[Cyclosporosis: an emergent parasitosis. (II) Microbiological diagnosis through a new staining technique]. / Ciclosporosis: una parasitosis emergente. (II) Diagnóstico microbiológico mediante una nueva técnica de coloración.

PURPOSE: Describe a new staining technique for the diagnosis of Cyclospora infection through lab tests. A differential microscopic diagnosis between Cyclospora and Blastocystis hominis is conducted. MATERIALS AND METHODS: The research was conducted by using fecal samples referred to a private lab in the city of Lima, Peru. A direct fresh assay was made by using a saline solution and Lugol's solution. Very thin fecal smear were prepared, and a staining technique using gentian violet was applied. RESULTS: Microphotography of Cyclospora cysts are shown with the fresh assay method and the new staining technique. Moreover the morphological and structural differences between Cyclospora and Blastocystis hominis were shown: the latter is larger, shows poor staining, and has vacuoles. CONCLUSIONS: The routine use of this technique is recommended for all fecal tests due to its simplicity and low cost, and because it allows a quick diagnosis of this type of infection that has a high prevalence in our country so it may be treated prematurely and specifically.

[Cyclosporosis: an emergent parasitosis. (I) Clinical and epidemiological aspects]. / Ciclosporosis: una parasitosis emergente. (I) Aspectos clínicos y epidemiológicos.

PURPOSE: Determine the prevalence of Cyclospora cayetanensis in asymptomatic patients consulting a physician, or dwellers of marginal urban settlements surrounding Lima, Peru. MATERIALS AND METHODS: The population was composed of 3,259 individuals: 2,968 individuals between 1 month and 87 years of age, who consulted a private physician because of digestive disorders, particularly diarrhea, and 291 individuals between 5 months and 75 years of age from marginal areas, all apparently healthy. The presence of Cyclospora was investigated through "fresh" microscopic techniques using a saline solution and Lugols solution. A new staining technique described in other publication was used. A record was created containing all clinical and epidemiological data, which were assessed statistically. RESULTS: Cycloscopora incidence was 7.3% in the first group, and 41.6% in the second group. A higher rate was observed in young and elder adults up to 60-year-old. No major seasonal incidence was found. Clinical signs/symptoms for individuals consulting a private physician were mainly diarrhea and abdominal pain while individuals from marginal urban areas mainly showed meteorism, abdominal plain, occasional diarrhea and general symptoms such as fatigue and weight loss. CONCLUSIONS: Cyclospora showed a high incidence, particularly in marginal urban areas. Two types of clinical signs/symptoms were found: an acute and very severe condition that can cause dehydration, and a chronic condition with several digestive signs/symptoms, particularly meteorism and abdominal pain. Individuals consulting a private physician show acute and chronic episodes while individuals from marginal urban areas do show a chronic condition. Apparently individuals showing acute episodes are immunologically exposed to the parasite, but they do not acquire immunity later in spite of the treatment because they may become re-infected from time to time. However, individuals showing chronic episodes apparently keep a host-parasite balance due to a permanent contact with the parasite. The contamination source appears to be the water. Therefore all required epidemiological actions shall be taken to prevent this problem from reaching higher dimensions.

Ciclosporosis: una parasitosis emergente (II) diagnóstico microbiológico mediante una nueva técnica de coloración / Cyclosporosis: an emergent parasitosis (II) microbiological diagnosis through a new staining technique

Objetivos: Se describe una nueva técnica de coloración para el diagnóstico de laboratorio de las infecciones por Cyclospora y el Blastocystis hominis. Material y métodos: La investigación se efectuó en heces que fueron remitidas a un laboratorio de atención privada, en la ciudad de Lima, Perú. Se practicó examen directo "en fresco", empleando solución salina y lugol parasitológico. Se prepararon frotices de heces muy delgados y se empleó una técnica de coloración utilizando violeta de genciana. Resultados: Se muestran microfotografías de los quistes de Cyclospora en fresco y mediante la nueva técnica de coloración, así mismo se demuestran las diferencias morfológicas y estructurales entre Cyclospora y Blastocystis hominis. El blastocystis es de mayor tamaño, capta pobremente el colorante y presenta vacuolas. Conclusiones: Se recomienda el empleo rutinario de esta nueva técnica, en todas las investigaciones de heces, por ser sencilla y económica y por permitir hacer un diagnóstico rápido en este tipo de infecciones que tienen una elevada prevalencia en nuestro medio y pueden ser tratadas en forma precoz y específica.

Purpose: Describe a new staining technique for the diagnosis of Cyclosporainfection through lab tests. A differential microscopic diagnosis between Cyclospora and Blastocystis hominis is conducted. Materials and Methods: The research was conducted by using fecal samples referred to a private lab in the city of Lima, Peru. A direct fresh assay was made by using a saline solution and Lugol’s solution. Very thin fecal smear were prepared, and a staining technique using gentian violet was applied. Results: Microphotography of Cyclospora cysts are shown with the fresh assay method and the new staining technique. Moreover the morphological and structural differences between Cyclospora and Blastocystis hominis were shown: the latter is larger, shows poor staining, and has vacuoles. Conclusions: The routine use of this technique is recommended for all fecal tests due to its simplicity and low cost, and because it allows a quick diagnosis of this type of infection that has a highprevalence in our country so it may be treated prematurely and specifically.

Ciclosporosis: una parasitosis emergente (I) aspectos clínicos y epidemiológicos / Cyclosporosis: an emergent parasitosis (I) clinical and epidemiological aspects

Objetivo: Determinar la prevalencia de Cyclospora cayetanensis en pacientes sintomáticos que acudieron a la consulta médica y en pobladores que habitan en asentamientos que rodean a la ciudad de Lima, Perú. Material y métodos: La población completa estuvo compuesta por 3,259 personas: 2,968 entre 1 mes y 87 años de edad, que acudieron a un laboratorio de atención privada por presentar trastornos digestivos, principalmente diarreas y el segundo por 291 pobladores de áreas periféricas, denominadas conos, de 5 meses a 75 años, aparentemente sanos. Se investigó la presencia de Cyclospora mediante técnicas microscópicas "en fresco" con solución salina y lugol y se empleó una nueva técnica de coloración descrita en otra publicación. Se hizo una ficha consignando los datos clínicos y epidemiológicos, que se evaluaron estadísticamente. Resultados: En el primer grupo la incidencia de Cyclospora fue de 7.3 por ciento y en el segundo 41.6 por ciento observándose con más frecuencia en adultos jóvenes y mayores, hasta los 60 años. No se encontró mayor incidencia estacional. Las manifestaciones clínicas de los pacientes que acudieron al laboratorio fueron mayormente diarrea y dolor abdominal, mientras que las personas que provenían de los conos, presentaron principalmente gases, dolor abdominal, diarreas ocasionales y síntomas generales, como cansancio y adelgazamiento. Conclusiones: La Cyclospora mostró una elevada incidencia, especialmente en los conos. Se encontraron dos tipos de manifestaciones clínicas: una aguda, muy severa que puede llevar a la deshidratación, otra crónica con diversas manifestaciones digestivas, principalmente gases y dolor abdominal. Los pacientes que acuden a la consulta médica presentan cuadros agudos y crónicos, mientras que los que habitan en los conos, sí presentan patología ésta es de tipo crónico. Aparentemente los pacientes que presentan cuadros agudos están inmunológicamente expuestos al parásito, pero no se inmunizan...

Purpose: Determine the prevalence of Cyclospora cayetanensis in asymptomatic patients consulting a physician, or dwellers of marginal urban settlements surrounding Lima, Peru. Materials and Methods: The population was composed of 3,259 individuals: 2,968 individuals between 1 month and 87 years of age, who consulted a private physician because of digestive disorders, particularly diarrhea, and 291 individuals between 5 months and 75 years of age from marginal areas, all apparently healthy. The presence of Cyclospora was investigated through “fresh” microscopic techniquesusing a saline solution and Lugol`s solution. A new staining technique described in other publication was used. A record was created containing all clinical and epidemiological data, which were assessed statistically. Results: Cycloscopora incidence was 7.3 per cent in the first group, and 41.6 per cent in the second group. A higher rate was observed in young and elder adults up to 60-yearold. No major seasonal incidence was found. Clinical signs/symptoms for individuals consulting a private physician were mainly diarrhea and abdominal pain while individuals from marginal urban areas mainly showed meteorism, abdominal plain, occasional diarrhea and general symptoms such as fatigue and weight loss. Conclusions: Cyclospora showed a high incidence, particularly in marginal urban areas. Two types of clinical signs/symptoms were found: an acute and very severe condition that can cause dehydration, and a chronic condition with several digestive signs/symptoms, particularly meteorism and abdominal pain. Individuals consulting a private physician show acute and chronic episodes while individuals from marginal urban areas do show a chronic condition. Apparently individuals showing acute episodes are immunologically exposed to the parasite, but they do not acquire immunity later in spite of the treatment because they may become re-infected from time to time. However, individuals showing...

Resistencia in vitro de Shigellas de Lima Metropolitana / In vitro Shigella resistance in Lima Metropolitana

Del 15 de noviembre de 1989 al 15 de enero de 1991 (14 meses) recolectamos 214 cepas de Shigella de 8 Laboratorios de Lima Metropolitana, predominando S. flexneri con el 61.7 por ciento. Aplicando el método de disco-difusión estandarizado para el antibiograma, se utilizaron discos de amikacina, ampicilina, cloranfenicol, ácido nalidíxico, norfloxacina, sulfadiazina, cotrimoxazol y tetraciclina. Encontramos resistencia a tetraciclina, 90.7 por ciento; ampicilina, 89.7 por ciento; cloranfenicol, 79.4 por ciento; sulfadiazina, 73.8 por ciento; cotrimoxazol, 34.1 por ciento; amikacina, 7.9 por ciento ácido nalidíxico, 0 por ciento y norfloxacina, 0 por ciento. El 89.7 por ciento de las cepas de Shigella fueron resistentes a 2 o más antimicrobianos. El patrón de resistencia más identificado fue a 5 de los antimicrobianos: AM: C, SD, STX, TE con la prevalencia de 26.5 por ciento. Todas las S. sonnei y S. boydii presentaron algún tipo de resistencia, mientras que S. dysenteriae el 94.1 por ciento y S. flexneri el 97 por ciento. La resistencia de Shigella aisladas en Lima ha sido en aumento en los últimos años, manteniéndose sensibles a las quinolonas, las cuales podrían ser el tratamiento de elección. Se enfatiza como medida preventiva lavarse las manos después de ir al baño y antes de manipular alimentos.

Two hundred and fourteen Shigella strains were isolated from patiens in eight laboratories in Metropolitan Lima from 15 November 1989 to 15 January 1991(14 months). S. flexneri was the predominant strain with 61. 7 per cent. Amikacin, ampicillin, chloramphenicol, nalidixic acid, norfloxacin, sulfadiazine, cotrimoxazol and tetracycline discs were used in the standardized disc- diffusion method for the susceptibility test. The strains were found to be resistant to tetracycline, 90.7 per cent; ampicillin, 89.7 per cent; choloramphenicol, 79.4 per cent;sulfadiazine, 73.8 per cent; cotrimaxol, 34.1 per cent; amikacin, 7.9 per cent; nalidixic acid, 0 per cent norfloxazin, 0 per cent. 89.7 per cent of the Shigella strains resistant to two or more antimicrobials.The most often identified resistance pattern was to 5 of the antimicrobials: AM, C, SD, STX, TE with a 26.2 per cent prevalence. All S. sonnei and S. boydii presented some type of resitance, whereas. S. dysenteriae showed 94.1 per cent and S. flexneri 97 per cent. Resistance from Shigella isolated in Lima has increased in the last years, athough they have sensitive to quinolones. Thus, quinolones may be the treatment of choice. Handwashing after and before using the bathroom or manipulating food is strongly enphasized as a preventive measure

El staphylococcus aureus en el niño sano / Staphylococcus aureus in the healthy child

Se investigó la incidencia de Staphylococcus aureus en la secreción faríngea y en las heces de 238 niños aparentemente sanos: 50 escolares, 50 en edad pre-escolar, 50 lactantes y 238 recíen nacidos. En este último grupo se hicieron cultivos diarios durante los días que el niño permaneció en el hospital, efectuándose igual determinación en la secreción faríngea y piel del pezón de sus respectivas madres. Se fagotiparon 108 cepas. Se aisló Staphylococcus aureus en la secreción faríngea del 75 por ciento de los recién nacidos, del 82 por ciento de lactantes, del 68 del grupo en edad pre-escolar y en 52 por ciento de escolares. En las heces, el porcentaje de aislamiento fue menor, pero guardó relación con el obtenido de la secreción faríngea. El 90 por ciento de las madres tenía Staphylococcus aureus en la piel del pezón. El fagotipaje efectuado tanto en la secreción faríngea de 23 neonatos como en sus madres, reveló en 17 casos el mismo comportamiento ante el fago, demostrando así la existencia de una cadena epidemiológica. La elevada incidencia de este germen en niños sanos, obliga a ser muy cautelosos en considerarlo como el agente etiológico de diarreas y faringitis, pero al mismo tiempo constituye una amenaza permanente de infección en un niño desnutrido y con desequilibrio inmunológico.

The presence of Staphylococcus aureus was studied in the pharyngeal secretion and feces of 150 children between 2 and 12 years of age and in 138 newborns. In the latter group, cultures were made daily. Similar studies were performad in the mother's pharyngeal secretion and nipple. Only healthy children and mothers, were included. 108 strains of staphylococci, were phagotyped. Staphylococcus aureus was isolated from the pharyngeal secretion in 75 per cent in neonates, 82 per cent in infants, 68 per cent in young children(2-5 years) and 52 per cent in older children (6-12 years). The bacteria was isolated from the feces in lesser proportion. 90 per cent of the mothers carried it in the nipple. The phagotyping of the strains isolated from the pharyngeal secretion of 23 newborns and the nipple of their mothers showed a similar behavior and it could be stablished and epidemic chain. The isolation of Staphylococcus aureus from the specimen investigated, does not indicate that this bacteria is the etiologic agent of pharyngitis or diarrhea, but we must keep in mind that the stage of healthy carrier is a permanent threat of real staphylococcal infections in undernourished children with inmunological disorders.