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Primary health care is at the core of health systems that aim to ensure equitable health outcomes. With an estimated 36% of rural population, Ecuador has a service year programme (created in 1970) for recently graduated doctors to provide primary care services in rural and remote communities. However, little has been done to monitor or evaluate the programme since its inception. The aim of this study was to assess Ecuador's rural medical service implementation with a focus on equitable distribution of doctors across the country. For this purpose, we analysed the distribution of all doctors, including rural service doctors, in health-care facilities across rural and remote areas of Ecuador in the public sector at the canton level for 2015 and 2019, by level of care (primary, secondary and tertiary). We used publicly available data from the Ministry of Public Health, the Ecuadorian Institute of Social Security and the Peasant Social Security. Our analyses show that two of every three rural service doctors are concentrated at the secondary level, while almost one in five rural service doctors, at the tertiary level. Moreover, cantons concentrating most rural service doctors were in the country's major urban centres (Quito, Guayaquil, Cuenca). To our knowledge, this is the first quantitative assessment of the mandatory rural service year in Ecuador in its five-decade existence. We provide evidence of gaps and inequities impacting rural communities and present decision makers with a methodology for placement, monitoring and support of the rural service doctors programme, provided that legal and programmatic reforms come into place. Changing the programme's approach would be more likely to fulfill the intended goals of rural service and contribute to strengthening primary health care.
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Servicios de Salud Rural , Población Rural , Humanos , EcuadorRESUMEN
Introduction: In Ecuador, poisonous snakebites are a public health problem. However, there is no recent hospital information from the Amazon. Objective: To retrospectively analyse the clinical-epidemiological characteristics of snakebites in patients admitted to a hospital in the Ecuadorian Amazon. Materials and methods: This is a cross-sectional study conducted at the Nueva Loja-Sucumbíos Provincial Hospital, bordering Colombia (2017-2021). Demographic, epidemiological and clinical variables, and condition at hospital discharge, were obtained from the epidemiological file of the Ministerio de Salud Pública. Results: In 5 years, 147 patients (29.4 per year) were hospitalized with no mortality. They corresponded to 26, 34, 32, 29 and 26 cases, in 2017, 2018, 2019, 2020 and 2021, respectively. Men with 99 (67.3%), aged 21-30 years with 28, mixed race with 94 cases, students, and farmers, were the most affected. The most affected (99; 67.3%) were men, people 21 to 30 years-old (28; 19.0%), mestizos (94; 63.9%), students, and farmers. The median age was 28 (range: 4-81) years. Prevalence was higher in April, June, and September. All accidents were caused by Viperidae snakes. Twenty (13.6%) cases were mild, (61.2%) were moderate and 37 (25.2%) were severe. The feet with 45 were the most bitten. Pre-hospitalization anti-venom serum was received by 53.1% and tourniquet by 19.8% patients. Median hospital arrival time was 5 (range 1-192) hours, mostly between 2-3 hours with 41 cases. No statistically significant differences were found considering the severity. Conclusions: A high prevalence of snakebites was evidenced in the north of the Amazon in Ecuador, with a higher incidence in the rainy season and all by Viperidae species. It is important to highlight the null mortality. Information campaigns on prevention and first aid, such as discouraging the use of tourniquets, especially among vulnerable groups.
Introducción. En Ecuador, las mordeduras de serpientes venenosas son un problema de salud pública. Sin embargo, no existe información hospitalaria reciente desde la Amazonía. Objetivo. Analizar retrospectivamente las características clínico-epidemiológicas de las mordeduras de serpientes en pacientes ingresados en un hospital de la Amazonía del Ecuador. Materiales y métodos. Se llevó a cabo un estudio transversal en el hospital provincial de Nueva Loja (Sucumbíos), que colinda con Colombia, 2017-2021. La información sobre las variables demográficas, epidemiológicas y clínicas, y la condición al egreso hospitalario, se obtuvieron de la ficha epidemiológica del Ministerio de Salud Pública. Resultados. En cinco años se hospitalizaron 147 pacientes (29,4 por año), sin que se presentaran muertes. Corresponden a 26, 34, 32, 29 y 26 casos, en el 2017, 2018, 2019, 2020 y 2021, respectivamente. Según el sexo, los más afectados fueron los hombres (n=99; 67,3 %), según el grupo etario, los de 21 a 30 años (n=28; 19,0 %) y, según la raza, los de etnia mestiza (n=94; 63,9 %), estudiantes y agricultores. La mediana de edad fue de 28 años (rango: 4 a 81). Hubo mayor prevalencia en abril, junio y septiembre. Todos los accidentes fueron causados por serpientes Viperidae. Veinte (13,6 %) casos fueron leves, 90 (61,2 %), moderados, y 37 (25,2 %), graves. La mordedura fue más frecuente en los pies (45 casos). El 53,1 % recibió suero antiofídico antes de la hospitalización y en el 19,8 % de los pacientes se colocó un torniquete. La mediana de tiempo de llegada al hospital fue de 5 horas (rango: 1-192), y lo más frecuente fue entre 2 y 3 horas (41 casos). No se encontraron diferencias estadísticamente significativas según la gravedad del caso. Conclusiones. Se evidenció una gran prevalencia de mordeduras de serpientes en el norte de la región amazónica-Ecuador, con mayor incidencia en la estación lluviosa y todas causadas por Viperidae. Es importante resaltar la mortalidad nula. Las campañas informativas sobre prevención y primeros auxilios, como la desmotivación del uso de torniquetes, serían fundamentales para reducir los casos, especialmente, en los grupos vulnerables.
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Hospitales , Ecuador , Colombia , Estudios RetrospectivosRESUMEN
The location of Ecuador-an equatorial nation-favors the multiplication and dispersal of the Leptospira genus both on the Pacific Coast and in the Amazon tropical ecoregions. Nevertheless, leptospirosis epidemiology has not been fully addressed, even though the disease has been recognized as a significant public health problem in the country. The purpose of this literature review is to update knowledge on the epidemiology and geographical distribution of Leptospira spp. and leptospirosis in Ecuador to target future research and develop a national control strategy. A retrospective literature search using five international, regional, and national databases on Leptospira and leptospirosis including humans, animals, and environmental isolations of the bacteria and the disease incidence in Ecuador published between 1919 and 2022 (103 years) with no restriction on language or publication date was performed. We found and analyzed 47 publications including 22 of humans, 19 of animals, and two of the environments; three of these covered more than one of these topics, and one covered all three (i.e., One Health). Most (60%) of the studies were conducted in the Coastal ecoregion. Twenty-four (51%) were published in international journals, and 27 (57%) were in Spanish. A total of 7342 human and 6314 other animal cases were studied. Leptospirosis was a frequent cause of acute undifferentiated febrile illness in the Coast and Amazon and was associated with rainfall. All three major clusters of Leptospira-pathogenic, intermediate, and saprophytic-were identified from both healthy and febrile humans, the environment, and animals; moreover, nine species and 29 serovars were recorded over the three Ecuadorian ecoregions. Leptospira infections were diagnosed in livestock, companion, and wild animals from the Amazon and the Coast regions along with sea lions from the Galápagos Islands. Microscopic-agglutination test was the diagnostic tool most widely used. Three reviews covering national data on outpatients and inpatients determined the varied annual incidence and mortality rate, with males being more commonly affected. No human cases have been reported in the Galápagos Islands. Genomic sequences of three pathogenic Leptospira were reported. No studies on clinical ground, antibiotic resistance, or treatment were reported, nor were control programs or clinical-practice guidelines found. The published literature demonstrated that leptospirosis was and still is an endemic disease with active transmission in the four geoclimatic regions of Ecuador including the Galápagos Islands. Animal infections, distributed in mainland and insular Ecuador, pose a significant health risk for humans. Nationwide epidemiological surveys-encouraging more research on the fauna and environment with appropriate sampling design on risk factors for human and animal leptospirosis, Leptospira genotyping, increased laboratory capability, and readily available official data-are required to improve our understanding of transmission patterns and to develop effective national intervention strategies with the intention of applying One Health approaches.
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Introducción. En Ecuador, las mordeduras de serpientes venenosas son un problema de salud pública. Sin embargo, no existe información hospitalaria reciente desde la Amazonía. Objetivo. Analizar retrospectivamente las características clínico-epidemiológicas de las mordeduras de serpientes en pacientes ingresados en un hospital de la Amazonía del Ecuador. Materiales y métodos. Se llevó a cabo un estudio transversal en el hospital provincial de Nueva Loja (Sucumbíos), que colinda con Colombia, 2017-2021. La información sobre las variables demográficas, epidemiológicas y clínicas, y la condición al egreso hospitalario, se obtuvieron de la ficha epidemiológica del Ministerio de Salud Pública. Resultados. En cinco años se hospitalizaron 147 pacientes (29,4 por año), sin que se presentaran muertes. Corresponden a 26, 34, 32, 29 y 26 casos, en el 2017, 2018, 2019, 2020 y 2021, respectivamente. Según el sexo, los más afectados fueron los hombres (n=99; 67,3 %), según el grupo etario, los de 21 a 30 años (n=28; 19,0 %) y, según la raza, los de etnia mestiza (n=94; 63,9 %), estudiantes y agricultores. La mediana de edad fue de 28 años (rango: 4 a 81). Hubo mayor prevalencia en abril, junio y septiembre. Todos los accidentes fueron causados por serpientes Viperidae. Veinte (13,6 %) casos fueron leves, 90 (61,2 %), moderados, y 37 (25,2 %), graves. La mordedura fue más frecuente en los pies (45 casos). El 53,1 % recibió suero antiofídico antes de la hospitalización y en el 19,8 % de los pacientes se colocó un torniquete. La mediana de tiempo de llegada al hospital fue de 5 horas (rango: 1-192), y lo más frecuente fue entre 2 y 3 horas (41 casos). No se encontraron diferencias estadísticamente significativas según la gravedad del caso. Conclusiones. Se evidenció una gran prevalencia de mordeduras de serpientes en el norte de la región amazónica-Ecuador, con mayor incidencia en la estación lluviosa y todas causadas por Viperidae. Es importante resaltar la mortalidad nula. Las campañas informativas sobre prevención y primeros auxilios, como la desmotivación del uso de torniquetes, serían fundamentales para reducir los casos, especialmente, en los grupos vulnerables.
Introduction: In Ecuador, poisonous snakebites are a public health problem. However, there is no recent hospital information from the Amazon. Objective: To retrospectively analyse the clinical-epidemiological characteristics of snakebites in patients admitted to a hospital in the Ecuadorian Amazon. Materials and methods: This is a cross-sectional study conducted at the Nueva Loja-Sucumbíos Provincial Hospital, bordering Colombia (2017-2021). Demographic, epidemiological and clinical variables, and condition at hospital discharge, were obtained from the epidemiological file of the Ministerio de Salud Pública. Results: In 5 years, 147 patients (29.4 per year) were hospitalized with no mortality. They corresponded to 26, 34, 32, 29 and 26 cases, in 2017, 2018, 2019, 2020 and 2021, respectively. Men with 99 (67.3%), aged 21-30 years with 28, mixed race with 94 cases, students, and farmers, were the most affected. The most affected (99; 67.3%) were men, people 21 to 30 years-old (28; 19.0%), mestizos (94; 63.9%), students, and farmers. The median age was 28 (range: 4-81) years. Prevalence was higher in April, June, and September. All accidents were caused by Viperidae snakes. Twenty (13.6%) cases were mild, (61.2%) were moderate and 37 (25.2%) were severe. The feet with 45 were the most bitten. Pre-hospitalization anti-venom serum was received by 53.1% and tourniquet by 19.8% patients. Median hospital arrival time was 5 (range 1-192) hours, mostly between 2-3 hours with 41 cases. No statistically significant differences were found considering the severity. Conclusions: A high prevalence of snakebites was evidenced in the north of the Amazon in Ecuador, with a higher incidence in the rainy season and all by Viperidae species. It is important to highlight the null mortality. Information campaigns on prevention and first aid, such as discouraging the use of tourniquets, especially among vulnerable groups.
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Mordeduras de Serpientes/epidemiología , Ecosistema Amazónico , Ecuador , Animales PonzoñososRESUMEN
Introduction: Stroke is the second most common cause of death and disability-adjusted life years (DALYs) globally. However, the incidence and impact of stroke by ethnicity and gender is frequently distinct. This is particularly the case in Ecuador where geographic and economic marginalization are often correlated with ethnic marginalization and the extent to which females lack the same opportunities as their male counterparts. The aim of this paper is to investigate the differential impacts in terms of stroke diagnosis and burden of disease by ethnicity and gender, using hospital discharge records over the years 2015-2020. Methods: This paper calculates stroke incidence, and fatality rates using hospital discharge and death records over the years 2015-2020. The DALY package in R was employed to calculate the Disability Adjusted Life Years lost due to stroke in Ecuador. Results: The results show that while the incidence rate of stroke in males (64.96 per 100,000 persons-year) is higher than that for females on average (57.84 per 100,000 persons-year), males accounted for 52.41% of all stroke cases and 53% of all surviving cases. Thus, hospital data suggests that females had a higher death rate when compared to males. Case fatality rates also differed significantly by ethnicity. The highest fatality rate corresponded to the Montubio ethnic group (87.65%), followed by Afrodescendants (67.21%). The estimated burden of disease of stroke calculated using Ecuadorian hospital records (2015-2020) varied from 1,468 to 2,991 DALY per 1,000 population on average. Discussion: Differences in the burden of disease by ethnic group are likely to reflect differential access to care by region and socio-economic group, both of which are frequently correlated with ethnic composition in Ecuador. Equitable access to health services remains an important challenge in the country. The gender discrepancy in fatality rates suggests that there is a need for targeted educational campaigns to identify stroke signs early, especially in the female population.
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Purpose: Extended-spectrum beta-lactamase-producing (ESBL) Enterobacteriaceae, which includes Escherichia coli, has emerged as a global health threat. ESBL enzymes including CTX-M, TEM, and SHV are the most detected. Here, a systematic review was developed to assess the status of ESBLs in E. coli considering studies performed in the human, animal, food, and environmental realms in South America. Methods: Following PRISMA guidelines, a systematic review was performed using the PubMed database as a primary source to identify studies containing data on ESBL-producing E. coli in South America. To obtain a comprehensive sample, studies in English, Spanish, and Portuguese were included from 1990 to April 2021. Inclusion such as the reporting of sample origin and diagnostic method and exclusion criteria such as review/letter articles were established to complete data extraction steps. Results: Amongst 506 articles retrieved, 130 met the inclusion criteria. Brazil reported 65 (50%) of publications, followed by Argentina, and Ecuador with 11.5% each. According to the category of studies, human studies represented the 56%, animals the 20%, environmental the 11%, and food studies the 6%. Interestingly, studies assessing more than one category (ie, interdisciplinary) represented the 7%. Prevalence of ESBL producing E. coli in animal, food, and environmental studies was widely superior compared to human sources. In clinical studies, Brazil presented the greatest diversity in terms of ESBLs, featuring CTX-M, TEM, SHV, TOHO, OXA, and AmpC. CTX-M enzymes were the most frequent variants with 89.4% detections. Conclusion: The present One Health review of 130 studies conducted over the past 21 years found ESBLs producing E. coli distributed across human, animal, food, and environmental samples across South America. There is a need to increment studies in underrepresented countries and to strengthen multi-sectoral antimicrobial resistance research and surveillance. This information can be used as basis for subsequent implementation of monitoring programs, targeting potential critical points of transmission sources.
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BACKGROUND: In Ecuador, leptospirosis surveillance involves a mandatory notification of all cases and a hospitalization for severe illness. Morbidity and mortality are, nevertheless, underestimated and contribute directly to the status of leptospirosis as a neglected disease. Leptospira spp. is zoonotic in Ecuador with established endemic transmission in the Tropics. Here, we review retrospective national data within the country to aid in control strategies. METHODOLOGY/PRINCIPAL FINDINGS: In a population-based nationwide study, we analysed morbidity, mortality, and spatial distribution on confirmed hospital-discharged leptospirosis cases from 2000-2020 from a publicly accesible National Database, including males and females of all ages. We computed data for the 24 provinces across the four-geoclimatic regions of Ecuador based on seasonal and monthly variations and calculated rates according to age and sex. The spatial distribution was estimated at the level of ecoregions, provinces, and cantons. A total of 2,584 hospitalizations were recorded over all three continental regions in 22 provinces, except Carchi province and the Galapagos Islands. The annual incidence varied from 0.27 to 2.45 cases per 100,000 inhabitants with ages ranging from 1 to 98 years-old and an overall male/female ratio of 1.92:1. Most hospitalizations and deaths occurred in males ages 25-34 years. We registered 79 fatalities (3.06%); the highest mortality rate was 0.05 per 100,000 inhabitants. More cases clustered in the tropical cantons of central and north of the Coast and in the southern Amazon when compared to the Andes. CONCLUSIONS AND SIGNIFICANCE: Our findings evidence leptospirosis endemicity and pinpoint the highest incidence within resource-poor tropical settings. The highest incidence occurred in males of adult age, with those also exhibiting the highest mortality. The national incidence rate was stable, but peaks occurred intermittently during the rainy seasons. Thus, strategies aimed at leptospirosis monitoring and control involving the application of preventive measures should consider this season and the aforementioned high-risk groups.
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Leptospirosis , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Ecuador/epidemiología , Femenino , Hospitalización , Humanos , Incidencia , Lactante , Leptospirosis/epidemiología , Masculino , Persona de Mediana Edad , Morbilidad , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: Estimates of the geographical distribution of Culex mosquitoes in the Americas have been limited to state and provincial levels in the United States and Canada and based on data from the 1980s. Since these estimates were made, there have been many more documented observations of mosquitoes and new methods have been developed for species distribution modeling. Moreover, mosquito distributions are affected by environmental conditions, which have changed since the 1980s. This calls for updated estimates of these distributions to understand the risk of emerging and re-emerging mosquito-borne diseases. METHODS: We used contemporary mosquito data, environmental drivers, and a machine learning ecological niche model to create updated estimates of the geographical range of seven predominant Culex species across North America and South America: Culex erraticus, Culex nigripalpus, Culex pipiens, Culex quinquefasciatus, Culex restuans, Culex salinarius, and Culex tarsalis. RESULTS: We found that Culex mosquito species differ in their geographical range. Each Culex species is sensitive to both natural and human-influenced environmental factors, especially climate and land cover type. Some prefer urban environments instead of rural ones, and some are limited to tropical or humid areas. Many are found throughout the Central Plains of the USA. CONCLUSIONS: Our updated contemporary Culex distribution maps may be used to assess mosquito-borne disease risk. It is critical to understand the current geographical distributions of these important disease vectors and the key environmental predictors structuring their distributions not only to assess current risk, but also to understand how they will respond to climate change. Since the environmental predictors structuring the geographical distribution of mosquito species varied, we hypothesize that each species may have a different response to climate change.
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Distribución Animal , Culex/fisiología , Mosquitos Vectores/fisiología , Américas , Animales , Cambio Climático , Culex/clasificación , Culex/parasitología , Culex/virología , Humanos , Aprendizaje Automático , Mosquitos Vectores/clasificación , Mosquitos Vectores/parasitología , Mosquitos Vectores/virología , América del Norte , América del SurRESUMEN
The World Health Organization (WHO) declared coronavirus disease-2019 (COVID-19) a global pandemic on 11 March 2020. In Ecuador, the first case of COVID-19 was recorded on 29 February 2020. Despite efforts to control its spread, SARS-CoV-2 overran the Ecuadorian public health system, which became one of the most affected in Latin America on 24 April 2020. The Hospital General del Sur de Quito (HGSQ) had to transition from a general to a specific COVID-19 health center in a short period of time to fulfill the health demand from patients with respiratory afflictions. Here, we summarized the implementations applied in the HGSQ to become a COVID-19 exclusive hospital, including the rearrangement of hospital rooms and a triage strategy based on a severity score calculated through an artificial intelligence (AI)-assisted chest computed tomography (CT). Moreover, we present clinical, epidemiological, and laboratory data from 75 laboratory tested COVID-19 patients, which represent the first outbreak of Quito city. The majority of patients were male with a median age of 50 years. We found differences in laboratory parameters between intensive care unit (ICU) and non-ICU cases considering C-reactive protein, lactate dehydrogenase, and lymphocytes. Sensitivity and specificity of the AI-assisted chest CT were 21.4% and 66.7%, respectively, when considering a score >70%; regardless, this system became a cornerstone of hospital triage due to the lack of RT-PCR testing and timely results. If health workers act as vectors of SARS-CoV-2 at their domiciles, they can seed outbreaks that might put 1,879,047 people at risk of infection within 15 km around the hospital. Despite our limited sample size, the information presented can be used as a local example that might aid future responses in low and middle-income countries facing respiratory transmitted epidemics.
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COVID-19/diagnóstico por imagen , COVID-19/epidemiología , Hospitales Especializados/organización & administración , Hospitales Especializados/tendencias , Pandemias/prevención & control , SARS-CoV-2/genética , Triaje/métodos , Adulto , Anciano , Inteligencia Artificial , COVID-19/prevención & control , COVID-19/virología , Prueba de Ácido Nucleico para COVID-19 , Ecuador/epidemiología , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Radiografías Pulmonares Masivas/métodos , Persona de Mediana Edad , Reacción en Cadena en Tiempo Real de la Polimerasa , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Factores de Riesgo , Tomografía Computarizada por Rayos X/métodosRESUMEN
Amphimerus sp. is a fluke that dwells in the biliary tracts of vertebrate definitive hosts including humans, domestic, and wild mammals in Latin America. Opisthorchiid liver infections are rarely studied in the Americas confirming its status as a neglected tropical disease. In Ecuador, small trematode eggs were reported in human cases from the province of Manabí in 1949, and recently, Amphimerus sp. adults were recovered from human and reservoir hosts in the province of Esmeraldas. Due to the lack of research on the infectious sources of Amphimerus sp. in the continent, we have developed a series of epidemiological studies with parasitological and molecular techniques to elucidate the endemicity of opisthorchiid fluke infections. We developed a cross-sectional study in three communities at Pedro Pablo Gómez parish in the province of Manabí, Ecuador. We examined a total of 176 fecal samples to detect opisthorchiid eggs, and four fish species to find opisthorchiid metacercariae. To study adult worms, we treated and purged seven patients in a family and dissected the livers of a dog and a cat infected. We observed morphological features of adults and metacercariae and used polymerase chain reaction with restricted fragment length polymorphism (PCR-RFLP) and DNA sequencing of a section of the ITS2 gene for identification. Small trematode eggs were detected in 63 (35.8%) out of 176 fecal samples of residents in the three study sites. Adult opisthorchiid flukes were recovered from human patients, a dog and a cat, and they were morphologically and molecularly identified as Amphimerus sp. Opisthorchiid metacercariae were also identified molecularly as Amphimerus sp. in four fish species, i.e., Rhoadsia altipinna, Bryconamericus bucay, Andinoacara rivulatus, and Piabucina aureoguttata. Metacercariae of the heterophyid Haplorchis pumilio were also found in the four fish species examined. This is the first study to confirm the current endemicity of Amphimerus sp. in Pedro Pablo Gómez, Manabí, Ecuador. The adult worms isolated here shared morphological characteristics with previous Amphimerus sp. descriptions and were molecularly similar to Amphimerus sp. described in the province of Esmeraldas. Moreover, this study is the first to document four fish species as infection sources of Amphimerus sp. detected via a molecular protocol targeting the metacercariae of the parasite. Fish species identified here should be targeted for public health campaigns to avoid further human liver-fluke infections by Amphimerus sp. or potential intestinal-fluke infections by H. pumilio or others.
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Enfermedades de los Peces/epidemiología , Parasitosis Hepáticas/veterinaria , Opisthorchidae/aislamiento & purificación , Infecciones por Trematodos/veterinaria , Zoonosis/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Gatos , Niño , Preescolar , Estudios Transversales , Perros , Ecuador/epidemiología , Heces/parasitología , Femenino , Peces , Humanos , Lactante , Parasitosis Hepáticas/epidemiología , Masculino , Persona de Mediana Edad , Infecciones por Trematodos/epidemiología , Adulto Joven , Zoonosis/parasitologíaRESUMEN
BACKGROUND: Dengue fever is a mosquito-borne infection transmitted by Aedes aegypti and mainly found in tropical and subtropical regions worldwide. Since its re-introduction in 1986, Brazil has become a hotspot for dengue and has experienced yearly epidemics. As a notifiable infectious disease, Brazil uses a passive epidemiological surveillance system to collect and report cases; however, dengue burden is underestimated. Thus, Internet data streams may complement surveillance activities by providing real-time information in the face of reporting lags. METHODS: We analyzed 19 terms related to dengue using Google Health Trends (GHT), a free-Internet data-source, and compared it with weekly dengue incidence between 2011 to 2016. We correlated GHT data with dengue incidence at the national and state-level for Brazil while using the adjusted R squared statistic as primary outcome measure (0/1). We used survey data on Internet access and variables from the official census of 2010 to identify where GHT could be useful in tracking dengue dynamics. Finally, we used a standardized volatility index on dengue incidence and developed models with different variables with the same objective. RESULTS: From the 19 terms explored with GHT, only seven were able to consistently track dengue. From the 27 states, only 12 reported an adjusted R squared higher than 0.8; these states were distributed mainly in the Northeast, Southeast, and South of Brazil. The usefulness of GHT was explained by the logarithm of the number of Internet users in the last 3 months, the total population per state, and the standardized volatility index. CONCLUSIONS: The potential contribution of GHT in complementing traditional established surveillance strategies should be analyzed in the context of geographical resolutions smaller than countries. For Brazil, GHT implementation should be analyzed in a case-by-case basis. State variables including total population, Internet usage in the last 3 months, and the standardized volatility index could serve as indicators determining when GHT could complement dengue state level surveillance in other countries.
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Dengue/epidemiología , Motor de Búsqueda/tendencias , Aedes , Animales , Brasil/epidemiología , Epidemias , Humanos , IncidenciaRESUMEN
BACKGROUND: Recently, a high prevalence of infection by the liver fluke Amphimerus spp. has been documented in the Chachi Amerindians of Ecuador. For diagnosis, no studies exist that compare the sensitivity of different coproparasitological detection techniques. The present study compares the Kato-Katz technique with three other coproparasitological methods for detecting eggs of Amphimerus in stools, as well as determines the prevalence of infection in Chachi residents in a Tropical rain forest area in the northwest coast of Ecuador. METHODOLOGY/RESULTS: A total of 105 samples, utilizing the Kato-Katz technique (KK), the spontaneous sedimentation technique in tube (SSTT), the formalin-ether concentration technique (FEC), and direct smear microscopy (DM), were examined. Combining the four methods (fixed "gold" standard), 38 samples were positive with a prevalence of infection of 36.2%. The sensitivities of individual methods were 71%, 58%, 50% and 3% for KK, SSTT, FEC, and DM respectively. Our results indicated that KK alone had the best performance, detecting 27 (71%) of the 38 positive samples. The combination of KK and SSTT detected amphimeriasis in 36 (95%) samples, and KK and FEC in 31 (82%) samples. CONCLUSIONS: DM showed the lowest sensitivity, which raises concern for its value, because it is the standard technique for stool examination for detection of parasites in both public and private laboratories in Ecuador. SSTT alone detected eggs in 22 samples (58%) and would be recommended for field studies because of its simplicity. Performing two techniques on a single sample enhances the detection of Amphimerus infection. Its sensitivity is relative to a fixed "gold" standard, determined as the combined results of the four techniques performed. This study confirms the high prevalence of human infection by Amphimerus in the indigenous Chachi group where the first human cases were described.
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Opisthorchidae/aislamiento & purificación , Recuento de Huevos de Parásitos/métodos , Infecciones por Trematodos/diagnóstico , Infecciones por Trematodos/epidemiología , Adolescente , Adulto , Animales , Niño , Preescolar , Estudios Transversales , Ecuador/etnología , Heces/parasitología , Femenino , Humanos , Lactante , Masculino , Sensibilidad y Especificidad , Adulto JovenRESUMEN
BACKGROUND: Hantavirus pulmonary syndrome (HPS) is an infection endemic in Chile and Argentina, caused by Andes hantavirus (ANDV). The rodent Oligoryzomys longicaudatus is suggested as the main reservoir, although several other species of Sigmodontinae are known hosts of ANDV. Here, we explore potential ANDV transmission risk to humans in southern South America, based on eco-epidemiological associations among: six rodent host species, seropositive rodents, and human HPS cases. METHODS: We used ecological niche modeling and macroecological approaches to determine potential geographic distributions and assess environmental similarity among rodents and human HPS cases. RESULTS: Highest numbers of rodent species (five) were in Chile between 35° and 41°S latitude. Background similarity tests showed niche similarity in 14 of the 56 possible comparisons: similarity between human HPS cases and the background of all species and seropositive rodents was supported (except for Abrothrix sanborni). Of interest among the results is the likely role of O. longicaudatus, Loxodontomys micropus, Abrothrix olivaceus, and Abrothrix longipilis in HPS transmission to humans. CONCLUSIONS: Our results support a role of rodent species' distributions as a risk factor for human HPS at coarse scales, and suggest that the role of the main reservoir (O. longicaudatus) may be supported by the broader rodent host community in some areas.
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Reservorios de Enfermedades/virología , Ecosistema , Infecciones por Hantavirus/epidemiología , Orthohantavirus/aislamiento & purificación , Animales , Argentina/epidemiología , Chile/epidemiología , Infecciones por Hantavirus/diagnóstico , Infecciones por Hantavirus/transmisión , Humanos , Sigmodontinae/virologíaRESUMEN
To determine that Paragonimus sp. is actively transmitted in a tropical area of the Pacific region of Ecuador where human cases of pulmonary paragonimiasis have recently been documented, a total of 75 freshwater crabs were collected from 2 different streams in the Pedernales area of Manabí Province, Ecuador. All collected crabs were identified as Hypolobocera guayaquilensis based on morphological characteristics of the male gonopods. The hepatopancreas of each crab was examined by compressing it between 2 glass plates followed by observation under a stereomicroscope. Excysted Paragonimus metacercariae were detected in 39 (52.0%) crabs and their densities varied from 1 to 32 per infected crab. There was a positive relationship between crab size and metacercarial density. Sequences of the second internal transcribed spacer region of the ribosomal RNA gene of the Paragonimus metacercariae obtained in this study were identical to those of Paragonimus mexicanus deposited in the DDBJ/EMBL/GenBank database. Thus, the present study is the first to confirm that the crab species H. guayaquilensis is the second intermediate host of P. mexicanus in Manabí Province, Ecuador. Because this crab might be the possible source of human infections in this area, residents should pay attention to improper crab-eating habits related with a neglected parasitic disease, i.e., paragonimiasis.
Asunto(s)
Decápodos/parasitología , Enfermedades Transmitidas por los Alimentos/parasitología , Interacciones Huésped-Parásitos , Paragonimiasis/parasitología , Paragonimus/aislamiento & purificación , Animales , Ecuador/epidemiología , Femenino , Enfermedades Transmitidas por los Alimentos/prevención & control , Humanos , Masculino , Metacercarias/aislamiento & purificación , Paragonimiasis/epidemiología , Paragonimiasis/prevención & controlRESUMEN
Scorpion envenoming by species in the genus Tityus is hereby reported from rural locations in the Amazonian province of Morona Santiago, southeastern Ecuador. Twenty envenoming cases (18 patients under 15 years of age) including one death (a 4-year-old male) were recorded at the Macas General Hospital, Morona Santiago, between January 2015 and December 2016 from the counties of Taisha (n=17), Huamboyo (n=1), Palora (n=1), and Logroño (n=1). An additional fatality from 2014 (a 3-year-old female from Nayantza, Taisha county) is also reported. Leukocytosis and low serum potassium levels were detected in most patients. We observed a significant negative correlation between leukocytosis and hypokalemia. Scorpions involved in three accidents from Macuma, Taisha County, were identified as genetically related to Tityus obscurus from the Brazilian Amazonian region based on comparison of mitochondrial DNA sequences encoding cytochrome oxidase subunit I. These cases, along with previously reported envenoming from northern Manabí, reinforce the notion that scorpionism is a health hazard for children in Ecuador and emphasizes the need to supply effective antivenoms against local species, which are not currently available. The genetic affinity of the Ecuadorian specimens with T. obscurus may underlay toxinological, clinical, and venom antigenic relationships among Amazonian scorpions that deserves further exploration for designing therapeutic strategies to treat scorpionism in the region.
Asunto(s)
Picaduras de Escorpión/epidemiología , Venenos de Escorpión/química , Venenos de Escorpión/genética , Escorpiones/clasificación , Escorpiones/genética , Adolescente , Adulto , Animales , Niño , Preescolar , ADN Mitocondrial , Ecuador/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Filogenia , Adulto JovenRESUMEN
Oropouche virus is the aetiological agent of Oropouche fever, a zoonotic disease mainly transmitted by midges of the species Culicoides paraensis. Although the virus was discovered in 1955, more attention has been given recently to both the virus and the disease due to outbreaks of Oropouche fever in different areas of Brazil and Peru. Serological studies in human and wild mammals have also found Oropouche virus in Argentina, Bolivia, Colombia, and Ecuador. Several mammals act as reservoirs of the disease, although the sylvatic cycle of Oropouche virus remains to be assessed properly. Oropouche fever lacks key symptoms to be differentiated from other arboviral febrile illnesses from the Americas. Sporadic cases of aseptic meningitis have also been described with good prognosis. Habitat loss can increase the likelihood of Oropouche virus emergence in the short-term in South America.
Asunto(s)
Arbovirus/fisiología , Infecciones por Bunyaviridae/epidemiología , Enfermedades Transmisibles Emergentes/epidemiología , Brotes de Enfermedades , Orthobunyavirus/fisiología , Animales , Infecciones por Bunyaviridae/diagnóstico , Infecciones por Bunyaviridae/fisiopatología , Infecciones por Bunyaviridae/transmisión , Ceratopogonidae/virología , Enfermedades Transmisibles Emergentes/diagnóstico , Enfermedades Transmisibles Emergentes/fisiopatología , Enfermedades Transmisibles Emergentes/transmisión , Humanos , Insectos Vectores/virología , América del Sur/epidemiología , Zoonosis/diagnóstico , Zoonosis/epidemiología , Zoonosis/fisiopatología , Zoonosis/transmisiónRESUMEN
This manuscript presents the concept of "surveillance fatigue" (fatigatio vigilantiae), to describe an epidemiological scenario of an evident underreporting of cases during overwhelming epidemics. We revised past epidemics and found that surveillance fatigue is a common pattern, thus, it may be a useful concept in modern epidemiology.
Asunto(s)
Epidemias , Monitoreo Epidemiológico , HumanosRESUMEN
OBJECTIVES: To describe a clinical case of Klebsiella pneumoniae harboring a New Delhi metallo-ß-lactamase (NDM) plasmid in Ecuador and to present a map of reports of NDM isolates in South America. METHODS: The modified Hodge test, carbapenem inactivation method, imipenem-EDTA disk method (synergy), and Rapidec Carba NP test were used to identify antibiotic resistance mechanisms. The presence of resistance genes was explored with a conjugation assay, and molecular confirmation of NDM was performed by PCR and DNA sequencing. Plasmid characterization was conducted by PCR-based replicon typing. A literature review was performed in Google Scholar and PubMed to identify reports from South America. RESULTS: An HIV-infected patient, who had never traveled abroad, developed a bloodstream infection caused by K. pneumoniae ST147 harboring the NDM-1 resistance gene in a plasmid from the IncA/C group. Local circulation of NDM has also been described in other South American countries, in particular in Colombia and Brazil, although published scientific records were not found for other countries. CONCLUSIONS: This report presents the first evidence of autochthonous circulation of the NDM-1 resistance gene harbored by an IncA/C plasmid isolated from a K. pneumoniae ST147 in Ecuador. Efforts should be implemented to monitor and characterize the spatial and temporal distribution of NDM in Ecuador and other countries of South America.
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Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/aislamiento & purificación , Factores R , beta-Lactamasas/genética , Adulto , Antibacterianos/farmacología , Carbapenémicos/farmacología , Ecuador , Humanos , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/enzimología , Masculino , Pruebas de Sensibilidad Microbiana , beta-Lactamasas/aislamiento & purificaciónRESUMEN
Ticks of the Amblyomma cajennense species complex are important vectors of spotted fever in Latin America. Environmental conditions determine the geographic distribution of ticks, such that climate change could influence the distribution of tick-borne diseases. This study aimed to analyze the potential geographic distribution of A. cajennense complex ticks in a Brazil region under present-day and future climate models, assuming dispersal limitations and non-evolutionary adaptation of these tick populations to climate warming. Records of A. cajennense sensu stricto (s.s.) and Amblyomma sculptum were analyzed. Niche models were calibrated using Maxent considering climate variables for 1950-2000 and projecting models to conditions anticipated for 2050 and 2070 under two models of future climate (CCSM4 and HadGEM2-AO). Broad suitable areas for A. cajennense s.s. and A. sculptum were found in present-day climate models, but suitability was reduced when models were projected to future conditions. Our exploration of future climates showed that broad areas had novel climates not existing currently in the study region, including novel extremely high temperatures. Indeed, predicted suitability in these novel conditions would lead to biologically unrealistic results and therefore incorrect forecasts of future tick-distribution. Previous studies anticipating expansions of vectors populations due to climate change should be considered with caution as they assume that model extrapolation anticipates that species would evolve rapidly for adaptation to novel climatic conditions.