Particular characteristics of allergic symptoms in tropical environments: follow up to 24 months in the FRAAT birth cohort study.

BACKGROUND: Early wheezing and asthma are relevant health problems in the tropics. Mite sensitization is an important risk factor, but the roles of others, inherent in poverty, are unknown. We designed a birth-cohort study in Cartagena (Colombia) to investigate genetic and environmental risk factors for asthma and atopy, considering as particular features perennial exposure to mites, parasite infections and poor living conditions. METHODS: Pregnant women representative of the low-income suburbs of the city were randomly screened for eligibility at delivery; 326 mother-infant pairs were included at baseline and biological samples were collected from birth to 24 months for immunological testing, molecular genetics and gene expression analysis. Pre and post-natal information was collected using questionnaires. RESULTS: 94% of families were from the poorest communes of the city, 40% lacked sewage and 11% tap-water. Intestinal parasites were found as early as 3 months; by the second year, 37.9% of children have had parasites and 5.22% detectable eggs of Ascaris lumbricoides in stools (Median 3458 epg, IQR 975-9256). The prevalence of "wheezing ever" was 17.5% at 6 months, 31.1% at 12 months and 38.3% at 24 months; and recurrent wheezing (3 or more episodes) 7.1% at 12 months and 14.2% at 24 months. Maternal rhinitis [aOR 3.03 (95%CI 1.60-5.74), p = 0.001] and male gender [aOR 2.09 (95%CI 1.09 - 4.01), p = 0.026], increased risk for wheezing at 6 months. At 24 months, maternal asthma was the main predisposing factor for wheezing [aOR 3.65 (95%CI 1.23-10.8), p = 0.01]. Clinical symptoms of milk/egg allergy or other food-induced allergies were scarce (1.8%) and no case of atopic eczema was observed. CONCLUSIONS: Wheezing is the most frequent phenotype during the first 24 months of life and is strongly associated with maternal asthma. At 24 months, the natural history of allergic symptoms is different to the "atopic march" described in some industrialized countries. This cohort is representative of socially deprived urban areas of underdeveloped tropical countries. The collection of biological samples, data on exposure and defined phenotypes, will contribute to understand the gene/environment interactions leading to allergy inception and evolution.

Detection of Escherichia coli enteropathogens by multiplex polymerase chain reaction from children's diarrheal stools in two Caribbean-Colombian cities.

Acute diarrheal disease is a leading cause of childhood morbidity and mortality in the developing world and Escherichia coli intestinal pathogens are important causative agents. Information on the epidemiology of E. coli intestinal pathogens and their association with diarrheal disease is limited because no diagnostic testing is available in countries with limited resources. To evaluate the prevalence of E. coli intestinal pathogens in a Caribbean-Colombian region, E. coli clinical isolates from children with diarrhea were analyzed by a recently reported two-reaction multiplex polymerase chain reaction (Gomez-Duarte et al., Diagn Microbiol Infect Dis 2009;63:1-9). The phylogenetic group from all E. coli isolates was also typed by a single-reaction multiplex polymerase chain reaction. We found that among 139 E. coli strains analyzed, 20 (14.4%) corresponded to E. coli diarrheagenic pathotypes. Enterotoxigenic, shiga-toxin-producing, enteroaggregative, diffuse adherent, and enteropathogenic E. coli pathotypes were detected, and most of them belonged to the phylogenetic groups A and B1, known to be associated with intestinal pathogens. This is the first report on the molecular characterization of E. coli diarrheogenic isolates in Colombia and the first report on the potential role of E. coli in childhood diarrhea in this geographic area.

Rotavirus type A and other enteric pathogens in stool samples from children with acute diarrhea on the Colombian northern coast.

The present study, conducted from March 1998 to July 2000, determined the etiology of acute diarrhea in 253 young children and infants from Cartagena and Sincelejo, Colombia. In 253 stool samples, the following enteric pathogens were recovered: rotavirus type A (36.6%) as the major agent, Salmonella spp (9.0%), Shigella spp (8.0%), enteric pathogenic Escherichia coli (6.0%), enteric hemorragic Esc. coli (2.8%), Providencia alcalifaciens (2.8%), Aeromonas hydrophila (2.0%), Yersinia enterocolitica (0.8%), Entamoeba hystolitica (10%), Giardia lamblia (4%), Endolimax nana (3.2%), Ascaris lumbricoides (2.8%), Ent. coli (1.2%), Balantidium coli (0.8%), Blastocystis hominis (0.8%), Dypilidium caninum (0.4%) and hook worm sp. (0.4%). Infection with more than one pathogen occurred in 96 (37.9%) patients. Rotavirus and enteric pathogenic Esc. coli were frequent. Concurrent infection by more than one parasite occurred in 18.6% of the infants. Most rotavirus infections (76.7%) occurred in infants under 12 months. Vomiting, severe dehydration and fever were frequent in children with rotavirus infection. At least one fecal marker of inflammatory diarrhea was registered in patients with bacterial infection. To our knowledge, this is first report of P. alcalifaciens associated with infantile diarrhea in Colombia and the first description of Esc. coli O157:H7 and Y. enterocolitica in our region.

Rotavirus type A and other enteric pathogens in stool samples from children with acute diarrhea in the Colombian northern coast / Rotavirus de tipo A y otros patógenos entéricos en muestras de heces de niños con diarrea aguda en la costa norte colombiana

The present study, conducted from March 1998 to July 2000, determined the etiology of acute diarrhea in 253 young children and infants from Cartagena and Sincelejo, Colombia. In 253 stool samples, the following enteric pathogens were recovered: rotavirus type A (36.6%) as the major agent, Salmonella spp (9.0%), Shigella spp (8.0%), enteric pathogenic Escherichia coli (6.0%), enteric hemorragic Esc. coli (2.8%), Providencia alcalifaciens (2.8%), Aeromonas hydrophila (2.0%), Yersinia enterocolitica (0.8%), Entamoeba hystolitica (10%), Giardia lamblia (4%), Endolimax nana (3.2%), Ascaris lumbricoides (2.8%), Ent. coli (1.2%), Balantidium coli (0.8%), Blastocystis hominis (0.8%), Dypilidium caninum (0.4%) and hook worm sp. (0.4%). Infection with more than one pathogen occurred in 96 (37.9%) patients. Rotavirus and enteric pathogenic Esc. coli were frequent. Concurrent infection by more than one parasite occurred in 18.6% of the infants. Most rotavirus infections (76.7%) occurred in infants under 12 months. Vomiting, severe dehydration and fever were frequent in children with rotavirus infection. At least one fecal marker of inflammatory diarrhea was registered in patients with bacterial infection. To our knowledge, this is first report of P. alcalifaciens associated with infantile diarrhea in Colombia and the first description of Esc. coli O157:H7 and Y. enterocolitica in our region (AU)

El presente estudio, llevado a cabo entre marzo de 1998 y julio de 2000, determinó la etiología de diarrea aguda en 253 niños y bebés de Cartagena y Sincelejo (Colombia). En 253 muestras de heces se encontraron los siguientes patógenos entéricos: rotavirus de tipo A (36,6 por ciento), que era el patógeno más frecuente, Salmonella spp. (9,0 por ciento), Shigella spp. (8,0 por ciento), Escherichia coli patógena entérica (6,0 por ciento), E. coli hemorrágica entérica (2,8 por ciento), Providencia alcalifaciens (2,8 por ciento), Aeromonas hydrophila (2,0 por ciento), Yersinia enterocolitica (0,8 por ciento), Entamoeba hystolitica (10 por ciento), Giardia lamblia (4 por ciento), Endolimax nana (3,2 por ciento), Ascaris lumbricoides (2,8 por ciento), Entamoeba coli (1,2 por ciento), Balantidium coli (0,8 por ciento), Blastocystis hominis (0,8 por ciento), Dypilidium caninum (0,4 por ciento) y y alguna especie del gusano uncinaria (0,4 por ciento). En 96 pacientes (37,9 por ciento) había infección por más de un patógeno. Los más frecuentes eran rotavirus y E. coli patógena entérica. En un 18,6 por ciento de los niños se daba infección concurrente con más de un parásito. La mayoría de las infecciones por rotavirus (76,7 por ciento) se daban en niños menores de 12 meses. Los síntomas más frecuentes en niños infectados por rotavirus eran vómitos, deshidratación grave y fiebre. Se registró un marcador fecal de diarrea inflamatoria en pacientes con infecciones bacterianas. Según nuestros datos, esta es la primera vez que se encuentra Providencia alcalifaciens asociada a diarrea infantil en Colombia, y la primera descripción de E. coli O157:H7 y Yersinia enterocolitica en nuestra región. (AU)

Cólera en Bolivar de 1991-1997 / Cholera in Bolivar from 1991 until 1997

El cólera, que se ha presentado a través de los siglos en forma endémica y epidémica, continúa siendo un problema de salud pública. Desde 1991, cuando el cólera apareció por primera vez en nuestro país en este siglo, el departamento de Bolívar ha sido uno de los más afectados en la costa atlántica. A partir de entonces, las autoridades de salud del departamento (Dasalud) solicitaron apoyo tecnológico para el diagnóstico microbiológico y capacitación del recurso humano al Laboratorio de Posgrado de Microbiología de la Universidad de Cartagena. Se adelantó este trabajo descriptivo de cooperación interinstitucional con el propósito de analizar el comportamiento del cólera en los municipios de Bolívar. A partir del caso índice, se inició la recolección de muestras en pacientes sospechosos provenientes de las cinco regionales de Dasalud. El diagnóstico de la enfermedad se hizo con base en los criterios clínicos, microbiológicos y epidemiológicos establecidos. Las heces recolectadas en el medio de transporte fueron procesadas para su aislamiento e identificación en medios de cultivo bacteriológicos, bioquímicos y serotipificación con antisueros específicos. De septiembre de 1991 al octavo período de 1997, se informaron 3.470 casos en 38 de 42 municipios y 94,6 por ciento ocurrió en las regionales 1 y 3; 60,2 por ciento correspondió a varones, 39,8 por ciento a mujeres y 79,2 por ciento fueron mayores de 14 años; hubo 33 defunciones; 39,8 por ciento de los casos fue diagnosticado microbiológicamente, con el hallazgo de Vibrio cholerae O1, biotipo El Tor, serotipos Inaba y Ogawa. V. Cholerae O1, serotipo Ogawa, presente en el brote de 1995 desplazó al serotipo Inaba predominante en 1991. En 1991,, el número de casos fue nueve veces mayor que en el brote de 1995 y, en 1997, aumentó 45,2 por ciento con relación a los dos últimos años; la letalidad, a su vez, mostró índices preocupantes a partir de 1992. Los municipios más afectados fueron: Cartagena, Mahates, Montecristo, María la Baja, Pinillos, Achí, Magangue, Arjona, Turbana, Calamar, Mompox, Santa Catalina, Hatillo de Loba, Turbaco, San Martín de Loba, Carmen de Bolívar, Villanueva, Zambrano, Morales, Talaigua Nuevo y Río Viejo, entre otros