Tendencia de la lepra en Formosa / Leprosy trend in Formosa

INTRODUCCIÓN La lepra es una enfermedad endémica en la provincia de Formosa, del noroeste Argentino. OBJETIVOS En este trabajo estudiamos la tendencia de los Indicadores Epidemiológicos en la serie temporal 2002-2016 y las proyecciones al 2022 de; los nuevos casos de lepra (NCL) en la provincia en general, en áreas rurales y urbanas y según el Nivel de Complejidad de Atención en Áreas Programáticas (AP) y Distritos Sanitarios (DS) en que fueron diagnosticados. MÉTODOS Se estudiaron 698 NCL diagnosticados por el Programa de Control de Leishmaniasis y Lepra de Formosa (PCLyLF). A partir de la tasas de detección de nuevos casos (TDNC) se evaluó la tendencia general mediante un modelo Autorregresivo de Media Móvil (TrARMA) y para las variables sexo, urbanización, forma clínica, área programática y distrito sanitario, un modelo Bayesiano TrARMA proporcional. Para todos los modelos se utilizaron cadenas de Markov-Montecarlo con el algoritmo de Metropolis-Hastings. RESULTADOS En el período 2002-2016, hubo una tendencia general decreciente de los NCL 66.029 [62.14 70.518] con una pendiente de 0.948 [0.938 0.957], que significó un descenso de 5.2% anual. Para el 2022, se estima 18.35 [23.18 27.41] NCL, siendo de 13.52 [10.94 16.34] para hombres y de 9.06 [7.33 10.94] para mujeres. En las áreas urbanas el número de NCL será de 19.70 [15.94 23.80] y en las rurales de 2.88 [2.33 3.48]. El mayor número de NCL se diagnosticó en las AP "B" 2do Nivel de Atención (n=459) y el menor en las AP "A" 1er Nivel de Atención (n=5) y será de 15.33 [12.40 18.52] y de 0.55 [0.44 0.66] en el 2022. Los DS-V (3.30 [2.67 3.99]), VII (2.79 [2.25 3.37]) y XII (2.43 [1.97 2.94]) serán los que diagnostiquen mayor número de casos. DISCUSIÓN La lepra es una enfermedad urbana, diagnosticada en el 2do Nivel de Atención, los DS VII y XII serán los más efectivos en el diagnóstico y si bien tiene una franca tendencia a decrecer, no se eliminará en el 2022

Towards leprosy elimination by 2020: forecasts of epidemiological indicators of leprosy in Corrientes, a province of northeastern Argentina that is a pioneer in leprosy elimination.

BACKGROUND: Corrientes, a province of northeastern Argentina with endemic leprosy, has improved its epidemiological indicators, however, a study of the dynamics over time is lacking. OBJECTIVES: We analysed data of 1308 leprosy patients between 1991 to 2014, and the forecast for 2020. METHODS: Descriptive statistics and stepwise Bayesian model selection were performed. Forecasts were made using the median of 100,000 projections using the parameters calculated via Monte Carlo methods. RESULTS: We found a decreasing number of new leprosy cases (-2.04 cases/year); this decrease is expected to continue by an estimated 20.28 +/- 10.00 cases by 2020, evidenced by a sustained decline in detection rate (from 11 to 2.9/100,000 inhabitants). Age groups that were most affected were 15-44 (40.13%) and 45-64 (38.83%) year olds. Multibacillary forms (MB) predominated (70.35%) and while gradually declining, between 10 and 30% developed disability grade 2 (DG2) (0.175 (0.110 - 0.337) DG2/MB cases), with a time delay between 0 to 15 years (median = 0). The proportion of MB clinic forms and DG2 increased and will continuously increase in the short term (0.036 +/- 0.018 logit (MB/total of cases). MAIN CONCLUSIONS: Corrientes is on the way to eliminating leprosy by 2020, however the increased proportion of MB clinical forms and DG2 signals a warning for disease control efforts.

Towards leprosy elimination by 2020: forecasts of epidemiological indicators of leprosy in Corrientes, a province of northeastern Argentina that is a pioneer in leprosy elimination

BACKGROUND Corrientes, a province of northeastern Argentina with endemic leprosy, has improved its epidemiological indicators, however, a study of the dynamics over time is lacking. OBJECTIVES We analysed data of 1308 leprosy patients between 1991 to 2014, and the forecast for 2020. METHODS Descriptive statistics and stepwise Bayesian model selection were performed. Forecasts were made using the median of 100,000 projections using the parameters calculated via Monte Carlo methods. RESULTS We found a decreasing number of new leprosy cases (-2.04 cases/year); this decrease is expected to continue by an estimated 20.28 +/- 10.00 cases by 2020, evidenced by a sustained decline in detection rate (from 11 to 2.9/100,000 inhabitants). Age groups that were most affected were 15-44 (40.13%) and 45-64 (38.83%) year olds. Multibacillary forms (MB) predominated (70.35%) and while gradually declining, between 10 and 30% developed disability grade 2 (DG2) (0.175 (0.110 - 0.337) DG2/MB cases), with a time delay between 0 to 15 years (median = 0). The proportion of MB clinic forms and DG2 increased and will continuously increase in the short term (0.036 +/- 0.018 logit (MB/total of cases). MAIN CONCLUSIONS Corrientes is on the way to eliminating leprosy by 2020, however the increased proportion of MB clinical forms and DG2 signals a warning for disease control efforts.

Sulfates are main targets of immune responses to cruzipain and are involved in heart damage in BALB/c immunized mice.

Trypanosoma cruzi, the agent of Chagas disease contains a major cysteine proteinase, cruzipain (Cz), with an unusual carboxyl-terminal extension (C-T). We have previously reported the presence of sulfate groups in the N-linked oligosaccharide chains of this domain. In order to evaluate the immune responses to sulfated moieties on Cz, BALB/c mice were immunized with purified Cz and C-T prior and after desulfation treatment. The humoral immune response to sulfates on Cz or C-T was mainly IgG2b. Interestingly, the abolishment of IgG2b reactivity when desulfated antigens were used as immunogens demonstrates that esterified sulfate groups are absolutely required for eliciting IgG2b response to Cz. Sera from chronically T. cruzi-infected subjects with mild disease displayed higher levels of total IgG and IgG2 antibodies specific for sulfated epitopes compared with those in more severe forms of the disease. A significant reduction of C-T-specific delayed-type hypersensitivity reaction in C-T-immunized mice was observed when desulfated C-T was challenged, suggesting the involvement of sulfate groups in the generation of memory T-cell responses. Moreover, immunization with C-T in the absence of infection elicited ultrastructural abnormalities in heart tissue. Surprisingly, hearts from sulfate-depleted C-T-immunized mice did not present pathological alterations. This is the first report showing that sulfate-bearing glycoproteins from trypanosomatids are able to elicit specific humoral and cellular immune responses and appeared to be involved in the generation of heart tissue damage. These results represent a further step in the understanding of the role of Cz in the course of T. cruzi infection.

Cardiac myocyte hypertrophy and proliferating cell nuclear antigen expression in Wistar rats infected with Trypanosoma cruzi.

Chagasic cardiomyopathy is a major life-threatening complication of Trypanosoma cruzi infection in human beings. This study focuses on the hypertrophic and hyperplastic mechanisms underlying the structural changes of the heart during experimental infection. Proliferating cell nuclear antigen (PCNA) expression, transversal diameter, nuclear area, and number of nuclei per unit volume were determined in the ventricular myocytes of T. cruzi-infected Wistar rats. PCNA expression was enhanced throughout the inflamed myocardium and in the spared areas of the left ventricular wall and the septum. Myocyte width increased from 26 to 75% at the inflammation-free myocardium (P < 0.0001), whereas it decreased 25% at the inflamed left ventricular wall areas (P < 0.001). Nuclear size increased in the inflammation-free myocardium of the left ventricle and the septum (> 10-36%, P < 0.01 and >0.2-32%, P < 0.03, respectively) and decreased at the inflamed areas of the left ventricular wall (10-22%. P < 0.02) with respect to the controls. The number of nuclei per unit volume decreased at the inflamed myocardium regardless of topographical location (36-65%) with respect to the controls (P < 0.0001) and in the inflammation-free myocardium of the right ventricle and the septum (<21-37%, P < 0.002 and <8-39%, P < 0.002, respectively). These results show that the heart responds to T. cruzi infection with DNA repair and cell multiplication in the inflamed sites and with hypertrophy of the unaffected myocardium.

Respuesta de las celulas musculares cardiacas a la infeccion con Trypanosoma cruzi / Myocardial cell response to Trypanosoma cruzi infection

El objetivo de este estudio es determinar la capacidad de respuesta de la célula muscular cardíaca a la infección por Trypanosoma cruzi. Se investigó el rol de la multiplicación de las células musculares en la remodelación cardíaca, y su capacidad de producción de óxido nítrico y control del parasitismo intracelular. Para ello, se determinó la presencia del antígeno nuclear de proliferación celular (PCNA) en los miocitos cardíacos re rata Wistar infectadas experimentalmente con T. cruzi, determinándose un aumento significativo del número de núcleos PCNA+ en los animales infectados agudos y crónicos. La capacidad de control del parasitismo intracelular y de producción de óxido nítrico fueron evaluados en cultivos primarios de miocitos cardíacos de ratas neonatas, estimulados con citoquinas in vitro. El análisis del parasitismo mostró que el número de miocitos cardíacos con amastigotes intracelulares fue menor en los cultivos estimulados con IL-1b, TNF-a e IFN-g. La producción de óxido nítrico fue mayor en los sobrenadantes de los cultivos celulares estimulados con citoquinas, tanto en los infectados como en los controles. Estos datos demuestran que la célula muscular cardíaca participa activamente en la respuesta del organismo durante la infección con T. cruzi.

Respuesta de las celulas musculares cardiacas a la infeccion con Trypanosoma cruzi / Myocardial cell response to Trypanosoma cruzi infection

El objetivo de este estudio es determinar la capacidad de respuesta de la célula muscular cardíaca a la infección por Trypanosoma cruzi. Se investigó el rol de la multiplicación de las células musculares en la remodelación cardíaca, y su capacidad de producción de óxido nítrico y control del parasitismo intracelular. Para ello, se determinó la presencia del antígeno nuclear de proliferación celular (PCNA) en los miocitos cardíacos re rata Wistar infectadas experimentalmente con T. cruzi, determinándose un aumento significativo del número de núcleos PCNA+ en los animales infectados agudos y crónicos. La capacidad de control del parasitismo intracelular y de producción de óxido nítrico fueron evaluados en cultivos primarios de miocitos cardíacos de ratas neonatas, estimulados con citoquinas in vitro. El análisis del parasitismo mostró que el número de miocitos cardíacos con amastigotes intracelulares fue menor en los cultivos estimulados con IL-1b, TNF-a e IFN-g. La producción de óxido nítrico fue mayor en los sobrenadantes de los cultivos celulares estimulados con citoquinas, tanto en los infectados como en los controles. Estos datos demuestran que la célula muscular cardíaca participa activamente en la respuesta del organismo durante la infección con T. cruzi. (AU)