Time distribution of positive nucleic acid detection in imported cases infected with SARS-CoV-2 in China / 中华流行病学杂志

Objective: To analyze the time distribution of the first positive nucleic acid detection in imported cases infected with SARS-CoV-2 reported nationwide in China and provide references for further improvement of the prevention and control of COVID-19 in international travelers. Methods: The data of imported cases infected with SARS-CoV-2 reported by provinces from 24 July 2020 and 23 July 2021 were collected for the analysis on the time distribution of the first positive nucleic acid detection after entering China. Results: A total of 7 199 imported cases infected with SARS-CoV-2 were reported in 28 provinces during 24 July 2020 to 23 July 2021. The median interval (Q1, Q3) from the entry to the first positive nucleic acid detection of SARS-CoV-2 was 1 (0, 5) day. The imported cases who had the first positive nucleic acid detections within 14 days and 14 days later after the entry accounted for 95.15% (6 850/7 199) and 4.85% (349/7 199) respectively. Among these cases, 3.65% (263/7 199), 0.88% (63/7 199) and 0.32% (23/7 199) had the first positive nucleic acid detections within 15-21 days, 22-28 days and 28 days later after the entry respectively. The proportion of asymptomatic infections were 47.24% (3 236/6 850) and 63.61% (222/349) among the cases who had the first positive nucleic acid detections within 14 days and 14 days later after the entry respectively. A total of 39.54% (138/349) of cases infected with SARS-CoV-2 with the first positive nucleic acid detections 14 days later after the entry had inter-provincial travel after the discharge of entry point isolation. Conclusions: About 5% of the imported cases infected with SARS-CoV-2 were first positive 14 days later after the entry. In order to effectively reduce the risk of domestic COVID-19 secondary outbreaks caused by imported cases, it is suggested to add a nucleic acid test on 8th -13th day after the entry.

Epidemiological characteristics of 17 imported patients infected with SARS-CoV-2 Omicron variant / 中南大学学报(医学版)

OBJECTIVES@#With the continuous generation of new variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pressure of epidemic prevention and control continues to increase in China. Omicron with stronger infectiousness, immune escape ability and repeated infection ability spread to many countries and regions around the world in a short period of time. China has also successively reported cases of imported Omicron infections. This study aims to understand the epidemiological characteristics of Omicron variant via analyzing the epidemiological characteristics of imported patients with Omicron in Hunan Province, and to provide reference for preventing and controlling the imported epidemics.@*METHODS@#The clinical data of imported patients with coronavirus disease 2019 admitted to Hunan Province from December 16 to December 31, 2021 were retrospectively collected. The epidemiological information, general information, clinical classification, clinical symptoms, vaccination status, and lung CT were analyzed. Nasopharyngeal swabs and blood samples were collected. Virus nucleic acid was detected by magnetic beads method using SARS-CoV-2 detection kit. Ct values of ORF1ab gene and N gene were compared between asymptomatic infected patients and confirmed patients. The specific IgM and IgG antibodies were detected by chemiluminescence assay using SARS-CoV-2 IgM test kit and SARS-CoV-2 IgG test kit, respectively. Ct values of IgM and IgG antibodies were compared between asymptomatic infected patients and confirmed patients.@*RESULTS@#Seventeen patients with Omicron variant infection were treated in Hunan, including 15 confirmed patients (5 common type and 10 mild type) and 2 asymptomatic infection patients. The 17 patients were all Chinese, they were generally young, and 16 were male. There were 9 patients with diseases. Of them 3 patients had respiratory diseases. All 17 patients had completed the whole process of vaccination, but only one person received a booster shot of SARS-CoV-2 vaccine. The clinical manifestations of the patients were mild, mainly including dry/painful/itchy throat, cough, and fatigue. The total protein and creatine in the asymptomatic infection and confirmed cases infected with Omicron variant were all within the normal range, but other biochemical indicators were abnormal. There were the significant differences in C-reactive protein and fibrinogen between asymptomatic infection and confirmed patients (both P<0.05). There were more patients with elevated C-reactive protein in confirmed patients than without confirmed ones. The detection rate of specific IgM and IgG antibodies on admission was 100%, and there was no significant difference in the specific antibody levels between asymptomatic infection and confirmed patients (P>0.05). There were no significant differences in Ct values of ORF1ab gene and N gene (21.35 and 18.39 vs 19.22 and 15.67) between the asymptomatic infection and the confirmed patients (both P>0.05). Only 3 patients had abnormal lung CT, showing a small amount of patchy and cord-like shadows. One of them had no abnormality on admission but had pulmonary lesions and migratory phenomenon after admission.@*CONCLUSIONS@#The patients with Omicron variant tend to be young people and have milder clinical symptoms, but the viral load is high and the infectiveness is strong. Therefore, the timely identification and effective isolation and control for asymptomatic infections and confirmed patients with mild symptoms are extremely important. In terms of epidemic prevention and control, the government still needs to strengthen the risk control of overseas input, adhere to normalized epidemic prevention and control measures, to effectively control the source of infection, cut off the route of transmission, and protect vulnerable people.

Vitamin D status and COVID-19 severity

Background: Age, body mass index (BMI) and pre-existing comorbidities are known risk factors of severe coronavirus disease 2019 (COVID-19). In this study we explore the relationship between vitamin D status and COVID-19 severity. Methods: We conducted a prospective, cross-sectional descriptive study. We enrolled 100 COVID-19 positive patients admitted to a tertiary level hospital in Johannesburg, South Africa. Fifty had symptomatic disease (COVID-19 pneumonia) and 50 who were asymptomatic (incidental diagnosis). Following written informed consent, patients were interviewed regarding age, gender and sunlight exposure during the past week, disease severity, BMI, calcium, albumin, magnesium and alkaline phosphatase levels. Finally, blood was collected for vitamin D measurement. Results: We found an 82% prevalence rate of vitamin D deficiency or insufficiency among COVID-19 patients. Vitamin D levels were lower in the symptomatic group (18.1 ng/mL ± 8.1 ng/mL) than the asymptomatic group (25.9 ng/mL ± 7.1 ng/mL) with a p-value of 0.000. The relative risk of symptomatic COVID-19 was 2.5-fold higher among vitamin D deficient patients than vitamin D non-deficient patients (confidence interval [CI]: 1.14­3.26). Additional predictors of symptomatic disease were older age, hypocalcaemia and hypoalbuminaemia. Using multiple regression, the only independent predictors of COVID-19 severity were age and vitamin D levels. The patients exposed to less sunlight had a 2.39-fold increased risk for symptomatic disease compared to those with more sunlight exposure (CI: 1.32­4.33). Conclusion: We found a high prevalence of vitamin D deficiency and insufficiency among patients admitted to hospital with COVID-19 and an increased risk for symptomatic disease in vitamin D deficient patients.

SARS-CoV-2 y RT-PCR en pacientes asintomáticos: resultados de una cohorte de trabajadores del Aeropuerto Internacional El Dorado de Bogotá, 2020 / SARS-CoV-2 and RT-PCR in asymptomatic patients: Results of a cohort of workers at El Dorado International Airport in Bogotá, 2020

Introducción. La pandemia de COVID-19 ha ocasionado cerca de 25 millones de casos en el mundo. Se ha descrito que los pacientes asintomáticos pueden ser fuentes de transmisión. Sin embargo, es difícil detectarlos y no es claro su papel en la dinámica de transmisión del virus, lo que obstaculiza la implementación de estrategias para la prevención. Objetivo. Describir el comportamiento de la infección asintomática por SARS-CoV-2 en una cohorte de trabajadores del Aeropuerto Internacional El Dorado "Luis Carlos Galán Sarmiento" de Bogotá, Colombia. Materiales y métodos. Se diseñó una cohorte prospectiva de trabajadores del Aeropuerto El Dorado. El seguimiento se inició en junio de 2020 con una encuesta a cada trabajador para caracterizar sus condiciones de salud y trabajo. Cada 21 días se tomó una muestra de hisopado nasofaríngeo para detectar la presencia del SARS-CoV-2 mediante reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR). Se analizó el comportamiento del umbral del ciclo (cycle threshold) de los genes ORFlab y N según el día de seguimiento. Resultados. En los primeros tres seguimientos de la cohorte se encontró una incidencia de la infección por SARS-CoV-2 del 16,51 %. La proporción de contactos positivos fue del 14,08 %. La mediana del umbral del ciclo fue de 33,53. Conclusión. Se determinaron las características de la infección asintomática por el SARS-CoV-2 en una cohorte de trabajadores. La detección de infectados asintomáticos sigue siendo un reto para los sistemas de vigilancia epidemiológica.

Introduction: The 2019 coronavirus pandemic (COVID-19) has caused around 25 million cases worldwide. Asymptomatic patients have been described as potential sources of transmission. However, there are difficulties to detect them and to establish their role in the dynamics of virus transmission, which hinders the implementation of prevention strategies. Objective: To describe the behavior of asymptomatic SARS-CoV-2 virus infection in a cohort of workers at the El Dorado "Luis Carlos Galán Sarmiento" International Airport in Bogotá, Colombia. Materials and methods: A prospective cohort of 212 workers from the El Dorado airport was designed. The follow-up began in June, 2020. A survey was used to characterize health and work conditions. Every 21 day, a nasopharyngeal swab was taken to identify the presence of SARS-CoV-2 using RT-PCR. We analyzed the behavior of the cycle threshold (ORFlab and N genes) according to the day of follow-up. Results: In the first three follow-ups of the cohort, we found an incidence of SARS-CoV-2 infection of 16.51%. The proportion of positive contacts was 14.08%. The median threshold for cycle threshold was 33.53. Conclusion: We characterized the asymptomatic SARS-CoV-2 infection in a cohort of workers. The identification of asymptomatic infected persons continues to be a challenge for epidemiological surveillance systems.

Apoptosis de neutrófilos en la infección asintomática por Virus de la Inmunodeficiencia Humana / Neutrophil apoptosis in asymptomatic Human Immunodeficiency Virus infection

En los últimos años se ha determinado que los neutrófilos son células altamente versátiles y sofisticadas, cuyas funciones van mucho más allá de la eliminación de los microorganismos. En la infección con el Virus de Inmunodeficiencia Humana (HIV), si bien el papel de los neutrófilos no está totalmente caracterizado, actualmente está claro que la relación entre los neutrófilos y el virus es mucho más compleja de lo que se pensaba. Los objetivos de este trabajo fueron evaluar en pacientes con infección asintomática, y sin tratamiento antirretroviral, el efecto de la infección por el HIV sobre la muerte celular de los neutrófilos y la expresión de receptores de superficie. En pacientes seropositivos sin tratamiento hubo un aumento de la apoptosis temprana de los neutrófilos en relación a los grupos controles. Esta apoptosis aumentada no depende de la activación de la vía extrínseca o intrínseca. En estos pacientes hubo un aumento de la expresión de TLR2 que, unido al aumento de la apoptosis temprana, podría ser indicativo de un fenotipo activado de los neutrófilos. En conclusión, este trabajo aporta información sobre aspectos relacionados con la apoptosis de los neutrófilos en estadios tempranos de la infección por HIV, contribuyendo así a una mayor comprensión acerca del efecto de este virus sobre componentes de la respuesta inmune innata.

In recent years it has been determined that neutrophils are highly versatile and sophisticated cells whose functions go far beyond the elimination of microorganisms. In Human Immunodeficiency Virus (HIV) infection, the role of neutrophils is not fully characterized but it is now clear that the relationship between neutrophils and HIV is much more complex than previously thought. The aims of this study were to evaluate the effect of HIV infection on neutrophil cell death and the expression of surface molecules on neutrophils in patients with asymptomatic infection and without antiretroviral treatment (ART). In HIV seropositive patients without antiretroviral therapy there was an increase in the early apoptosis of neutrophils in relation to the control groups. This increased apoptosis does not depend on the activation of the extrinsic or intrinsic pathway. In these patients there was an increase in the expression of TLR2 which, together with the increase of early apoptosis, could be indicative of an activated phenotype of neutrophils. In conclusion, this study provides information on aspects related to the apoptosis of neutrophils in early stages of HIV infection and therefore contributes to a better understanding of the effect of this virus on components of the innate immune response.

Nos últimos anos, determinou-se que os neutrófilos são células altamente versáteis e sofisticadas, cujas funções vão muito além da eliminação dos microrganismos. Na infecção pelo HIV, embora o papel dos neutrófilos não esteja totalmente caracterizado, atualmente fica bem claro que a relação entre os neutrófilos e o vírus é muito mais complexa do que se pensava anteriormente. Os objetivos deste trabalho foram avaliar em pacientes com infecção assintomática, e sem tratamento antirretroviral, o efeito da infecção pelo HIV na morte celular dos neutrófilos e a expressão de receptores de superfície. Nos pacientes soropositivos sem tratamento, houve um aumento da apoptose precoce dos neutrófilos em relação aos grupos controle.Esta apoptose aumentada não depende da ativação da via extrínseca ou intrínseca. Nestes pacientes, houve um aumento da expressão de TLR2 que, juntamente com o aumento da apoptose precoce, poderia ser indicativo de um fenótipo ativado dos neutrófilos. Em conclusão, este trabalho fornece informações sobre aspectos relacionados com a apoptose dos neutrófilos em estágios precoces da infecção pelo HIV, contribuindo desse modo para uma maior compreensão sobre o efeito deste vírus nos componentes da resposta imune inata.

Situación de enfermería en América, frente a la pandemia Covid-19 / NursingSituacion in America, in front of the Covid -19 pandemic

INTRODUCCIÓN: en el mismo año en que se declara Año Internacional de la Enfermería y Partería, la inesperada aparición del nuevo coronavirus SARS-CoV-2,dio un giro a lo que se tenía planeado dentro de los programas de salud a nivel mundial y deja en evidencia las debilidades de los sistemas sanitarios, donde el continente más afectado por dicho virus fue América, ya que sus esfuerzos por contener la pandemia fueron insuficientes, el tiempo de reacción para establecer protocolos de salud fue tardío y la disponibilidad para dotar al personal de salud de equipos de protección fue mínimo, y aun así el accionar del personal sanitario en especial de enfermería. OBJETIVO: describir la situación de enfermería en América, frente a la pandemia Covid-19. METODOLOGÍA: la investigación se realizó mediante un diseño narrativo, de carácter documental, analítico de enfoque cualitativo y método inductivo; obteniendo la información de fuentes secundarias confiables. RESULTADOS Y CONCLUSIONES: la actual pandemia demuestra la importancia de disponer de profesionales de salud en un número adecuado según las necesidades y cuidados que requiere cada paciente; es por esta razón que se precisa que los países inviertan en mejorar las condiciones de trabajo de los profesionales de enfermería, que incluyan equipos de protección individual, apoyo al trabajo en equipo y educación continua en enfermería, lo cual llevará a importantes logros, evidenciando el profesionalismo de enfermería y su entrega absoluta, al aplicar sus cuatro roles fundamentales con el fin de proteger la salud y mejorar la vida de las personas, a pesar de los evidentes riesgos reales y potenciales a los que se enfrentan a nivel laboral.

INTRODUCTION: in the same year in which the International Year of Nursing and Midwifery is declared, the unexpected appearance of the new SARS-CoV-2 coronavirus, gave a turn to what was planned within health programs worldwide and leaves in evidence the weaknesses of the health systems, where the continent most affected by this virus was America, since their efforts to contain the pandemic were insufficient, the reaction time to establish health protocols was late and the availability to provide staff with The health ofprotective equipment was minimal, and even so, the actions of health personnel, especially nursing personnel. OBJECTIVE: to describe the nursing situation in America, in the face of the Covid-19 pandemic. METHODOLOGY: the research was carried out through a narrative, documentary, analytical design with a qualitative approach and an inductive method; obtaining the information from reliable secondary sources. RESULTS AND CONCLUSIONS: the current pandemic shows the importance of having adequate numbers of health professionals according to the needs and care that each patient requires; It is for this reason that it is necessary for countries to invest in improving the working conditions of nursing professionals, which include individual protection equipment, support for teamwork and continuing education in nursing, which will lead to important achievements, evidencing the Nursing professionalism and its absolute dedication, by applying its four fundamental roles in order to protect health and improve people's lives, despite the obvious real and potential risks they face at the work level.

Probable horizontal transmission of SARS-CoV-2 in an asymptomatic neonate: A case report

Introduction: Preterm delivery is of considerable concern to clinicians and researchers being a leading cause of infant morbidity and mortality in the industrialized countries and also contributes to substantial complications among survivors. Sub-Saharan Africa, including Nigeria accounts for significant proportion of preterm births, with over million deaths due to complication of prematurity. Objectives: The study aimed to determine the prevalence and associated morbidities of preterm deliveries at the University of Maiduguri Teaching Hospital, Maiduguri, North-Eastern Nigeria. Patients and methods: This is a retrospective review of neonates delivered before 37 completed weeks of gestation and admitted into the Special Care Baby Unit (SCBU) of the University of Maiduguri Teaching Hospital, from 1st January 2008 to 31st December 2015. Results: There were 3435 admissions into the Special Care baby Unit (SCBU) during the 8 year period. Out of these 1129 were preterm babies giving a prevalence of 32.9%. Of the 1129 preterm babies managed in SCBU, 714 case records were retrieved and analyzed giving a retrieval rate of 63%. There were 372 (52.1%) males and 342 (47.9%) females; with the male to female ratio of 1:1.08. There were 17(2.3%) extreme low birth weight (1000-1499 g), 406 (56.9%) low birth weight (1500- 2499 g) babies. The range of admission weights was 700-2500g with mean of 1600±900g. Conclusion: The burden, complications and mortality from preterm newborns remain significant public health challenges to care givers in Nigeria

Salud pública y pruebas diagnósticas del COVID-19: caso Venezuela / Public health and diagnostics tests for SARS-COVID-2 infection: The venezuela case

La salud pública mundial presenta en la actualidad un reto de grandes dimensiones para realizar las funciones esenciales del Siglo XXI, "el diagnóstico temprano y el tratamiento preventivo de las enfermedades"; por lo tanto la OMS considera que para conocer la magnitud de la epidemia COVID-19 es básico contar con suficientes pruebas diagnósticas en cantidad y calidad. En Venezuela, el Ministerio de la Salud comunica que se han realizado más de 80.484 pruebas por millón de habitantes (marzo-diciembre 2020), las más altas de la región; sin embargo, las pruebas diagnósticas de PCR y Prueba de antígenos, no alcanzan a 1.488,8 (105) y 11,9 (105) respectivamente, muy bajas. Se revisan las pruebas más usadas para detección de genoma, antígenos y serología, mediante pruebas de tiempo y rápidas, ambulatorias o de estricto manejo en laboratorio(AU)

Global public health currently presents a major challenge in performing the essential functions of the 21st century, "early diagnosis and preventive treatment of diseases", so WHO believes that sufficient diagnostic evidence in quantity and quality is essential to understand the scale of the COVID-19 epidemic. In Venezuela, the Ministry of Health reports that more than 80,484 tests per million inhabitants (march-december 2020) have been carried out; however, diagnostic tests of PCR and Antigen Test, do not reach 14,888 (106) and 110 (106) respectively, which is very low compared to neighboring countries. The most commonly used tests for genome, antigen and serology are reviewed(AU)

Evolução da prevalência de infecção por COVID-19 no Rio Grande do Sul, Brasil: inquéritos sorológicos seriados / Trends in the prevalence of COVID-19 infection in Rio Grande do Sul, Brazil: repeated serological surveys

Resumo A COVID-19 é uma doença produzida pelo vírus SARS-CoV-2. Esse vírus se espalhou rapidamente pelo mundo, o que levou a Organização Mundial da Saúde a classificar a COVID-19 como uma emergência de saúde internacional e, posteriormente, a declará-la uma pandemia. O número de casos confirmados, no dia 11 de abril de 2020, já passa de 1.700.000, porém esses dados não refletem a real prevalência de COVID-19 na população, visto que, em muitos países, os testes são quase que exclusivamente realizados em pessoas com sintomas, especialmente os mais graves. Para definir políticas de enfrentamento, é essencial dispor de dados sobre a prevalência real de infecção na população. Este estudo tem por objetivos avaliar a proporção de indivíduos já infectados pelo SARS-CoV-2 no Rio Grande do Sul, Brasil, analisar a velocidade de expansão da infecção e estimar o percentual de infectados com e sem sintomas. Serão realizados quatro inquéritos sorológicos repetidos a cada 15 dias, com amostragem probabilística de nove cidades sentinela, em todas as sub-regiões do Estado. As entrevistas e testes ocorrerão no âmbito domiciliar. Serão utilizados testes rápidos para detecção de anticorpos, validados previamente ao início da coleta de dados.

Abstract COVID-19, the disease produced by the virus SARS-CoV-2, has spread quickly throughout the world, leading the World Health Organization to first classify it as an international health emergency and, subsequently, declaring it pandemic. The number of confirmed cases, as April 11, surpassed 1,700,000, but this figure does not reflect the prevalence of COVID-19 in the population as, in many countries, tests are almost exclusively performed in people with symptoms, particularly severe cases. To properly assess the magnitude of the problem and to contribute to the design of evidence-based policies for fighting COVID-19, one must accurately estimate the population prevalence of infection. Our study is aimed at estimating the prevalence of infected individuals in the state of Rio Grande do Sul, Brazil, to document how fast the infection spreads, and to estimate the proportion of infected persons who present or presented symptoms, as well as the proportion of asymptomatic infections. Four repeated serological surveys will be conducted in probability samples of nine sentinel cities every two weeks. Tests will be performed in 4,500 participants in each survey, totaling18,000 interviews. Interviews and tests will be conducted at the participants' household. A rapid test for the detection of antibodies will be used; the test was validated prior to the beginning of the fieldwork.

Genomic and phylogenetic characterisation of an imported case of SARS-CoV-2 in Amazonas State, Brazil

A new coronavirus [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] is currently causing a life-threatening pandemic. In this study, we report the complete genome sequencing and genetic characterisation of a SARS-CoV-2 detected in Manaus, Amazonas, Brazil, and the protocol we designed to generate high-quality SARS-CoV-2 full genome data. The isolate was obtained from an asymptomatic carrier returning from Madrid, Spain. Nucleotide sequence analysis showed a total of nine mutations in comparison with the original human case in Wuhan, China, and support this case as belonging to the recently proposed lineage A.2. Phylogeographic analysis further confirmed the likely European origin of this case. To our knowledge, this is the first SARS-CoV-2 genome obtained from the North Brazilian Region. We believe that the information generated in this study may contribute to the ongoing efforts toward the SARS-CoV-2 emergence.

Canine leptospirosis in asymptomatic populations from the Southwest Region of São Paulo State, Brazil / Leptospirose canina em uma população assintomática da região sudoeste do estado de São Paulo, Brasil

Leptospirosis is an infectious disease that can affect animals and humans. Distributed worldwide, the disease is more prevalent in tropical regions due to socioenvironmental characteristics. Dogs can serve as sentinels for environmental contamination due to their frequent contact with humans. This study investigated the frequency of occurrence of canine leptospirosis in asymptomatic populations from the Southwest Region of the State of São Paulo, Brazil. Thus, blood samples collected from 572 asymptomatic dogs from the cities of Apiaí, Cananeia, Itapeva, and Itu were tested with a microscopic agglutination test (MAT). A total of 40.5% of animals in Apiaí reacted to Leptospira spp., 42.6% in Itapeva, 7.1% in Cananeia, and 5.1% in Itu. The data from the present study demonstrate that at least one animal from the municipalities of Itapeva, Apiaí, and Cananeia had a titer equal to or higher than 800, indicating that Leptospira is circulating in these municipalities and that the teams working on castration campaigns need to be educated on the correct use of personal protective equipment, especially when mechanically emptying the bladder of these animals. This study also suggests that castration campaigns can strategically monitor zoonotic diseases and assist in establishing preventive strategies for human and animal health.(AU)

A leptospirose é uma enfermidade infectocontagiosa que pode acometer os animais e o homem. Nos países tropicais e em desenvolvimento ocorrem 70% dos casos humanos, com mortalidade variando entre 10 a 70%. Os cães podem se tornar portadores assintomáticos por um longo período, podendo transmitir a Leptospira para humanos. Devido ao intenso convívio com o ser humano, os cães podem servir como sentinelas da contaminação ambiental. Esse trabalho investigou a frequência de ocorrência da leptospirose canina em populações assintomáticas da região sudoeste do estado de São Paulo. Para isso foram examinadas pela técnica de soroaglutinação microscópica (MAT), amostras de sangue provenientes de 572 cães assintomáticos dos municípios de Apiaí, Cananeia, Itapeva e Itu por amostragem de conveniência, oriundos de campanhas de castração. Em Apiaí, foram encontrados 40,5% dos animais reagentes para Leptospira spp.; em Itapeva, 42,6%; em Cananeia, 7,7% e em Itu, 5,1%. Os dados encontrados demonstram que, pelo menos, um animal dos municípios de Itapeva, Apiaí e Cananeia apresentaram título igual ou maior que 800, indicando a circulação da bactéria nessas localidades e que a equipe envolvida nas campanhas de castração precisam ser alertadas sobre o correto uso de equipamento de proteção individual, principalmente no esvaziamento mecânico da bexiga antes do procedimento cirúrgico. O estudo também sugere que as campanhas de castração podem ser estratégicas no monitoramento de doenças zoonóticas e poderiam auxiliar no estabelecimento de ações preventivas para a saúde humana e animal.(AU)

La infección asintomática por el SARS-CoV-2: evidencias para un estudio poblacional en Cuba / Asymptomatic Infection by SARS-CoV-2: evidence for a Population Study in Cuba a

Introducción: La transmisión del SARS-CoV-2 entre personas asintomáticas continúa siendo motivo de debate y preocupación para la comunidad científica internacional. Objetivo: Exponer algunas consideraciones sobre la infección asintomática por SARS-CoV-2 y características de los casos notificados en Cuba entre el 11 de marzo y 17 de junio de 2020 como evidencia para un estudio poblacional de seguimiento. Métodos: Se realizó una revisión bibliográfica de la literatura sobre la infección por SARS-CoV-2 y las particularidades de las manifestaciones clínicas de la COVID-19; para ello se consultaron informaciones diarias y evidencias reportadas a través del portal web de la red Infomed. Se analizó la información contenida en la base de datos nacional de casos confirmados de la COVID-19, entre el 11 de marzo y 17 de junio de 2020. Además de la condición de asintomático al momento del diagnóstico se analizaron otras variables como grupos de edad y provincia. Se resumió la información mediante totales y tasa de incidencia acumulada. Se ajustó la línea recta y un polinomio de orden 4 a la serie de casos asintomáticos. Conclusiones: Se denota cuan comunes son las personas asintomáticas al momento del diagnóstico y parece existir consenso en el ámbito científico en cuanto a su implicación en la propagación subclínica de la enfermedad. Desde el inicio de la epidemia, la mayoría de los casos notificados en Cuba han sido asintomáticos, lo cual se ha evidenciado en la mayoría de las provincias y en los diferentes grupos etarios, exceptuando los menores de un año y el grupo entre 60 y 79 años de edad. El conocimiento incompleto sobre la magnitud de la infección asintomática en la población supuestamente sana, las peculiaridades de esos casos y su influencia en la transmisión viral, alentaron la realización de un estudio poblacional de seguimiento(AU)

Introduction: SARS-CoV-2 transmission among asymptomatic people continues to be a matter of debate and concern for the international scientific community. Objective: To present some considerations about SARS-CoV-2 asymptomatic infection and the characteristics of the cases reported in Cuba between March 11 and June 17, 2020, as evidence for a population follow-up study. Methods: We carried out a bibliographic review of the literature about SARS-CoV-2 infection and the particularities of the clinical manifestations of COVID-19, for which we consulted the daily information and the evidence reported through the web portal of the Infomed network. We analyzed the information contained in the national database of confirmed COVID-19 cases, between March 11 and June 17, 2020. In addition to the asymptomatic condition at the time of diagnosis, other variables were analyzed, such as age groups and province. The information was summarized using totals and the cumulative incidence rate. The straight line and a polynomial of order 4 were adjusted to the series of asymptomatic cases. Conclusions: It is evident how common asymptomatic people are at the time of diagnosis, while there seems to be consensus, in the scientific field, regarding their involvement in the subclinical spread of the disease. Since the beginning of the epidemic, most of the cases reported in Cuba have been asymptomatic, which has been evidenced in most of the provinces and different age groups, except those aged less than one year or 60-79 years old. Incomplete knowledge of the extent of asymptomatic infection in the supposedly healthy population, the peculiarities of these cases and its influence on viral transmission, encouraged a population "follow-up study(AU)

Cribado de infecciones cervicales de transmisión sexual en mujeres embarazadas y su relación con la microbiota vaginal / Screening of cervical sexually transmitted infections in pregnant women and the relation with the vaginal microbiota

Resumen Introducción: La mujer embarazada está expuesta anumerosas infecciones de transmisión sexual (ITS), las que pueden producir aborto, enfermedad en el feto y/o en el recién nacido, además de alteraciones en el curso normal del embarazo. Objetivo: Realizar tamizaje de infección cervical asintomática en mujeres embarazadas y su relación con la microbiota. Pacientes y Métodos: Se enrolaron 85 mujeres embarazadas sin cervicitis clínica que consultaron en control de rutina de embarazo (47 pacientes) o que fueron derivadas a una unidad de ITS (38 pacientes). Se tomaron muestras de fondo de saco vaginal, que fueron analizadas por técnicas clásicas de microscopía y cultivo corriente y reacción de polimerasa en cadena para Neisseria gonorrhoeae, Trichomonas vaginalis y Chlamydia trachomatis. Resultados: Se encontró 12,9% de infección por C. trachomatis, 2,4% de T. vaginalis. En este estudio no se encontró N. gonorrhoeae. El 23,3% de pacientes con microbiota alterada (vaginosis bacteriana y microbiota intermedia) fue positiva para C. trachomatis. Conclusión: En este trabajo, encontramos una alta frecuencia de infección por C. trachomatis, que se relaciona en forma significativa con la presencia de microbiota alterada. Esta alta frecuencia debería promover estrategias preventivas en los controles de salud de la mujer embarazada.

Background: Pregnant woman is exposed to many sexual transmitted infections (STI). Many of these infections may produce diseases in the fetus and newborn, and also alteration in the normal course of the pregnancy. Aim: Screening of asymptomatic cervical infection in pregnant woman and its relationship with the vaginal microbiota. Patients and Methods: 85 pregnant women without clinical cervicitis who consult in the routine pregnant control (47 patients) and women derived from STI service (38 patients). The samples were obtained from the vaginal fund sac and were analyzed with optic microscopy, cultures and PCR of Neisseria gonorrhoeae, Trichomonas vaginalis and Chlamydia trachomatis. Results: 12,9% of the enrolled women were positive for C. trachomatis, 2,4% for T. vaginalis. In this study, we did not found N. gonorrhoeae. We observed 23,3% of patients with altered microbiota (bacterial vaginosis and intermediate microbiota) was positive for C. trachomatis. Conclusions: In this study, we found a high frequency of C. trachomatis infection, that correlates with the presence of altered microbiota. This high frequency would promote preventive strategies in the pregnant women routine controls.

Colonization and risk of infection by multidrug-resistant bacteria in hemodialysis patients: a topic of concern / Colonización e infección por bacterias multirresistentes en pacientes en hemodiálisis: un tema de preocupación

Abstract Antimicrobial resistance worsens the prognosis in patients with chronic diseases. Patients on hemodialysis have infection rates that exceed those reported in other types of patients. Colonization has been suggested as a risk factor for the development of infections. However, the majority of the studies that have evaluated this association have methodological limitations that have called into question the validity of the results; such as the lack of use of molecular methods to confirm that the colonizing species are the same as that which causes infection, the measurement of exposure only at the beginning of the study, the absence of follow-up, the evaluation of bacteremia as the only important outcome and the focus only on Staphylococcus aureus, without including other resistant bacteria of clinical importance such as multidrug-resistant Gram-negative bacteria. This lead to the need to use molecular epidemiology methods for refine the association between colonization and infection in endemic countries like Colombia, where the high rates of antimicrobial resistance demand accurate prevention strategies in susceptible patients.

Resumen La resistencia antimicrobiana empeora el pronóstico en pacientes con enfermedades crónicas. Los pacientes en hemodiálisis son un grupo particularmente afectado con porcentajes de infección bacteriana que exceden las reportadas en otro tipo de pacientes. La colonización ha sido sugerida como un factor de riesgo para el desarrollo de infecciones. Sin embargo, los estudios que han evaluado esta asociación presentan limitaciones metodológicas que han cuestionado la validez de los resultados; como la falta de utilización de métodos moleculares que confirmen que la especie que coloniza es la misma que causa infección, la medición de la exposición solo al inicio del estudio, la ausencia de seguimiento y la evaluación de bacteriemia como el único desenlace de importancia. Así mismo, la mayoría de los estudios se han enfocado solo en Staphylococcus aureus sin incluir otras bacterias resistentes de importancia clínica como son los bacilos Gram negativos multirresistentes. Lo anterior lleva a la necesidad de utilizar métodos de epidemiología molecular que permitan refinar el análisis de la asociación entre colonización e infección, más aún en países endémicos como Colombia, en el que los altos porcentajes de resistencia demandan estrategias de prevención más certeras en pacientes susceptibles.

Antibiotic prophylaxis prior to urodynamic study in patients with traumatic spinal cord injury. Is there an indication?

ABSTRACT Study design: Retrospective cohort of patients with traumatic spinal cord injury (SCI) that have been hospitalized for physical-functional rehabilitation purposes. Objectives: To compare the incidence of urinary tract infection (UTI) after urodynamic study (UDS) in three hospitals that adopted different protocols with regard to the preparation of patients. Setting: Sarah Network of Rehabilitation Hospitals, Brazil. Materials and Methods: Between 2014 and 2015, 661 patients from three units of the same hospital network, one of which does not use antimicrobial prophylaxis independently of urine culture results, were evaluated after having undergone UDS. The results were compared in both univariate and multivariate analyses (logistic regression). Results: The global rate of UTI after UDS was that of 3.18% (IC 95% 2.1-4.8), with no differences between the units. In the univariate analysis the only variable that was associated with UTI after UDS was that of T6 injuries or above (P = 0.029). The logistic regression has confirmed this result, with an adjusted odds ratio of 3.06 (IC 95% 1.01 to 9.26; P = 0.0476). The use of antimicrobial prophylaxis did not alter that risk. Conclusions: This study has demonstrated that the use of antimicrobials does not prevent UTI after UDS. Patients with T6 traumatic SCI or above have got three times more chance of developing UTI after UDS if compared to those with a T7 injury or below, independently of the use of antimicrobials. Even in these patients the use of antimicrobials would not be justified.

Expressão diferencial de biomarcadores imunológicos de infecção subclínica em casos multibacilares de hanseníase e seus contatos domiciliares / Differential expression of immunological biomarkers of subclinical infection in multibacillary leprosy cases and their home contacts

A hanseníase é uma doença infectocontagiosa, causada pelo bacilo Mycobacterium leprae, com sintomatologia dermatoneurológica. Várias estratégias têm sido adotadas para o controle da hanseníase, porém o diagnóstico da hanseníase é essencialmente clínico. O desafio atual é identificar biomarcadores que possibilitem a identificação de parâmetros imunológicos de infecção subclínica e, em última análise, o diagnóstico precoce da hanseníase em indivíduos infectados e assintomáticos, para realização de imunoprofilaxia de forma oportuna quebrando, assim, a cadeia de transmissão do bacilo. Aprofundar nas diferenças entre casos índice multibacilares e seus contatos domiciliares foi a estratégia deste estudo, através da avaliação conjunta de parâmetros imunológicos gerais e específicos. Objetivo: o objetivo deste trabalho foi avaliar o perfil da resposta imune inata e adaptativa de casos multibacilares de hanseníase e seus contatos domiciliares para a identificação de parâmetros imunológicos de infecção subclínica. Metodologia: Para mensurar a expressão de moléculas de superfície foi realizada imunofenotipagem por citometria de fluxo. Para dosar os níveis de citocinas e quimiocinas séricas as foi utilizada a técnica de Cytometric Bead Array (CBA). Os níveis de IgM anti PGL-1 de foram mensurados pela técnica de ELISA. Resultados: Os níveis de IgM/IgG anti PGL-1, de linfócitos ativados T CD4+ e CD8+ e a frequência de monócitos circulantes estavam mais elevados em casos índice em relação aos seus contatos. A frequência de linfócitos T estava menor em casos índice MB. A distância imunológica entre casos e contatos domiciliares não foi significativa quando se avaliou em conjunto todos os parâmetros imunológicos. Conclusão: Nós inferimos, a partir dos parâmetros diferencialmente expressos em casos índice MB e contatos domiciliares, que a elevação da resposta humoral específica, o maior nível de ativação de linfócitos (com provável proliferação e diferenciação em células T efetoras e/ou de memória), a maior frequência de monócitos em trânsito no sangue periférico, podem ser opções de biomarcadores preditores de infecção subclínica em contatos domiciliares.(AU)

Leprosy is an infectious disease caused by the bacillus Mycobacterium leprae, with dermatoneurological symptoms. Several strategies have been adopted for leprosy control, but the diagnosis of leprosy is essentially clinical. The current challenge is to identify biomarkers that enable the identification of immunological parameters of subclinical infection and, ultimately, the early diagnosis of leprosy in infected and asymptomatic individuals, to perform immunoprophylaxis in a timely manner, thus breaking the bacillus transmission chain. Deepening the differences between multibacillary index cases and their household contacts was the strategy of this study, through the joint evaluation of general and specific immunological parameters. Objective: The aim of this study was to evaluate the profile of the innate and adaptive immune response of multibacillary leprosy cases and their household contacts for the identification of immunological parameters of subclinical infection. Methodology: To measure the expression of surface molecules, immunophenotyping was performed by flow cytometry. To measure serum cytokine and chemokine levels, the Cytometric Bead Array (CBA) technique was used. Anti-PGL-1 IgM/IgG levels were measured by ELISA. Results: Anti-PGL-1 IgM/IgG levels, CD4 + and CD8 + activated T lymphocytes and the frequency of circulating monocytes were higher in index cases compared to their contacts. The frequency of T lymphocytes was lower in MB index cases. The immunological distance between cases and home contacts was not significant when all immunological parameters were evaluated together. Conclusion: We infer from the differentially expressed parameters in MB index cases and household contacts that the elevation of specific humoral response, the highest level of lymphocyte activation (with probable proliferation and differentiation in effector and / or memory T cells), the higher frequency of peripheral blood transit monocytes, may be predictive biomarker options for subclinical infection in household contacts.

Colonización por Staphylococcus aureusmeticilino resistente de la comunidad y factores predisponentes en soldados ingresantes a una institución militar / Colonization by community resistant Staphylococcus aureusmeticillin and predisposing factors in soldiers admitted to a military institution

Introducción: La colonización por Staphylococcus aureus meticilino resistente adquirido en la comunidad (SAMR-AC) ha ido en aumento desde su aparición. El objetivo de este trabajo fue conocer la prevalencia de colonización por SAMR-AC en soldados, determinar los factores predisponentes y conocer la dinámica de colonización a los seis meses de convivencia. Materiales y métodos: Estudio descriptivo, de corte transversal. Se incluyó una muestra de los soldados ingresantes a un establecimiento militar. Se tomó una muestra de hisopado nasal y, en caso de aislamiento de Staphylococcus aureus, se determinó la frecuencia de la cepa meticilino resistente de la comunidad. Se realizó una encuesta sobre los posibles factores predisponentes para la colonización. Luego de seis meses de convivencia se efectuó un nuevo hisopado y se analizó el cambio en la prevalencia y la dinámica de colonización. Resultados: Se incluyeron 346 soldados provenientes de diferentes provincias de Argentina. La prevalencia inicial de colonización por Staphylococcus aureus meticilino resistente de la comunidad fue 7,8% y, luego de seis meses, 9,5% (aumento del 21,8%). Los factores que mostraron asociación con la colonización por SAMR-AC fueron los antecedentes de un conviviente con forunculosis (p=0,02), forunculosis previa (p=0,04) y forunculosis en familiar de primer grado no conviviente (p=0.03). Se constató persistencia de colonización en el 79% del grupo inicial. Conclusiones: Se observó una prevalencia de colonización por Staphylococcus aureus meticilino resistente de la comunidad del 7,8%, superior a la encontrada en la mayoría de los estudios publicados

Introduction: Colonization by community-acquired methicillin-resistant Staphylococcus aureus has been on the rise since its appearance. The objective of this study was to estimate the prevalence of colonization by community-acquired methicillin-resistant staphylococcus aureus in soldiers, determine the predisposing factors and know the dynamics of colonization during coexistence. Materials and methods: descriptive, cross-sectional study. A sample of the incoming soldiers in a military establishment was included. A nasal swab was taken and, in case of isolation of Staphylococcus aureus, the frequency of the resistant meticillin strain in the community was determined. A survey was made on possible predisposing factors for colonization by this germ. After 6 months of cohabitation, a new swab was performed and the change in prevalence and colonization dynamics was analyzed. Results: 346 soldiers from different provinces of the country were included. The initial prevalence of soldiers colonized by community-acquired methicillin-resistant was 7.8%, and after 6 months, 9.5% (21.8% increase). The factors associated with SAMR-AC colonization were the antecedent of a household members with forunculosis (p=0.02), history of forunculosis (p=0.04) and the antecedent of forunculosis in a non-cohabiting first-degree relative (p=0.03). Persistence of colonization was found in 79% of the initial group.Conclusion: a prevalence of 7.8% community methicillin resistant Staphylococcus aureus colonization was observed, superior to that found in the majority of published studies.

Asymptomatic plasmodium infection in a residual malaria transmission area in the atlantic forest region: implications for elimination

Abstract INTRODUCTION: Elimination of malaria in areas of interrupted transmission warrants careful case assessment to avoid the reintroduction of this disease. Occasional malaria cases are reported among visitors of the Atlantic Forest area of Brazil, while data on residents of this area are scarce. METHODS: A sectional study was carried out to examine 324 individuals living in a municipality where autochthonous cases were detected. RESULTS: Asymptomatic Plasmodium infections were detected in 2.8% of the individuals by polymerase chain reaction (PCR), with one case of P. falciparum (0.3%), two cases of P. vivax (0.6%), and six cases of P. malariae (1.9%). The thick blood smears were negative in all individuals. Serological tests performed in 314 subjects were reactive in 11.1%, with 3.5% for P. falciparum and 7.7% for P. vivax. A subsample of 42 reactive individuals for any Plasmodium species showed P. malariae in 30.9% of specimens. Individuals who entered the Atlantic Forest region were 2.7 times more likely to exhibit reactive serology for P. vivax compared with individuals who did not enter this region (p<0.05). Children <15 years had a higher chance of reactive serology for P. falciparum and P. vivax than individuals ≥15 years of age (p<0.05). Individuals living in the Paraiso district had a higher chance of reactive serology for P. vivax compared to other districts (p<0.05). No associations were found between sex, past exposure to malaria, or serological response to antibodies of any Plasmodium species. CONCLUSIONS: The implications of these results for the elimination of malaria were discussed.

Analysis of subclinical infections and biofilm formation in cases of capsular contracture after silicone augmentation rhinoplasty: Prevalence and microbiological study

BACKGROUND: Implant-related deformities in aesthetic rhinoplasty are a major problem for rhinoplasty surgeons. Capsular contracture is believed to be the pathological cause of delayed contour deformities, comparable to breast implant-related contracture. This study investigated the prevalence of bacterial biofilms and other epidemiological factors related to capsular contracture in cases of silicone augmentation rhinoplasty. METHODS: Thirty-three patients who underwent corrective rhinoplasty due to a delayed contour deformity or aesthetic revision after implant rhinoplasty were studied from December 2014 to December 2016. All recruited patients received surgical correction by the authors. The patients were categorized by clinical severity into four grades. Demographic data and related confounding factors were recorded. Samples of capsular tissue and silicone removed from each patient were analyzed for the presence of a biofilm by ultrasonication with bacterial culture and scanning electron microscopy. RESULTS: Thirty-three paired samples of capsular tissue and silicone implants from the study group were analyzed. Biofilms were detected in one of 10 subjects (10%) with grade 1 contracture, two of four (50%) with grade 2 contracture, 10 of 14 (71.40%) with grade 3 contracture, and four of five (80%) with grade 4 contracture (P<0.05). The organisms found were Staphylococcus epidermidis (47.10%), coagulase-negative staphylococci (35.30%), and Staphylococcus aureus (17.60%). CONCLUSIONS: As with breast implant-related capsular contracture, silicone nasal augmentation deformities likely result from bacterial biofilms. We demonstrated the prevalence of biofilms in patients with various degrees of contracture. Implant type and operative technique seemed to have only vague correlations with biofilm presence.