Cutaneous anthrax in Lima, Peru: retrospective analysis of 71 cases, including four with a meningoencephalic complication

Anthrax is a zoonosis produced by Bacillus anthracis, and as an human infection is endemic in several areas in the world, including Peru. More than 95% of the reported naturally acquired infections are cutaneous, and approximately 5% of them can progress to meningoencephalitis. In this study we review the clinical and epidemiological characteristics of the patients with diagnosis of cutaneous anthrax evaluated between 1969 and 2002 at the Hospital Nacional Cayetano Heredia (HNCH) and the Instituto de Medicina Tropical Alexander von Humboldt in Lima, Peru. Seventy one patients were included [49/71 (69%) of them men], with a mean age of 37 years. The diagnoses were classified as definitive (44%) or probable (56%). The most common occupation of the patients was agriculture (39%). The source of infection was found in 63 (88.7%) patients. All the patients had ulcerative lesions, with a central necrosis. Most of the patients (65%) had several lesions, mainly located in the upper limbs (80%). Four patients (5.6%) developed meningoencephalitis, and three of them eventually died. In conclusion, considering its clinical and epidemiological characteristics, cutaneous anthrax must be included in the differential diagnosis of skin ulcers. A patient with clinical suspicion of the disease should receive effective treatment soon, in order to avoid neurological complications which carry a high fatality rate.

Fascioliasis in relatives of patients with Fasciola hepatica infection in Peru

High prevalence rates of human fascioliasis have been described in several regions of Peru. We surveyed 20 families in an endemic area of Peru in order to determine the proportion of infection with F. hepatica in relatives of diagnosed subjects and in order to identify associated risk factors. The study included feces and blood samples of 93 subjects. Ages ranged from one to 53 (mean = 18.6; SD = 14.2). The overall prevalence of fascioliasis by fecal examinations was 33.3% (n = 83) and by serology, 51.9% (n = 86). The prevalence in age group I (< 19 years old) by coprological and serological tests was 61.4% and 75.9%, respectively; in group II (> 19 years old) 15.4% and 37.5%. The main associated risk factor with fascioliasis was eating salads (OR = 3.29, CI = 1.2 - 9.0, p = 0.02). In conclusion, human fascioliasis is highly prevalent in the relatives of index cases and the most significant risk factor of acquiring fascioliasis in the family is eating salads in endemic areas.

Clinical and serological evidence of Toxocara infection in school children from Morrope District, Lambayeque, Peru

The aim of this study was to estimate the frequency of human toxocariosis in a child population from Morrope district, Lambayeque, Peru. From October to December 2005, 182 school children (96 male and 86 female) were studied. Blood samples were collected for Toxocara ELISA-IgG test and hematological examination. Additionally, stool samples were collected for coproparasitological examination to check cross reactions. We found frequency of positives in 32.4% (59/182) with a significant higher proportion of positivity in male children (p < 0.00001). 71.2% of the children with positive serology (52 male and seven female), were between five and 10 years old, 77.96% had respiratory symptoms, 61.02% had ocular manifestations, 38.98% had hepatic symptoms, 38.98% had mild or moderate eosinophilia, signs statistically associated with seropositivity. 83.5% of studied population had some intestinal parasite, such as: Blastocystis hominis (53.3%), Giardia lamblia (31.3%), Entamoeba coli (29.1%), Entamoeba histolytica/E. dispar (1.1%), Hymenolepis nana (5.49%), and Ascaris lumbricoides (3.3%), but they had not any association with serology results. The ownership of dogs or/and cats were significantly associated with seropositivity to anti-Toxocara antibodies although the presence of such pets within the house was not. In conclusion, clinical and serological evidence of Toxocara infection exists in the studied population.

Frequency of eosinophilia and risk factors and their association with Toxocara infection in schoolchildren during a health survey in the north of Lima, Peru

During a health survey in a primary school from the district of Carabayllo (North of Lima, Peru), 200 schoolchildren (96 male and 104 female between five to 12 years old) were randomly selected and divided in two groups (as positive or negative group), according to the serologic result of the Toxocara ELISA test from a total population of 646 schoolchildren. All children were analyzed by hematologic tests to determinate the frequency of eosinophilia and leukocytosis. Additionally, all clinical and epidemiological data were also analyzed to determine their association with toxocariasis. From group of children with positive serology, 40% had some type of eosinophilia in contrast to 19% of children with negative serology, and their association was statistically significant (OR = 2.84, p < 0.001). From all signs and symptoms evaluated, only 'dry cough' was more frequent and statistically significant in the positive serology group (OR = 2.79, p < 0.001). Almost all risk factors evaluated were highly frequent and statistically associated to the positive serology. In conclusion, the presence of eosinophilia and the risk factors evaluated in this population were frequently associated to human toxocariasis.

Confirming the presence of HTLV-1 infection and the absence of HTLV-2 in blood donors from Arequipa, Peru

Epidemiological studies conducted in Peru disclosed HTLV-1 to be prevalent in different ethnic groups, and found HTLV-2 in some Amazonian Indians and in men who have sex with men. No data concerning HTLV-1/2 infection in blood donors from Arequipa, a highlands region in southern Peru, is available. We searched for the presence of HTLV-1 and HTLV-2 antibodies in 2,732 serum samples obtained from blood donors from this geographic area. HTLV-1/2-specific antibodies were detected using an enzyme-linked immunosorbent assay (ELISA) and were confirmed by Western blot (WB). Reactive sera had their blood bags discarded from donation, and the demographic characteristics of the donors were analyzed. Thirty-five sera (1.2%) were HTLV seroreactive by ELISA, and 25 were confirmed HTLV-1-positive by WB. One serum disclosed HTLV-positivity, and the remaining nine serum samples showed indeterminate results by WB; three of which had an HTLV-1 indeterminate Gag profile. The median age of HTLV-positive individuals was 34.6 years; 27 were male and eight were female. All individuals were from southern Peru: 27 from Arequipa, five from Puno, and three from Cuzco. HTLV co-positivity with hepatitis B (five sera) and syphilis (one serum) were detected. Previous transfusion and tattooing were observed in two and one individuals, respectively. No serum was positive for HTLV/HIV co-infection. This study confirmed, for the first time, HTLV-1 infection and the absence of HTLV-2 infection in blood donors from Arequipa, Peru and suggests vertical transmission as the major route of HTLV-1 transmission and acquisition in this geographic region.

Frequency of human toxocariasis in a rural population from Cajamarca, Peru determined by DOT-ELISA test

The aim of this study was to estimate the frequency of human toxocariasis in Cauday district, Cajamarca, Peru, using a dot-ELISA test. From June to October 2005, a total of 256 adult subjects were studied. Blood samples were collected for serology by a dot-ELISA test and for hematological examination. Parasitological examination was also carried out in stool samples to check cross-reactions in the dot-ELISA. The frequency observed was 44.92%, with a significant higher proportion of positivity in male subjects. From subjects with positive serology, 45.6% had respiratory symptoms, 40.44% abdominal pain, 32.35% hepatic symptoms, 14.7% cutaneous signs, 13.23% ocular manifestations, 43.38% eosinophilia, and all of these were statistically associated to serology. Among the population evaluated, 90.23% (231/256) were parasitized. From subjects with positive serology, 92.17% had at least one intestinal parasite and the most frequent were: Blastocystis hominis (68.38%), Giardia lamblia (28.68%), Hymenolepis nana (20.0%), Ascaris lumbricoides (15.65%), Entamoeba histolytica/E. dispar (13.24%), Cyclospora cayetanensis (4.41%), Cryptosporidium sp. (1.47%), Enterobius vermicularis (0.87%), Strongyloides stercoralis (0.87%), Taenia sp. (0.87%), and Trichuris trichiura (0.87%). The rate of false positives in the dot-ELISA test was improved by serum absorption each with A. suum antigens, with a decrease of cross-reactions. In conclusion, human toxocariasis is highly frequent in this population and some risk factors like dog/cat ownership, presence of pets within house, and previous history of geophagia were observed in the present study.

Seroprevalence of human toxocariasis in Andean communities from the Northeast of Lima, Peru

The aim of this study was to assess the seroprevalence of human toxocariasis in three Andean communities from the Northeast of Lima, Peru. A total of 303 subjects including children and adults were studied and blood samples were collected to detect anti-Toxocara antibodies by ELISA-IgG test and by hematological examination; stool samples were collected also for parasitological examination. The overall seroprevalence of toxocariasis observed in the total population was 20.46%, with a significant high proportion in children from one to 10 years old (p = 0.034). Among the subjects with positive serology, 32.26% of them had respiratory disturbances, 22.58% hepatomegaly, 17.74% ocular signs or symptoms, 14.51% abdominal pain, 9.68% neurological involvement, and 4.84% cutaneous signs, but none of these clinical features were associated to a positive serology by multivariate analysis. Furthermore, 79.03% of seropositive subjects also harbored at least one intestinal parasite, which was associated to a positive serology (p < 0.05). The presence of pets within the houses, a previous history of pica or geophagia and the use of public places were also present in this population, but only the latter was associated to the serology (p < 0.05). In conclusion, clinical, serological, and epidemiological evidences for larval Toxocara infection were found in the studied population.

Human toxocariasis: a seroepidemiological survey in the Amazonian city of Yurimaguas, Peru

The aim of this study was to determine the seroprevalence of the infection by Toxocara in the general population of the Amazonian city of Yurimaguas, Peru. From March to August 2008, a total of 300 subjects were sampled and tested by means of a Toxocara ELISA-IgG test. A clinical and epidemiological questionnaire was used to assess the symptomatology and risk factors associated with human toxocariasis. The overall rate of seropositivity was 35.66%, with a significant high proportion in children (p < 0.001). The clinical evaluation revealed that 95.33% of the seropositive group had some type of symptomatology: headache (66.36%), respiratory compromise (63.55%), abdominal pain (54.21%), cutaneous signs (40.19%) and ocular manifestations (36.45%), and almost all of them were statistically significant (p < 0.001). Furthermore, 56.07% of the seropositive subjects presented at least one intestinal pathogen parasite with predominance of helminthes, but without significant association (p = 0.334). The analysis of risk factors showed only that the use of public places and geophagia exhibited a significant association with the seropositivity (p < 0.001). Clinical, serological and epidemiological findings associated to infection with Toxocara were observed in the present study and future studies should be done to assess this serious health problem.

Geographical distribution and intra-domiciliary capture of sylvatic triatomines in La Convención province, Cusco, Peru

The geographical distribution and intra-domiciliary capture of sylvatic triatomines in three districts of the province of La Convención, Cusco, Peru are presented. In the district of Vilcabamba, eight adults of Rhodnius pictipes and five adults of Panstrongylus geniculatus were found. In the district of Ocobamba, 19 adults, 14 nymphs, and eggs of P. rufotuberculatus were found. In the district of Echarate, six adults and 10 nymphs of Eratyrus mucronatus, an adult of R. pictipes and P. geniculatus, and a nymph of P. rufotuberculatus were also found. The geographical distribution of E. mucronatus has extended to Cusco. This is the first report in Peru of household colonization by this triatomine.

Cytokines and T-Lymphocute count in patients in the acute and chronic phases of Bartonella bacilliformis infection in an endemic area in peru: a pilot study

Human Bartonellosis has an acute phase characterized by fever and hemolytic anemia, and a chronic phase with bacillary angiomatosis-like lesions. This cross-sectional pilot study evaluated the immunology patterns using pre- and post-treatment samples in patients with Human Bartonellosis. Patients between five and 60 years of age, from endemic areas in Peru, in the acute or chronic phases were included. In patients in the acute phase of Bartonellosis a state of immune peripheral tolerance should be established for persistence of the infection. Our findings were that elevation of the anti-inflammatory cytokine IL-10 and numeric abnormalities of CD4+ and CD8+ T-Lymphocyte counts correlated significantly with an unfavorable immune state. During the chronic phase, the elevated levels of IFN-γ and IL-4 observed in our series correlated with previous findings of endothelial invasion of B. henselae in animal models.

ISOLATION AND MOLECULAR IDENTIFICATION OF POTENTIALLY PATHOGENIC Escherichia coli AND Campylobacter jejuni IN FERAL PIGEONS FROM AN URBAN AREA IN THE CITY OF LIMA, PERU

SUMMARY Feral pigeons (Columbia livia) live in close contact with humans and other animals. They can transmit potentially pathogenic and zoonotic agents. The objective of this study was to isolate and detect strains of diarrheagenic Escherichia coli and Campylobacter jejuniof urban feral pigeons from an area of Lima, Peru. Fresh dropping samples from urban parks were collected for microbiological isolation of E. coli strains in selective agar, and Campylobacterby filtration method. Molecular identification of diarrheagenic pathotypes of E.coliand Campylobacter jejuni was performed by PCR. Twenty-two parks were sampled and 16 colonies of Campylobacter spp. were isolated. The 100% of isolates were identified as Campylobacter jejuni. Furthermore, 102 colonies of E. coli were isolated and the 5.88% resulted as Enteropathogenic (EPEC) type and 0.98% as Shiga toxin-producing E. coli (STEC). The urban feral pigeons of Lima in Peru can act as a reservoir or carriers of zoonotic potentially pathogenic enteric agents.

Behaviour of a Peru strain of Trypanosoma cruzi in Rhesus monkeys

The course of infection with a Peru strain of T. cruzi was studied in 3 rhesus monkeys. An unsuccessful attempt to vaccinate one monkey is described. The IaM leves rise during the course of infection in ali 3 animais. A lumnhocytosis and mild anaemia was noted in these acute infections. Orbital oedema occurred in all 3 animais following subcutaneous inoculation of the infection dose into the eyelid.

Estudos sobre a persistência da infectividade do Trypanosoma cruzi: I. Efeito da temperatura sobre a infectividade de flagelados da amostra Peru de T. cruzi obtidos de fezes de triatomíneos

An investigation was made about the influence of environment temperature on the infectivity of flagellate of T. cruzi Peru sample in triatomine feces by periconjuntival instilation in albino mice. The results demonstrate that infection, measured by patent parasitemia decreases when fecal suspension is maintained at 30ºC. The possible implication of these findings in relation to transmission of T. cruzi to human, in field, is briefty discussed.

Biomphalaria straminea no Peru e sua suscetibilidade a cepas brasileiras de Schistosoma mansoni

Em Maio de 1973, um dos autores (C.A.C.) coletou na localidade de Imacita, Província de Bagua, Departamento de Amazonas, vários espécimes de Biomphalaria straminea (Dunker, 1848), uma espécie que, até então, não havia sido assinalada no Peru. Descendentes destes indivíduos foram submetidos a provas de suscetibilidade às cepas BH e SJ de Schistosoma mansoni que, em condições naturais, evoluem em B. glabrata de Belo Horizonte e B. tenagophila de São José dos Campos, respectivamente. Oitenta espécimens foram expostos à cepa BH dos quais em 13 ou 16,2% a infecção evoluiu caracteristicamente até a formação de esporocistos secundários sem haver, contudo, eliminação de cercárias, mesmo no indivíduo que apresentou uma sobrevivência de 88 dias após a exposição. Não se verificou cura espontânea neste lote. Entre as 40 B. straminea expostas à cepa SJ 9 ou 22,5% infectaram-se, sendo que apenas duas eliminaram poucas cercárias aos 57 e 77 dias após a exposição, por dois dias consecutivos, tendo uma morrido e uma se curado espontaneamente. A cura espontânea do parasitismo foi notado em mais dois indivíduos, nos quais a infecção foi observada através da concha. Cortes histológicos seriados de 9 caramujos, expostos individualmente a 50 miracídios da cepa BH e fixados entre 6 e 120 horas após a exposição, mostraram esporocistos em desenvolvimento e esporocistos invadidos por amebócitos, sem formação de granulomas por parte do hospedeiro, fato assinalado em caramujos suscetíveis. A população estudada comportou-se experimentalmente de modo semelhante a outras populações de B. straminea testadas em laboratório, isto é, com baixa suscetibilidade, embora tal comportamento não afaste a possibilidade dela vir a manter o ciclo do parasita em sua área de distribuição.

La fauna flebotomica (Diptera: Psychodedae) de tres províncias de la region nor oriental del Marañon, Peru

En localidades ubicadas entre los distritos de San José de Lourdes (05°03'Longitud Sur), provinda de San Ignacio y Lonya Grande (06°05'30" Longitud Sur), provinda de Utcubamba, Region Nor Orietital del Maranón, donde la bartonellosis humana o Verruga Peruana es endémica, se capturaron 2774 flebótomos entre 1987 y 1992; identificándo se 13 especies; 11 correspondeu al género Lutzomyia, 1 a Brumptomyia y 1 a Warileya. De las especies capturadas, Zutzomyia sp. similar a Lutzomyia serrana y Lutzomyia maranonensis sp. n., Galati, Cáceres & Le Pont, son las mas abundantes (89.74%), por lo que, se especula que puedeit ser consideradas vectores potenciales de la Verruga Peruana. Se reporta Lutzomyia verrucarum (Townsend, 1913) por primem vez para la provinda de Utcubamba.