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1.
BMC Med ; 20(1): 216, 2022 06 09.
Article in English | MEDLINE | ID: covidwho-1951230

ABSTRACT

BACKGROUND: Chile was severely affected by COVID19 outbreaks but was also one of the first countries to start a nationwide program to vaccinate against the disease. Furthermore, Chile became one of the fastest countries to inoculate a high percentage of the target population and implemented homologous and heterologous booster schemes in late 2021 to prevent potential immunological waning. The aim of this study is to compare the immunogenicity and time course of the humoral response elicited by the CoronaVac vaccine in combination with homologous versus heterologous boosters. METHODS: We compared the immunogenicity of two doses of CoronaVac and BNT162b2 vaccines and one homologous or heterologous booster through an ELISA assay directed against the ancestral spike protein of SARS-CoV-2. Sera were collected from individuals during the vaccination schedule and throughout the implementation of homologous and heterologous booster programs in Chile. RESULTS: Our findings demonstrate that a two-dose vaccination scheme with CoronaVac induces lower levels of anti-SARS-CoV-2 spike antibodies than BNT162b2 in a broad age range (median age 42 years; interquartile range (IQR) 27-61). Furthermore, antibody production declines with time in individuals vaccinated with CoronaVac and less noticeably, with BNT162b2. Analysis of booster schemes revealed that individuals vaccinated with two doses of CoronaVac generate immunological memory against the SARS-CoV-2 ancestral strain, which can be re-activated with homologous or heterologous (BNT162b2 and ChAdOx1) boosters. Nevertheless, the magnitude of the antibody response with the heterologous booster regime was considerably higher (induction fold BNT162b2: 11.2x; ChAdoX1; 12.4x; CoronaVac: 6.0x) than the responses induced by the homologous scheme. Both homologous and heterologous boosters induced persistent humoral responses (median 122 days, IQR (108-133)), although heterologous boosters remained superior in activating a humoral response after 100 days. CONCLUSIONS: Two doses of CoronaVac induces antibody titers against the SARS-CoV-2 ancestral strain which are lower in magnitude than those induced by the BNT162b2 vaccine. However, the response induced by CoronaVac can be greatly potentiated with a heterologous booster scheme with BNT162b2 or ChAdOx1 vaccines. Furthermore, the heterologous and homologous booster regimes induce a durable antibody response which does not show signs of decay 3 months after the booster dose.


Subject(s)
COVID-19 , SARS-CoV-2 , Adult , Antibodies, Viral , BNT162 Vaccine , COVID-19/prevention & control , COVID-19 Vaccines , Chile/epidemiology , Humans
2.
PLoS One ; 17(2): e0263047, 2022.
Article in English | MEDLINE | ID: covidwho-1938413

ABSTRACT

Fitting Susceptible-Infected-Recovered (SIR) models to incidence data is problematic when not all infected individuals are reported. Assuming an underlying SIR model with general but known distribution for the time to recovery, this paper derives the implied differential-integral equations for observed incidence data when a fixed fraction of newly infected individuals are not observed. The parameters of the resulting system of differential equations are identifiable. Using these differential equations, we develop a stochastic model for the conditional distribution of current disease incidence given the entire past history of reported cases. We estimate the model parameters using Bayesian Markov Chain Monte-Carlo sampling of the posterior distribution. We use our model to estimate the transmission rate and fraction of asymptomatic individuals for the current Coronavirus 2019 outbreak in eight American Countries: the United States of America, Brazil, Mexico, Argentina, Chile, Colombia, Peru, and Panama, from January 2020 to May 2021. Our analysis reveals that the fraction of reported cases varies across all countries. For example, the reported incidence fraction for the United States of America varies from 0.3 to 0.6, while for Brazil it varies from 0.2 to 0.4.


Subject(s)
COVID-19/epidemiology , Argentina/epidemiology , Bayes Theorem , Brazil/epidemiology , Chile/epidemiology , Colombia/epidemiology , Humans , Incidence , Markov Chains , Mexico/epidemiology , Panama/epidemiology , Peru/epidemiology , Stochastic Processes , United States/epidemiology
3.
Rev Med Chil ; 149(11): 1657-1663, 2021 Nov.
Article in Spanish | MEDLINE | ID: covidwho-1939133

ABSTRACT

With or without a COVID19 pandemic, cancer is and will continue to be one of the greatest health challenges on the planet. In Chile, during 2016, this disease was the second cause of death in the country and during 2019, it was the first cause in seven Chilean regions, surpassing cardiovascular diseases. With the advent of precision medicine as a powerful tool for cancer control, it is necessary to have genomic, proteomic, and molecular data in general, ideally on a population scale. This is essential for decision-making, for example in public and private oncology, to be as cost-effective as possible. Chile has a mass of high-quality researchers in cancer. However, until today the investment in research and development is far below the peers in the OECD. In this work we put into perspective the role of precision medicine and omic sciences as essential tools for public health. We offer a brief national diagnosis of the knowledge collected to date by the local scientific community regarding onco-genomic data from our own population. We finally discuss the potential behind the strengthening of this scientific knowledge, aiming to optimize the comprehensive management of cancer.


Subject(s)
COVID-19 , Neoplasms , Chile/epidemiology , Delivery of Health Care , Humans , Neoplasms/therapy , Proteomics
4.
Andes Pediatr ; 92(6): 854-861, 2021 Dec.
Article in Spanish | MEDLINE | ID: covidwho-1918329

ABSTRACT

INTRODUCTION: COVID-19 pandemic has meant adapting to a different reality, with long-term lockdowns that might cause an increase of burns in children at home. OBJECTIVE: To compare the epidemiological situation of patients admitted to the Corporación de Ayuda al Niño Quemado (COANIQUEM) due to out patient burn injuries management at the beginning of COVID-19 lockdown with the same period the year before. PATIENTS AND METHODS: Analytical and cross-sectional study. A population of 2,027 patients under the age of 20, who were admitted to COANIQUEM for the first time with burn inju ries, between April and July of 2019 and 2020 was analyzed. The number of patients admitted each month was registered as well as their demographic, social, and clinical characteristics. The monthly percentage variation was calculated by comparing patient data in both years. RESULTS: During 2020, there was a 48.7% decrease in overall outpatient admissions. There was a relative increase of 10.5% in burns in patients under 5 years old, 18.3% in scalds, 33.1% in the number of burns in 3 or more body locations, and 16.8% in burns occurring at home. These parameters were not influenced by geographic location, sex, or socioeconomic level. CONCLUSIONS: In the first period of the COVID-19 pandemic, with strict lockdown strategies, there was a decrease in the demand for burn care, affecting both outpatients with acute burns and those who were admitted for sequelae rehabilitation, as a result of the effective decrease in the burns incidence and the reduced access to health care.


Subject(s)
Burns , COVID-19 , Adolescent , Age Distribution , Burns/epidemiology , Burns/etiology , Burns/therapy , COVID-19/epidemiology , COVID-19/prevention & control , Child , Child, Preschool , Chile/epidemiology , Communicable Disease Control , Cross-Sectional Studies , Delivery of Health Care , Humans , Outpatients , Pandemics/prevention & control
5.
Int J Environ Res Public Health ; 19(13)2022 Jun 30.
Article in English | MEDLINE | ID: covidwho-1917463

ABSTRACT

Epivigila is a Chilean integrated epidemiological surveillance system with more than 17,000,000 Chilean patient records, making it an essential and unique source of information for the quantitative and qualitative analysis of the COVID-19 pandemic in Chile. Nevertheless, given the extensive volume of data controlled by Epivigila, it is difficult for health professionals to classify vast volumes of data to determine which symptoms and comorbidities are related to infected patients. This paper aims to compare machine learning techniques (such as support-vector machine, decision tree and random forest techniques) to determine whether a patient has COVID-19 or not based on the symptoms and comorbidities reported by Epivigila. From the group of patients with COVID-19, we selected a sample of 10% confirmed patients to execute and evaluate the techniques. We used precision, recall, accuracy, F1-score, and AUC to compare the techniques. The results suggest that the support-vector machine performs better than decision tree and random forest regarding the recall, accuracy, F1-score, and AUC. Machine learning techniques help process and classify large volumes of data more efficiently and effectively, speeding up healthcare decision making.


Subject(s)
COVID-19 , COVID-19/epidemiology , Chile/epidemiology , Humans , Machine Learning , Pandemics , Support Vector Machine
6.
Int J Environ Res Public Health ; 19(13)2022 Jun 30.
Article in English | MEDLINE | ID: covidwho-1917451

ABSTRACT

Experts and international organizations hypothesize that the number of cases of fatal intimate partner violence against women increased during the COVID-19 pandemic, primarily due to social distancing strategies and the implementation of lockdowns to reduce the spread of the virus. We described cases of attempted femicide and femicide in Chile before (January 2014 to February 2020) and during (March 2020 to June 2021) the pandemic. The attempted-femicide rate increased during the pandemic (incidence rate ratio: 1.22 [95% confidence interval: 1.04 to 1.43], p value: 0.016), while the rate of femicide cases remained unchanged. When a comparison between attempted-femicide and femicide cases was performed, being a foreigner, having an intimate partner relationship with a perpetrator aged 40 years or more, and the use of firearms during the assault were identified as factors associated independently with a higher probability of being a fatal victim in Chile. In conclusion, this study emphasizes that attempted femicide and femicide continued to occur frequently in family contexts both before and during the COVID-19 pandemic.


Subject(s)
COVID-19 , Intimate Partner Violence , COVID-19/epidemiology , Chile/epidemiology , Communicable Disease Control , Female , Homicide , Humans , Pandemics
7.
Int J Environ Res Public Health ; 19(13)2022 Jun 23.
Article in English | MEDLINE | ID: covidwho-1911344

ABSTRACT

The COVID-19 pandemic has substantially impacted mental health-workers at institutions are not exempt. In our research, from positive organizational psychology, specifically from the healthy and resilient organization (HERO) model, we analyzed the relationship between healthy organizational practices-engagement and workers' burnout, and evaluated the mediation role of engagement between healthy organizational practices and worker burnout levels during the COVID-19 pandemic, through structural equation models of a cross-sectional survey-based study. We collected data from a sample of 594 Chilean workers. Our results of the correlations and structural equations demonstrate the relationship between PHOs with engagement (ß = 0.51; p < 0.001) and burnout (ß = -0.44; p < 0.001), in addition to the mediating effect of engagement between HOP with burnout (ß = -0.66; p < 0.001). In conclusion, our findings suggest that healthy organizational practices promoted worker engagement and decreased worker burnout during the COVID-19 pandemic, contributing to the postulates of the HERO model. In addition, we were able to visualize a similar scenario, which showed that burnout during a pandemic decreases when worker engagement mediates the relationship with HOP.


Subject(s)
Burnout, Professional , COVID-19 , Burnout, Professional/epidemiology , Burnout, Professional/psychology , COVID-19/epidemiology , Chile/epidemiology , Cross-Sectional Studies , Humans , Latent Class Analysis , Pandemics
8.
Nat Med ; 28(7): 1377-1380, 2022 07.
Article in English | MEDLINE | ID: covidwho-1900514

ABSTRACT

The outbreak of the B.1.1.529 lineage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Omicron) has caused an unprecedented number of Coronavirus Disease 2019 (COVID-19) cases, including pediatric hospital admissions. Policymakers urgently need evidence of vaccine effectiveness in children to balance the costs and benefits of vaccination campaigns, but, to date, the evidence is sparse. Leveraging a population-based cohort in Chile of 490,694 children aged 3-5 years, we estimated the effectiveness of administering a two-dose schedule, 28 days apart, of Sinovac's inactivated SARS-CoV-2 vaccine (CoronaVac). We used inverse probability-weighted survival regression models to estimate hazard ratios of symptomatic COVID-19, hospitalization and admission to an intensive care unit (ICU) for children with complete immunization over non-vaccination, accounting for time-varying vaccination exposure and relevant confounders. The study was conducted between 6 December 2021 and 26 February 2022, during the Omicron outbreak in Chile. The estimated vaccine effectiveness was 38.2% (95% confidence interval (CI), 36.5-39.9) against symptomatic COVID-19, 64.6% (95% CI, 49.6-75.2) against hospitalization and 69.0% (95% CI, 18.6-88.2) against ICU admission. The effectiveness against symptomatic COVID-19 was modest; however, protection against severe disease was high. These results support vaccination of children aged 3-5 years to prevent severe illness and associated complications and highlight the importance of maintaining layered protections against SARS-CoV-2 infection.


Subject(s)
COVID-19 , Viral Vaccines , COVID-19/epidemiology , COVID-19 Vaccines , Child , Child, Preschool , Chile/epidemiology , Disease Outbreaks/prevention & control , Humans , SARS-CoV-2
9.
PLoS One ; 17(6): e0269843, 2022.
Article in English | MEDLINE | ID: covidwho-1896483

ABSTRACT

The classical SEIR model, being an autonomous system of differential equations, has important limitations when representing a pandemic situation. Particularly, the geometric unimodal shape of the epidemic curve is not what is generally observed. This work introduces the ßSEIR model, which adds to the classical SEIR model a differential law to model the variation in the transmission rate. It considers two opposite thrives generally found in a population: first, reaction to disease presence that may be linked to mitigation strategies, which tends to decrease transmission, and second, the urge to return to normal conditions that pulls to restore the initial value of the transmission rate. Our results open a wide spectrum of dynamic variabilities in the curve of new infected, which are justified by reaction and restoration thrives that affect disease transmission over time. Some of these dynamics have been observed in the existing COVID-19 disease data. In particular and to further exemplify the potential of the model proposed in this article, we show its capability of capturing the evolution of the number of new confirmed cases of Chile and Italy for several months after epidemic onset, while incorporating a reaction to disease presence with decreasing adherence to mitigation strategies, as well as a seasonal effect on the restoration of the initial transmissibility conditions.


Subject(s)
COVID-19 , COVID-19/epidemiology , Chile/epidemiology , Humans , Italy/epidemiology , Pandemics , SARS-CoV-2
10.
Sci Rep ; 12(1): 9516, 2022 06 09.
Article in English | MEDLINE | ID: covidwho-1886234

ABSTRACT

During the first year of the COVID-19 pandemic, several countries have implemented non-pharmacologic measures, mainly lockdowns and social distancing, to reduce the spread of the SARS-CoV-2 virus. These strategies varied widely across nations, and their efficacy is currently being studied. This study explores demographic, socioeconomic, and epidemiological factors associated with the duration of lockdowns applied in Chile between March 25th and December 25th, 2020. Joint models for longitudinal and time-to-event data were used. In this case, the number of days under lockdown for each Chilean commune and longitudinal information were modeled jointly. Our results indicate that overcrowding, number of active cases, and positivity index are significantly associated with the duration of lockdowns, being identified as risk factors for longer lockdown duration. In short, joint models for longitudinal and time-to-event data permit the identification of factors associated with the duration of lockdowns in Chile. Indeed, our findings suggest that demographic, socioeconomic, and epidemiological factors should be used to define both entering and exiting lockdown.


Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19/prevention & control , Chile/epidemiology , Communicable Disease Control/methods , Humans , Pandemics , SARS-CoV-2
12.
Rev Med Chil ; 149(8): 1141-1149, 2021 Aug.
Article in Spanish | MEDLINE | ID: covidwho-1884531

ABSTRACT

BACKGROUND: Several risk factors are associated with COVID-19 severity and death, such as advanced age, male sex, and the presence of comorbidities. AIM: To study the effect of these risk factors and socioeconomic variables on the outcome of Chilean patients admitted with COVID-19 to a Chilean public hospital. MATERIAL AND METHODS: Review of medical records of patients admitted to a Chilean public hospital with a positive PCR test for COVID-19, Chile from March to June 2020. The outcome variable was severity (ICU admission or death). The exposure variables were age, sex, socioeconomic level, and comorbidities. A multivariable logistic regression analysis was performed. RESULTS: Of 1,141 confirmed cases, 266 cases had a severe evolution (23.3%), including 147 deaths (fatality 12.9%). Advanced age and low socioeconomic status were the variables most strongly associated with severity. An age of 80 years or over had an odds ratio (OR) = 11.1 [95% confidence intervals (CI) 5.22-23.53]. The OR [95% CI] for a low socioeconomic level was 3.1 [1.1-8.5]. The figure for male sex was 2.13 [1.5-3.0], for chronic kidney disease was 2.65 [1.49-4.73], for obesity was 2.36 [1.65-3.39], and for diabetes 1.78 [1.22-2.61]. No significant association with severity was found for high blood pressure, chronic pulmonary disease, cardiovascular disease, or smoking. CONCLUSIONS: Following age, a low socioeconomic level was the factor with the higher association with a poor outcome or severe evolution of COVID-19.


Subject(s)
COVID-19 , Aged, 80 and over , Chile/epidemiology , Comorbidity , Demography , Hospitals , Humans , Male
13.
Int J Environ Res Public Health ; 19(11)2022 06 03.
Article in English | MEDLINE | ID: covidwho-1884133

ABSTRACT

COVID-19 causes cardiovascular and lung problems that can be aggravated by confinement, but the practice of physical activity (PA) could lessen these effects. The objective of this study was to evaluate the association of maximum oxygen consumption (V˙O2max) with vaccination and PCR tests in apparently healthy Chilean adults. An observational and cross-sectional study was performed, in which 557 people from south-central Chile participated, who answered an online questionnaire on the control of COVID-19, demographic data, lifestyles, and diagnosis of non-communicable diseases. V˙O2max was estimated with an abbreviated method. With respect to the unvaccinated, those who received the first (OR:0.52 [CI:0.29;0.95], p = 0.019) and second vaccine (OR:0.33 [CI:0.18;0.59], p = 0.0001) were less likely to have an increased V˙O2max. The first vaccine was inversely associated with V˙O2max (mL/kg/min) (ß:-1.68 [CI:-3.06; -0.3], p = 0.017), adjusted for BMI (ß:-1.37 [CI:-2.71; -0.03], p = 0.044) and by demographic variables (ß:-1.82 [CI:-3.18; -0.46], p = 0.009); similarly occur for the second vaccine (ß: between -2.54 and -3.44, p < 0.001) on models with and without adjustment. Having taken a PCR test was not significantly associated with V˙O2max (mL/kg/min). It is concluded that vaccination significantly decreased V˙O2max, although it did not indicate cause and effect. There is little evidence of this interaction, although the results suggest an association, since V˙ O2max could prevent and attenuate the contagion symptoms and effects.


Subject(s)
COVID-19 , Exercise Test , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Chile/epidemiology , Cross-Sectional Studies , Exercise Test/methods , Humans , Life Style , Morbidity , Oxygen Consumption , Polymerase Chain Reaction , Vaccination
14.
Int J Environ Res Public Health ; 19(10)2022 05 12.
Article in English | MEDLINE | ID: covidwho-1855592

ABSTRACT

In Chile, during the COVID-19 pandemic, reports of cyberbullying victimization increased for adolescents and younger adults. Research has shown that cyber-victims-adolescents and young adults alike-are at greater risk for mental health problems such as depression as a result of this negative type of aggression. Yet, a paucity of research has examined the individual mechanisms germane to cyber-victim depression. We focused on loneliness for the current study. We hypothesized that cyber-victimization would be positively related to depressive symptoms through increased fears of loneliness and that this effect would differ between adolescents and younger adults. Thus, we examined a sample of 2370 participants from all main regions of Chile aged from 15 to 29 years. Moderated mediation results showed a negative effect of cyberbullying on depression, which was mediated by increased fears of being alone. The effect of frequency of cyberbullying on fear of loneliness was stronger for younger adults compared to adolescents. Our results suggest different mechanisms for both age groups, which can inform prevention programs and their specific activities.


Subject(s)
COVID-19 , Cyberbullying , Adolescent , COVID-19/epidemiology , Chile/epidemiology , Cyberbullying/psychology , Depression/epidemiology , Depression/psychology , Humans , Loneliness , Pandemics , Young Adult
15.
Medwave ; 22(4): e8731, 2022 May 12.
Article in Spanish, English | MEDLINE | ID: covidwho-1847604

ABSTRACT

Introduction: The need for beds and health personnel to treat coronavirus (COVID- 19) patients has led to the suspension of many elective sur-geries in Chile, including knee arthroplasties. This study aims to determine the incidence of knee arthroplasty in 2020, reflecting the effect of the COVID- 19 pandemic, and estimate the cost and time it would take to recover the waiting list prior to March 2020. Methods: A cross- sectional study was designed. We analyzed databases from The Department of Statistics and Health Information databases from Chile for 2019 and 2020, identifying patients with surgical discharges associated with knee arthroplasty codes. We estimated the time it would take to recover the surgeries unperformed in 2020 by simulating a monthly workload increase from the 2019 baseline. The costs of knee arthroplasty paid by the National Health Fund to institutions were estimated by diagnosis-related groups. Results: We found that the incidence rate of knee arthroplasty in 2020 decreased by 64% compared with 2019. The impact was higher in the public system (68%) and the National Health Found (63%). A simulated increase in knee arthroplasty productivity by 30% would allow recovering the postponed knee arthroplasty surgeries in 27 months, at a monthly cost to the public system of 318 million Chilean pesos (378 thousand US dollars). Conclusions: The incidence rate of knee arthroplasty during 2020 decreased by 64%, revealing the extensive waiting line for people with knee osteoarthritis. An increase between 20- 40% in productivity compared with 2019 would allow recovering the unperformed surgeries in 20 to 41 months, at a monthly cost to the public network between 210 and 425 million Chilean pesos (250 to 506 thousand US dollars).


Introducción: Debido a la respuesta de los servicios de salud a la pandemia por COVID- 19, se han suspendido cirugías electivas como la artroplastía de rodilla. El objetivo de este estudio es determinar la incidencia de artroplastías de rodilla en 2020 reflejando el efecto de la pandemia, y estimar el tiempo y el costo para recuperar la situación de lista de espera previa a marzo de 2020. Métodos: Estudio transversal. Se analizaron las bases de datos del Departamento de Estadística e Información en Salud de Chile de 2019 y 2020, identificando pacientes asociados a códigos de artroplastía de rodilla. Se calculó el número mensual de artroplastias realizadas durante 2019 para estimar el tiempo que tomará recuperar las cirugías no realizadas en 2020. El costo asociado a artroplastía de rodilla se hizo según el método de pago utilizado por el Fondo Nacional de Salud estimado por grupos relacionados por diagnóstico. Resultados: En 2020 la tasa de incidencia de artroplastía de rodilla por 100 000 habitantes disminuyó 64% comparado con 2019. El impacto fue mayor en el sistema público (68%) y en beneficiarios del Fondo Nacional de Salud (63%). Un aumento en la productividad en 30% respecto a 2019 haría que en 27 meses se recuperen las cirugías no realizadas en 2020, significando un costo adicional mensual en el sistema público de 318 262 530 pesos chilenos (equivalentes a 378 mil dólares americanos, USD). Conclusiones: Hubo una importante disminución de la tasa de artroplastías de rodilla en 2020, estimándose una caída del 64% en la incidencia por 100 000 habitantes. Esto muestra un incremento importante de personas que esperan la resolución a la artrosis de rodilla. Un aumento entre 20 y 40% respecto de 2019 permitiría recuperar las cirugías no realizadas en un plazo entre 20 y 41 meses, a un costo mensual en el sistema público que varía entre 210 y 425 millones pesos chilenos (de 250 a 506 mil dólares americanos, USD).


Subject(s)
Arthroplasty, Replacement, Knee , COVID-19 , COVID-19/epidemiology , Chile/epidemiology , Cross-Sectional Studies , Disease Outbreaks , Humans , Registries
16.
PLoS One ; 17(5): e0267413, 2022.
Article in English | MEDLINE | ID: covidwho-1846927

ABSTRACT

Personal protective measures such use of face masks, hand washing and physical distancing have proven to be effective in controlling the spread of the Covid-19 pandemic. However, adherence to these measures may have been relaxed over time. The objective of this work is to assess the change in adherence to these measures and to find factors that explain the change For this purpose, we conducted a survey in the Metropolitan Region of Chile in which we asked the adherence to these measures in August-September 2021 and retrospectively for 2020. With the answers obtained we fit a logistic regression model in which the response variable is the relaxation of each of the self-care preventive actions. The explanatory variables used are socio-demographic characteristics such as the age, sex, income, and vaccination status of the respondents. The results obtained show that there has been a significant decrease in adherence to the three personal protection measures in the Metropolitan Region of Chile. In addition, it was observed that younger people are more likely to relax these measures. The results show the importance of generating new incentives for maintaining adherence to personal protection measures.


Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19/prevention & control , Chile/epidemiology , Cross-Sectional Studies , Humans , Pandemics/prevention & control , Retrospective Studies , SARS-CoV-2
17.
Rev Chilena Infectol ; 38(6): 754-760, 2021 12.
Article in Spanish | MEDLINE | ID: covidwho-1835030

ABSTRACT

BACKGROUND: Aspergillus spp. fungal coinfections have been described in critically ill COVID-19 patients. AIM: To describe the clinical characteristics, diagnosis, treatment and evolution of patients with acute respiratory distress syndrome with COVID-19, who present with COVID-19 associated pulmonary aspergillosis (CAPA) in a single public hospital. METHODS: Retrospective review of clinical records during 12 months in patients diagnosed with CAPA by cultures of respiratory samples or determination of galactomannan (GM). RESULTS: Probable CAPA was diagnosed in 11 patients (average APACHE II score of 11.7). Respiratory samples were obtained in 73% of cases by bronchoalveolar lavage and in 27% by tracheal aspirate. A. fumigatus was isolated in 4 cultures, A. niger, A. terreus and Aspergillus spp on one occasion each and the cultures were negative in 4 samples. Respiratory sample GM was performed in 7 patients, median: 3.6 (IQR: 1.71 - 4.4). In 10 patients, serum GM was performed, median: 0.5 (IQR: 0.265 - 0.9 75) with 50% of them > 0.5. Two patients showed classic findings suggestive of CAPA on computed tomography. All received antifungal therapy with voriconazole, mean time 14 days. Four patients died. CONCLUSIONS: The presence of CAPA should be a diagnosis to be considered in critically ill COVID-19 patients.


Subject(s)
COVID-19 , Invasive Pulmonary Aspergillosis , Pulmonary Aspergillosis , Aspergillus , COVID-19/complications , Chile/epidemiology , Critical Illness , Hospitals, Public , Humans , Invasive Pulmonary Aspergillosis/complications , Invasive Pulmonary Aspergillosis/diagnosis , Invasive Pulmonary Aspergillosis/drug therapy , Pulmonary Aspergillosis/complications , Pulmonary Aspergillosis/diagnosis , Pulmonary Aspergillosis/drug therapy , SARS-CoV-2
18.
Rev Chilena Infectol ; 38(5): 613-621, 2021 10.
Article in Spanish | MEDLINE | ID: covidwho-1835026

ABSTRACT

BACKGROUND: Elizabethkingia is a genus of gramnegative bacteria whose relevance as an opportunistic pathogen in immunosuppressed hosts and critically ill patients has been progressively recognized in recent years. This genus is mainly composed of E. meningoseptica, E. anophelis, and E. miricola. Although E. meningoseptica was initially reported as the most relevant pathogenic species, thanks to advances in microbiological identificaron techniques E. anophelis has been recognized as the main pathogen of this group. AIM: To characterize Elizabethkingia spp.'s infections in a health network and make a brief review of this infection. METHOD: We conducted a review of clinical cultures that were positive for Elizabethkingia sp. in the Microbiology Laboratory of the UC-CHRISTUS Health Network (Chile), between 2017 and 2021. RESULTS: Seventeen positive cultures were obtained corresponding to seven clinical cases, all originating from a university hospital. All cases had known risk factors for Elizabethkingia sp. infection, including recent use of antibiotics. Notably, previous use of carbapenems was present in 85.7% of the patients. Four cases occurred in patients with SARS-CoV-2 pneumonia, a coinfection not previously reported in the literature. Elizabethkingia anophelis was identified by ribosomal RNA sequencing in 80% of the recovered strains, which corresponds to the first report of this species in Chile. CONCLUSION: We report the clinical experience of a university hospital with infections by Elizabethkingia spp., including the first cases of coinfection in patients with SARS-CoV-2 pneumonía and the first identification of Elizabethkingia anophelis in Chile.


Subject(s)
COVID-19 , Coinfection , Flavobacteriaceae Infections , COVID-19/epidemiology , Chile/epidemiology , Coinfection/epidemiology , Flavobacteriaceae , Flavobacteriaceae Infections/epidemiology , Flavobacteriaceae Infections/microbiology , Hospitals, University , Humans , SARS-CoV-2
19.
J Environ Public Health ; 2022: 3859071, 2022.
Article in English | MEDLINE | ID: covidwho-1832674

ABSTRACT

The identification and tracking of SARS-CoV-2 infected patients in the general population are essential components of the global strategy to limit the COVID-19 viral spread, specifically for maintaining traceability and suppressing the resurgence of local outbreaks. Public health programs that include continuous RT-qPCR testing for COVID-19 in the general population, viral sequencing, and genomic surveillance for highly contagious forms of the virus have allowed for the identification of SARS-CoV-2 infections and reinfections. This work identified SARS-CoV-2 reinfection in a homeless person, which occurred 58 days after the first COVID-19 diagnosis. Genomic sequencing identified a different Nextstrain classification clade (20A and 20B) and PANGO lineage, with a divergence of 4 single nucleotide variants (SNVs) in S and ORF1ab genes, suggesting reinfection by different viral variants. This study is the first from the great metropolitan area of Santiago, Chile, one of the top ten countries in the world to live during the COVID-19 pandemic. We support the importance of performing intensive genomic surveillance programs in the whole population and high-risk groups, such as homeless people, nearly 20 thousand people in Chile, and have limited access to health care services and poor viral traceability.


Subject(s)
COVID-19 , Homeless Persons , COVID-19/epidemiology , COVID-19 Testing , Chile/epidemiology , Humans , Pandemics , Reinfection , SARS-CoV-2/genetics
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