Mortalidad por parasitosis endémicas e importadas en Chile. 1997-2020 / Mortality due to endemic and imported parasitoses in Chile. 1997-2020

INTRODUCCIÓN: Las parasitosis son un problema de salud pública mundial por su alta prevalencia en países en vías de desarrollo, su persistencia en países desarrollados debido principalmente por la migración de personas, y por su morbi-mortalidad asociada. OBJETIVO: Determinar las defunciones causadas por parasitosis endémicas e importadas en Chile, según región, sexo, grupo etario, procedencia urbana/rural y nivel educacional, y estimar tasas de mortalidad. MÉTODO: Estudio de base poblacional y serie de tiempo de mortalidad (1997 a 2020). Los análisis estadísticos fueron realizados mediante programas Excel y R Studio, cálculo de χ2, valor p < 0,05. RESULTADOS: 2.413 muertes fueron causadas por parásitos, 65,1% por protozoos, 33% por helmintos y 1,9% por artrópodos. La tasa promedio de mortalidad nacional fue de 0,6 por cada 100 mil habitantes. Las principales causas de fallecimiento fueron: enfermedad de Chagas (63,6%), hidatidosis (24,3%) y cisticercosis (8,1%). La mayoría de los fallecidos pertenecía a la Región de Coquimbo. La edad promedio de defunción fue de 74, 62 y 67 años para muertes por protozoos, helmintos y artrópodos, respectivamente. Las defunciones ocurrieron mayormente en hombres. La mayoría provenía de zona urbana y poseían un nivel educacional bajo. CONCLUSIONES: La enfermedad de Chagas es la principal causa de muerte por parasitosis en Chile.

BACKGROUND: Parasites are a public health problem due to their high prevalence in developing countries, their persistence in developed countries mainly due to the migration of people, and their associated morbidity and mortality. AIM: To determine the deaths in Chile caused by endemic and imported parasites; according to region, sex, age group, urban-rural origin and educational level, and mortality rates. METHOD: Population-based study, times series of mortality (1997 to 2020). Statistical analysis was performed using Excel and R Studio programs, calculation of χ2, p value < 0.05. RESULTS: 2,413 deaths occurred due to parasites, 65.1% by protozoa, 33% by helminths and 1.9% by arthropods. The average national mortality rate was 0.6 per 100.000 inhabitants. The main causes of death were Chagas disease (63.6%), hydatidosis (24.3%) and cysticercosis (8.1%). Most of the deceased belonged to the Coquimbo Region. The mean age of death was 74, 62 and 67 years old for deaths from protozoa, helminths and arthropods, respectively. Deaths occurred mostly in men. Most came from urban areas and had a low educational level. CONCLUSIONS: Chagas disease is the main cause of death from parasites in Chile.

Loxoscelismo y latrodectismo en una paciente: caso clínico / Loxoscelism and latrodectism in the same patient

We report a 51 years old, woman, who live in a rural zone of Llolleo, San Antonio, V Región of Chile. Her dewelling is near a wheat ground sown. In november 1999 during the cleaning of her house she felt a "bug" in her head, but did not find it. She started immediatly with itching, hypoesthesia of arms and legs, dispnea, thoracic pain, vomiting, 40§C fever, myalgias in right arm, thorax, and hypogastric zone, trembling, plantiful sweating, and rapidly lost consciousness. She recovered consciousness 1 hour later and asked for help. A neighbour saw and captured a spider going out of her clothes. She was taken to the emergency room, where she received sera and oxigen, and was discharged two days later with a prescription of antihistaminics, glucosteroids, a muscle relaxing agend and diuretics. During six months se was controled in the out patient clinic of the hospital. The spider was identified by entomologist as Latrodectus mactans. In june 2002 when she was sleeping, felt a wounding lancet pain in the middle finger of the right hand. Afterwards a black plate with yellow vesicles in his center appeared in that same zone. The right arm become edematous and paresthetic; the patient complained of an important asthenia. She was hospitalized receiving intravenous steroids. In this ocassion the patients couldnït keep the spider, but when she describes it to the entomologist of the National Science and Arqueological Museum of San Antonio, the specimen was identified as an exemplar of Loxosceles laeta . Latrodectism is usually a day out door accident, during agricultural activities. Loxoscelism is in general a night in door accident. In this excepcional case the patient lives near a wheat ground sown and the absence of routinary cleaning of her dewelling, could explain both accidents. We couldïnt find publications of accidents of both spiders affecting the same person. For this reason we consider important to comunicate this case

Fasciolosis aguda: caso clínico / Acute fasciolosis: a clinical case

Mujer de 39 años procedente de la provincia de Talca (VII Región) que presentó un cuadro de dolor abdominal intenso que se interpretó como abdomen agudo por el cual se le hizo laparotomía exploradora que no fue concluyente. Después de diferentes procedimientos y exámenes se llegó al diagnóstico de fascioliasis aguda. Se trató con triclabendazol

Inmunofenotipificación de linfocitos en sangre periférica de pacientes chagásicos crónicos chilenos mediante citometría de flujo / Immnunophenotyping by flow cytometry of peripheral blood lymphocytes from Chilean chronic chagasic patients

Background: Cellular immune mechanisms of the resistance to infection by T cruzi as well as the pathogenesis of Chagas disease are still controversial. Aim: To quantify and analyse the peripheral blood immune cells from chagasic and non chagasic patients by flow cytometry. Patients and methods: Peripheral blood samples were taken from 21 individuals seropositive for Chagas disease, under no specific treatment. Control samples from 21 healthy blood donors were also obtained. To quantify immune cells populations by flow cytometry, antibodies against CD3, CD4, CD8, CD16/56, CD45/14, CD19 and HLA-DR markers were used. Results: The percentage of CD8+ cells was low and the CD4+/CD8+ ratio was high in chagasic patients, compared to their non infected counterparts. No statistically significant differences in the number of CD4+, NK, B, CD4+HLADR+ and CD8+HLADR+ cells, were observed within the two groups. Conclusions: These results show that Chilean chronic chagasic patients have lower percentage of CD8+ cells and higher CD4+/CD8+ ratio than non infected individuals

Trastornos digestivos secundarios a enfermedad de Chagas en 40 egresos con diagnóstico de megacolon, fecaloma, obstrucción intestinal o acalasia en el Hospital Barros Luco Trudeau: Santiago, Chile durante el año 1999 / Chagas' disease in 40 clinical file cases with megacolon, fecaloma, intestinal obstruction or achalasia from the Hospital Barros Luco Trudeau: Santiago, Chile, 1999

La revisión de fichas clínicas del año 1999 en el Hospital Barros Luco Trudeau, permitió pesquisar 40 casos con diagnóstico principal al egreso de megacolon, fecaloma, obstrucción intestinal o acalasia. En un solo caso de megacolon pesquisado ese año, se confirmó la etiología chagásica mediante serología convencional anti-Trypanosoma cruzi. La baja incidencia en esta casuística es debida a que este servicio hospitalario es una zona de baja endemia chagástica, a falencias en los registros y a la falta de sospecha clínica

Evaluación serológica del tratamiento de la enfermedad de Chagas crónica con alopurinol e itraconazol / Serologic evaluation of treatment of chronic Chagas disease with allopurinol and itraconazole

Background: Chagas disease is endemic in Chile. Allopurinol and itraconazole have activity against Trypanosoma cruzi and are recommended for the treatment of chronic disease in adults. Aim: To evaluate the chemotherapeutic effects of allopurinol and itraconazole using conventional and non conventional serologic test. Patients and methods: Sera of 90 patients with chonic Chagas disease were studied before and after 9 to 11 months of treatment with allopurinol or itraconazole and after two month of treatment with placebo. Indirect immunofluorescence, ELISA and Western Blot analysis were the conventional serologic tests used and antibody dependent complement mediated lysis (CoML) the non conventional test. Results: There were no differences in ELISA and indirect immunofluorescence tests before and after therapy. Antigenic recognition profiles by Western Blot showed qualitative and quantitative differences in a small number of cases. CoML showed that the greater negativity was achieved in the Chagasic group treated with allopurinol or itraconazole that had a negative xenodiagnosis before drugs treatment (35.8 and 61.6 percent, respectively). Conclusions: There is a reversion of lytic activity in sera of patients with negative xenodiagnosis before treatment, suggesting the parasitemia could be an important parameter to be considered in the chemotherapy of Chagas disease

Detección de cardiopatía en escolares chagásicos y no chagásicoa de Combarbalá, IV región, Chile / Detetion of cardiopathy in school chagasic and non-chagasic children at Combarbalá, IV region, Chile

Con el propósito de registrar la aparición de alteraciones electrocardiográficas consideradas sugerentes de miocardiopatía chagásica se realizó un seguimiento clínico, electrocardiográfico y serológico (con reacciones de inmunofluorescencia indirecta, hemaglutinación indirecta y ELISA para enfermedad de Chagas), cada cuatro meses hasta completar un año de seguimiento, en 115 escolares asintomáticos de Combarbalá (IV región de Coquimbo), 55 con evidencia serológica de enfermedad de Chagas y 60 sin ella, de ambos sexos y de 9 a 18 años de edad (media 13,7 años). Los electrocardiogramas mostraron signos incluídos en los criterios de sospecha de miocardiopatía chagásica de la OPS en 22 (40 porciento) de los escolares infectados por Trypanosoma cruzi, aunque todos continuaron asintomáticos por todo el seguimiento. Las alteraciones más frecuentes en ellos fueron prolongación del intervalo QT y bloqueo incompleto de la rama derecha del haz de Hiss. En 7,3 porciento y 6,7 porciento de los escolares infectados y no infectados por TC respectivamente, se detectaron alteraciones electrocardiográficas consideradas no atribuibles a la parasitosis según los criterios empleados. En 91 porciento de los niños infectados y con alteraciones electrocardiográficas sugerentes de cardiopatía chagásica se registró, sin embargo, a lo menos un electrocardiograma normal, en cambio éste estuvo siempre alterado en los niños cuyas anomalías tenían, supuestamente otro origen

Evaluación de ELISA y contrainmunoelectroforesis en el diagnóstico de la neurocisticercosis humana en Chile / Evaluation of ELISA and counterimmunoelectrophoresis in human neurocysticercosis diagnosis in Chile

The aim of this work was to assess the diagnostic accuracy for neurocysticercosis of ELISA and counterimmunoelectrophoresis techniques, in sera and cerebrospinal fluid. 208 serum samples (47 coming from patients with confirmed cysticercosis) and 87 cerebrospinal fluid samples (27 coming from patients with confirmed cysticercosis) were analyzed. A crude and standardized extract of swine muscle cysticercus cellulosae was used as antigen. ELISA and counterimmunoelectrophoresis had a 100 percent specificity in cerebrospinal fluid, ELISA had a 85.1 percent sensitivity. Cross reactions were observed in sera of patients with confirmed hydatidosis. Thus, the high specificity of both techniques in cerebrospinal fluid is probably due to the low incidence of cerebral hydatidosis in Chile. It is concluded that for the diagnosis of neurocysteicersosis, antibodies against cysticercus cellulosae must be sought paralelly in serum and cerebrospinal fluid using ELISA and counterimmunoelectrophoresis

Ensayo inmunoenzimático Elisa-IgG aplicado al diagnóstico de la fascioliasis hepática humana crónica / Enzyme inmunoassay, Elisa IgG, in the diagnosis of human chronic fasciolasis

Los sueros de 3.838 individuos aparentemente sanos de las provincias de Talca y Linares (VII Región de Chile), zona endémica de fascioliasis humana, fueron evaluados por ELISA-IgG usando antígeno somático soluble de Fasciola hepatica cuya estandarización previa demostró sensibilidad de 92,3%, especificidad de 99,4%. Se consideró límite discriminativo de postividad una absorbancia > 0,170. El estudio parasitológico en heces y bilis fue realizado por técnicas de sedimentación en copa y sondeo respectivamente. Los resultados de 3.733 sueros fueron ELISA-IgG negativos. De 76 sueros con ELISA-IgG positiva, se confirmo la infección en 21 individuos. De 29 sueros que presentaron absorbancia cercana al límite discriminativo (ELISA-IgG sospechosa) se confirmó la infección en 7 individuos. La prueba de Scheffé de promedio mayor permitió establecer que el grupo ELISA-IgG positiva o sospechosa no confirmado parasitológicamente pertenece a la misma población que el grupo ELISA-IgG positiva o sospechosa confirmado, lo que sugiere alta probabilidad de parasitismo en el grupo no confirmado. Se realizó además estudio parasitológico en heces y bilis en 31 personas con ELISA-IgG negativa. Los resultados fueron negativos en todas las muestras examinadas