RESUMO
OBJECTIVE: To describe the epidemiology of laboratory-confirmed Diarrhoeagenic Escherichia coli (DEC) cases from active facility-based surveillance in Guatemala. METHODS: We collected clinical and risk factor data on enrolled patients (aged 0-52 years) with acute diarrhoea at government healthcare facilities (1 hospital and 6 clinics) in Santa Rosa, Guatemala, during 2008-2009 and 2014-2015. Stool samples were analysed, E. coli identified through culture and biochemical tests, PCR amplification of genes encoding pathotype-specific virulence factors identified specific DEC pathotypes. Healthcare-seeking adjusted incidence rates were calculated. RESULTS: A total of 3041 diarrhoea cases were captured by surveillance (647 hospitalisations (H), 2394 clinic visits (CV)); general E. coli prevalence was 17.9%. DEC pathotypes were identified in 19% (n = 95/497) and 21% (n = 450/2113) in diarrhoea H and CV, respectively. Enteropathogenic E. coli (EPEC) was most frequently isolated (8.2% (n = 41) in diarrhoea H, 12.0% (n = 255) in diarrhoea CV), followed by ETEC (6.8% (n = 34) in H, 6% (n = 128) in CV) and STEC (0.6% (n = 3) in H, 0.6% (n = 13) in CV). We did not find evidence of a difference in severity between DEC and non-DEC diarrhoea. Incidence of DEC clinic visits and hospitalisations was 648.0 and 29.3, respectively, per 10,000 persons aged ≤5 years and 36.8 and 0.4, respectively, per 10,000 persons aged >5 years. CONCLUSIONS: DEC pathotypes, especially EPEC and ETEC, were detected frequently from patients presenting with diarrhoeal illness in Santa Rosa, Guatemala. Our findings suggest that preventive interventions should be prioritised for young children.
Assuntos
Infecções por Escherichia coli , Rosa , Adolescente , Adulto , Criança , Pré-Escolar , Diarreia/epidemiologia , Escherichia coli/genética , Infecções por Escherichia coli/epidemiologia , Fezes , Guatemala/epidemiologia , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: Diarrhea is a major cause of morbidity and mortality, yet incidence and etiology data are limited. We conducted laboratory-based diarrhea surveillance in Guatemala. METHODS: A diarrhea case was defined as ≥3 loose stools in a 24-h period in a person presenting to the surveillance facilities. Epidemiologic data and stool specimens were collected. Specimens were tested for bacterial, parasitic, and viral pathogens. Yearly incidence was adjusted for healthcare seeking behaviors determined from a household survey conducted in the surveillance catchment area. RESULTS: From November 2008 to December 2012, the surveillance system captured 5331 diarrhea cases; among these 1381 (26%) had specimens tested for all enteric pathogens of interest. The adjusted incidence averaged 659 diarrhea cases per 10,000 persons per year, and was highest among children aged < 5 years, averaging 1584 cases per 10,000 children per year. Among 1381 (26%) specimens tested for all the pathogens of interest, 235 (17%) had a viral etiology, 275 (20%) had a bacterial, 50 (4%) had parasites, and 86 (6%) had co-infections. Among 827 (60%) specimens from children aged < 5 years, a virus was identified in 196 (23%) patients; 165 (20%) had norovirus and 99 (12%) rotavirus, including co-infections. Among 554 patients aged ≥5 years, 103 (19%) had a bacterial etiology, including diarrheagenic Escherichia coli in 94 (17%) cases, Shigella spp. in 31 (6%), Campylobacter spp. in 5 (1%), and Salmonella spp. in 4 (1%) cases. Detection of Giardia and Cryptosporidium was infrequent (73 cases; 5%). CONCLUSIONS: There was a substantial burden of viral and bacterial diarrheal diseases in Guatemala, highlighting the importance of strengthening laboratory capacity for rapid detection and control and for evaluation of public health interventions.
Assuntos
Disenteria/epidemiologia , Disenteria/etiologia , Vigilância em Saúde Pública/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Fezes/microbiologia , Fezes/parasitologia , Fezes/virologia , Feminino , Guatemala/epidemiologia , Humanos , Incidência , Lactente , Laboratórios , Masculino , Pessoa de Meia-Idade , Adulto JovemAssuntos
Proteínas de Bactérias/genética , Cólera/microbiologia , Farmacorresistência Bacteriana Múltipla/genética , Fosfoproteínas/genética , Plasmídeos/genética , Vibrio cholerae/genética , Antibacterianos/farmacologia , Cólera/epidemiologia , Surtos de Doenças , Haiti/epidemiologia , Humanos , Testes de Sensibilidade Microbiana , Mutação , Vibrio cholerae/efeitos dos fármacos , Vibrio cholerae/isolamento & purificaçãoRESUMO
INTRODUCTION: Campylobacteriosis is one of the leading causes of gastroenteritis worldwide. This study describes the epidemiology of laboratory-confirmed Campylobacter diarrheal infections in two facility-based surveillance sites in Guatemala. METHODS: Clinical, epidemiologic, and laboratory data were collected on patients presenting with acute diarrhea from select healthcare facilities in the departments of Santa Rosa and Quetzaltenango, Guatemala, from January 2008 through August 2012. Stool specimens were cultured for Campylobacter and antimicrobial susceptibility testing was performed on a subset of isolates. Multidrug resistance (MDR) was defined as resistance to ≥3 antimicrobial classes. RESULTS: Campylobacter was isolated from 306 (6.0%) of 5137 stool specimens collected. For children <5 years of age, annual incidence was as high as 1288.8 per 100,000 children in Santa Rosa and 185.5 per 100,000 children in Quetzaltenango. Among 224 ambulatory care patients with Campylobacter, 169 (75.5%) received metronidazole or trimethoprim-sulfamethoxazole, and 152 (66.7%) received or were prescribed oral rehydration therapy. Antimicrobial susceptibilities were tested in 96 isolates; 57 (59.4%) were resistant to ciprofloxacin and 12 (12.5%) were MDR. CONCLUSION: Campylobacter was a major cause of diarrhea in children in two departments in Guatemala; antimicrobial resistance was high, and treatment regimens in the ambulatory setting which included metronidazole and trimethoprim-sulfamethoxazole and lacked oral rehydration were sub-optimal.
Assuntos
Antibacterianos/uso terapêutico , Infecções por Campylobacter/epidemiologia , Diarreia/epidemiologia , Farmacorresistência Bacteriana Múltipla , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Campylobacter/isolamento & purificação , Infecções por Campylobacter/complicações , Infecções por Campylobacter/tratamento farmacológico , Criança , Pré-Escolar , Ciprofloxacina/uso terapêutico , Controle de Doenças Transmissíveis/métodos , Efeitos Psicossociais da Doença , Diarreia/tratamento farmacológico , Diarreia/microbiologia , Fezes/microbiologia , Feminino , Hidratação , Guatemala/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Metronidazol/uso terapêutico , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Soluções para Reidratação/administração & dosagem , Vigilância de Evento Sentinela , Adulto JovemRESUMO
An outbreak of cholera began in Haiti in October of 2010. To understand the progression of epidemic cholera in Haiti, in April of 2012, we initiated laboratory-enhanced surveillance for diarrheal disease in four Haitian hospitals in three departments. At each site, we sampled up to 10 hospitalized patients each week with acute watery diarrhea. We tested 1,616 specimens collected from April 2, 2012 to March 28, 2013; 1,030 (63.7%) specimens yielded Vibrio cholerae, 13 (0.8%) specimens yielded Shigella, 6 (0.4%) specimens yielded Salmonella, and 63 (3.9%) specimens tested positive for rotavirus. Additionally, 13.5% of children < 5 years old tested positive for rotavirus. Of 1,030 V. cholerae isolates, 1,020 (99.0%) isolates were serotype Ogawa, 9 (0.9%) isolates were serotype Inaba, and 1 isolate was non-toxigenic V. cholerae O139. During 1 year of surveillance, toxigenic cholera continued to be the main cause of acute diarrhea in hospitalized patients, and rotavirus was an important cause of diarrhea-related hospitalizations in children.
Assuntos
Cólera/complicações , Cólera/epidemiologia , Diarreia/etiologia , Infecções por Rotavirus/complicações , Infecções por Rotavirus/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Haiti/epidemiologia , Hospitais , Humanos , Lactente , Recém-Nascido , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Vigilância da População , Rotavirus/isolamento & purificação , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: Leptospirosis is a zoonosis usually transmitted through contact with water or soil contaminated with urine from infected animals. Severe flooding can put individuals at greater risk for contracting leptospirosis in endemic areas. Rapid testing for the disease and large-scale interventions are necessary to identify and control infection. We describe a leptospirosis outbreak following severe flooding and a mass chemoprophylaxis campaign in Guyana. METHODOLOGY/PRINCIPAL FINDINGS: From January-March 2005, we collected data on suspected leptospirosis hospitalizations and deaths. Laboratory testing included anti-leptospiral dot enzyme immunoassay (DST), immunohistochemistry (IHC) staining, and microscopic agglutination testing (MAT). DST testing was conducted for 105 (44%) of 236 patients; 52 (50%) tested positive. Four (57%) paired serum samples tested by MAT were confirmed leptospirosis. Of 34 total deaths attributed to leptospirosis, postmortem samples from 10 (83%) of 12 patients were positive by IHC. Of 201 patients interviewed, 89% reported direct contact with flood waters. A 3-week doxycycline chemoprophylaxis campaign reached over 280,000 people. CONCLUSIONS: A confirmed leptospirosis outbreak in Guyana occurred after severe flooding, resulting in a massive chemoprophylaxis campaign to try to limit morbidity and mortality.
Assuntos
Antibacterianos/uso terapêutico , Surtos de Doenças , Doxiciclina/uso terapêutico , Leptospira/patogenicidade , Leptospirose/epidemiologia , Leptospirose/prevenção & controle , Adulto , Testes de Aglutinação , Animais , Feminino , Inundações , Guiana/epidemiologia , Humanos , Imunoensaio , Imuno-Histoquímica , Leptospira/fisiologia , Leptospirose/microbiologia , Leptospirose/mortalidade , Masculino , Taxa de SobrevidaRESUMO
Cholera is rare in the United States (annual average 6 cases). Since epidemic cholera began in Hispaniola in 2010, a total of 23 cholera cases caused by toxigenic Vibrio cholerae O1 have been confirmed in the United States. Twenty-two case-patients reported travel to Hispaniola and 1 reported consumption of seafood from Haiti.
Assuntos
Cólera/epidemiologia , Epidemias , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Criança , Cólera/terapia , Cólera/transmissão , República Dominicana/epidemiologia , Feminino , Hidratação , Haiti/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Viagem , Estados Unidos/epidemiologia , Vibrio cholerae O1/isolamento & purificação , Adulto JovemRESUMO
In October 2010, the US Centers for Disease Control and Prevention received reports of cases of severe watery diarrhea in Haiti. The cause was confirmed to be toxigenic Vibrio cholerae, serogroup O1, serotype Ogawa, biotype El Tor. We characterized 122 isolates from Haiti and compared them with isolates from other countries. Antimicrobial drug susceptibility was tested by disk diffusion and broth microdilution. Analyses included identification of rstR and VC2346 genes, sequencing of ctxAB and tcpA genes, and pulsed-field gel electrophoresis with SfiI and NotI enzymes. All isolates were susceptible to doxycycline and azithromycin. One pulsed-field gel electrophoresis pattern predominated, and ctxB sequence of all isolates matched the B-7 allele. We identified the tcpETCIRS allele, which is also present in Bangladesh strain CIRS 101. These data show that the isolates from Haiti are clonally and genetically similar to isolates originating in Africa and southern Asia and that ctxB-7 and tcpET(CIRS) alleles are undergoing global dissemination.
Assuntos
Vibrio cholerae/genética , Vibrio cholerae/patogenicidade , Alelos , Técnicas de Tipagem Bacteriana , Cólera/epidemiologia , Toxina da Cólera/genética , Surtos de Doenças , Eletroforese em Gel de Campo Pulsado , Genótipo , Haiti/epidemiologia , Humanos , Testes de Sensibilidade Microbiana , Vibrio cholerae/classificação , Virulência , Fatores de Virulência/genéticaRESUMO
To increase understanding of drug-resistant Vibrio cholerae, we studied selected molecular mechanisms of antimicrobial drug resistance in the 2010 Haiti V. cholerae outbreak strain. Most resistance resulted from acquired genes located on an integrating conjugative element showing high homology to an integrating conjugative element identified in a V. cholerae isolate from India.