RESUMEN
During early 2021, Peru had the highest COVID-19-associated per-capita mortality rate. Socioeconomic inequality, insufficiently prepared healthcare, and surveillance systems are factors explaining the mortality rate, which can be severely worsened by early undetected SARS-CoV-2 circulation. We tested 1,441 individuals with fever sampled during August 2019-May 2021, several months before the first SARS-CoV-2 seroprevalence study available so far in Lima, Peru, for SARS-CoV-2-specific antibodies. The testing algorithm included a chemiluminescence immunoassay and surrogate virus neutralization test. Early positive samples (N = 24) from January-March 2020 were further tested using a plaque-reduction neutralization test (PRNT) and avidity test against the SARS-CoV-2 spike and nucleoprotein. None of the early samples were PRNT-confirmed, in contrast to 81.8% (18/22) of a subsample from April 2020 onward (Fisher exact test; P <0.0001). Therefore, we excluded non-PRNT-confirmed samples from subsequent analyses. The SARS-CoV-2 antibody detection rate was 0.9% in mid-April 2020 (1/104; 95% CI: 0.1-5.8%), suggesting viral circulation in early-middle March 2020, consistent with the first molecular detection of SARS-CoV-2 in Peru on March 2020. Mean avidity increase of 62-77% to 81-94% from all PRNT-confirmed SARS-CoV-2-positive samples during early 2020 were consistent with onset of SARS-CoV-2 circulation during late February/March 2020. Early circulation was also confirmed in a susceptible, exposed, infected, and recovered mathematical model that calculated an effective reproduction number >1 during February-March 2020. Early introduction of SARS-CoV-2 thus contributed to the high COVID-19 mortality rate in Peru. Emphasizing the role of diagnostic confirmation in understanding the pandemic's trajectory, this study highlights the importance of early detection and accurate testing in managing infectious disease outbreaks.
RESUMEN
Fort Sherman virus (FSV) was isolated in Panama in 1985 from a US soldier. We report a case of human FSV infection in a febrile patient from northern coastal Peru in 2020. FSV infections spanning ≈35 years and a distance of 2,000 km warrant diagnostics, genomic surveillance, and investigation of transmission cycles.
Asunto(s)
Filogenia , Humanos , Perú/epidemiología , Masculino , Adulto , Infecciones por Picornaviridae/epidemiología , Infecciones por Picornaviridae/diagnóstico , Infecciones por Picornaviridae/virología , Historia del Siglo XXIRESUMEN
RESUMEN Introducción. Las aplicaciones móviles representan una alternativa prometedora para brindar soporte en la gestión de pacientes con dengue. Sin embargo, se desconoce la usabilidad de estas herramientas en el Perú. Objetivo. Evaluar la usabilidad y las recomendaciones de uso de la aplicación Dengue ONQOY en la gestión de pacientes con dengue en zonas rurales de Perú. Métodos. Se realizó un estudio cualitativo que incluyó entrevistas semiestructuradas a 8 expertos en el tratamiento del dengue, los datos fueron codificados mediante el programa Atlas. Ti. Fueron evaluadas tres categorías: (1) usabilidad informativa, (2) usabilidad de diseño y (3) recomendaciones para su mejoramiento. Resultados. Se destacaron tres aspectos clave: (1) la aplicación es percibida como valiosa para los médicos de primer nivel en áreas periféricas con poca experiencia en dengue debido a su enfoque personalizado y valor académico; (2) se destacó su facilidad de uso y practicidad, aunque se señaló la limitación de la conectividad en algunas áreas; y, (3) se recomendó la inclusión de diagnósticos diferenciales, factores de riesgo adicionales, referencias actualizadas, guías de hidratación y dosis de medicamentos para mejorar la aplicación. Conclusión. Dengue ONQOY fue considerado altamente utilizable por médicos que atienden casos de dengue en el primer nivel de atención en Perú. A pesar de las limitaciones relacionadas con la conectividad y las posibles mejoras en su diseño, su desarrollo e implementación ofrecen una alternativa prometedora para el manejo de pacientes con Dengue en el país.
ABSTRACT Introduction. Mobile applications represent a promising alternative for providing support in the management of Dengue patients. However, the usability of these tools in Peru is unknown. Objectives. To evaluate the usability and usage recommendations of the Dengue ONQOY application in managing Dengue patients in rural areas of Peru. Methods. A qualitative study was conducted, which included semi-structured interviews with 8 experts in Dengue management. Data were coded using Atlas. Ti software. Three categories were assessed: (1) informative usability (2) design usability, and (3) recommendations for improvement. Results. Three key aspects were highlighted. (1) The application is perceived as valuable for first- level doctors in peripheral areas with limited Dengue experience due to its personalized approach and academic value. (2) Its ease of use and practicality were emphasized, although connectivity limitations in some areas were noted. (3) Recommendations for improvement included the inclusion of differential diagnoses, additional risk factors, updated references, hydration guidelines, and medication dosages. Conclusions. Dengue ONQOY is considered highly usable by doctors treating Dengue cases at the primary care level in Peru. Despite connectivity limitations and potential design improvements, its development and implementation offer a promising alternative for managing Dengue patients in the country in this field.
RESUMEN
Introducción. La aspergilosis invasiva presenta alta mortalidad en pacientes con enfermedades crónicas e inmunocomprometidos. Aspergillus fumigatus sensu stricto (AFSS) es el principal agente etiológico y su tipificación requiere de métodos moleculares. La incidencia incrementada de AI resistentes a los antifúngicos demanda un diagnóstico certero y oportuno. Métodos. Se estudiaron 20 cepas de la micoteca del Instituto de Medicina Tropical - Universidad Nacional Mayor de San Marcos, aisladas de muestras respiratorias e identificadas como Aspergillus fumigatus sensu lato mediante el estudio macroscópico y microscópico. Las cepas fueron referidas a la Universidad Nacional del Litoral para su tipificación mediante una PCR screening para AFSS basada en secuencias del gen CYP51A y el estudio de sensibilidad antifúngica para voriconazol (VOR), itraconazol (ITC), posaconazol (POS), isavuconazol (ISA), anidulafungina (ANF), caspofungina (CSF) y anfotericina B (AMB) obteniendo la concentración inhibitoria mínima (CIM) mediante el protocolo de CLSI M38M51S-Ed3. Resultados. Las 20 cepas fueron identificadas como AFSS. Ninguna de las cepas tuvo una CIM por encima del punto de corte clínico (VOR), ni epidemiológico (ITC, ISA, AMB y CSF). POS fue la droga más potente frente a la colección de cepas evaluadas (media geométrica (GM) de CIM de 0,042 µg/ml). Conclusiones. Todos los aislamientos fueron tipificados como AFSS sensibles a los azoles según los puntos de corte clínico, posaconazol tuvo la mayor actividad antifúngica. Nuestros hallazgos aportan a incrementar la escasa información sobre la etiología y sensibilidad a los antifúngicos de uso clínico de las aspergilosis invasiva en nuestro país.
Introduction. Invasive Aspergillosis (IA) poses a significant threat to patients with chronic diseases and compromised immune systems, with Aspergillus fumigatus sensu stricto (AFSS) being the primary etiological agent. Accurate and timely diagnosis is crucial, particularly given the rising incidence of IA strains resistant to antifungals, necessitating molecular methods for typing. Methods. Twenty strains from Instituto de Medicina Tropical - Universidad Nacional Mayor de San Marcos, mycological collection, previously identified as Aspergillus fumigatus sensu lato through macroscopic and microscopic analysis, were studied. These strains were forwarded to the Universidad Nacional del Litoral for AFSS typing using a PCR screening based on CYP51A gene sequences. Antifungal susceptibility testing was performed for Voriconazole (VOR), Itraconazole (ITC), Posaconazole (POS), Isavuconazole (ISA), Anidulafungin (ANF), Caspofungin (CSF), and Amphotericin B (AMB), obtaining Minimum Inhibitory Concentrations (MICs) according to CLSI M38M51S-Ed3. Results. All 20 strains were identified as AFSS. None of the strains exhibited MICs above the clinical breakpoint (VOR) or the epidemiological cutoffs (ITC, ISA, AMB, and CSF). POS demonstrated the highest potency against the strain collection, with a geometric mean MIC of 0,042 µg/ml. Conclusions. All isolates were classified as azole-sensitive Aspergillus fumigatus sensu stricto (AFSS) based on clinical cutoff points, particularly posaconazole, which exhibited superior antifungal activity. Our findings contribute to augmenting the limited information on the etiology and clinical antifungal sensitivity of IA in our country.
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El síndrome de Guillain Barré es una enfermedad derivada del compromiso en las neuronas del sistema nervioso periférico por una respuesta descontrolada del sistema inmune que conduce daño axonal y/o desmielinización. El objetivo de este reporte fue describir los 10 primeros casos sospechosos de Síndrome de Guillain Barré en Piura. Se logró identificar la presencia de Campylobacter jejuni en las muestras de heces del 80% de los pacientes reportados. Es muy importante reconocer rápida y oportunamente al paciente con diagnóstico sospechoso de Guillain Barré, y realizar los estudios necesarios en un brote para identificar los agentes desencadenantes del cuadro.
Guillain Barré syndrome is a disease derived from compromise in neurons of the peripheral nervous system by an uncontrolled response from the immune system that leads to axonal damage and/or demyelination. The objective of this report was to describe the first 10 suspected cases of Guillain Barre Syndrome in Piura. It was possible to identify the presence of Campylobacter jejuni in the stool samples of 80% of the reported patients. It is very important to quickly and opportunely recognize the patient with a suspected diagnosis of Guillain Barré, and to carry out the necessary studies in an outbreak to identify the triggering agents of the condition.
RESUMEN
Introducción. El virus de la hepatitis delta (VHD) es el causante de la forma más severa de la hepatitis viral humana, se asocia con un riesgo alto de fibrosis al hígado y carcinoma hepatocelular (HCC). Existen 8 genotipos del VHD con diferente distribución geográfica. Objetivos. Identificar los genotipos del VHD circulante en Huanta y tres pueblos indígenas de la Amazonía peruana. Métodos. Estudio observacional y transversal, realizado en 582 muestras reactivas para anti-HBc del VHB. Por el método nRT-PCR se procesaron todos los anti VHD positivos, el genotipo fue determinado mediante secuenciamiento directo tipo Sanger y análisis filogenético del fragmento R0. Se utilizaron 111 secuencias de referencia del GenBank. Las 42 secuencias del estudio fueron editadas y ensambladas con programas bioinformáticos. El análisis filogenético y evolutivo se realizó con los programas: Beast V2.5.2, Jmodeltest v2.1.10, Tracer v1.7.1, Tree Annotator y Figtree v1.4.4. Se utilizaron los modelos Bayesianos Yule y Birth Death skyline serial, el MCMC en 30 y 80 millones respectivamente, con el relaxed uncorrelated Exponential molecular clock. Se calcularon las medidas de resumen y de tendencia central utilizando el programa en STATA 14.0. Resultados. La media de la edad fue de 38 años, el 52,8% fueron mujeres. 101 muestras fueron positivas para anticuerpos anti-VHD. El ARN del VHD fue detectado en el 49,5% de las muestras reactivas a ELISA anti-VHD. El análisis filogenético determinó la presencia del genotipo 3. Conclusiones. Se evidencia la presencia del genotipo 3 del VHD en comunidades andinas y amazónicas del Perú.
Introduction. The Hepatitis Delta Virus (HDV) is the cause of the most severe form of human viral hepatitis and is associated with a high risk of liver fibrosis and hepatocellular carcinoma (HCC). There are 8 HDV genotypes with different geographic distribution. Objectives. To identify the genotypes of VHD circulating in Huanta and three indigenous peoples of the Peruvian Amazon. Methods. Observational and cross-sectional study, from 582 reactive samples for anti-HBc-HBV. Anti-HDV positive samples were processed with the nRT-PCR method, genotype was determined by direct Sanger-type sequencing and phylogenetic analysis of the R0 fragment. 111 reference sequences from GenBank were used. The 42 sequences of the study were edited y assembled with the bioinformatics programs. Phylogenetic and evolutionary analysis was performed with the following software: Beast v2.5.2, Jmodeltest v2.1.10, Tracer v1.7.1, Tree Annotator and Figtree v1.4.4. The Bayesian Yule and Birth Death skyline serial models were used, the MCMC at 30 and 80 million respectively, with the relaxed uncorrelated Exponential molecular clock. Summary and central tendency measures were calculated using the program in STATA 14.0. Results. The mean age was 38 years, 52.8% were women. 101 samples were positive for anti-HDV antibodies. HDV RNA was detected in 49.5% of the anti-HDV ELISA reactive samples. Phylogenetic analysis determined the presence of genotype 3. Conclusions. The presence of HDV genotype 3 in Andean and Amazonian communities of Peru is evidenced.
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Introducción. La vacunación contra el virus de la hepatitis B (VHB) en recién nacidos es crucial para la prevención de la transmisión perinatal. Objetivo. Determinar factores individuales e institucionales asociados a la vacunación contra el VHB en las 12 y 24 primeras horas de vida. Métodos. Se diseñó un estudio transversal y multicéntrico. Los datos sobre la vacunación fueron recogidos de los padres y de la revisión de reportes. Los datos de los variables individuales de los recién nacidos y madres fueron recogidos de las historias clínicas. Los datos institucionales fueron recogidos de registros de atención inmediata y directamente del personal de inmunizaciones. Resultados. Se incluyó 777 recién nacidos en 10 establecimientos. En el análisis multinivel resultó favorable a la vacunación en las primeras 12 horas, el mayor tiempo de atención en los servicios de inmunizaciones (RP: 1,0; IC95%: 0,99 - 1,01). Para la vacunación dentro de las 24 horas de vida fue favorable la mayor cantidad de personal de enfermería en los servicios de vacunación (RP: 1,02; IC95%: 1,01 - 1,03) y desfavorable la mayor cantidad de partos al día de los establecimientos (RP: 0,99; IC95%: 0,99 - 0,997). No se identificó factores individuales. Conclusión. Factores institucionales, como el tiempo de atención, la cantidad de personal de enfermería y la cantidad de partos, estuvieron asociados con la vacunación contra el VHB en recién nacidos. Se requiere estrategias de mejora como la introducción de la vacunación en la atención inmediata del neonato para la prevención de la transmisión perinatal del VHB.
Introduction. Vaccination against hepatitis B Virus (HBV) in newborns is crucial for the prevention of perinatal transmission. Objective. To determine the individual and institutional factors associated with vaccine for HBV in newborns in the first 12 hours and 24 hours of life. Methods. A cross-sectional, multicenter-design study was conducted in high level public and private hospitals in Lima Metropolitana and Callao. Information on vaccination was obtained through consultations with parents and review of health service reports. Individual variables of the newborns and their mothers were obtained from the medical records of the newborns. Institutional data were collected from immediate care records and from health personnel responsible for the immunization program. Results. The study was conducted in 10 health facilities, including 777 newborns. In the multilevel analysis, the longest care time in the vaccination service was favorable for vaccination within 12 hours of life (PR: 1,0; 95% CI: 0,9995-1,01); while for vaccination within 24 hours of life was favorable the greater number of nursing personnel (RP: 1,02; IC95%: 1,01-1,03) and unfavorable the greater number of deliveries per day in the institution (RP:0,99; IC95%: 0,99-0,997). No individual factors related to vaccination were identified. Conclusions. Institutional factors, such as length of care, number of nursing staff, and number of deliveries, were associated with newborn HBV vaccination. Improvement strategies are required, such as the introduction of vaccination in the immediate care of the newborn for the prevention of perinatal transmission of HBV.
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One of the biggest challenges during the pandemic has been obtaining and maintaining critical material to conduct the increasing demand for molecular tests. Sometimes, the lack of suppliers and the global shortage of these reagents, a consequence of the high demand, make it difficult to detect and diagnose patients with suspected SARS-CoV-2 infection, negatively impacting the control of virus spread. Many alternatives have enabled the continuous processing of samples and have presented a decrease in time and cost. These measures thus allow broad testing of the population and should be ideal for controlling the disease. In this sense, we compared the SARS-CoV-2 molecular detection effectiveness by Real time RT-PCR using two different protocols for RNA extraction. The experiments were conducted in the National Institute of Health (INS) from Peru. We compared Ct values average (experimental triplicate) results from two different targets, a viral and internal control. All samples were extracted in parallel using a commercial kit and our alternative protocol-samples submitted to proteinase K treatment (3 µg/µL, 56°C for 10 minutes) followed by thermal shock (98°C for 5 minutes followed by 4°C for 2 minutes); the agreement between results was 100% in the samples tested. In addition, we compared the COVID-19 positivity between six epidemiological weeks: the initial two in that the Real time RT-PCR reactions were conducted using RNA extracted by commercial kit, followed by two other using RNA obtained by our kit-free method, and the last two using kit once again; they did not differ significantly. We concluded that our in-house method is an easy, fast, and cost-effective alternative method for extracting RNA and conducing molecular diagnosis of COVID-19.