RESUMO
BACKGROUND: Chagas disease represents a major public health concern in several Latin American countries, including Bolivia. METHODS: We present a longitudinal serosurvey for Trypanosoma cruzi antibodies among a cohort of 120 school-age children from rural communities in the Bolivian Chaco at three time points between 2017 and 2019. Serum samples extracted from dry blood spots collected on filter paper were tested for T. cruzi antibodies by enzyme-linked immunosorbent assay and rapid diagnostic test. RESULTS: T. cruzi antibodies were detected in 7/120 (5.8%), 8/120 (6.7%) and 11/120 (9.2%) samples in 2017, 2018 and 2019, respectively. An average incidence of 1.76 per 100 person-years was observed. CONCLUSIONS: Our findings support the persistence of vector-borne T. cruzi transmission in this area, highlighting the need for strengthening multidisciplinary efforts against Chagas disease.
Assuntos
Doença de Chagas , Trypanosoma cruzi , Humanos , Criança , Bolívia/epidemiologia , Doença de Chagas/epidemiologia , Ensaio de Imunoadsorção Enzimática , Anticorpos AntiprotozoáriosRESUMO
The Bolivian Chaco is a semiarid region with a low population density, situated in the southeast part of the Plurinational State of Bolivia. Here, despite the improvements of the last 15 years, poverty remains high in rural areas, where social vulnerability is widespread. The Guaraní ethnic group often lives in isolated communities with a low standard of hygiene and sanitation. This epidemiological scenario favors the spread of transmissible diseases, including several parasitic infections belonging to the neglected tropical diseases (NTDs) group. In this area, a long-standing research activity, built upon the synergism between local and foreign institutions, has been established since the late 1980s and helps to fill in the knowledge gap about the epidemiology dynamics of soil-transmitted helminths, vector-borne parasites, and other parasitic diseases. A 35-year history of cooperation programs in parasitology research has contributed to informing local health authorities of the NTD burden in the Bolivian Chaco and, ultimately, supports local healthcare providers in the management of parasitic diseases.
RESUMO
INTRODUCTION: Chagas disease (CD) remains a public health concern in several Latin American countries. At global level, Bolivia has the highest CD burden and the Chaco region, in the southeast of the country, is the most affected area. We report the results of four serosurveys for Trypanosoma cruzi antibodies, carried out approximately ten years apart from each other, during the lapse 1987-2013, in different localities of the Bolivian Chaco. METHODOLOGY: Four cross-sectional surveys were conducted in various localities, mostly rural, of the Bolivian Chaco, during the period 1987-2013. RESULTS: Although a reliable analysis of CD epidemiological trend is challenging, a partial reduction of anti-T. cruzi seroprevalence over the past four decades in the Bolivian Chaco may be assumed. In particular, in 1987 the exposure to T. cruzi in rural setting was universal since the first years of life, while it resulted gradually lower and age-dependent thereafter. Moreover, T. cruzi seroprevalence among women of reproductive age (15-45 years) has been persistently high in rural areas. CONCLUSIONS: T. cruzi transmission is still active and CD remains a concern throughout the Bolivian Chaco. More efforts are needed in order to achieve a sustainable interruption of vector-borne CD transmission in this area.
Assuntos
Anticorpos Antiprotozoários/sangue , Doença de Chagas/epidemiologia , Adolescente , Adulto , Idoso , Bolívia/epidemiologia , Doença de Chagas/sangue , Criança , Pré-Escolar , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , População Rural , Estudos Soroepidemiológicos , Trypanosoma cruzi/imunologia , Adulto JovemRESUMO
Tropical anemia can have multiple causes, whether socioeconomic, dietary, or infectious. In the Bolivian Chaco, soil-transmitted helminthiases (STH), malaria, and Chagas disease are potential infectious causes of anemia among school-aged children (SAC). Following years of preventive chemotherapy with mebendazole, the prevalence of STH among SAC living in that area is now negligible, whereas protozoan infections are still highly prevalent (81%); Hymenolepis nana is the most frequent intestinal helminth (â¼13%). We present results of hemoglobin (Hb) assessment and the association between parasitic infections and Hb levels of that SAC population. Overall, 511 SAC (girls:boys ratio 1:1, mean age 9.4 years [95% confidence interval {CI}: 9.3-9.5]) had Hb levels measured by using a point of care testing (HemoCue® Hb 301 System; HemoCue, Angelhome, Sweden). The prevalence of anemia was 23% (117/511), with mean and median Hb level = 12.2 g/dL (95% CI: 12.1-12.3; range 9.2-15.4 g/dL). By multivariate analysis, H. nana infection was associated with an increased risk of anemia (odds ratio 2.9, 95% CI: 1.5-5.7, P = 0.002). Two samples (0.5%) were positive for Trypanosoma cruzi and none for Plasmodium spp. by polymerase chain reaction of the 439 children tested. Anemia is still a concern among SAC living in the Bolivian Chaco. Our findings call for a greater attention to fecal-oral emerging pathogens, such as H. nana, and highlight the importance of water, sanitation, and hygiene improvements for disadvantaged population such as those living in the Bolivian Chaco.
Assuntos
Anemia/epidemiologia , Doença de Chagas/epidemiologia , Hemoglobinas/metabolismo , Himenolepíase/epidemiologia , Hymenolepis nana/isolamento & purificação , Trypanosoma cruzi/isolamento & purificação , Adolescente , Anemia/complicações , Anemia/diagnóstico , Anemia/parasitologia , Animais , Bolívia/epidemiologia , Doença de Chagas/complicações , Doença de Chagas/diagnóstico , Doença de Chagas/parasitologia , Criança , Estudos Transversais , Feminino , Humanos , Higiene/educação , Himenolepíase/complicações , Himenolepíase/diagnóstico , Himenolepíase/parasitologia , Hymenolepis nana/genética , Masculino , Prevalência , Instituições Acadêmicas , Solo/parasitologia , Trypanosoma cruzi/genéticaRESUMO
OBJECTIVE: Preventive chemotherapy is the WHO-recommended control method for soil-transmitted helminthiases. In the Bolivian Chaco, 6-monthly single-dose mebendazole delivery to school-age children achieved a dramatic decrease in soil-transmitted helminthiases prevalence between 1987 and 2013. Consequently, in September 2016, preventive chemotherapy delivery was interrupted in nine rural communities. In compliance with WHO recommendations, we intensified surveillance to monitor soil-transmitted helminthiases prevalence and detect potential changes that would require interventions. METHODS: We conducted two cross-sectional parasitology surveys 12 months apart (September 2016-2017) among school-age children living in the communities where preventive chemotherapy delivery had been halted. Study design, methods of sampling and sample analysis technique (direct microscopy, Kato-Katz technique) followed WHO recommendations, aiming to obtain data representative of the Bolivian Chaco ecological zone. RESULTS: We collected 426 samples in 2016 and 520 in 2017. Soil-transmitted helminthiasis prevalence was unremarkable: 0.7% (95% CI 0-1.5%) in 2016 and 0.8% (0-1.5%) in 2017. Conversely, the prevalence of tapeworms (13% in 2016, 12% in 2017) and intestinal protozoan infections (81% in 2016 and 75% in 2017) continued to be high. CONCLUSIONS: Our findings support the role of preventive chemotherapy in reducing soil-transmitted helminthiases transmission, as otherwise poor hygienic and health conditions persist in the Bolivian Chaco. A national survey, involving areas from all the ecological zones of Bolivia, is now warranted.
Assuntos
Anti-Helmínticos/uso terapêutico , Helmintíase/prevenção & controle , Mebendazol/uso terapêutico , Bolívia/epidemiologia , Quimioprevenção/métodos , Criança , Estudos Transversais , Feminino , Helmintíase/epidemiologia , Humanos , Masculino , Prevalência , Avaliação de Programas e Projetos de Saúde , População Rural/estatística & dados numéricos , Solo/parasitologiaAssuntos
Antibacterianos/farmacologia , Citrobacter/efeitos dos fármacos , Citrobacter/genética , Colistina/farmacologia , Microbiologia de Alimentos , Genes Bacterianos , Bolívia , Citrobacter/enzimologia , Citrobacter/isolamento & purificação , DNA Bacteriano/química , Farmacorresistência Bacteriana/genética , Plasmídeos , Análise de Sequência de DNA , Solanum tuberosum/microbiologiaAssuntos
Acinetobacter baumannii/isolamento & purificação , beta-Lactamases/genética , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/genética , Bolívia , Farmacorresistência Bacteriana Múltipla , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Farmacorresistência Bacteriana Múltipla , Transferência Genética Horizontal , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/isolamento & purificação , Plasmídeos/análise , Adulto , Idoso , Antibacterianos/farmacologia , Bolívia , Eletroforese em Gel de Campo Pulsado , Feminino , Ordem dos Genes , Genótipo , Humanos , Klebsiella pneumoniae/classificação , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Tipagem de Sequências Multilocus , Análise de Sequência de DNARESUMO
BACKGROUND: Bolivia is among the lowest-resourced South American countries, with very few data available on antibiotic resistance in bacterial pathogens. The phenotypic and molecular characterization of bacterial isolates responsible for urinary tract infections (UTIs) in the Bolivian Chaco are reported here. METHODS: All clinical isolates from UTIs collected in the Hospital Basico Villa Montes between June 2010 and January 2014 were analyzed (N=213). Characterization included susceptibility testing, extended-spectrum beta-lactamase (ESBL) detection, identification of relevant resistance determinants (e.g., CTX-M-type ESBLs, 16S rRNA methyltransferases, glutathione S-transferases), and genotyping of CTX-M producers. RESULTS: Very high resistance rates were observed. Overall, the lowest susceptibility was observed for trimethoprim-sulphamethoxazole, tetracycline, nalidixic acid, amoxicillin-clavulanic acid, ciprofloxacin, and gentamicin. Of E. coli and K. pneumoniae, 11.6% were ESBL producers. Resistance to nitrofurantoin, amikacin, and fosfomycin remained low, and susceptibility to carbapenems was fully preserved. CTX-M-15 was the dominant CTX-M variant. Four E. coli ST131 (two being H30-Rx) were identified. Of note, isolates harbouring rmtB and fosA3 were detected. CONCLUSIONS: Bolivia is not an exception to the very high resistance burden affecting many South American countries. Optimization of alternative approaches to monitor local antibiotic resistance trends in resource-limited settings is strongly encouraged to support the implementation of effective empiric treatment guidelines.
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Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana/efeitos dos fármacos , Infecções por Escherichia coli/tratamento farmacológico , Escherichia coli/isolamento & purificação , Klebsiella pneumoniae/isolamento & purificação , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Infecções Urinárias/microbiologia , Bolívia/epidemiologia , Farmacorresistência Bacteriana/genética , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Proteínas de Escherichia coli/efeitos dos fármacos , Proteínas de Escherichia coli/genética , Fosfomicina/uso terapêutico , Genótipo , Humanos , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/microbiologia , Metiltransferases/efeitos dos fármacos , Metiltransferases/genética , RNA Ribossômico 16S/efeitos dos fármacos , RNA Ribossômico 16S/genética , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , beta-Lactamases/efeitos dos fármacos , beta-Lactamases/genéticaRESUMO
OBJECTIVES: Information is lacking on the methicillin-resistant Staphylococcus aureus (MRSA) clonal lineages circulating in Bolivia. We investigated the prevalence and molecular epidemiology of S. aureus colonization in hospitalized patients from the Bolivian Chaco, and compared their features with those of the few clinical isolates available from that setting. METHODS: S. aureus nasal/inguinal colonization was investigated in 280 inpatients from eight hospitals in two point prevalence surveys (2012, n=90; 2013, n=190). Molecular characterization included genotyping (spa typing, multilocus sequence typing, and pulsed-field gel electrophoresis), detection of virulence genes, and SCCmec typing. RESULTS: Forty-one inpatients (14.6%) were S. aureus nasal/inguinal carriers, of whom five were colonized by MRSA (1.8%). MRSA isolates mostly belonged to spa-type t701, harboured SCCmec IVc, and were negative for Panton-Valentine leukocidin (PVL) genes. However, a USA300-related isolate was also detected, which showed the characteristics of the USA300 Latin American variant (USA300-LV; i.e., ST8, spa-type t008, SCCmec IVc, presence of PVL genes, absence of arcA). Notably, all the available MRSA clinical isolates (n=5, collected during 2011-2013) were also identified as USA300-LV. CONCLUSIONS: Overall, MRSA colonization in inpatients from the Bolivian Chaco was low. However, USA300-LV-related isolates were detected in colonization and infections, emphasizing the importance of implementing control measures to limit their further dissemination in this resource-limited area.