Molecular Characterization of Norovirus Circulating in Northwest Mexico During 2013-2014.

Norovirus (NoV) is an important etiological agent of diarrhea in children and adults. In Mexico, NoV screening is not routinely performed. NoV is highly infectious and is responsible for massive outbreaks due to the consumption of contaminated food. The study was a cross-sectional design. Samples of diarrheal stools were collected from (62) children and (38) adults with acute gastroenteritis during 2013-2014. The circulating genogroups of NoV were detected by amplifying the RdRp gene fragment, and for the genotyping, the capsid and polymerase fragments were sequenced. Seventy-seven percent of the analyzed samples were positive for NoV. Genotyping was possible for 51 samples; for polymerase GII.P2, GII.P31, GII.P4, GII.P7, GII.P40, and GI.P14 were identified, whereas for capsid, genotypes GI.3, GII.2, GII.4, GII.5, GII.14, and GII.17. In conclusion, there is a high prevalence of gastroenteritis due to NoV in the northwest of Mexico, including genotypes that have not been reported previously in Mexico.

Intussusception risk and health benefits of rotavirus vaccination in Mexico and Brazil.

BACKGROUND: Because postlicensure surveillance determined that a previous rotavirus vaccine, RotaShield, caused intussusception in 1 of every 10,000 recipients, we assessed the association of the new monovalent rotavirus vaccine (RV1) with intussusception after routine immunization of infants in Mexico and Brazil. METHODS: We used case-series and case-control methods to assess the association between RV1 and intussusception. Infants with intussusception were identified through active surveillance at 69 hospitals (16 in Mexico and 53 in Brazil), and age-matched infants from the same neighborhood were enrolled as controls. Vaccination dates were verified by a review of vaccination cards or clinic records. RESULTS: We enrolled 615 case patients (285 in Mexico and 330 in Brazil) and 2050 controls. An increased risk of intussusception 1 to 7 days after the first dose of RV1 was identified among infants in Mexico with the use of both the case-series method (incidence ratio, 5.3; 95% confidence interval [CI], 3.0 to 9.3) and the case-control method (odds ratio, 5.8; 95% CI, 2.6 to 13.0). No significant risk was found after the first dose among infants in Brazil, but an increased risk, albeit smaller than that seen after the first dose in Mexico--an increase by a factor of 1.9 to 2.6 - was seen 1 to 7 days after the second dose. A combined annual excess of 96 cases of intussusception in Mexico (approximately 1 per 51,000 infants) and in Brazil (approximately 1 per 68,000 infants) and of 5 deaths due to intussusception was attributable to RV1. However, RV1 prevented approximately 80,000 hospitalizations and 1300 deaths from diarrhea each year in these two countries. CONCLUSIONS: RV1 was associated with a short-term risk of intussusception in approximately 1 of every 51,000 to 68,000 vaccinated infants. The absolute number of deaths and hospitalizations averted because of vaccination far exceeded the number of intussusception cases that may have been associated with vaccination. (Funded in part by the GAVI Alliance and the U.S. Department of Health and Human Services.).

Tratamiento de coccidioidomicosis meníngea con anfotericina liposomal: presentación de un caso / Treatment of meningeal coccidiomycosis with liposomal amphotericin: case report

Introducción. La coccidioidomicosis fue descrita por primera vez a finales del siglo XVIII por Alejandro Posadas; el primer caso autóctono en Sonora fue reportado por Madrid en 1948. Es causada por un hongo dimórfico del que se reconocen dos especies: una limitada al área de California llamada C. immitis y otra especie no californiana conocida como C. posadasii. Presentación del caso clínico. Se trata de paciente masculino de 6 años de vida, residente de Caborca, Sonora. A los 2 años 6 meses presenta cuadro clínico caracterizado por cefalea y vómito en proyectil, por lo que acude al hospital y se establece el diagnóstico de hidrocefalia de origen no determinado. A los 3 años 6 meses se establece el diagnóstico de coccidioidomicosis meníngea, sin conocer los títulos de anticuerpos séricos en suero y en liquido cefalorraquídeo (LCR). Recibe tratamiento con fluconazol durante 3 años, asociado a un corto curso de desoxicolato de anfotericina B por un mes. Al ingreso a nuestra institución, se demuestran títulos de anticuerpos elevados en LCR lumbar y en suero, aunque no en LCR ventricular. Conclusiones. Posteriormente a ser tratado con anfotericina liposomal a dosis de 2 mg/kg durante nueve meses (dosis total de 5475 mg), presentó buena evolución clínica asociada a disminución de los títulos de anticuerpos en suero y en LCR. Durante su tratamiento no se presentaron datos clínicos ni de laboratorio sugestivos de toxicidad secundaria a la administración de anfotericina liposomal.

Background: Coccidioidomycosis was first described in the late 18th century by Alejandro Posadas. The first case in Sonora was reported in 1948 by Madrid. Coccidioidomycosis is caused by both species of a dimorphic fungus, one limited to the California area (C.immitis) and the other a non-California strain (C. posadassi). Clinical case: A 6-year-old male patient from Caborca, Sonora presented headache and projectile vomiting. At 2½ years of age he was treated at a hospital with the diagnosis of undetermined hydrocephalus. At 3½ years of age, a diagnosis of coccidioidal meningitis was made without knowing the serum antibody and cerebrospinal fluid (CSF) titers. He received treatment with fluconazole for 3 years with 1 month of amphotericin B deoxycholate. Upon admission to our hospital, elevated antibody CSF titers were present. Conclusion: After being treated with liposomal amphotericin (2 mg/kg) for 9 months, he reached a total dose of 5475 mg, presenting good clinical outcome with decreased serum antibodies and CSF titers. During his treatment no clinical or laboratory data suggested toxicity due to liposomal amphotericin administration.