Spatial-temporal clusters of host-seeking Aedes albopictus, Aedes japonicus, and Aedes triseriatus collections in a La Crosse virus endemic county (Knox County, Tennessee, USA).

A bite from a La Crosse virus (LACV) infected Aedes mosquito can cause La Crosse encephalitis (LACE), which is a neuro-invasive disease that disproportionately affects children under the age of 16 in Southern Appalachia. The three vectors for LACV are Aedes albopictus (Skuse), Ae. japonicus (Theobald), and Ae. triseriatus (Say). Localized maps of the geographic distribution of vectors are practical tools for mosquito management personnel to target areas with high mosquito abundance. This study hypothesized that LACV vectors have unique species-specific spatial and temporal clusters. To test this, 44 sites were identified in Knox County, Tennessee for their land use/type. At each site, host-seeking mosquitoes were collected approximately every other week from May-October 2018. Spatial clusters of host-seeking mosquito collections for each of the three mosquito species were investigated using Kulldorff's spatial scan statistic, specifying a retrospective space-time Bernoulli model. Most vector clusters were identified in south-central Knox County while the seasonality of clusters varied by mosquito species. Clusters of Ae. albopictus were observed throughout the entire study period while clusters of Ae. japonicus and Ae. triseriatus only occurred May-June. The findings indicate that the relative abundance of LACV vectors were more abundant in south-central Knox County compared to the rest of the county. Of interest, these clusters spatially overlapped with previous LACE diagnosed cases. These findings are useful in guiding decisions on targeted mosquito control in Knox County and may be applied to other counties within Southern Appalachia.

Manejo quirúrgico de Liposarcoma Retroperitoneal Gigante en Hospital Abel Gilbert Pontón 2013-2017 / Surgical Management of Giant Retroperitoneal Liposarcoma in "Abel Gilbert Pontón" Hospital 2013-2017

Introducción: De los tumores de retroperitóneo, el liposarcoma es considerado de crecimiento rápido y gran porcentaje de recurrencia, los autores lo consideran una patología inusual. Los sarcomas retroperitoneales son poco comunes constituyen el 10 a 15% de todos los sarcomas y su incidencia anual está estimada en 2.7 casos por millón de habitantes. Se decide realizar el presente estudio debido a ser patología inusual, siendo el objetivo principal la importancia del manejo quirúrgico de este tipo de tumores gigantes retroperitoneales. Métodos: Estudio descriptivo, retrospectivo, longitudinal, realizado en el Hospital Abel Gilbert Pontón desde enero 2013 a diciembre 2017. Se realiza revisión de historias clínica de todos los pacientes que acudieron a consulta externa presentando masa abdominal. Se seleccionan aquellos con diagnóstico anatomopatológico de liposarcoma retroperitoneal gigante, con datos completos en su historial y con mínimo 2 controles por consulta externa. Resultados: la muestra estudiada fue de 4 pacientes intervenidos quirúrgicamente entre 40 y 65 años. Tumores entre 45 a 70 cm, 1 caso con compromiso a órganos vecinos. No se reportaron complicaciones. Recibieron el alta en promedio a las 2 semanas de operados Conclusión: La serie de casos revisada evidencia que el manejo adecuado de este tipo de patologías, es multidisciplinario, siendo la piedra angular el tratamiento quirúrgico.

Introduction: Of the retroperitoneal tumors, the liposarcoma is considered of fast growth and great percentage of recurrence, the authors consider it an unusual pathology. Retroperitoneal sarcomas are uncommon, accounting for 10 to 15% of all sarcomas, and their annual incidence is estimated at 2.7 cases per million inhabitants. It was decided to perform the present study due to its unusual pathology, the main objective being the importance of the surgical management of this type of giant retroperitoneal tumors. Methods: A descriptive, retrospective, longitudinal study was carried out at the Abel Gilbert Pontón Hospital from January 2013 to December 2017. A review of the clinical histories of all the patients who attended the outpatient clinic presenting abdominal mass was performed. Those with anatomopathological diagnosis of giant retroperitoneal liposarcoma are selected, with complete data in their history and with at least 2 controls by external consultation. Results: the sample studied was of 4 patients surgically intervened between 40 and 65 years. Tumors between 45 to 70 cm, 1 case with commitment to neighboring organs. No complications were reported. They were discharged on average 2 weeks after surgery. Conclusion: The series of cases reviewed shows that the proper management of this type of pathologies is multidisciplinary, being the cornerstone the surgical treatment.

Evaluating Surveillance Methods for Arboviral Vectors of La Crosse Virus and West Nile Virus of Southern Appalachia.

To monitor mosquito-borne diseases, public health departments conduct mosquito and pathogen surveillance. Our objective was to evaluate mosquito monitoring methods for collecting La Crosse virus (LACV) and West Nile virus (WNV) vectors (Aedes and Culex mosquitoes, respectively) in southern Appalachia. Centers for Disease Control and Prevention (CDC) light traps baited with carbon dioxide (CO(2)), CDC light traps baited with CO(2) and BG lure, BG-Sentinel traps baited with CO(2), gravid traps baited with oak (Quercus)-water infusion, and resting traps were compared in eastern Tennessee in 2013. Traps operated at 8 different urban sites throughout Knox County were randomly assigned to and rotated among 6 plots within each site. Results were specific for each vector; the BG-Sentinel trap was the best method for Aedes triseriatus, the CDC trap baited with CO(2) and BG lure was the best method for Ae. albopictus, and the gravid trap was the best method for Ae. japonicus. Culex erraticus collections varied by week and trapping method, indicating no single method was best, but the questing traps collected more mosquitoes. There was no significant trapping difference for Cx. pipiens complex in this region using the methods tested. The results suggest using a combination of trapping methods when sampling for LACV and/or WNV mosquito vectors in southern Appalachia. Effective trapping methods are necessary to enable accurate surveillance, improve control methods, enhance understanding of dispersal, and use for early detection of vectors and pathogens.

Spatiotemporal Co-occurrence of Flanders and West Nile Viruses Within Culex Populations in Shelby County, Tennessee.

West Nile virus (WNV) and Flanders virus (FLAV) can cocirculate in Culex mosquitoes in parts of North America. A large dataset of mosquito pools tested for WNV and FLAV was queried to understand the spatiotemporal relationship between these two viruses in Shelby County, TN. We found strong evidence of global clustering (i.e., spatial autocorrelation) and overlapping of local clustering (i.e., Hot Spots based on Getis Ord Gi*) of maximum likelihood estimates (MLE) of infection rates (IR) during 2008-2013. Temporally, FLAV emerges and peaks on average 10.2 wk prior to WNV based on IR. Higher levels of WNV IR were detected within 3,000 m of FLAV-positive pool buffers than outside these buffers.

Effects of geohelminth infection and age on the associations between allergen-specific IgE, skin test reactivity and wheeze: a case-control study.

BACKGROUND: Most childhood asthma in poor populations in Latin America is not associated with aeroallergen sensitization, an observation that could be explained by the attenuation of atopy by chronic helminth infections or effects of age. OBJECTIVE: To explore the effects of geohelminth infections and age on atopy, wheeze, and the association between atopy and wheeze. METHODS: A case-control study was done in 376 subjects (149 cases and 227 controls) aged 7-19 years living in rural communities in Ecuador. Wheeze cases, identified from a large cross-sectional survey, had recent wheeze and controls were a random sample of those without wheeze. Atopy was measured by the presence of allergen-specific IgE (asIgE) and skin prick test (SPT) responses to house dust mite and cockroach. Geohelminth infections were measured in stools and anti-Ascaris IgE in plasma. RESULTS: The fraction of recent wheeze attributable to anti-Ascaris IgE was 45.9%, while those for SPT and asIgE were 10.0% and 10.5% respectively. The association between atopy and wheeze was greater in adolescents than children. Although Anti-Ascaris IgE was strongly associated with wheeze (adj. OR 2.24 (95% CI 1.33-3.78, P = 0.003) and with asIgE (adj. OR 5.34, 95% CI 2.49-11.45, P < 0.001), the association with wheeze was independent of asIgE. There was some evidence that the association between atopy and wheeze was greater in uninfected subjects compared with those with active geohelminth infections. CONCLUSIONS AND CLINICAL RELEVANCE: Atopy to house dust mite and cockroach explained few wheeze cases in our study population, while the presence of anti-Ascaris IgE was an important risk factor. Our data provided only limited evidence that active geohelminth infections attenuated the association between atopy and wheeze in endemic areas or that age modified this association. The role of allergic sensitization to Ascaris in the development of wheeze, independent of atopy, requires further investigation.

Long-term periodic anthelmintic treatments are associated with increased allergen skin reactivity.

BACKGROUND: The low prevalence of allergic disease in the rural tropics has been attributed to the protective effects of chronic helminth infections. There is concern that treatment-based control programmes for these parasites may lead to an increase in the prevalence of allergic diseases. OBJECTIVE: We measured the impact of 15-17 years of anthelmintic treatment with ivermectin on the prevalence of allergen skin test reactivity and allergic symptoms in school-age children. METHODS: The prevalence of allergen skin test reactivity, exercise-induced bronchospasm and allergic symptoms was compared between school-age children living in communities that had received community-based treatments with ivermectin (for onchocerciasis control) for a period of 15-17 years with those living in geographically adjacent communities that had received no ivermectin. RESULTS: The prevalence of allergen skin test reactivity was double in children living in treated communities compared with those in untreated communities (16.7% vs. 8.7%, adjusted OR 2.10, 95% CI 1.50-2.94, P<0.0001), and the effect was mediated partly by a reduced prevalence of Trichuris trichiura among treated children. Ivermectin treatments were associated with an increased prevalence of recent eczema symptoms (adjusted OR 2.24, 95% CI 1.05-4.78, P=0.04) but not symptoms of asthma or rhino-conjunctivitis. The effect on eczema symptoms was not associated with reductions in geohelminth infections. CONCLUSION: Long-term periodic treatments with ivermectin were associated with an increased prevalence of allergen skin test reactivity. There was some evidence that treatment was associated with an increased prevalence of recent eczema symptoms but not those of asthma or rhino-conjunctivitis.

Host associations of Dermacentor, Amblyomma, and Ixodes (Acari: Ixodidae) ticks in Tennessee.

From April 2007 to September 2008, 1,793 adult and nymphal ixodid ticks were collected from 49 counties in Tennessee. Six species were identified, including Dermacentor variabilis (Say), Amblyomma americanum (L.), Ixodes texanus (Banks), Ixodes cookei Packard, Ixodes scapularis (Say), and Amblyomma maculatum Koch, from 13 medium- to large-sized mammalian hosts and dragging through vegetation. Raccoons were the most common vertebrate source (198 captures), accounting for 60% of ticks collected. Dermacentor variabilis was the predominant species from raccoons with a prevalence of 92% and mean intensity of 5.3. A. americanum was predominated in white-tailed deer and drags with respective mean intensities of 3.1 and 14.1 and prevalence values of 94%. All tick species were identified between April and August, coinciding with the majority of animal captures. Only A. americanum, I. texanus, and I. cookei were identified from 22 animal captures from November to March. I. texanus and I. cookei were more common in the eastern portions of the state, but this may be a result of higher raccoon captures in those areas. Only four specimens of I. scapularis were collected in this study, which may reflect the absence of small mammal or reptile captures. Two A. maculatum were collected, and we report new distribution records in Tennessee for this species. Despite unequal sampling among ecoregions, the large numbers of D. variabilis and A. americanum from multiple host species suggest their widespread distribution throughout the state. These species of ticks can transmit multiple pathogens, including spotted fever group rickettsiae and ehrlichiae.

An update on Chagas disease (human American trypanosomiasis).

Human American trypanosomiasis or Chagas disease -- named after Carlos Chagas who first described it in 1909 -- exists only on the American continent. It is caused by a parasite, Trypanosoma cruzi, that is transmitted to humans by blood-sucking triatomine bugs, by blood transfusion, and transplacentally. Chagas disease has two, successive phases: acute and chronic. The acute phase lasts 6-8 weeks. After several years of starting the chronic phase, 20%-35% of infected individuals (the percentage varying with geographical area) develop irreversible lesions of the autonomous nervous system in the heart, the oesophagus, the colon and/or the peripheral nervous system. Data on the prevalence and distribution of Chagas disease markedly improved in quality during the 1980s, as a result of demographically representative, cross-sectional studies carried out in countries where no accurate information on these parameters was available. Experts had previously met in Brasilia, in 1979, and devised standard protocols for carrying out country-wide studies not only on the prevalence of human infection with T. cruzi but also on house infestation with the triatomine vectors. Thanks to a co-ordinated programme in the southernmost countries of South America (i.e.the 'Southern Cone'), transmission of T. cruzi by the vectors or blood transfusion has been successfully interrupted in Uruguay (from 1997), Chile (from 1999) and Brazil (from 2005), and the global incidence of new human infection with T. cruzi has decreased by 67%. Similar multi-country control initiatives have been launched in the Andean countries and in Central America, with the goal of interrupting all transmission of T. cruzi to humans by 2010 -- a goal set, in 1998, as a resolution of the World Health Assembly. Recent advances in basic research on T. cruzi include the genetic characterization of populations of the parasite and the sequencing of its genome.

Vector competence of rural and urban strains of Aedes (Stegomyia) albopictus (Diptera: Culicidae) from São Paulo State, Brazil for IC, ID, and IF subtypes of Venezuelan equine encephalitis virus.

Aedes albopictus (Skuse) is an Asiatic mosquito species that has spread and colonized all continents except Antarctica. It has major public health importance because it is a potential vector of several pathogens. The objectives of our study were to analyze the vector competence of urban and rural strains of Ae. albopictus from São Paulo State (Brazil) for Venezuelan equine encephalitis virus (VEE) subtypes IC, ID, and IF, and to evaluate the effect of infection with subtype IC of VEE on mosquito longevity. Both mosquito strains were susceptible to subtypes IC and ID, but the infection rate for subtype IF was low. Infection and transmission rates of Ae. albopictus for subtype IC were similar to those reported for Ochlerotatus taeniorhynchus (Wiedemann). The high infection, dissemination, and transmission rates for subtype ID reported for Oc. fulvus (Wiedemann) and Culex (Melanoconion) spp. are comparable with those found in this study. We found significant differences in the susceptibility to subtype IC between rural and urban populations of São Paulo. Significant survival rate differences were observed between uninfected and infected mosquitoes, but there were no differences in survival between rural and urban mosquito strains.

Allpahuayo virus: a newly recognized arenavirus (arenaviridae) from arboreal rice rats (oecomys bicolor and oecomys paricola) in northeastern peru.

Allpahuayo virus was initially isolated from arboreal rice rats (Oecomys bicolor and Oecomys paricola) collected during 1997 at the Allpahuayo Biological Station in northeastern Peru. Serological and genetic studies identified the virus as a new member of the Tacaribe complex of the genus Arenavirus. The small (S) segment of the Allpahuayo virus prototype strain CLHP-2098 (Accession No. AY012686) was sequenced, as well as that of sympatric isolate CLHP-2472 (Accession No. AY012687), from the same rodent species. The S segment was 3382 bases in length and phylogenetic analysis indicated that Allpahuayo is a sister virus to Pichinde in clade A. Two ambisense, nonoverlapping reading frames were identified, which result in two predicted gene products, a glycoprotein precursor (GPC) and a nucleocapsid protein (NP). A predicted stable single hairpin secondary structure was identified in the intergenic region between GPC and NP. Details of the genetic organization of Allpahuayo virus are discussed.

Meconial peritrophic membranes and the fate of midgut bacteria during mosquito (Diptera: Culicidae) metamorphosis.

The location of midgut bacteria relative to meconial peritrophic membranes (MPMs) and changes in bacterial numbers during midgut metamorphosis were studied in Anopheles punctipennis (Say), Culex pipiens (L.), and Aedes aegypti (L.) pupae and newly emerged adults. After adult emergence in Aedes, Anopheles, and most Culex, there were few to no bacteria in the midgut. In most newly emerged adult mosquitoes, few bacteria were found in either the lumen or within the MPMs/meconia. In a few Culex specimens, high numbers of bacteria were found in the MPMs/meconia and low numbers in the lumen. In all three species bacterial counts were high in fourth instars, decreased after final larval defecation, increased in young pupae, and increased further in old pupae. A very effective gut sterilization mechanism is operating during mosquito metamorphosis and adult emergence. This mechanism appears to involve the sequestration of remaining larval gut bacteria within the confines of the meconium and one or two MPMs and the possible bactericidal effect of the exuvial (molting) fluid, which is ingested during the process of adult emergence.

Genetic diversity and relationships among Venezuelan equine encephalitis virus field isolates from Colombia and Venezuela.

During field studies of enzootic Venezuelan equine encephalitis (VEE) viruses associated with epizootic emergence, a large number of virus isolates were made in sylvatic foci of Venezuela and Colombia. To rapidly characterize these isolates, antigenic subtypes were determined by means of immunofluorescence and by single-strand conformational polymorphism (SSCP) analysis by use of an 856-bp fragment from the P62 gene, which we used to distinguish genetic variants. Representative isolates were sequenced to assess the sensitivity of SSCP to detect genetic differences. The SSCP analysis distinguished isolates differing by as little as 1 nucleotide; overall, differences of > or = 1 nucleotide were recognized 89% of the time, and the sensitivity to distinguish strains that differed by only 1 or 4 nucleotides was 17 and 57%, respectively. Phylogenetic analyses of representative sequences showed that all recent isolates from the Catatumbo region of western Venezuela and the middle Magdalena Valley of Colombia were closely related to epizootic subtype IAB and IC strains; strains from Yaracuy and Miranda States were more distantly related. Cocirculation of the same virus genotype in both Colombian and Venezuelan foci indicated that these viruses are readily transported between enzootic regions separated by > 300 km. The SSCP analysis appears to be a simple, fast, and relatively efficient method of screening VEE virus isolates to identify meaningful genetic variants.

The occurrence and fate of the meconium and meconial peritrophic membranes in pupal and adult mosquitoes (Diptera: Culicidae).

In mosquitoes, in addition to larval and adult peritrophic membranes (PMs), a PM (meconial peritrophic membrane or MPM1) forms in the pupa around the meconium, the sloughed, degenerating larval midgut epithelium. Often, a second membrane (MPM2) forms in temporal proximity to adult emergence. Differences in the occurrence, persistence, and timing of disappearance of the meconium/MPMs and gas were studied by dissecting the midgut contents from pupae of known ages postpupation and from adults of known ages postemergence. MPM1 was found in all Anopheles and Culex studied and nearly all Culiseta. The occurrence of MPM1 varied in the Aedes species. In one series of Aedes aegypti (L.) dissections, no fully formed MPM2 was found in any specimens. The occurrence of MPM2 appeared to be associated with adult emergence and varied among and within the seven species studied. It typically was seen in recently emerged adults but was observed occasionally in old pupae. Much of our data supports the idea that MPM2 formation is stimulated by midgut epithelium distention.

Trauma abdominal: estudio de lesiones viscerales

Se estudiaron 575 pacientes con trauma cerrado y penetrante de abdomen operados en el Servicio de Emergencia del Hospital Luis Vernaza de 1997 a 1998. Del total de pacientes operados encontramos que el 15.4 por ciento de los pacientes tuvieron traumas cerrados y 84.5 por ciento tuvieron trauma penetrante de abdomen. Los órganos más afectados fueron intestino con el 36.1 por ciento (ileon 24 por ciento y yeyuno 12.1 por ciento), hígado 26.6 por ciento, colon 24.3 por ciento, estómago 13.5 por ciento. Los traumas encontrados fueron en 4 casos de tipo especial, en 219 casos producidos por arma cortopunzante y en 263 por arma de fuego.

Traumas hepáticos: revisión de 215 casos operados en el Servicio de Emergencia del Hospital Luis Vernaza de Guayaquil

El presente estudio fue realizado de 1997 a 1999. Se analizan las fichas clínicas de 215 pacientes (193 hombres y 22 mujeres) con traumas hepáticos. El trauma tuvo una frecuencia mayor de presentación en el sexo masculino (193 casos), con una edad media de 25 a 30 años. Un 60 por ciento de los pacientes se encontraba en estado de ebriedad y un 30 por ciento en estado de shock en el momento del ingreso. Traumas asociados se rpesentaron en un 24 por ciento.

Heridas penetrantes toracoabdominales: análisis de 134 casos atendidos en el Servicio de Emergencia del Hospital Luis Vernaza

Recogimos los datos clínicos de evaluación y tratamiento 134 pacientes con heridas penetrantes localizadas en la región toracoabdominal operados en el Servicio de Emergencia del Hospital Luis Vernaza de 1998 al 2000. Predominaron los varones en 94,02 por ciento; un 40 por ciento por arma cortopunzante y 60 por ciento por arma de fuego. La lesión más frecuente fue herida de hígado.

Effect of eastern equine encephalomyelitis virus on the survival of Aedes albopictus, Anopheles quadrimaculatus, and Coquillettidia perturbans (Diptera: Culicidae).

The effect of eastern equine encephalomyelitis (EEE) virus on the survivorship of Aedes albopictus (Skuse), Anopheles quadrimaculatus Say, and Coquillettidia perturbans (Walker) was determined experimentally. Female mosquitoes were allowed to feed on EEE viremic chicks, and survival rates were compared for infected and uninfected mosquitoes. Additionally, the survival of female Cq. perturbans and An. quadrimaculatus intrathoracically (i.t.) inoculated with EEE was compared with controls receiving diluent inoculations. Infection with EEE significantly reduced survival in Cq. perturbans compared with uninfected individuals in per os infection experiments. I.t. infections of Cq. perturbans did not reduce survival when compared with diluent inoculated groups. In contrast, infection with EEE did not affect the survival of Ae. albopictus after per os infection or An. quadrimaculatus after either i.t. or per os infections.

Application of geographic information technology in determining risk of eastern equine encephalomyelitis virus transmission.

Geographic information system (GIS) technology and remote sensing were used to identify landscape features determining risk of eastern equine encephalomyelitis virus (EEE) transmission as defined by the abundance of Culiseta melanura (the enzootic vector) and 6 putative epidemic-epizootic vectors in Massachusetts. Landsat Thematic Mapper data combined with aerial videography data were used to generate a map of landscape elements at epidemic-epizootic foci in southeastern Massachusetts. Geographic information system technology was used to determine the proportion of landscape elements surrounding 15 human and horse case sites where abundance data were collected for Culiseta melanura, Aedes canadensis, Aedes vexans, Culex salinarius, Coquillettidia perturbans, Anopheles quadrimaculatus, and Anopheles punctipennis. The relationships between vector abundance and landscape proportions were analyzed using stepwise linear regression. Stepwise regression indicated wetlands as the most important major class element, which accounted for up to 72.5% of the observed variation in the host-seeking populations of Ae. canadensis, Ae. vexans, and Cs. melanura. Moreover, stepwise linear regression demonstrated deciduous wetlands to be the specific wetland category contributing to the major class models. This approach of utilizing GIS technology and remote sensing in combination with street mapping can be employed to identify deciduous wetlands in neighborhoods at risk for EEE transmission and to plan more efficient schedules of pesticide applications targeting adults.

Toward the incrimination of epidemic vectors of eastern equine encephalomyelitis virus in Massachusetts: abundance of mosquito populations at epidemic foci.

Putative epidemic/epizootic eastern equine encephalomyelitis virus (EEE) vector populations were compared at 15 recent (1982-90) human and horse case sites in Bristol and Plymouth counties in southeastern Massachusetts. Carbon dioxide-baited American Biophysics Corporation light traps were used for trapping adult mosquitoes to estimate biting risk in these foci of known transmission. Population data suggest that Coquillettidia perturbans, Aedes canadensis, and Culex salinarius are more likely vectors of EEE in Massachusetts than Aedes vexans, Anopheles punctipennis, and Anopheles quadrimaculatus.