used as food for dogs (Canis familiaris). We evaluated infection and exposure to Trichinella spp. in wild boars from EPNP, as well as exposure to Trichinella spp. and associated risk factors in dogs and human consumers of wild boar meat. Trichinella spp. larvae were detected in muscle samples from 5/49 wild boars by AD (10.2%; 95% confidence interval [CI], 3.8%-23%), with a mean burden of 0.24 larvae per gram (lpg; range, 0.06-0.95 lpg). Anti-Trichinella antibodies were not detected in wild boar serum samples (n=42). In dogs, 12/34 were seropositive to Trichinella spp. (35.29%; 95%, CI, 20.3%-53.5%). Immunoglobulin (Ig) G antibodies were not detected in human serum samples (n=63). Our results reveal the presence, albeit at low prevalence, of Trichinella spp. in wild boars and exposure in dogs fed game offal. These findings suggest that the low prevalence and parasitic load in wild boars, together with the best practices applied by EPNP culling program personnel, contribute to keeping the risk of infection in people low. The dog results highlight that the parasite is circulating in the area, and therefore the risk of infection is not negligible. We recommend the implementation of an animal surveillance strategy in order to monitor the evolution of this zoonosis in the study area.

Endometriosis: A Comprehensive Analysis of the Pathophysiology, Treatment, and Nutritional Aspects, and Its Repercussions on the Quality of Life of Patients.

Endometriosis is a chronic proinflammatory pathology characterized by the growth of tissue similar to the endometrium outside the uterus, affecting approximately 5 to 15% of women worldwide. Suffering from endometriosis entails a complex pathophysiological process, significantly impacting the quality of life and reproductive function of affected women; therefore, it must be addressed in a personalized and comprehensive manner, as its management requires a multidisciplinary approach. This article aims to conduct a comprehensive literature review of endometriosis, not only as a pathophysiological condition but also as a significant factor impacting the social, nutritional, and mental well-being of those who experience it. Emphasis is placed on the importance of understanding and assessing the impact of the pathology to provide a better and more comprehensive approach, integrating various alternatives and strategic treatments for the factors involved in its development. The aim is to provide a complete overview of endometriosis, from its pathophysiology to its impact on the quality of life of patients, as well as a review of current treatment options, both pharmacological and alternative, in order to broaden the perspective on the pathology to improve the care of patients with this disease.

[Epidemiology of hemolytic uremic syndrome in two regions of Buenos Aires Province]. / Epidemiología del síndrome urémico hemolítico en dos regiones de la Provincia de Buenos Aires.

The objectives of this study were (a) to describe and estimate the frequency of hemolytic uremic syndrome (HUS) in rural and urban populations in two regions of Buenos Aires Province, and (b) to compare the presentation and distribution of factors hypothetically associated with HUS. A total of 82 HUS cases, recorded during the years 2005-2010 in rural and urban areas of the south-central region of Buenos Aires Province, were clinically and epidemiologically characterized. Statistical data analysis included Chi square or Fisher test and median test. The incidence rate of HUS was significantly higher in the rural population, being 12.7 cases per 100 000 (CI 0-23.5) in rural inhabitants vs. 7.1 cases per 100 000 (CI 0-9.5) in urban inhabitants. The median age of the patients was 27 months (5-139 months), significantly lower in children from the rural area. This could be explained by a more frequent contact with bovine feces, the consumption of raw milk and a higher proportion of relatives who work in risk labors found in the rural population. Although HUS is often associated with the consumption of undercooked minced meat, most of the children cases here included did not present this antecedent. Clinical manifestations were similar in both subpopulations. One-third of urban patients had received antibiotics prior to HUS development.

Epidemiology of Leptospira spp. infection in a beef cattle area of Argentina.

Leptospirosis is an infectious disease caused by pathogenic Leptospira that affect humans and animals. This disease is complex and non-eradicable in nature. Therefore, the understanding of it is epidemiology in different environments is crucial to implement prevention and control measures. The prevalence of Leptospira infection in beef cattle farms is affected by multiple environmental, management and individual factors. In this study, a cross-sectional serological survey was carried on to estimate the prevalence of Leptospira antibodies in beef cattle in Tandil and Ayacucho Departments (Buenos Aires Province) and to identify risk factors and spatial clusters associated with seropositivity. Using a probabilistic two-stage sampling, 25 farms and 15 animals per farm were selected. The Microagglutination Test was used to analize all serum samples. Bivariate and multivariate analyses were performed. Seventy-three out of 375 cows were seropositive, representing a positivity rate of 19.47% (95% CI: 10.51-28.42), with Sejroe and Pomona being the most reactive serogroups: 9.33% (95% CI: 6.26-12.41) and 8.27% (95% CI: 5.35-11.19), respectively. The prevalence in Ayacucho was 23.11% (95% CI: 10.05-36.17), and in Tandil, 14% (95% CI: 3.25-24.75). The animals from Ayacucho presented 2.01 (1.16-3.49) more chances of being positive compared with those from Tandil (p < 0.01). After the Generalized Linear Mixed Model (GLMM) with random effect of farm-level risk, the presence of lagoons (OR: 7.32, 95% CI: 1.68-31.8, p < 0.05) and undulating terrain (OR: 0.24, 95% CI: 0.07-0.74, p < 0.05) were associated with bovine leptospirosis. Four spatial clusters with higher rates of seropositivity were detected. A new GLMM was performed with the significant variables detected in the first GLMM and a new variable, "being inside the spatial cluster," being the only one that remained significant (OR: 9.58, 95% CI: 3.39-27.08, p < 0.0001). The animals inside the clusters belonged to farms with a greater presence of creeks (OR: 9.03, 95% CI: 3.37-24.18, p < 0.0001), higher accumulated rainfall (OR: 1.01, 95% CI: 1-1.01, p < 0.0001) and less undulating terrain (OR: 0.18, 95% CI: 0.10-0.35, p < 0.0001). We conclude that Leptospira is seroprevalent in beef cattle in Tandil and Ayacucho Departments, especially in the latter, where the largest cattle farms are located. Prevalence of seropositivity animals was associated with selected environmental risk factors.

Unraveling swine hepatitis E in the central region of Argentina through ELISA development and epidemiological insights.

Hepatitis E virus (HEV) is a public health concern globally, causing acute viral hepatitis in humans. Genotype-3 HEV (HEV-3), the most frequently genotype detected in South America, is zoonotic and the main reservoirs are the domestic pig and wild boar. Circulation of HEV-3 in Argentina has been confirmed in humans as well as in pig herds, wild boar and environmental waters. However, data are scarce mainly due to the inaccessibility of serological assays in this country. In order to provide insights in the epidemiology of HEV in swine in Argentina, we developed an indirect ELISA based on the native recombinant protein ORF2 and conducted a serological survey to determine the prevalence of seropositive swine in small-scale pig farms in the central region of Argentina. The method was evaluated in a panel of 157 serum samples, resulting in relative sensitivity of 98.6 % (95 % CI 95 %-100 %) and relative specificity of 97.7 % (95 % CI 94 %-100 %) compared to a commercial test. An almost perfect agreement was obtained between the two tests (Kappa index of 0.961). A survey on 294 samples from 49 small-scale farms resulted in a seropositivity rate of 54 %. Seropositive animals were found in 34 out of 49 (69.4 %) farms. Most of the farms (70.6 %) had over 50 % of seropositive animals. The wide spreading of HEV in the swine population of Tandil, Argentina, underscore the need to better understand the epidemiology of HEV in the region, enabling the implementation of targeted interventions to mitigate the impact of this virus on public health.

Exploring hepatitis E virus seroprevalence and associated risk factors among the human population in Tandil, Buenos Aires, Argentina.

Background: Hepatitis E virus (HEV) infection is a common cause of acute clinical hepatitis worldwide and is emerging as a disease in Argentina. It is primarily transmitted through contaminated water and food, following the fecal-oral route. Furthermore, is a zoonotic disease with swine as the primary reservoir. Prevalence of HEV infection in humans in several regions of Argentina remains unknown. Objectives: (i) Determine the seroprevalence of HEV among the human population in Tandil, Buenos Aires, Argentina; (ii) Evaluate its association with demographic, socioeconomic and other risk exposures variables, and (iii) Describe and analyze spatial patterns related to HEV infection. Methods: From August 2020 to July 2021, serum samples were collected from 969 individuals aged 1-80 years. Seroprevalence and 95% Confidence Interval was determined. To assess the factors associated with the presence of anti-HEV antibodies, associations between the variables and seropositivity were evaluated through bivariate and multivariate analysis. Spatial scanning for clusters of positivity was carried out. Factors associated with these clusters were also assessed. Results: Anti-HEV antibodies were detected in 4.64% (IC 95% 3.27-6.02) of samples. Dark urine was associated with seropositivity (p = 0.02). Seropositivity was linked with the presence of natural water courses near their households (p = 0.02); the age (p = 0.04); and previous travel to Europe (p = 0.04). A spatial cluster of low rates of HEV seropositivity was detected, with greater distance of the households to water courses associated to the cluster, and male sex inversely associated to it. Discussion and conclusion: This study is the first study to investigate the prevalence of HEV in the population from Tandil, Buenos Aires, Argentina. Considering HEV infection in the differential diagnosis in individuals presenting acute hepatitis is highlighted. The incorporation of HEV testing into blood screening policies should be mandatory. Factors related to the infection and spatial patterns of high and low risk were determined, and should be considered when implementing specific preventive measures.

Leptospiral infection: a serosurvey in urban and rural communities in Olavarría county, Argentina.

INTRODUCTION: Leptospirosis is a neglected zoonotic disease, affecting mainly poor and vulnerable populations. METHODOLOGY: A cross sectional-study was carried out in 557 subjects from Olavarría county (Argentina) to estimate the seroprevalence of leptospirosis and the factors associated with seropositivity. A survey was carried out to obtain clinical and epidemiological data. Serum was tested for anti-leptospiral antibodies by Microscopic Agglutination Test (MAT). Chi-square or Fisher Exact tests were used to assess association between the MAT results and the exploratory variables. For the variables statistically associated, odds ratios (ORs) and 95% confidence intervals (95% CI) were calculated. Individuals from Olavarría city were georeferenced to describe the spatial distribution and to detect clusters of seropositivity for leptospiral antibodies. RESULTS: The overall prevalence of leptospirosis infection was 7.00%, higher in rural (19.66%) than in urban populations (3.64%) (p < 0.001). Sejroe was the most predominant serogroup in rural communities while Icterohaemorrhagiae was the most prevalent in urban populations. The factors associated with Leptospira infection were the presence of rodents inside households (OR = 3.9) in rural populations, while contact with cats (OR = 4.97) and male gender (OR = 7.75) represented higher risk of infection for the urban ones. Cases with positive serology have been found near Tapalqué stream or in the peripheral areas of Olavarría city. CONCLUSIONS: The results from data obtained during the study period were similar to other reports and demonstrate the importance of continuous epidemiological surveillance system and specific community educational campaigns to prevent the leptospirosis infection in Olavarría county and other communities with similar characteristics especially in rural areas.

Factors associated with sporadic verotoxigenic Escherichia coli infection in children with diarrhea from the Central Eastern Area of Argentina.

Verotoxigenic Escherichia coli (VTEC) are one of the most important emerging foodborne pathogens and the principal cause of hemolytic uremic syndrome (HUS). This entity has been recognized worldwide as a priority issue in the field of zoonoses and public health, and Argentina is the country with the highest incidence of HUS in children less than 5 years of age.The lack of specific treatment, combined with the high morbidity rate of VTEC infection, makes prevention the main tool for reducing the incidence of HUS. The current work aimed at assessing the factors associated with sporadic VTEC infection in children with acute diarrhea from the Central Eastern area of Argentina where the incidence rate of HUS in children under 5 is the highest worldwide. A univariate analysis was performed to identify potential factors associated with VTEC infection by calculating odds ratios (OR) with 95% confidence intervals (CI). Then, a multivariate logistic regression model was performed. Interaction and association between significant factors were checked. "Recent consumption of food prepared outside home" (OR: 2.4, 95% CI 1.05-5.7) and "recent vegetables consumption" (OR=0.4; 0.2-0.8) were identified as independent factors associated with VTEC infection. We believe that the data obtained from this study further the current knowledge about the epidemiology of VTEC infection in Argentina and could be considered when planning strategies for the prevention of the disease.

Mucosal immunization with polymeric antigen BLSOmp31 using alternative delivery systems against Brucella ovis in rams.

Subcellular vaccines against ovine contagious epididymitis due Brucella ovis can solve some shortcomings associated with the use of Brucella melitensis Rev 1. We have demonstrated that the parenteral immunization with polymeric antigen BLSOmp31 emulsified in oil adjuvant conferred significant protection against B. ovis in rams. In our previous studies, we have characterized chitosan microspheres (ChMs) and a thermoresponsive and mucoadhesive in situ gel (Poloxamer 407-Ch) as two novel formulation strategies for the delivery of BLSOmp31 in nasal as well as conjunctival mucosa. In the present work, we evaluated the immunogenicity and protection conferred by the intranasal and conjunctival immunization with these two mucosal delivery systems against B. ovis in rams. BLSOmp31-ChM administered by intranasal route and BLSOmp31-P407-Ch applied by intranasal or conjunctival routes induced systemic, local and preputial IgG and IgA antibody response. Neither formulation showed interference in the serological diagnosis. Thus, mucosal immunization using either formulation induced significant specific cellular immune responses (in vitro and in vivo) and it prevented the excretion of B. ovis in semen. Although these vaccines did not prevent infection in immunized rams, colonization reduction of infected organs and bacterial distribution differed significantly between vaccinated and unvaccinated rams.

Seroprevalence of human leptospirosis in a rural community from Tandil, Argentina. Assessment of risk factors and spatial analysis / Seroprevalencia de leptospirosis humana en una comunidad rural del partido de Tandil (Argentina). Identificación de los factores de riesgo y del análisis espacial

Abstract Leptospirosis is a neglected zoonosis that is widely distributed in the world. Although it is endemic in Argentina, prevalence remains unknown. The aims of the study were: (i) to determine the prevalence of leptospirosis in humans from a rural community in Tandil Argentina, (ii) to identify infecting Leptospira spp. serogroups, (iii) to identify factors associated with the infection, (iv) to estimate the population attributable fraction (PAF) of the risk factors and (v) to determine the spatial patterns of disease presentation and related risk factors. Blood samples from 202 participants were collected. A survey was conducted to obtain clinical and epidemiological data. Serological testing was performed by the microscopic agglutination test (MAT). Univariate and multivariate methods were applied to evaluate associations. Spatial clusters were investigated for seroprevalence and risk factors. Antibodies were found in 32.2% of participants (95% CI: 25.8-39.1). The most prevalent serogroup was Hebdomadis followed by Sejroe; Icterohaemorrhagiae; Tarassovi and Canicola. Living at lower altitudes (OR: 13.04; 95% CI: 2.60-65.32); not having access to water supply network (OR: 2.95; 95% CI: 1.30-6.69); living close to flooded streets (OR: 2.94; 95% CI: 1.14-7.69) and practicing water sports (OR: 3.12; 95% CI: 1.12-8.33) were associated with seropositivity. Factors related with housing characteristics, services and infrastructure had the higher PAF (from 17% to 81%). A spatial cluster with higher rates of positivity and of the main risk factors was determined. This work contributes useful data for specific preventive measures that should be implemented for the control of the disease.

Resumen La leptospirosis es una enfermedad desatendida, ampliamente distribuida a nivel mundial. Aunque es endémica en Argentina, su prevalencia es desconocida. Los objetivos de este estudio fueron los siguientes: (i) determinar la prevalencia de leptospirosis humana en comunidades rurales del partido de Tandil (Argentina), (ii) identificar serogrupos infectantes de Leptospira spp., (iii) identificar factores de riesgo asociados, (iv) estimar la fracción atribuible poblacional (FAP) de los factores de riesgo y (v) determinar los patrones espaciales de la enfermedad y de los factores de riesgo. Se tomaron muestras de sangre a 202 personas, y se registró información clínica y epidemiológica. El diagnóstico se realizó por microaglutinación (MAT). Para evaluar asociaciones, se utilizaron métodos univariados y multivariados. Se estudiaron clusters espaciales de la seroprevalencia y de los factores de riesgo. El 32,2% de los participantes (IC 95%: 25,8-39,1) presentaron anticuerpos. Los serogrupos más prevalentes fueron Hebdomadis, Sejroe, Icterohaemorrhagiae, Tarassovi y Canicola. Vivir a menores altitudes (OR: 13,04; IC 95%: 2,60-65,32) y cerca de calles inundables (OR: 2,94; IC 95%: 1,14-7,69), la falta de acceso a agua de red (OR: 2,95; IC 95%: 1,30-6,69) y la práctica de deportes acuáticos (OR: 3,12; IC 95%: 1,12-8,33) estuvieron asociados con la seropositividad. Factores relacionados con las características de las viviendas, los servicios y la infraestructura tuvieron mayor proporción de FAP (17 al 81%). Se encontró un área de mayor riesgo de presentación de individuos seropositivos y de los principales factores de riesgo. Este trabajo provee información útil para generar medidas preventivas específicas que podrían ser aplicadas para controlar esta enfermedad.

Immune response induced by conjunctival immunization with polymeric antigen BLSOmp31 using a thermoresponsive and mucoadhesive in situ gel as vaccine delivery system for prevention of ovine brucellosis.

Control of ovine brucellosis with subcellular vaccines can solve some drawbacks associated with the use of Brucella melitensis Rev.1. Previous studies have demonstrated that the polymeric antigen BLSOmp31 administered by parenteral route was immunogenic and conferred significant protection against B. ovis in rams. Immunization with BLSOmp31 by conjunctival route could be efficient for the induction of mucosal and systemic immune responses. In this work, we evaluated the conjunctival immunization using a thermoresponsive and mucoadhesive in situ gel composed of Poloxamer 407 (P407) and chitosan (Ch) as vaccine delivery system for BLSOmp31 in rams. Serum samples, saliva, lacrimal, preputial and nasal secretions were analyzed to measure specific IgG and IgA antibodies. Cellular immune response was evaluated in vivo and in vitro. Immunization with BLSOmp31-P407-Ch induced high IgG antibody levels in serum and preputial secretions which remained at similar levels until the end of the experiment. Levels of IgG in saliva, lacrimal and nasal secretions were also higher compared to unvaccinated control group but decreased more rapidly. IgA antibodies were only detected in nasal and preputial secretions. BLSOmp31-P407-Ch stimulated a significant cellular immune response in vivo and in vitro. The induction of systemic and local immune responses indicates a promising potential of P407-Ch for the delivery of BLSOmp31 by conjunctival route.

Microscopio agglutination test: Variables that affect the time of serological confirmation of human leptospirosis cases / Test de microaglutinación: variables que afectan el tiempo de confirmación de los casos humanos de leptospirosis

Abstrac Leptospirosis is considered an endemic disease in Buenos Aires province, Argentina,with human cases reported annually from rural and urban areas. The aim of the study was todescribe the variables that influence the delay in the serological confirmation of leptospirosisin human cases (period 2006-2014) from Buenos Aires province. Sixty-four percent (64%) ofcases could be confirmed by microscopic agglutination test (MAT) with the first sample. The time of confirmation of the human leptospirosis cases was on average 21 days from the onset of the first clinical signs, and varied depending on the distance of the different sanitary regions. The geographical distribution of the confirmed leptospirosis human cases, in addition to the high number of suspected cases and probable cases (which could not be confirmed by MAT), demonstrate that leptospirosis is endemic and underreported in Buenos Aires province, and that distance and lack of resources could be determinant factors of this situation.

Resumen La leptospirosis se considera una enfermedad endémica en la provincia de Buenos Aires, con casos humanos registrados anualmente en áreas rurales y urbanas. El objetivo de este estudio fue describir las variables que influyen en el retraso de la confirmación serológica de la leptospirosis en humanos, a partir del análisis de los casos ocurridos en el período 2006-2014 en la provincia de Buenos Aires. El 64% de los casos fue confirmado por microaglutinación (MAT) con la primera muestra clínica. El tiempo de confirmación promedio fue de 21 días desde el inicio de los primeros signos clínicos; este valor se vio afectado por la distancia entre los centros de salud y los laboratorios de referencia en las distintas regiones sanitarias. La distribución geográfica de los casos confirmados de leptospirosis en humanos, además del alto número de casos sospechosos y probables (que no pudieron ser confirmados por MAT), demuestra que esta afección es endémica y se encuentra subregistrada en la provincia de Buenos Aires, y que la distancia y la falta de recursos serían factores determinantes de estas características.

[Enterohemorrhagic Escherichia coli and hemolytic-uremic syndrome in Argentina]. / Escherichia coli enterohemorrágica y síndrome urémico hemolítico en Argentina.

The hemolytic-uremic syndrome (HUS) is a multisystemic disorder that is characterized by the onset of acute renal failure, microangiopathic hemolytic anemia and thrombocytopenia. It is the most common cause of acute renal failure and the second cause of chronic renal failure and renal transplantation in children in Argentina. Our country has the highest incidence of HUS in the world, with approximately 420 new cases observed each year with an incidence of 12.2 cases per 100,000 children in the age group 0-5 years. Numerous etiologic factors have been associated with HUS but the infection with enterohemorrhagic Escherichia coli (EHEC) is considered the most common cause. The majority of outbreaks and sporadic cases in humans have been associated with serotype O157:H7, although other O:H serotypes have been isolated, and they are a subgroup of Verocytotoxin-producing Escherichia coli (VTEC). Cattle are the principal reservoir of VTEC. Infections in humans are a consequence of consumption of undercooked meat, raw milk and other contaminated food or water. Direct contact with animals or people infected is another source of infection.

Epidemiologia de Hidatidosis en Bovinos de Consumo en la Comarca Andina del Paralelo 42 / Epidemiology of Hydatidosis in Cattle for Consumption in the Andean Region of Parallel 42

: La hidatidosis es un problema relevante en toda Argentina, y no se conoce la situación del bovino en su transmisión. El objetivo general del estudio fue indagar acerca de esta situación y, en particular, estimar la prevalencia de hidatidosis, evaluar la fertilidad de quistes hidatídicos (QH) y analizar los factores de riesgo y el patrón de distribución espacial. MÉTODOS: Se evaluó presencia de QH en hígados y pulmones de 432 bovinos. Se estimó prevalencia hidatídica y de establecimientos positivos y el intervalo de confianza (IC95%). Se tomaron 42 muestras de contenido de QH y se evaluó fertilidad. Se estudiaron variables asociadas a presencia de QH. Se calculó razón de prevalencia (RP) con IC95%. RESULTADOS: La prevalencia estimada fue del 22,2% (IC95%: 18,4-26,5%); 12 de 13 (92,3%) establecimientos fueron positivos. La localización de los QH fue 50% pulmonar, 4,2% hepática y 45,8% hepato-pulmonar. No se encontraron QH fértiles. Las variables que mejor explicaron la positividad fueron

Anemia inflamatoria: fisiopatología, diagnóstico y tratamiento / Inflammatory anemia: phisiopathology, diagnosis and treatment / Anemia inflamatória: fisiopatologia, diagnóstico e tratamento

La anemia de la Inflamación (AI) es considerada la segunda causa más frecuente de anemia a nivel mundial después de la deficiencia de hierro. Se observa comúnmente en infecciones crónicas, tumores, traumas, y desórdenes inflamatorios. La AI es típicamente normocítica normocrómica usualmente moderada y se produce por una hipoferremia como resultado del secuestro de hierro en el sistema retículo endotelial, de la reducción de la eritropoyesis y de la inhibición de la absorción del hierro en intestino. La patogenia de la AI está mediada por citoquinas inflamatorias y hepcidina, péptido producido en el hígado, que regulan la homeostasis del hierro, actúan suprimiendo la eritropoyesis, y la vida media de los eritrocitos se encuentra ligeramente acortada. Los métodos diagnósticos de rutina que se describen en esta revisión pueden ser de utilidad, pero quedará un grupo de estados anémicos con alta sospecha de AI que no podrán ser fácilmente clasificados. Recientemente se han desarrollado inmunoensayos para determinar hepcidina y citoquinas inflamatorias que podrán colaborar, en un futuro, para un diagnóstico correcto. Existen actualmente modelos experimentales de AI en ratones, los cuales podrían ser útiles para evaluar diferentes tratamientos. En este sentido, los inhibidores de la hepcidina y diversos moduladores inflamatorios aparecen como terapias prometedoras.

Anemia da inflamação (AI) é considerada a segunda causa mais comum de anemia em todo o mundo após a deficiência de ferro. É geralmente observada em infecções crônicas, tumores, traumas e distúrbios inflamatórios. A AI é tipicamente normocítica normocrômica comumente moderada e ocorre por uma hipoferremia como resultado do sequestro de ferro no sistema retículo endotelial, da redução da eritropoiese e da inibição da absorção do ferro no intestino. A patogenia da AI é mediada por citocinas inflamatórias e hepcidina, peptídeo produzido no fígado, que regulam a homeostase do ferro, agem suprimindo a eritropoiese e a meia-vida dos eritrócitos é levemente diminuída. Os métodos de diagnóstico de rotina descritos nesta revisão podem ser úteis, mas ficará um grupo de estados anêmicos com alta suspeita de AI que não poderão ser classificados facilmente. Recentemente têm sido desenvolvidos imunoensaios para determinar hepcidina e citocinas inflamatórias, que poderão colaborar no futuro, para um diagnóstico certo. Existem atualmente modelos experimentais de AI em ratos que poderiam ser úteis para avaliar diferentes tratamentos. A este respeito, os inibidores de hepcidina e vários moduladores inflamatórios aparecem como terapias promissoras.

Role and clinical course of verotoxigenic Escherichia coli infections in childhood acute diarrhoea in Argentina.

The aim of this study was to investigate the role and clinical course of verotoxigenic Escherichia coli (VTEC) infections in children with acute diarrhoea from Argentina, the country with the highest worldwide incidence of haemolytic uraemic syndrome (HUS). To accomplish this objective, 437 samples from children up to 6 years old with acute diarrhoea were collected and processed. More than 60 % of the children studied presented watery or mucous diarrhoea without blood, and in 25.2 % of the cases the samples contained blood. In a first screening, a multiplex PCR was performed to detect the presence of the vt(1), vt(2), eae, ehxA and saa virulence genes. The strains were then isolated and analysed to characterize their serotypes, virulence genes, antibiotic susceptibility profiles and verotoxin (VT) production. Forty-four of the 437 samples (10.1 %) were positive for VTEC virulence genes. VTEC-infected patients presented different types of diarrhoea (27.3 % belonged to the non-bloody type). Several serotypes and virulence genotypes were found. Isolates belonged to the serotypes O157 : H7, O145 : H(-), O26 : H11, O121 : H19, O111 : H2 and O118 : H2. HUS developed in 16 (36.4 %) patients positive for VTEC virulence genes. All of the VTEC isolates produced a cytopathic effect on Vero cell monolayers, confirming the ability to express VT. Despite most strains being sensitive to all of the antimicrobials studied, a positive association between clinical progression to HUS and antibiotic therapy was observed for the total number of patients studied, as well as for the VTEC(+) group. In conclusion, the data obtained in this study increase our knowledge of the role and clinical course of VTEC infection in childhood acute diarrhoea beyond bloody diarrhoea, and might be considered for the prevention, diagnosis and management of this disease. It is possible that the optimal approach for VTEC diagnosis could be using multiplex PCR to search for the presence of the vt(1), vt(2), eae and ehxA genes.

Determinación temprana del sexo fetal en plasma materno mediante PCR en tiempo real / Early fetal sex determination in maternal plasma by real-time PCR / Determinação precoce do sexo fetal em plasma materno por PCR em tempo real

El análisis de ADN fetal libre en plasma ,materno permite estudiar material genético del feto sin realizar procedimientos invasivos sobre el embarazo. La identificación del sexo fetal mediante la detección de ADN del cromosoma masculino Y, en el plasma de mujeres embarazadas, es de gran utilidad en embarazos con riesgos para hiperplasia suprarrenal congénita o para enfermedades ligadas al cromosoma X. El presente estudio tuvo objetivo evaluar la factibilidad y desempeño diagnostico de la determinación del sexo fetal a través del análisis por PCR en tiempo real de ADN fetal libre en plasma de embarazadas . Se extrajeron 10 mL de sangre periférica a 134 pacientes embrazadas entre las 5 y 32 semanas de gestación, se separó el plasma y se efectuó extracción de ADN. Las muestras se analizaron mediante PCR en tiempo real amplificando el marcador DYS 14 presente en el cromosoma Y. El sexo fetal se confirmo mediante ecografia realizada entre las semanas 20 y 32. la sensibilidad y especificidad de la técnica para detectar el sexo fetal fue 98.5%y del 80,7% respectivamente. La menor edad gestacional de diagnóstico fue 5 semanas. La técnica implementada ha mostrado un desempeño diagnostico similar al descrito en la bibliografía...