Global status of Toxoplasma gondii infection: systematic review and prevalence snapshots

@#Our group sought to determine the global status of T. gondii infection and to evaluate any continental and geographical trends by systematically examining the currently available epidemiological data on the prevalence of T. gondii infection. A comprehensive literature search was conducted from 10 electronic databases (Google Scholar, Science Direct, Embase, PubMed, PLOS ONE, Web of Knowledge, SciELO, MyAIS, Free Medical Journals, and Scopus) without date or language restrictions. Specific medical subject heading terms were used to search for human T. gondii seroprevalence studies that recruited subjects from general apparently healthy populations. The data were collated and analysed for both continental and global trends. The search identified 152 published studies that examined a total of 648,010 subjects. From these, 166,255 were seropositive for T. gondii infection indicating an average global seroprevalence rate of 25.7% (95% CI: 25.6 – 25.8%). The overall range of seroprevalence was determined to be 0.5 – 87.7%. African countries had the highest average seroprevalence rate of 61.4%, followed by Oceania with 38.5%, South America with 31.2%, Europe with 29.6%, USA/Canada with 17.5%, and Asia with 16.4%. Numerous environmental and human factors affect the differences in T. gondii seroprevalence rates observed between the various countries and continents. Monitoring the source and transmission may assist public health authorities to clarify the risk factors involved, as well as focus on implementing optimal state-specific health policies targeting T. gondii transmission control.

Prevalence of cholera risk factors between migrant Haitians and Dominicans in the Dominican Republic / Prevalencia de los factores de riesgo de cólera entre los inmigrantes haitianos y los dominicanos en la República Dominicana

OBJECTIVE: To determine whether cholera risk factor prevalence in the Dominican Republic can be explained by nationality, independent of other factors, given the vulnerability of many Haitians in the country and the need for targeted prevention. METHODS: A cross-sectional, observational household survey (103 Haitian and 260 Dominican) was completed in 18 communities in July 2012. The survey included modules for demographics, knowledge, socioeconomic status, and access to adequate water, sanitation, and hygiene (WASH) infrastructure. Logistic regression assessed differential access to WASH infrastructure and Poisson regression assessed differences in cholera knowledge, controlling for potential confounders. RESULTS: Dominican and Haitian households differed on demographic characteristics. Haitians had lower educational attainment, socioeconomic status, and less knowledge of cholera than Dominicans (adjusted odds ratio [aOR] = 0.66; 95% confidence interval [95%CI] = 0.55-0.81). Access to improved drinking water was low for both groups, but particularly low among rural Haitians (aOR = 0.21; 95%CI: 0.04-1.01). No differences were found in access to sanitation after adjusting for sociodemographic confounders (aOR = 1.00; 95%CI: 0.57-1.76). CONCLUSIONS: Urban/rural geography and socioeconomic status play a larger role in cholera risk factor prevalence than nationality, indicating that Haitians' perceived vulnerability to cholera is confounded by contextual factors. Understanding the social dynamics that lead to cholera risk can inform control strategies, leading to better targeting and the possibility of eliminating cholera from the island.

OBJETIVO: Determinar si la prevalencia de los factores de riesgo de cólera en la República Dominicana puede explicarse por la nacionalidad, independiente de otros factores, dada la vulnerabilidad de muchos habitantes haitianos que viven en el país y la necesidad de actividades de prevención orientadas. MÉTODOS: En julio del 2012, se llevó a cabo una encuesta domiciliaria transversal y de observación (103 hogares haitianos y 260 hogares dominicanos) en 18 comunidades. La encuesta incluía módulos sobre características demográficas, conocimientos, nivel socioeconómico y acceso a una infraestructura adecuada de agua, saneamiento e higiene (WASH). Mediante regresión logística, se evaluaron las diferencias de acceso a una infraestructura de WASH y, mediante regresión de Poisson, se evaluaron las diferencias en materia de conocimientos sobre el cólera, con control de los potenciales factores de confusión. RESULTADOS: Los hogares dominicanos y haitianos diferían en cuanto a características demográficas. Los segundos mostraban un nivel educativo inferior, una peor situación socioeconómica y menores conocimientos sobre el cólera que los hogares dominicanos (razón de posibilidades ajustada [ORa] = 0,66; intervalo de confianza de 95% [IC95%] = 0,55-0,81). El acceso a agua potable mejorada fue bajo en ambos grupos pero particularmente entre los hogares haitianos rurales (ORa = 0,21; IC95%: 0,04-1,01). No se observaron diferencias en cuanto al acceso al saneamiento después de ajustar para los factores de confusión sociodemográficos (ORa = 1,00; IC95%: 0,57-1,76). CONCLUSIONES: La geografía urbana o rural y el nivel socioeconómico repercuten más ampliamente en la prevalencia de los factores de riesgo de cólera que la nacionalidad, lo que indica que la vulnerabilidad percibida de los habitantes haitianos al cólera se confunde por factores contextuales. La comprensión de la dinámica social que conduce al riesgo de cólera puede servir de base a las estrategias de control, y llevar a una mejor orientación de las iniciativas y a la posibilidad de eliminar el cólera de la isla.

Trasplante hepático pediátrico estudio descriptivo de la experiencia recogida por el grupo de trasplante pediátrico de Clínica Las Condes y Hospital Luis Calvo Mackenna / Pediatric liver transplantation: descriptive study of the experience in liver transplantation at Clínica Las Condes and Luis Calvo Mackenna Hospital

El trasplante hepático pediátrico (THP) es la única alternativa de tratamiento para niños que padecen enfermedades hepáticas terminales, ya sean éstas agudas o crónicas. En Chile el THP representa aproximadamente un 20 por ciento del total de trasplantes de hígado realizados en nuestro país. Objetivo: Exponer las indicaciones, procedimientos y principales complicaciones del THP desde el punto de vista teórico y realizar un estudio descriptivo de la experiencia recogida por el grupo de trasplante pediátrico de Clínica Las Condes y Hospital Luis Calvo Mackenna desde 1994 a 2009 en esta materia. Material y Métodos: Se recolectaron los datos de 209 trasplantes hepáticos realizados a 173 pacientes menores de 18 entre 1994 y 2009 en ambos centros, realizando estadística descriptiva y curvas de sobrevida de Kaplan y Meier. Resultados: Las principales causas de trasplante fueron Atresia de Vías Biliares (48 por ciento) y Falla hepática aguda (28 por ciento). Cuarenta y un trasplantes se realizaron en niños menores de 10 kilos. Se trasplantaron con donante vivo 27 por ciento de los casos. Las complicaciones vasculares se presentaron en 13 por ciento de los casos y las biliares en 14 por ciento. Rechazos moderados o severos se diagnosticaron en 36 por ciento de los trasplantes. Enfermedad por Citomegalovirus se detectó en 30 por ciento de los pacientes dentro del primer año post trasplante y síndrome linfoproliferativo en 5 por ciento. La sobrevida actuarial de pacientes a 1 año ha sido de 76 por ciento, a 5 años de 67 por ciento y a 10 años de 65 por ciento. Conclusión: Los resultados del THP en términos de sobrevida y complicaciones es similar a la experiencia de centros extranjeros, la cual es superior a las expectativas y calidad de vida de los pacientes sin trasplante. Las áreas de mayor desarrollo de nuestro centro y que presentan los mayores desafíos son el trasplante hepático en niños menores de 10 kilos, en falla hepática aguda, y el uso de donante vivo.

Pediatric liver transplantation (PLT) is the only therapeutic option for children with acute or chronic end stage liver disease. In Chile PLT represents approximately 20 percent of all liver transplants performed. Objective: To present indications, procedures and main complications of PLT from an theoretic point of view and describe the experience achieved by the pediatric liver transplant team of Clínica Las Condes and Hospital Luis Calvo Mackenna from 1994 to 2009 in this field. Methods: Data from 209 liver transplants performed in 173 patients younger than 18 years old, between 1994 and 2009 were analyzed with descriptive statistics. Kaplan-Meier’sactuarial survival graphs were calculated. Results: The main liver diseases leading to PLT were Biliary Atresia (48 percent) and Acute Liver Failure (28 percent). Forty-one transplants were performed in children weighting b 10 kilograms. Living donor was used in 27 percent of the cases. Vascular complications occurred in 13 percent and biliary reoperations performed in 14 percent. Moderate and severe acute graft rejection was diagnosed in 36 percent of the transplants. Cytomegalovirus disease occurred in 30 percent of the cases and post transplant lymphoproliferative disease in 5 percent. Actuarial patients survival at 1 year has been 76 percent, at 5 years 67 percent and at 10 years 65 percent. Conclusion: Results of PLT in terms of survival and complications is comparable to foreign transplant centers, which is superior to life expectancy and quality of life of these patients without liver transplant. The areas that have exhibit major development in our center and represent the biggest challenge are liver transplant in small children, in patients with acute liver failure, and the use of living donors.

Infección y enfermedad por citomegalovirus en niños sometidos a trasplante de órgano sólido: experiencia en un centro de referencia chileno / Cytomegalovirus infection and disease in pediatric solid organ transplarntation: experience in a Chilean multiorganic transplantation center

Cytomegalovirus (CMV) infection and disease in transplant (Tx) recipients may severely complícate the patients outcome. Aim: To determine the incidence, clinical characteristics and risk factors for CMV infection and disease in liver and kidney transplant recipients in a tertiary care children's hospital. Method: A clinical and laboratory evaluation was prospectively performed in 44 and 20 children receiving a renal and liver Tx respectively in the Hospital Luis Calvo Mackenna between 2004 and 2006. Results: At the time of the organ Tx 20.3 percent (13/64) children were seronegative for CMV. Thirty six per cent (23/64) patients were infected with CMV, of whom 32 percent (14/44) received kidney Tx and 9/20 (45 percent) received liver Tx. CMV disease occurred in 52 percent (12/23) of infected patients. CMV disease was characterized by fever (100 percent), anemia (50 percent), leucopenia (16.6 percent) and specific organ involvement (renal graft 60 percent liver graft 57.1 percent, lung 25 percent, intestine 16.6 percent). Variables significantly associated with infection were a CMV seronegative status (p = 0.035) and lower age 5.5 + 3.7 years oíd vs 8.3 + 4.4 years oíd (p = 0.01). Conclusions: Incidence of CMV infection was high in children receiving a solid organ transplant in our institution and near half of infected children developed CMV-associated disease.

La infección y enfermedad por citomegalovirus (CMV) en pacientes sometidos a trasplantes (Tx) es una complicación que condiciona la evolución del injerto y la sobrevida del paciente. Objetivos: Determinar la incidencia de infección y enfermedad por CMV durante los primeros seis meses de efectuados Tx hepático y renal. Caracterizar la enfermedad, e identificar factores de riesgo asociados a infección. Metodología: Análisis prospectivo en 64 pacientes pediátricos sometidos a Tx renal (n: 44) o hepático (n: 20) en el Hospital Luis Calvo Mackenna entre 2004 y 2006. Resultados: Al trasplante, 23,1 por ciento (13/64) eran receptores IgG CMV (-). Cumplieron criterio de infección 36 por cientoo (23/64) de los pacientes, con Tx renal 32 por ciento (14/44) y con Tx hepático 45 por ciento (9/20). Desarrolló enfermedad el 52 por ciento) (12/23) la que se caracterizó porfiebre (100 por cientoo), anemia (50 por cientoo), leucopenia (16,6 por cientoo), disfunción del órgano trasplantado 60 por cientoo en Tx renal, hepático 57, l por cientoo, compromiso pulmonar en 25 por cientoo e intestinal en 16,6 por cientoo del total de pacientes. Variables asociadas a infección fueron: ser receptor IgG CMV (-)pre-Tx (p=0,035) y una menor edad del paciente 5,5 +3,7 vs 8,3 + 4,4 (p= 0,01). Conclusiones: Hay una elevada tasa de infección por CMV en la población de pacientes con Tx renal y hepática en nuestro medio, la mitad de ellos desarrolló enfermedad amenazando la función del injerto.

Estado actual del diagnóstico y presentaciones clínicas de enfermedad celíaca: Estudio multicéntrico / Diagnosis and clinical presentations of celiac disease: A multicenter study

Background: Ample use of serological markers of high sensitivity and specificity led to relevant changes in the epidemiology of celiac disease. The impact of these changes in our country is poorly known. Aim: To assess the diagnostic procedures, clinical presentations and follow up of celiac disease as conducted in current pediatric practice. Material and methods: A multicentric retrospective study of patients diagnosed between 2000 and 2005 in five pediatric hospitals in Santiago, Chile. Data was obtained from clinical records, recorded in electronic spreadsheets and analyzed by descriptive statistics. Results: Seventy four of 83 identified patients fulfilled the inclusion criteria and were analyzed. Mean time to reach the diagnosis was 2.1 years. Cases younger than 10 years presented digestive manifestations such as chronic diarrhea and abdominal distension. Twenty one percent of older patients had atypical presentations (mainly short stature, refractory anaemia). Ten percent of cases were screened because a first degree relative had celiac disease. All patients had significant duodenal/jejunal lesion. IgA-antiendomysial antibodies (n =65) and IgA-antigliadin antibodies (n =23) were the most commonly used screening tests used but often, they were not available for follow up. A second biopsy was planned in all patients but only 26 had it due to repeated dietary transgressions, often due to unnoticed consumption of gluten in poorly labeled products. Conclusions: Digestive manifestations were the main presentation form for celiac disease among patients under 10 years of age. Atypical symptoms become relevant in patients older than 10 years. Antiendomysial and antitransglutaminase antibody measurement should be incorporated for routine screening and follow up of celiac disease in public hospitals. To improve food labeling about their gluten content is needed.

Tiempo de exposición al gluten y marcadores de riesgo de diabetes mellitus insulino dependiente en pacientes celíacos / Risk markers for insulin-dependent diabetes mellitus and duration of exposure to gluten in celiac patients

Background: Celiac patients are at high risk of developing insulin-dependent diabetes mellitus, a condition that has a long pre-diabetic period. During this lapse, anti-islet cell antibodies serve as markers for future disease. This may be related with the duration of the exposure to gluten. Aim: To test the hypothesis that long term adherence to a gluten free diet decreases the frequency of risk markers for insulin dependent diabetes mellitus during adolescence and early adulthood. Patients and methods: 158 celiac patients were classified as: G1, (n=30 patients) studied at the time of diagnosis; G2 (n=97 patients) exposed to gluten as a result of non compliance with the gluten free diet and, G3 (n=31 patients) who had maintained a long term, strict gluten free diet. Isotype IgG anti-islet cell antibodies were detected by indirect immunofluorescence using monkey pancreas; results were reported in Juvenile Diabetes Foundation (JDF) units. Results: Celiac patients exposed to a gluten containing diet had a significantly higher prevalence of anti-islet cell antibodies than those who had been exposed only briefly (p <0.017). In addition, a significantly higher prevalence of anti-islet cell antibodies was observed in those patients whose exposure to gluten was longer than 5 years than in those whose exposure was shorter (p <0.02). Conclusions: Celiac patients long exposed to gluten have a significantly higher prevalence of anti-islet cell antibodies than those exposed for a short period. This fact supports the hypothesis that the development of these antibodies is associated with the length of the exposure to gluten (Rev Méd Chile 2004; 132: 979-84).

Anticuerpos anti-transglutaminasa tisular: ¿una mejor prueba para detectar transgresiones menores de la dieta en pacientes celíacos? / Tissue transglutaminase antibodies: a better test to detec minor dietary trasgressions in celiac patients?

Background: Endomysium antibodies (EMA) do not detect minor dietary transgressions in patients with celiac disease. Aim : To compare the sensitivity and specificity of tissue transglutaminase antibodies (tTGA) and endomysium antibodies (EMA) in biopsy proven celiac patients at the time of diagnosis and during gluten free diet (GFD). Patients and methods : One hundred fifty three subjects were studied: a) 30 healthy controls; b) 9 cases with cow's milk allergy; c) 24 celiac patients at time of diagnosis; d) 25 celiac patients adhering to the GFD; e) 65 celiac patients with poor/no adhesion to GFD. EMA and tTGA IgA were measured by immunofluorescence and ELISA, respectively. Results: Sensitivity and specificity were 100 percent and 97.4 percent for tTGA, respectively. All patients with cow's milk allergy were EMA (-) and 8 of 9 (88.9 percent) were tTGA (-). In celiac patients not adhering to the GFD, EMA and tTGA positivity were similar (80 percent and 81,5 percent, respectively); 95,4 percent of the subjects tested positive for at least one of them. All patients adhering to GFD were EMA (-) but tTGA were (+) in 28 percent of them. Conclusions : EMA and tTGA have similar sensitivity and specificity at the time of diagnosis of celiac disease. Positive tTGA in 28 percent of patients that adhered strictly to the GFD and whose EMA were negative suggest that tTGA may be helpful in detecting minor dietary transgressions and should be further evaluated

Síndrome de la úlcera solitaria del recto / Solitary rectal ulcer syndrome

El síndrome de la úlcera solitaria del recto (SUSR) es una entidad poco frecuente que consiste en una anormalidad recto-anal, causada por un esfuerzo defecatorio excesivo y que tiene características específicas. Se presenta con mayor frecuencia entre la tercera y la cuarta década, pero existen casos publicados en pediatría. Se presentan 5 pacientes (4 varones). Todos tuvieron rectorragia moderada repetida, esfuerzo defecatorio excesivo, pujo, tenesmo y abundantes mucosidades en las deposiciones. Un niño tuvo prolapso rectal completo, lo que fue comprobado endoscópicamente. La defecografía mostró en todos una falta de relajación del músculo puborrectal durante la evacuación. La endoscopía mostró en cuatro pacientes la existencia de una o múltiples úlceras y en el quinto una lesión nodular fibrótica. El examen histopatológico de la mucosa rectal demostró en todos los casos una fibrosis de la "lámina propria", aumento de las fibras musculares lisas con acentuado engrosamiento de la "muscularis mucosae". El tratamiento médico fue suficiente en cuatro niños, pero uno solo alivió sus síntomas después de una sacro-promonto-pexia. Esta enfermedad raramente se diagnostica en niños. Sin embargo, creemos que su búsqueda adecuada permitirá encontrar más pacientes en el futuro. No existe uniformidad en el tratamiento médico, pero generalmente se consigue aliviar la sintomatología. La cirugía debe reservarse para los cuadros clínicos severos, en los cuales el prolapso rectal fue comprobado