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While the first 1,000 days of life are a critical period in child's development, limited information on the main determinants affecting this period in the Latin America and the Caribbean (LAC) region is available. Therefore, the Latin American Pediatric Infectious Diseases Society (SLIPE) held an ad hoc workshop in May 2022 with an expert panel designed to analyze the main factors impacting the development of childhood in the region during this period and the main causes of maternal infant morbimortality. The aim was to identify priorities, generate recommendations, and advise practical actions to improve this situation. Considerations were made about the challenges involved in bridging the gap that separates the region from more developed countries regarding an optimal early childhood and maternal care. Extensive discussion was conducted to reach consensus recommendations on general strategies intended to reduce maternal and infant mortality associated with infections and immune-preventable diseases during the first 1,000 days of life in LAC.
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Three Colombian patients with chronic HTLV-1 infection and severe intermediate and/or posterior uveitis are described. In one case, retinal ablation was necessary due to extensive peripheral degeneration, while the other two were successfully managed with local anti-inflammatory therapy. Gradual resolution of ocular findings was observed in all three patients on follow-up. Uveitis is a rarely recognized late complication of this infection, which represents a diagnostic and therapeutic challenge for clinicians in endemic countries. The real extension of HTLV-1 prevalence in Colombia and the frequency of its ophthalmologic complications remain to be determined.
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BACKGROUND: Malaria-endemic areas are not spared from the impact of coronavirus disease 2019 (COVID-19), leading to co-infection scenarios where overlapping symptoms impose serious diagnostic challenges. Current knowledge on Plasmodium spp. and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) co-infection in pregnant women remains limited, especially in Latin America, where Plasmodium vivax infection is highly prevalent. METHODS: This is a case series of five pregnant women with P. vivax and SARS-CoV-2 co-infection hospitalized in two main malaria referral centers of the Capital District and Bolivar state, Venezuela between March 13, 2020 and December 31, 2021. RESULTS: Clinical and laboratory data from five pregnant women with a mean age of 22 years were analyzed; three of them were in the third trimester of pregnancy. Comorbidities included obesity in two cases, hypertension in one, and asthma in one. Three out of five patients had severe to critical COVID-19 disease. Dry cough, fever, chills, and headache were the most frequent symptoms reported. Laboratory analyses showed elevated aspartate/alanine aminotransferase and creatinine levels, thrombocytopenia, and severe anemia as the most relevant abnormalities. The mean period between symptom onset and a positive molecular test for SARS-CoV-2 infection or positive microscopy for Plasmodium spp. was 4.8 ± 2.5 days and 2.8 ± 1.6 days, respectively. The mean hospital stay was 5.4 ± 7 days. Three women recovered and were discharged from the hospital. Two women died, one from cerebral malaria and one from respiratory failure. Three adverse fetal outcomes were registered, two miscarriages and one stillbirth. CONCLUSION: This study documented a predominance of severe/critical COVID-19 disease and a high proportion of adverse maternal-fetal outcomes among pregnant women with malaria and COVID-19 co-infection. More comprehensive prospective cohort studies are warranted to explore the risk factors, management challenges, and clinical outcomes of pregnant women with this co-infection.
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Aborto Espontâneo , COVID-19 , Coinfecção , Malária Vivax , Malária , Complicações Infecciosas na Gravidez , Feminino , Humanos , Gravidez , Adulto Jovem , Coinfecção/diagnóstico , Coinfecção/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , Malária Vivax/diagnóstico , Malária Vivax/epidemiologia , Plasmodium vivax , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Gestantes , Estudos Prospectivos , SARS-CoV-2 , Venezuela/epidemiologiaRESUMO
Ante el riesgo real de ocurrencia de brotes de parálisis fláccida aguda en la región debidos a poliovirus derivado de la vacuna Sabin o a la importación de poliovirus salvaje, la Sociedad Latinoamericana de Infectología Pediátrica comisionó a un grupo ad hoc de expertos integrantes del Comité de Vacunas y Biológicos de la institución, para redactar un documento oficial de posición sobre la necesidad imperiosa de incrementar los niveles de inmunización contra la enfermedad en la región e incorporar definitivamente en forma exclusiva la vacuna de polio inactivada en todos los esquemas nacionales de vacunación. La presente publicación discute las principales conclusiones y recomendaciones generadas como resultado de esta actividad.
Given the actual risk of poliomyelitis outbreaks in the region due to poliovirus derived from the Sabin vaccine or the importation of wild poliovirus, the Latin American Society of Pediatric Infectious Diseases commissioned an ad hoc group of experts from the institution's Vaccines and Biologicals Committee, to draft an official position paper on the urgent need to increase immunization levels against the disease in the region and incorporate inactivated polio vaccine exclusive schedules in all national immunization programs. This publication discusses the main conclusions and recommendations generated as a result of such activity.
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Humanos , Poliomielite/prevenção & controle , Vacina Antipólio de Vírus Inativado/administração & dosagem , Vacina Antipólio de Vírus Inativado/provisão & distribuição , Vacina Antipólio Oral/administração & dosagem , Vacina Antipólio Oral/provisão & distribuição , Paralisia/etiologia , Poliomielite/complicações , Poliomielite/epidemiologia , Poliovirus/imunologia , Cobertura Vacinal , Erradicação de Doenças , Monitoramento Epidemiológico , América LatinaRESUMO
Given the actual risk of poliomyelitis outbreaks in the region due to poliovirus derived from the Sabin vaccine or the importation of wild poliovirus, the Latin American Society of Pediatric Infectious Diseases commissioned an ad hoc group of experts from the institution's Vaccines and Biologicals Committee, to draft an official position paper on the urgent need to increase immunization levels against the disease in the region and incorporate inactivated polio vaccine exclusive schedules in all national immunization programs. This publication discusses the main conclusions and recommendations generated as a result of such activity.
Ante el riesgo real de ocurrencia de brotes de parálisis fláccida aguda en la región debidos a poliovirus derivado de la vacuna Sabin o a la importación de poliovirus salvaje, la Sociedad Latinoamericana de Infectología Pediátrica comisionó a un grupo ad hoc de expertos integrantes del Comité de Vacunas y Biológicos de la institución, para redactar un documento oficial de posición sobre la necesidad imperiosa de incrementar los niveles de inmunización contra la enfermedad en la región e incorporar definitivamente en forma exclusiva la vacuna de polio inactivada en todos los esquemas nacionales de vacunación. La presente publicación discute las principales conclusiones y recomendaciones generadas como resultado de esta actividad.
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Humanos , Poliomielite/prevenção & controle , Vacina Antipólio de Vírus Inativado/administração & dosagem , Vacina Antipólio de Vírus Inativado/provisão & distribuição , Vacina Antipólio Oral/administração & dosagem , Vacina Antipólio Oral/provisão & distribuição , Paralisia/etiologia , Poliomielite/complicações , Poliomielite/epidemiologia , Poliovirus/imunologia , Cobertura Vacinal , Erradicação de Doenças , Monitoramento Epidemiológico , América LatinaRESUMO
INTRODUCTION: The 1st Regional Experts on Infant Vaccination (REIV) meeting generated updated consensus recommendations to improve the control of various major vaccine preventable diseases (VPD) in Latin America. AREAS COVERED: Workshops highlighted recent changes in immunization schedules within the region, experience of countries incorporating combined acellular pertussis vaccines schedules and parenteral inactivated polio vaccine (IPV). The need to definitively replace oral polio vaccine (OPV) by IPV, and potential benefits of introducing new combined vaccines, were extensively discussed. EXPERT OPINION: REIV strongly advised immediate adoption of either complete IPV schedules for all Latin America or schedules including at least two initial doses of IPV. Use of fractional doses of intradermally administered IPV (fIPV ID) was not recommended due to lower immunogenicity, lack of evidence on long-term protection, and technical difficulty to implement. Routine pertussis vaccination of pregnant women in addition to health workers of neonatology units and any previously unimmunized parent was encouraged. Administration of HBV vaccine to newborns within the first 24 hours of life, and then at 2, 4, and 6 months, and of a booster dose of conjugate Hib vaccine at age 12 through 15 months, was also recommended. Incorporation of combined vaccines (CV) was considered potentially advantageous.
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Esquemas de Imunização , Vacinação/métodos , Doenças Preveníveis por Vacina/prevenção & controle , Vacinas/administração & dosagem , Humanos , Imunização Secundária , Lactente , Recém-Nascido , América Latina , Vacinas Combinadas/administração & dosagemRESUMO
INTRODUCTION: Dengue Fever is a neglected increasing public health thread. Developing countries are facing surveillance system problems like delay and data loss. Lately, the access and the availability of health-related information on the internet have changed what people seek on the web. In 2004 Google developed Google Dengue Trends (GDT) based on the number of search terms related with the disease in a determined time and place. The goal of this review is to evaluate the accuracy of GDT in comparison with traditional surveillance systems in Venezuela. METHODS: Weekly epidemic data from GDT, Official Reported Cases (ORC) and Expected Cases (EC) according the Ministry of Health (MH) was obtained Monthly and yearly correlation between GDT and ORC from 2004 until 2014 was obtained. Linear regressions taking the reported cases as dependent variable were calculated. RESULTS: The overall Pearson correlation between GDT and ORC was r=0.87 (p <0.001), while between ORC and EC according the Ministry of Health (MH) was r=0.33 (p<0.001). After clustering data in epidemic and non-epidemic weeks in comparison with GDT correlation were r=0.86 (p<0.001) and r=0.65 (p <0.001) respectively. Important interannual variation of the epidemic was observed. The model shows a high accuracy in comparison with the EC, particularly when the incidence of the disease is higher. CONCLUSIONS: This early warning tool can be used as an indicator for other communicable diseases in order to apply effective and timely public health measures especially in the setting of weak surveillance systems.
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Bases de Dados Factuais , Dengue/epidemiologia , Epidemias , Vigilância em Saúde Pública/métodos , Ferramenta de Busca/estatística & dados numéricos , Humanos , Incidência , Venezuela/epidemiologiaRESUMO
Three adult Venezuelan patients with virologically confirmed Chikungunya fever, who developed extensive acute nasal skin necrosis early in the course of a life-threatening illness characterized by shock and multiple organ dysfunction syndrome, are discussed. One patient survived and fully recovered. Nasal necrosis has not previously been associated with the disease.
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Febre de Chikungunya/complicações , Necrose , Doenças Nasais , Dermatopatias , Adulto , Idoso , Evolução Fatal , Humanos , Pessoa de Meia-Idade , Necrose/etiologia , Necrose/patologia , Nariz/patologia , Doenças Nasais/etiologia , Doenças Nasais/patologia , Dermatopatias/etiologia , Dermatopatias/patologia , VenezuelaRESUMO
Dengue is a mosquito-borne viral disease that has evolved from a sporadic infection to a major public health problem in the Americas, Southeast Asia and the western Pacific, and Africa. Its incidence has increased 30-fold over the past 50 years, and although the true disease burden is not well known, the annual incidence in some areas of the Americas may reach 5%-10% of all children when underreporting is considered. We recently analyzed the disease burden of dengue in Venezuela, and we found an overall decline in case numbers and mortality over the period of 1950-2011. However, there were increases in case number and mortality during epidemic years, especially among children. In this report, we focus on the most recent period of data, from 2000 to 2011, comparing pediatric and adult case numbers and mortality.
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Dengue/epidemiologia , Dengue Grave/epidemiologia , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Dengue/mortalidade , Vírus da Dengue , Surtos de Doenças , Humanos , Incidência , Lactente , Estudos Retrospectivos , Dengue Grave/mortalidade , VenezuelaRESUMO
A large epidemic of Chikungunya fever currently affects the Caribbean, Central and South America. Despite a high number of reported cases, little is known on the occurrence of severe clinical complications. We describe four Venezuelan patients with a severe and/or lethal course who exhibit unusual manifestations of the disease. Case 1 describes a 75 year-old man with rapid onset of septic shock and multi-organ failure. Cases 2 and 3 describe two patients with rapid aggressive clinical course who developed shock, severe purpuric lesions and a distinct area large of necrosis in the nasal region. Case 4 depicts a splenectomized woman with shock, generalized purpuric lesions, bullous dermatosis and acronecrosis of an upper limb. Chikungunya fever in the Western hemisphere may also associate with atypical and severe manifestations. Some patients experience a life-threatening, aggressive clinical course, with rapid deterioration and death due to multisystem failure.
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The aim of this study was to evaluate the prevalence and genetic diversity of hepatitis B virus (HBV) and hepatitis C virus (HCV) in human immunodeficiency virus type 1 (HIV-1)-co-infected Venezuelan patients. The prevalence of HBV and HCV markers of infection in HIV-1 patients was 14% for anti-hepatitis B core antigen, 3% for hepatitis B surface antigen and 0.7% for anti-HCV, respectively. HBV prevalence was higher than HCV, as expected for a country where sexual intercourse, not intravenous drug use, is the main mode of HIV-1 transmission. The HCV genotype distribution in HIV-1-co-infected patients was similar to that obtained in HCV-mono-infected patients, but genotype 1a was more frequent in HIV-1-infected patients. The HBV genotype distribution exhibited differences between mono-infected and HIV-1-co-infected individuals. HBV F3 was the most common subgenotype in both groups, followed by F1b in HIV-1 co-infection and F2 in HBV mono-infection. In addition, genotype G (single infection) was found in an HIV-1-co-infected individual. A high prevalence of occult HBV infection was detected in HIV-1-co-infected naïve patients (18%), with F2 being the most common genotype (75%). To the best of our knowledge, these results correspond to the first description of frequency and molecular characterization of HBV and HCV in HIV-1 Venezuelan patients.
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Coinfecção/virologia , Variação Genética , Infecções por HIV/complicações , Hepacivirus/genética , Hepatite B/virologia , Hepatite C/virologia , Adolescente , Adulto , Coinfecção/epidemiologia , Feminino , Genótipo , Infecções por HIV/virologia , HIV-1 , Hepatite B/epidemiologia , Vírus da Hepatite B/genética , Hepatite C/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Venezuela/epidemiologia , Adulto JovemAssuntos
Antiprotozoários/administração & dosagem , Fluconazol/administração & dosagem , Leishmania braziliensis/efeitos dos fármacos , Leishmania braziliensis/isolamento & purificação , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/parasitologia , Feminino , Humanos , MasculinoRESUMO
The preexistence of mutations to integrase inhibitors in HIV-1-infected Venezuelan patients was evaluated. The integrase region of the HIV-1 genome was amplified by nested-PCR and sequenced in 57 isolates from both naive (n = 24) and treated patients who received protease and/or reverse transcriptase inhibitors (PI and RTI, n = 33), but were never exposed to integrase inhibitors. Only one primary integrase resistance mutation, not conferring drug resistance by itself, was found among these patients, although several minor viral mutations, equally distributed among naive and PI- and RTI-treated patients, were also found. In the limited number of samples, no relation was found among the presence of resistance mutations to PI or RTI and the presence of minor mutations to integrase. The absence of resistance to integrase inhibitors may be related to the recent introduction of these drugs in our country. The availability of in-house assays allows for a more comprehensive surveillance of drug resistance to integrase inhibitors in Venezuela.
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Infecções por HIV/virologia , Inibidores de Integrase de HIV/uso terapêutico , Integrase de HIV/genética , HIV-1/genética , DNA Viral/genética , Farmacorresistência Viral Múltipla/efeitos dos fármacos , Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/uso terapêutico , HIV-1/efeitos dos fármacos , Humanos , Dados de Sequência Molecular , Mutação , Inibidores da Transcriptase Reversa/uso terapêutico , VenezuelaRESUMO
We evaluated a commercially available immunochromatographic dipstick test to detect Trypanosoma cruzi infection in 366 human serum samples with known serological results from Argentina, Ecuador, Mexico, and Venezuela. One hundred forty-nine of 366 (40.7%) and 171/366 (46.7%) samples tested positive by dipstick and serology, respectively. Dipstick sensitivity was calculated to be 84.8% (range between countries, 77.5 to 95%), and specificity was 97.9% (95.9 to 100%).
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Doença de Chagas/diagnóstico , Parasitologia/métodos , Soro/parasitologia , Trypanosoma cruzi/isolamento & purificação , Argentina , Doença de Chagas/parasitologia , Equador , Humanos , Imunoensaio/métodos , México , Sensibilidade e Especificidade , Fatores de Tempo , Trypanosoma cruzi/imunologia , VenezuelaRESUMO
The aim of this study was the analysis of human immunodeficiency virus (HIV) diversity in Venezuela, and the characterization of variants other than subtype B. A total of 425 HIV isolates, collected between 2003 and 2008, were analyzed. The sequence of at least one genomic region (Pol, Env, Vif, or Nef ) was available for all of them and at least two genomic regions were analyzed in 46% of them. From the 425 HIV isolates analyzed, 421 (99.1%) were classified as HIV-1 subtype B. The four non-subtype B isolates correspond to one subtype C, one recombinant AG, and two HIV-2 isolates. This study shows that HIV-1 subtype B is still highly predominant in Venezuela. Whereas some sporadic cases of other HIV types can be found, they do not seem to have disseminated to the present.
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Infecções por HIV/virologia , HIV-1/classificação , HIV-1/genética , Polimorfismo Genético , Análise por Conglomerados , Genótipo , HIV-1/isolamento & purificação , Humanos , Filogenia , Análise de Sequência de DNA , Homologia de Sequência , VenezuelaRESUMO
Clinically severe, acute polyarthritis, associated with high doses of oral moxifloxacin, has been documented for the first time in a 12-y-old child. MR studies revealed massive joint effusion, as well as moderate ligament and cartilage damage. On follow-up, neither long-term sequelae nor functional impairment of the involved joints was observed.