[Anogenital lesions produced by Human Papillomavirus. Prevalence study in children and adolescent not vaccinated]. / Lesiones anogenitales por Virus Papiloma Humano. Estudio de prevalencia en niños, niñas y adolescentes no vacunados.

In Chilean children and adolescents, human papillomavirus (HPV) infection prevalence is unknown. In 2014, the HPV vaccine was incorporated into the National Immunization Program for girls, and since 2019 for boys. OBJECTIVE: To determine the prevalence, genotypes, and characteristics of HPV infection in children and adolescents with anogenital lesions not vaccinated against HPV. PATIENTS AND METHOD: Children and adolescents with anogenital lesions who consulted at the Luis Calvo Mackenna Children's Hospital between 2013 and 2017 were studied. The reason for consultation, age, sex, family history of HPV lesions, history of sexual abuse, and consensual sexual activity were recorded. HPV was detected by PCR and typification by reverse hybridization of the L1 gene. The samples were analyzed in the Oncogenic Virus Section of the Institute of Public Health. RESULTS: 110 patients were studied; 44.5% were children. HPV was detected in 34 cases (30.9% [CI95% 22.4- 40.4]), 22 (44.9%) were children and 12 (19.7%) adolescents. Eleven (91.7%) adolescents had a history of sexual con tact (p < 0.005); 4 (18.2%) children disclosed sexual abuse. HPV was found in 25% of patients with genital lesions and 50% with perianal lesions (p < 0.015). The most frequent genotypes were 59, 58, 16, 18, 6, and 11. Only low-risk genotypes were detected in children and high-risk genotypes were detected in 11/12 (91.7%) of HPV (+) adolescents. CONCLUSION: The prevalence of HPV infection was 30%. In adolescents, the infection was related to sexual contact and high-risk HPV. In children, it was associated with low-risk genotypes. Perianal lesions are more frequently associated with HPV infec tion than genital lesions in children and adolescents. The visual inspection does not allow to specify the etiology of the genital lesions, so it is necessary to perform a PCR test for HPV.

Correlación de las curvas Doppler de arterias uterinas con el desarrollo puberal de los genitales internos de niñas y adolescentes: experiencia en un servicio de imagenología pediátrico / Correlation of uterine artery Doppler patterns and the development of the internal genitalia of girls and adolescents: experience in a pediatric imaging department

Ultrasound allows evaluate in girls, the internal genitals development and their follow up during puberty. Doppler of the uterine arteries (UA) has demonstrated be a complementary parameter to detect the onset of puberty. Objective: To show through our experience, the correlation between the internal genital development and the Doppler of UA morphology in girls and adolescents. We analyzed in 84 ultrasounds (US); uterine morphology and the relation body/cervix, endometrial thickness, ovarian volume and the pattern of Doppler UA. We obtained a relationship between the anatomic changes usually studied and the patterns of the Doppler UA, since childhood to puberty. Conclusion: The diastolic flow changes in the UA can be complementary for the diagnosis of the degree of puberty.

El ultrasonido permite la evaluación del desarrollo de los genitales internos en las niñas y seguimiento a través de la pubertad. La curva del Doppler de arterias uterinas (AU) ha demostrado ser un parámetro complementario en la detección del inicio de la pubertad.Objetivo: mostrar la correlación del desarrollo de los genitales internos, con la morfología de las curvas Doppler de AU en niñas y adolescentes a través de nuestra experiencia. Analizamos en 85 ultrasonidos (US); morfología uterina, relación cuerpo/cervix, grosor endometrial, volumen ovárico y morfología de la curva del Doppler de AU. Constatamos una asociaciónentre los cambios morfológico estudiados habitualmente con los distintos patrones de las curvas del Doppler desde la niñez a la pubertad. Conclusión: Los cambios en el flujodiastólico de las arterias uterinas permiten complementar el diagnóstico del grado de progreso de la pubertad.

A new baseline for fascioliasis in Venezuela: lymnaeid vectors ascertained by DNA sequencing and analysis of their relationships with human and animal infection.

BACKGROUND: Human and animal fascioliasis poses serious public health problems in South America. In Venezuela, livestock infection represents an important veterinary problem whereas there appear to be few human cases reported, most of which are passively detected in health centres. However, results of recent surveys suggest that the situation may be underestimated in particular areas. To obtain a baseline for future fascioliasis assessment, studies were undertaken by means of rDNA ITS-2 and ITS-1 and mtDNA cox1 sequencing to clarify the specific status of Venezuelan lymnaeids, their geographical distribution and fascioliasis transmission capacity, by comparison with other American countries and other continents. RESULTS: Results obtained completely change the lymnaeid scenario known so far. The relatively rich lymnaeid fauna of Venezuela has been proven to include (i) Lymnaea meridensis and L. neotropica as the only native members, (ii) L. cubensis and Pseudosuccinea columella introduced from the Caribbean area, and (iii) Galba truncatula and L. schirazensis introduced from the Old World. The absence of representatives of the stagnicoline and Radix groups is remarkable. Four species are fascioliasis vectors: G. truncatula, L. cubensis and L. neotropica, which have the capacity to give rise to human endemic areas, and P. columella, which is a source of animal infection and is responsible for the spread of disease. Vector capacity in the apparently highland endemic L. meridensis is to be confimed, although may be expected given its phylogenetic relationships. Similarly as elsewhere, the non-transmitting L. schirazensis has been confused with L. cubensis, also with G. truncatula and possibly with L. neotropica. CONCLUSIONS: The new scenario leads to the re-opening of many disease aspects. In Venezuela, altitude appears to be the main factor influencing fascioliasis distribution. Human infection shows an altitude pattern similar to other Andean countries, although a differing highland/lowland impact on animal infection does not appear evident. The overlap of G. truncatula, L. cubensis and probably also L. neotropica in temperate and cold zones suggests a higher risk for human infection in mid and high altitude areas. A lymnaeid species mapping by means of DNA markers becomes a priority to determine human and animal fascioliasis distribution in Venezuela, owing to the importance of lymnaeid vectors in defining transmission and epidemiological patterns.

Hyperendemic human fascioliasis in Andean valleys: an altitudinal transect analysis in children of Cajamarca province, Peru.

A coprological survey including 476 2-18 year old school children from six rural localities between 2627 and 3061 m altitude was performed in Cajamarca province, Peru. Prevalences of fascioliasis ranging from 6.7 to 47.7% (mean 24.4%) proved to be the highest so far recorded in that human hyperendemic area. Higher prevalences in females and in the 2-5 year old group were not significant. Intensities ranged from 24 to 864 eggs per gram (arithmetic mean: 113; geometric mean: 68), the majority shedding less than 100, and without significant differences according to gender or age group. Fasciola hepatica was the most common helminth within a spectrum of 11-12 protozoan and 9-11 helminth species, 97.3% of the children showing infection with at least one parasite. The highest levels corresponded to coinfection with seven different species in females and subjects older than 5 years. Fascioliasis prevalence correlation with altitude appeared significant. An epidemiological characterisation of the valley transmission pattern of fascioliasis in Cajamarca is made by comparison with other better known hyperendemic areas. Results suggest that human fascioliasis may be widespread throughout different parts of Cajamarca province, even far away from the city, and that long-term fascioliasis chronicity and superimposed repetitive infections may be probably frequent.