7 datos sobre la Enfermedad de Carrión

Endémica de los valles andinos de Perú, Ecuador y Colombia, la enfermedad de Carrión, si no es tratada, resulta fatal entre el 44% y el 88% de los casos.

Author(s): Del Valle Mendoza, Juana
Source: Universidad Peruana de Ciencias Aplicadas - UPC

URL: http://hdl.handle.net/10757/575406

A systematic review of the relative efficacy and toxicity of treatment regimens for HIV-associated cerebral toxoplasmosis: is trimephoprim-sulfamethaxozole a real option?

Background: Pyrimethamine and sulfadiazine (P-S) combination is effective and considered the mainstay therapy for cerebral toxoplasmosis (CT). Alternative treatment regimens are available, but their relative efficacy and tolerability are not well known. Particularly, trimephoprim-sulfamethaxozole (TMP-SMX) shows potential advantages (i.e., tolerability, posology, parenteral formulation, cost, and accessibility) but its use is infrequent when P-S is available. Methods: We searched PubMed and 4 other databases to identify randomized controlled trials (RCTs) and cohort studies comparing different regimens for the treatment of HIV-associated CT. Two independent reviewers searched and identified studies and extracted data. Risk ratios (RRs) were pooled across studies using random-effects models. Results: Nine studies were included (5 RCTs, 3 retrospective cohorts, 1 prospective cohort). Treatment with P-S has the same or better clinical efficacy than P-C or TMP-SMX in terms of partial or complete response clinical response (P-C vs P-S: RR 0.87, 95%CI 0.70-1.08; TMP-SMX vs P-S: RR 0.97, 95%CI 0.78-1.21) and radiological response (P-C vs P-S: RR 0.92, 95%CI 0.82-1.03). Safety profile in terms of skin rash (P-C vs P-S: RR 0.81, 95%CI 0.56-1.17; TMP-SMX vs P-S: RR 0.17, 95%CI 0.02-1.29), liver impairment (P-C vs P-S: RR 0.48, 95%CI 0.24-0.97) and drug discontinuation due to adverse events (P-C vs P-S: RR 0.32, 95%CI 0.07-1.47) were worse with P-S regimen. Conclusion: The available evidence fails to identify any one superior regimen for the treatment of CT. However, P-S regimen has worse safety profile than P-C or TMP-SMX. Although current evidence does not allow a definitive recommendation, use of TMP-SMX for treatment of HIV-associated CT is consistent with the available data. More large studies comparing alternative therapies are needed.; IDWeek, Evento que se llevó a cabo del 7 -11 de Octubre de 2015, en la ciudad de San Diego, CA, EE.UU. Evento Sesión HIV: Other Opportunistic Infections in HIV. Saturday, October 10, 2015. Room: Poster Hall

Author(s): Thota, P.; Deshpande, A.; Pellegrino, D.; Pasupuleti, V.; Benites Zapata, V.; Vidal, J.; Hernandez, Adrian V.
Source: Universidad Peruana de Ciencias Aplicadas - UPC

URL: http://hdl.handle.net/10757/579779

High prevalence of Bordetella pertussis in severe acute respiratory infections in hospitalized children under 5 years in Lima, Peru

Acute respiratory infections (ARI) are the main cause of morbidity and mortality in children under 5 years worldwide. Bordetella pertussis is a highly contagious bacterium that can cause serious illness, and approximately half of infected infants less than 1 year old are hospitalized. Also, pertussis immunization series is not completed until six months of age, leaving young infants vulnerable to pertussis. In Peru, pertussis is an increasing health problem despite immunization efforts, and the role of B. pertussis in ARI is unknown. We determined the prevalence of B. pertussis among children under 5 years old admitted to Hospital Nacional Cayetano Heredia in Lima with diagnosis of ARI between Jan-2009 and Dec 2010. Epidemiological and clinical features were collected, and presence of B. pertussis was determined by PCR (pertussis toxin and IS481 gene). A total of 596 nasopharyngeal samples among children under 5 years were analyzed. In 114 (19.1%) samples were positive for B. pertussis. 32.5% of sample positive to B. pertussis were diagnosed as viral pneumonia at diagnosis. Importantly, 71.9% of cases were under 12 months of age and 58.8% have been contact with other ARI infected people. Significant differences in clinical symptoms between the total ARI cases and B. pertussis cases were not found. The most frequent symptoms in B. pertussis cases were fever (100%), rhinorrhea 78%, cough 71.9% and respiratory distress 60.5%. One child died due to the infection. B. pertussis cases showed a seasonal distribution with peaks during the months March June and November. This study shows the high prevalence of B. pertussis in infants who were hospitalized due to severe acute respiratory infections in Lima, Peru. Epidemiologic surveillance programs for B. pertussis are essential in the future in Peru

Author(s): Pavic Espinoza, Ivana; Bendezu Medina, Sandy; Herrera Alzamora, Angella; Pons Casellas, Maria; Hernandez, Adrian V. ( 0000-0002-9999-4003 )  ; del Valle Mendoza, Juana Mercedes ( 0000-0002-6011-5040 ) 
Source: Universidad Peruana de Ciencias Aplicadas - UPC

URL: http://hdl.handle.net/10757/582376

Identification of new antigen candidates of Bartonella bacilliformis

Bartonella bacilliformis is the aetiological agent of Carrion's disease, an overlooked illness with a lethal febrile stage and a benign warty phase. Its endemic in Andean areas, mainly affecting Peru, but also reported in Ecuador, Colombia, Bolivia and Chile.

Author(s):  Gomes, Cláudia; Palma, Noemí; Sandoval, Isabel; Tinco, Carmen; Gutarra, Carlos; Ruiz, Joaquim; del Valle Mendoza, Juana Mercedes ( 0000-0002-6011-5040 )  ; Kubota, Mayumi
Source:  Universidad Peruana de Ciencias Aplicadas - UPC

URL:  http://hdl.handle.net/10757/582366

Direct blood analysis of Bartonella bacilliformis Multi Locus Sequence Typing in patients with Oroya’s fever during a Peruvian outbreak

The bacteria Bartonella bacilliformis is the etiological agent of Carrion’s disease, which is a neglected poverty-related disease, affecting Mountain Andean valleys of Peru, Colombia and Ecuador. This disease, in absence of treatment presents a high mortality during the acute phase, called Oroya’s Fever. The second phase is characterized by the development of dermal eruptions, known as “Peruvian wart”. This bacterium is a fastidious slow growing microorganism, being difficult and cumbersome to culture and isolate from clinical sources. Then, the available data about phylogenetic relationship in clinical samples are really scarce, but suggesting high variability. The aim of the study was to perform direct blood analysis of B. bacilliformis Multi Locus Sequence Typing (MLST), a genotyping tool, in patients with Oroya fever during an outbreak. The present study demonstrate that the direct blood MLST PCR is a technique useful in the phylogenic characterization of this fastidious microorganism endemic from Andean regions. In this study, we demonstrate that the outbreak of Oroya’s fever was caused by closely related Sequence Typing (ST) microorganisms and, additionally, new STs have been described.

Author(s): Pons, Maria J.; Silva, Wilmer; Gomes, Cláudia; Ruiz, Joaquim; del Valle Mendoza, Juana Mercedes
Source: Universidad Peruana de Ciencias Aplicadas - UPC

URL: http://hdl.handle.net/10757/582375