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Tick-borne viruses (TBV) have gained public health relevance in recent years due to the recognition of human-associated fatal cases and the increase in tick-borne disease and transmission. However, many tick species have not been studied for their potential to transmit pathogenic viruses, especially those found in Latin America. To gain better understanding of the tick virome, we conducted targeted amplification using broadly-reactive consensus-degenerate pan-viral targeting viruses from the genera Flavivirus, Bandavirus, Uukuvirus, and Orthonairovirus genus. Additionally, we conducted unbiased metagenomic analyses to investigate the presence of viral RNA sequences in Amblyomma cajennense, A. patinoi and Rhipicephalus microplus ticks collected from a horse slaughter plant in Medellín, Colombia. While no viral products were detected by PCR, results of the metagenomic analyses revealed the presence of viral genomes belonging to the genera Phlebovirus, Bandavirus, and Uukuvirus, including Lihan Tick Virus (LTV), which was previously reported in Rhipicephalus microplus from Colombia. Overall, the results emphasized the enormous utility of the next-generation sequencing in identifying virus genetic diversity presents in ticks and other species of vectors and reservoirs.
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Vírus de RNA , Rhipicephalus , Animais , Humanos , Cavalos , Rhipicephalus/genética , Amblyomma , Colômbia , Viroma/genéticaRESUMO
Madariaga virus (MADV) and Venezuelan equine encephalitis virus (VEEV) are emerging arboviruses affecting rural and remote areas of Latin America. However, there are limited clinical and epidemiological reports available, and outbreaks are occurring at an increasing frequency. We addressed this gap by analyzing all the available clinical and epidemiological data of MADV and VEEV infections recorded since 1961 in Panama. A total of 168 of human alphavirus encephalitis cases were detected in Panama from 1961 to 2023. Here we describe the clinical signs and symptoms and epidemiological characteristics of these cases, and also explored signs and symptoms as potential predictors of encephalitic alphavirus infection when compared to those of other arbovirus infections occurring in the region. Our results highlight the challenges clinical diagnosis of alphavirus disease in endemic regions with overlapping circulation of multiple arboviruses.
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Background: Acute undifferentiated febrile illness (AUFI) is one of the leading causes of illness in tropical regions. Although malaria is the most important cause, other pathogens such as Dengue (DENV), Leptospira and recently, Coronavirus Disease 2019 (COVID-19) have gained importance. In Colombia, few studies aimed to identify the etiology of AUFI. Most of them performed in Apartadó and Villeta municipalities, identifying the active circulation of several pathogens. Thus, we conducted a cross-sectional study in these municipalities to characterize the etiologies of AUFI during COVID-19 pandemic. Methods: An active surveillance was conducted between September and December 2021 in local hospitals of Apartadó and Villeta municipalities. Febrile patients were enrolled after voluntarily agreeing to participate in the study. Ten different etiologies were evaluated through direct, serological, molecular and rapid diagnostic methods. Results: In Apartadó a confirmed etiology was found in 60% of subjects, DENV (25%) being the most frequent, followed by leptospirosis (16.7%), malaria (10%), COVID-19 (8.3%), spotted fever group (SFG) rickettsiosis (6.7%) and Chikungunya (1.7%). In Villeta, a specific etiology was confirmed in 55.4% of patients, of which SFG rickettsiosis (39.3%) was the most frequent, followed by leptospirosis (21.4%), DENV (3.6%) and malaria (1.8%). No cases due to Mayaro, Yellow Fever, Oropouche and Venezuelan Equine Encephalitis viruses were detected. Conclusion: We confirm the relevance of dengue fever, leptospirosis, SFG rickettsiosis, COVID-19 and malaria as causes of AUFI in the municipality of Apartadó, and highlight the great importance of SFG rickettsiosis as the main cause of AUFI in the municipality of Villeta.
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BACKGROUND: Neoadjuvant chemoradiation(nCRT) has been considered the preferred initial treatment strategy for distal rectal cancer. Advantages of this approach include improved local control after radical surgery but also the opportunity for organ preserving strategies (Watch and Wait-WW). Consolidation chemotherapy(cCT) regimens using fluoropyrimidine-based with or without oxalipatin following nCRT have demonstrated to increase complete response and organ preservation rates among these patients. However, the benefit of adding oxaliplatin to cCT compared to fluoropirimidine alone regimens in terms of primary tumor response remains unclear. Since oxalipatin-treatment may be associated with considerable toxicity, it becomes imperative to understand the benefit of its incorporation into standard cCT regimens in terms of primary tumor response. The aim of the present trial is to compare the outcomes of 2 different cCT regimens following nCRT (fluoropyrimidine-alone versus fluoropyrimidine + oxaliplatin) for patients with distal rectal cancer. METHODS: In this multi-centre study, patients with magnetic resonance-defined distal rectal tumors will be randomized on a 1:1 ratio to receive long-course chemoradiation (54 Gy) followed by cCT with fluoropyrimidine alone versus fluoropyrimidine + oxaliplatin. Magnetic resonance(MR) will be analyzed centrally prior to patient inclusion and randomization. mrT2-3N0-1 tumor located no more than 1 cm above the anorectal ring determined by sagittal views on MR will be eligible for the study. Tumor response will be assessed after 12 weeks from radiotherapy(RT) completion. Patients with clinical complete response (clinical, endoscopic and radiological) may be enrolled in an organ-preservation program(WW). The primary endpoint of this trial is decision to organ-preservation surveillance (WW) at 18 weeks from RT completion. Secondary endpoints are 3-year surgery-free survival, TME-free survival, distant metastases-free survival, local regrowth-free survival and colostomy-free survival. DISCUSSION: Long-course nCRT with cCT is associated with improved complete response rates and may be a very attractive alternative to increase the chances for organ-preservation strategies. Fluoropyrimidine-based cCT with or without oxaliplatin has never been investigated in the setting of a randomized trial to compare clinical response rates and the possibility of organ-preservation. The outcomes of this study may significantly impact clinical practice of patients with distal rectal cancer interested in organ-preservation. TRIAL REGISTRATION: www. CLINICALTRIALS: gov NCT05000697; registered on August 11th, 2021.
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Deficiência Intelectual , Neoplasias Retais , Humanos , Oxaliplatina , Quimioterapia de Consolidação , Neoplasias Retais/tratamento farmacológico , QuimiorradioterapiaRESUMO
Several arboviruses have emerged or reemerged into the New World during the past several decades, causing outbreaks of significant proportion. In particular, the outbreaks of Dengue virus (DENV), Zika virus, and Chikungunya virus (CHIKV) have been explosive and unpredictable, and have led to significant adverse health effects. These viruses are considered the leading cause of acute undifferentiated febrile illnesses in Colombia. However, Venezuelan equine encephalitis virus (VEEV) is endemic in Colombia, and arboviruses such as the Mayaro virus (MAYV) and the Oropouche virus (OROV) cause febrile illnesses in neighboring countries. Yet, evidence of human exposure to MAYV and OROV in Colombia is scarce. In this study, we conducted a serosurvey study in healthy individuals from the Cauca Department in Colombia. We assessed the seroprevalence of antibodies against multiple arboviruses, including DENV serotype 2, CHIKV, VEEV, MAYV, and OROV. Based on serological analyses, we found that the overall seroprevalence for DENV serotype 2 was 30%, 1% for MAYV, 2.6% for CHIKV, 4.4% for VEEV, and 2% for OROV. This study provides evidence about the circulation of MAYV and OROV in Colombia, and suggests that they-along with VEEV and CHIKV-might be responsible for cases of acute undifferentiated febrile illnesses that remain undiagnosed in the region. The study results also highlight the need to strengthen surveillance programs to identify outbreaks caused by these and other vector-borne pathogens.
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Arbovírus , Febre de Chikungunya , Vírus Chikungunya , Infecção por Zika virus , Zika virus , Humanos , Estudos Soroepidemiológicos , Colômbia/epidemiologia , Anticorpos Antivirais , Infecção por Zika virus/epidemiologia , FebreRESUMO
The objective of this study was to determine the etiology of febrile illnesses among patients from October 1, 1993 through September 30, 1999, in the urban community of Iquitos in the Amazon River Basin of Peru. Epidemiological and clinical data as well as blood samples were obtained from consenting patients at hospitals, health clinics and private residences. Samples were tested for arboviruses in cell cultures and for IgM and IgG antibodies by ELISA. Blood smears were examined for malaria, and sera were tested for antibodies to Leptospira spp. by ELISA and microscopic agglutination. Among 6,607 febrile patients studied, dengue viruses caused 14.6% of the cases, and Venezuelan equine encephalitis virus caused 2.5%, Oropouche virus 1.0%, Mayaro virus 0.4%, and other arboviruses caused 0.2% of the cases. Also, 22.9% of 4,844 patients tested were positive for malaria, and of 400 samples tested, 9% had evidence of acute leptospirosis. Although the study was not designed to assess the importance of these pathogens as a cause of human morbidity in the total population, these results indicate that arboviruses, leptospirosis, and malaria were the cause of approximately 50% of the febrile cases. Although the arboviruses that were diagnosed can produce asymptomatic infections, our findings increased the overall understanding of the relative health burden of these infections, as well as baseline knowledge needed for designing and implementing further studies to better assess the health impact and threat of these pathogens in the Amazon Basin of Peru.
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Arbovírus , Vírus da Encefalite Equina Venezuelana , Leptospirose , Malária , Humanos , Peru/epidemiologia , Rios , Leptospirose/epidemiologia , Febre/epidemiologiaRESUMO
PURPOSE: To evaluate the impact of cranial stereotactic radiotherapy (SRT) on overall survival (OS) of melanoma brain metastases (MBM) patients treated with combined nivolumab and ipilimumab (CNI) in a contemporary and real-world setting. METHODS/PATIENTS: The study was performed by using TriNetX, a global health network dataset of electronic medical records from patients in 49 healthcare organizations. We queried for patients with specific terms between January 2016 and December 2020 and run a propensity score matching (PSM) analysis. OS was estimated by Kaplan-Meier and log-rank test was applied. RESULTS: After initial query and PSM, 114 patients were selected in each cohort. Median OS was 327 days in CNI and not reached in the CNI + SRT cohort, with OS probability of 54.4 and 40.9%, respectively (log-rank P = .0057). CNI + SRT was associated with significantly decreased mortality (HR, 0.57; 95% CI 0.377-0.853; proportionality P = .0034). CONCLUSIONS: This real-world analysis showed that CNI + SRT led to an improvement in OS compared to CNI.
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Neoplasias Encefálicas , Melanoma , Radiocirurgia , Neoplasias Encefálicas/secundário , Humanos , Imunoterapia , Ipilimumab/uso terapêutico , Melanoma/patologia , Nivolumabe/uso terapêutico , Estudos RetrospectivosRESUMO
Introducción: La Nefropatía Inducida por Contraste (NIC) es una complicación causada por la ad-ministración intravenosa de medios de contrastes para estudios imagenológicos, lo cual incrementa la morbi-mortalidad y costos hospitalarios. La incidencia oscila el 2% en personas sin factores de riesgo, pudiendo llegar hasta el 25 a 50% cuando se asocian factores predisponentes. El objetivo de este estudio fue evaluar el desarrollo de NIC en pacientes oncológicos y no oncológicos hospitaliza-dos, sus características clínicas, prevalencia, factores asociados y aplicación de una escala de riesgo pre exposición. Metodología: Se realizó un estudio de casos y controles en los Hospitales "Abel Gilbert Pontón" y el Instituto Oncológico Nacional "Dr. Juan Tanca Marengo" - Guayaquil en el período Abril a Septiembre del 2020. La muestra fue no probabilística, de pacientes con y sin diagnóstico oncológico. En ambos grupos se requirió una tomografía contrastada. Se registró edad, sexo, tipo de cáncer, presencia de Diabetes Tipo 2 (DMT2), Hipertensión arterial, creatinina basal y a las 48 horas. Se usó una escala de preexposición para NIC. Se compara las prevalencias con Chi2, y las asociaciones con Odds Ratio. Resultados: Fueron 100 casos y 100 controles. La prevalencia de NIC fue 28% en no oncológicos y 22% en oncológicos (P=0.33), el factor de riesgo asociado fue la Diabetes Mellitus tipo 2 (OR 2.19 [IC95% 1.0007 4.808; P=0.0498). El valor de creatinina previa no tuvo efecto sobre el desenlace de nefropatía. La distribución de categorías pre exposición no mostró diferencias significativas entre los pacientes que desarrollaron NIC en relación con los que no desarrollaron (P=0.063). Conclusión: El desarrollo de NIC no se ve influenciado por edad, sexo, paciente e HTA, pero si se ve asociado a la presencia de DM2. La estratificación de riesgo pre exposición no fue de utilidad en este caso, su distribución fue similar en pacientes con o sin NIC
Introduction: Contrast Induced Nephropathy (CIN) is a complication caused by intravenous administration of contrast media for imaging studies, which increases morbidity and mortality and hospital costs. The incidence ranges from 2% in people without risk factors, and can reach up to 25 to 50% when predisposing factors are associated. The objective of this study was to evaluate the develop-ment of CIN in hospitalized cancer and non-cancer patients, their clinical characteristics, prevalence, associated factors, and the application of a pre-exposure risk scale. Methodology: A case-control study was carried out at the "Abel Gilbert Pontón" Hospitals and the "Dr. Juan Tanca Marengo "- Guayaquil in the period April to September 2020. The sample was non-probabilistic, of patients with and without oncological diagnosis. Contrast tomography was required in both groups. Age, sex, type of cancer, presence of Type 2 Diabetes (T2DM), arterial hypertension, creatinine at baseline and at 48 hours were recorded. A pre-exposure scale for CIN was used. The prevalences are compared with Chi2, and the associations with Odds Ratio. Results: There were 100 cases and 100 controls. The prevalence of CIN was 28% in non-cancer patients and 22% in oncological patients (P = 0.33). The associated risk factor was Type 2 Diabetes Mellitus (OR 2.19 [95% CI 1.0007 - 4.808; P = 0.0498). The previous creatinine value had no effect on the outcome of nephropathy. The distribution of pre-exposure categories did not show significant differences between the patients who developed CIN in relation to those who did not develop (P = 0.063). Conclusion: The development of CIN is not influenced by age, sex, patient and hypertension, but is associated with the presence of DM2. Pre-exposure risk stratification was not useful in this case, its distribution was similar in patients with or without CIN
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Humanos , Adulto , Pessoa de Meia-Idade , Meios de Contraste , Nefropatias , Tomografia , Fatores de Risco , CreatininaRESUMO
Mayaro virus (MAYV) is an alphavirus endemic to both Latin America and the Caribbean. Recent reports have questioned the ability of MAYV and its close relative, Chikungunya virus (CHIKV), to generate cross-reactive, neutralizing antibodies to one another. Since CHIKV was introduced to South America in 2013, discerning whether individuals have cross-reactive antibodies or whether they have had exposures to both viruses previously has been difficult. Using samples obtained from people infected with MAYV prior to the introduction of CHIKV in the Americas, we performed neutralizing assays and observed no discernable neutralization of CHIKV by sera from patients previously infected with MAYV. These data suggest that a positive CHIKV neutralization test cannot be attributed to prior exposure to MAYV and that previous exposure to MAYV may not be protective against a subsequent CHIKV infection.