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In countries where soil-transmitted helminth (STH) infections are endemic, deworming programs are recommended to reduce morbidity; however, increasing levels of resistance to benzimidazoles are of concern. In an observational study in Peru, we studied the clinical efficacy of 400 mg of albendazole 20 days after treatment among children aged 2-11 years. Of 426 participants who provided samples, 52.3% were infected with a STH, 144 (33.8%) were positive for Ascaris (41.8% light, 50.8% moderate, and 7.4% heavy infections), 147 (34.5%) were positive for Trichuris (75.2% light, 22.5% moderate, and 2.3% heavy infections), and 1.1% were positive for hookworm species (100% light infections). Additional stool samples were examined at 20, 90, and 130 days after the initial treatment. At 20 days post-administration of albendazole, the cure rate (CR) of Ascaris infection was 80.1% (95% CI: 73.5-86.7), and the egg reduction rate (ERR) was 70.8% (95% CI: 57.8-88.7); the CR for Trichuris infection was 27.1% (95% CI: 20.0-34.3), and the ERR was 29.8% (95% CI: -1.40 to 57.5). Among participants with persistent or recurrent infections with Trichuris, the combined therapy of albendazole (400 mg) and ivermectin at 600 µg/dose increased overall CR for Trichuris infection to 75.2% (95% CI: 67.3-83.2%) with an ERR of 84.2% (95% CI: 61.3-93.8%). Albendazole administration alone for the control of STH was associated with high rates of treatment failure, especially for Trichuris. Combined single doses of albendazole and ivermectin was observed to have improved efficacy.
Assuntos
Albendazol , Anti-Helmínticos , Helmintíase , Ivermectina , Solo , Humanos , Albendazol/uso terapêutico , Albendazol/administração & dosagem , Peru/epidemiologia , Pré-Escolar , Criança , Ivermectina/uso terapêutico , Ivermectina/administração & dosagem , Masculino , Feminino , Solo/parasitologia , Helmintíase/tratamento farmacológico , Helmintíase/epidemiologia , Anti-Helmínticos/uso terapêutico , Anti-Helmínticos/administração & dosagem , Fezes/parasitologia , Quimioterapia Combinada , Animais , Resultado do Tratamento , Tricuríase/tratamento farmacológico , Tricuríase/epidemiologia , Ascaríase/tratamento farmacológico , Ascaríase/epidemiologia , Trichuris/efeitos dos fármacosRESUMO
Background: The Enterics for Global Health (EFGH) Peru site will enroll subjects in a periurban area of the low Amazon rainforest. The political department of Loreto lags behind most of Peru in access to improved sources of water and sanitation, per capita income, children born <2.5â kg, and infant and child mortality. Chronic undernutrition as manifested by linear growth shortfalls is common, but wasting and acute malnutrition are not. Methods: The recruitment of children seeking care for acute diarrheal disease takes place at a geographic cluster of government-based primary care centers in an area where most residents are beneficiaries of free primary healthcare. Results: Rates of diarrheal disease, dysentery, and Shigella are known to be high in the region, with some of the highest rates of disease documented in the literature and little evidence in improvement over the last 2 decades. This study will update estimates of shigellosis by measuring the prevalence of Shigella by polymerase chain reaction and culture in children seeking care and deriving population-based estimates by measuring healthcare seeking at the community level. Conclusions: Immunization has been offered universally against rotavirus in the region since 2009, and in a context where adequate water and sanitation are unlikely to obtain high standards in the near future, control of principal enteropathogens through immunization may be the most feasible way to decrease the high burden of disease in the area in the near future.
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Introducción: El establecimiento del Puesto Fronterizo Las Tablillas implica la segregación de 12.12 ha del Refugio Nacional de Vida Silvestre Corredor Fronterizo (RNVSCF), en el norte de Costa Rica. El sitio tiene una larga historia de uso de la tierra y su entorno natural está muy degradado. Este es un caso que se puede abordar desde el coste de oportunidad que se refiere al valor de la alternativa a la que se renuncia al tomar una decisión económica. Objetivo: En este artículo, usamos este precepto para evaluar la compensación por pérdidas en la estructura del hábitat y la biodiversidad si se interrumpiera la dinámica de sucesión dentro de un área silvestre protegida. Métodos: Para encontrar la ganancia neta en compensación requerida por dicha segregación, analizamos la diversidad y composición de la cubertura forestal cercana para pronosticar el ambiente que se perdería si se interrumpieran sus objetivos de conservación (costo de oportunidad). Compensar estas pérdidas requiere un ambiente equivalente, por lo que seleccionamos dos propiedades, entre 27 investigadas adyacentes al RNVSCF, que comparten cobertura forestal, están registradas legalmente y poseen atributos ambientales favorables para el diseño de reservas. Las dos propiedades seleccionadas y el sitio Las Tablillas fueron caracterizados a nivel de atributos geológicos e hidrológicos y de composición biológica de grupos indicadores. Resultados: Ambas propiedades son física y biológicamente favorables para el intercambio. La escogencia de cualquiera aumentaría el área del RNVSCF en más de 100 ha de un ambiente con mejor cobertura, más diversidad y mejor conexión con otras masas forestales que el observado en el sitio de segregación. Esto es una ventaja para el objetivo de conservación del refugio. Conclusión: En este caso, el coste de oportunidad favoreció la ganancia ambiental para la propuesta de compensación y podría ser utilizado para evaluar otras compensaciones que involucren ambientes sensibles o protegidos.
Introduction: The establishment of the Las Tablillas Border Post implies the segregation of 12.12 ha within the National Wildlife Refuge Border Corridor (RNVSCF) in northern Costa Rica. The site has a long land use history, so its environment is highly degraded. This case can be studied from the opportunity cost, which refers to the amount of the alternative given up when making an economic decision. Objective: In this paper, we use this precept to assess the compensation for losses in habitat structure and biodiversity if succession dynamics within a protected wilderness area were interrupted. Methods: To find the net gain in compensation required by this segregation, we analyzed the diversity and composition of nearby forest cover to forecast the environment that would be lost if its conservation objectives were interrupted (opportunity cost). Compensating for these losses requires an equivalent environment, so we selected two properties, among the 27 investigated, that shared forest cover, are located adjacent to the RNVSCF, are registered, and possess other attributes favorable to the design of reserves. The two selected properties and the Las Tablillas site were characterized at the level of geological and hydrological attributes and the composition of indicator groups. Results: Both properties are physically and biologically favorable for the exchange. It would increase the area of the RNVSCF by more than 100 ha of an environment with better coverage, more diversity, and a better connection to other forest masses than the one observed in the segregation site, which is an advantage to the conservation objective of the refuge. Conclusion: In this case, the opportunity cost favored the environmental gain for the offset proposal and could be used to evaluate other compensation involving sensitive or protected environments.
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Campylobacter spp. are a major cause of bacterial diarrhea worldwide and are associated with high rates of mortality and linear growth faltering in children living in low- to middle-income countries (LMICs). Campylobacter jejuni and Campylobacter coli are most often the causative agents of enteric disease among children in LMICs. However, previous work on a collection of stool samples from children under 2 years of age, living in a low resource community in Peru with either acute diarrheal disease or asymptomatic, were found to be qPCR positive for Campylobacter species but qPCR negative for C. jejuni and C. coli. The goal of this study was to determine if whole-genome shotgun metagenomic sequencing (WSMS) could identify the Campylobacter species within these samples. The Campylobacter species identified in these stool samples included C. jejuni, C. coli, C. upsaliensis, C. concisus, and the potential new species of Campylobacter, "Candidatus Campylobacter infans". Moreover, WSMS results demonstrate that over 65% of the samples represented co-infections with multiple Campylobacter species present in a single stool sample, a novel finding in human populations.
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Infecções por Campylobacter , Campylobacter , Coinfecção , Campylobacter/genética , Infecções por Campylobacter/epidemiologia , Infecções por Campylobacter/microbiologia , Criança , Coinfecção/epidemiologia , Diarreia/epidemiologia , Diarreia/microbiologia , Fezes/microbiologia , Humanos , Lactente , Metagenômica , Peru/epidemiologia , ReinfecçãoRESUMO
A working hypothesis is that less common species of Campylobacter (other than C. jejuni and C. coli) play a role in enteric disease among children in low resource settings and explain the gap between the detection of Campylobacter using culture and culture independent methods. "Candidatus Campylobacter infans" (C. infans), was recently detected in stool samples from children and hypothesized to play a role in Campylobacter epidemiology in low- and middle-income countries (LMIC). This study determined the prevalence of C. infans in symptomatic and asymptomatic stool samples from children living in Iquitos, Peru. Stool samples from 215 children with diarrhea and 50 stool samples from children without diarrhea under the age of two were evaluated using a multiplex qPCR assay to detect Campylobacter spp. (16S rRNA), Campylobacter jejuni / Campylobacter coli (cadF gene), C. infans (lpxA), and Shigella spp. (ipaH). C. infans was detected in 7.9% (17/215) symptomatic samples and 4.0% (2/50) asymptomatic samples. The association between diarrhea and the presence of these targets was evaluated using univariate logistic regressions. C. infans was not associated with diarrhea. Fifty-one percent (75/146) of Campylobacter positive fecal samples were negative for C. jejuni, C. coli, and C. infans via qPCR. Shotgun metagenomics confirmed the presence of C. infans among 13 out of 14 positive C. infans positive stool samples. C infans explained only 20.7% of the diagnostic gap in stools from children with diarrhea and 16.7% of the gap in children without diarrhea. We posit that poor cadF primer performance better explains the observed gap than the prevalence of atypical non-C. jejuni/coli species.
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Infecções por Campylobacter , Campylobacter , Criança , Humanos , Infecções por Campylobacter/diagnóstico , Infecções por Campylobacter/epidemiologia , RNA Ribossômico 16S/genética , Peru/epidemiologia , Campylobacter/genética , Diarreia/epidemiologia , Diarreia/diagnóstico , FezesRESUMO
Using previously validated microbial source tracking markers, we detected and quantified fecal contamination from avian species and avian exposure, dogs, and humans on household cooking tables and floors. The association among contamination, infrastructure, and socioeconomic covariates was assessed using simple and multiple ordinal logistic regressions. The presence of Campylobacter spp. in surface samples was linked to avian markers. Using molecular methods, animal feces were detected in 75.0% and human feces in 20.2% of 104 households. Floors were more contaminated than tables as detected by the avian marker Av4143, dog marker Bactcan, and human marker Bachum. Wood tables were consistently more contaminated than non-wood surfaces, specifically with the mitochondrial avian markers ND5 and CytB, fecal marker Av4143, and canine marker Bactcan. Final multivariable models with socioeconomic and infrastructure characteristics included as covariates indicate that detection of avian feces and avian exposure was associated with the presence of chickens, maternal age, and length of tenancy, whereas detection of human markers was associated with unimproved water source. Detection of Campylobacter in surface samples was associated with the avian fecal marker Av4143. We highlight the critical need to detect and measure the burden of animal fecal waste when evaluating household water, hygiene, and sanitation interventions, and the possibility of decreasing risk of exposure through the modification of surfaces to permit more effective household disinfection practices. Animals may be a more important source of household fecal contamination than humans in many low-resource settings, although interventions have historically focused almost exclusively on managing human waste.