Alvarez M.G.,Hospital Interzonal General Of Agudos Eva Peron |
Hernandez Y.,Instituto Nacional Of Parasitologia Dr Mario Fatala Chaben |
Bertocchi G.,Hospital Interzonal General Of Agudos Eva Peron |
Fernandez M.,Instituto Nacional Of Parasitologia Dr Mario Fatala Chaben |
And 8 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2016
There is a clinical need to test new schemes of benznidazole administration that are expected to be at least as effective as the current therapeutic scheme but safer. This study assessed a new scheme of benznidazole administration in chronic Chagas disease patients. A pilot study with intermittent doses of benznidazole at 5 mg/kg/day in two daily doses every 5 days for a total of 60 days was designed. The main criterion of response was the comparison of quantitative PCR (qPCR) findings prior to and 1 week after the end of treatment. The safety profile was assessed by the rate of suspensions and severity of adverse effects. Twenty patients were analyzed for safety, while qPCR was tested for 17 of them. The average age was 43 ± 7.9 years; 55% were female. Sixty-five percent of treated subjects showed detectable qPCR results prior to treatment of 1.45 (0.63 to 2.81) and 2.1 (1.18 to 2.78) parasitic equivalents per milliliter of blood (par.eq/ml) for kinetoplastic DNA (kDNA) qPCR and nuclear repetitive sequence satellite DNA (SatDNA) qPCR, respectively. One patient showed detectable PCR at the end of treatment (1/17), corresponding to 6% treatment failure, compared with 11/17 (65%) patients pretreatment (P = 0.01). Adverse effects were present in 10/20 (50%) patients, but in only one case was treatment suspended. Eight patients showed mild adverse effects, whereas moderate reactions with increased liver enzymes were observed in two patients. The main accomplishment of this pilot study is the promising low rate of treatment suspension. Intermittent administration of benznidazole emerges a new potential therapeutic scheme, the efficacy of which should be confirmed by long-term assessment posttreatment. Copyright © 2016, American Society for Microbiology. All Rights Reserved.
Krolewiecki A.J.,National University of Salta |
Krolewiecki A.J.,CONICET |
Lammie P.,Centers for Disease Control and Prevention |
Jacobson J.,Bill and Melinda Gates Foundation |
And 12 more authors.
PLoS Neglected Tropical Diseases | Year: 2013
Strongyloides stercoralis infections have a worldwide distribution with a global burden in terms of prevalence and morbidity that is largely ignored. A public health response against soil-transmitted helminth (STH) infections should broaden the strategy to include S. stercoralis and overcome the epidemiological, diagnostic, and therapeutic challenges that this parasite poses in comparison to Ascaris lumbricoides, Trichuris trichiura, and hookworms. The relatively poor sensitivity of single stool evaluations, which is further lowered when quantitative techniques aimed at detecting eggs are used, also complicates morbidity evaluations and adequate drug efficacy measurements, since S. stercoralis is eliminated in stools in a larval stage. Specific stool techniques for the detection of larvae of S. stercoralis, like Baermann's and Koga's agar plate, despite superiority over direct techniques are still suboptimal. New serologies using recombinant antigens and molecular-based techniques offer new hopes in those areas. The use of ivermectin rather than benzimidazoles for its treatment and the need to have curative regimens rather than lowering the parasite burden are also unique for S. stercoralis in comparison to the other STH due to its life cycle, which allows reproduction and amplification of the worm burden within the human host. The potential impact on STH of the benzimidazoles/ivermectin combinations, already used for control/elimination of lymphatic filariasis, should be further evaluated in public health settings. While waiting for more effective single-dose drug regimens and new sensitive diagnostics, the evidence and the tools already available warrant the planning of a common platform for STH and S. stercoralis control. © 2013 Krolewiecki et al.
PubMed | Hospital Interzonal General Of Agudos Eva Peron, Institute Ingenieria Genetica y Biologia Molecular INGEBI, Fundacion Mundo Sano and Instituto Nacional Of Parasitologia Dr Mario Fatala Chaben
Type: Journal Article | Journal: Antimicrobial agents and chemotherapy | Year: 2016
There is a clinical need to test new schemes of benznidazole administration that are expected to be at least as effective as the current therapeutic scheme but safer. This study assessed a new scheme of benznidazole administration in chronic Chagas disease patients. A pilot study with intermittent doses of benznidazole at 5 mg/kg/day in two daily doses every 5 days for a total of 60 days was designed. The main criterion of response was the comparison of quantitative PCR (qPCR) findings prior to and 1 week after the end of treatment. The safety profile was assessed by the rate of suspensions and severity of adverse effects. Twenty patients were analyzed for safety, while qPCR was tested for 17 of them. The average age was 43 7.9 years; 55% were female. Sixty-five percent of treated subjects showed detectable qPCR results prior to treatment of 1.45 (0.63 to 2.81) and 2.1 (1.18 to 2.78) parasitic equivalents per milliliter of blood (par.eq/ml) for kinetoplastic DNA (kDNA) qPCR and nuclear repetitive sequence satellite DNA (SatDNA) qPCR, respectively. One patient showed detectable PCR at the end of treatment (1/17), corresponding to 6% treatment failure, compared with 11/17 (65%) patients pretreatment (P = 0.01). Adverse effects were present in 10/20 (50%) patients, but in only one case was treatment suspended. Eight patients showed mild adverse effects, whereas moderate reactions with increased liver enzymes were observed in two patients. The main accomplishment of this pilot study is the promising low rate of treatment suspension. Intermittent administration of benznidazole emerges a new potential therapeutic scheme, the efficacy of which should be confirmed by long-term assessment posttreatment.
Vertical transmission of dengue virus in aedes aegypti collected in Puerto Iguazú, Misiones, Argentina [Transmisión vertical de virus dengue en Aedes aegypti, capturados en Puerto Iguazú, Misiones, Argentina]
Espinosa M.,Fundacion Mundo Sano |
Giamperetti S.,Hospital Fj Muniz |
Abril M.,Fundacion Mundo Sano |
Seijo A.,Hospital Fj Muniz
Revista do Instituto de Medicina Tropical de Sao Paulo | Year: 2014
A finding of vertical transmission of the DEN 3 virus in male specimens of Aedes aegypti, collected in the 2009 fall-winter period, in Puerto Iguazú city, Misiones, Argentina, using the RT-PCR technique in a 15-specimen pool is reported. This result is analyzed within the context of the epidemiological situation of Argentina's northeast border.
Bravo A.G.,Fundacion Mundo Sano |
Quintana M.G.,National University of Tucuman |
Quintana M.G.,CONICET |
Abril M.,Fundacion Mundo Sano |
And 2 more authors.
Memorias do Instituto Oswaldo Cruz | Year: 2013
In 2004, the urban presence of Lutzomyia longipalpis was recorded for the first time in Formosa province. In 2006, the first autochthonous case of human urban visceral leishmaniasis (VL) was recorded in Misiones in the presence of the vector, along with some canine VL cases. After this first case, the vector began to spread primarily in northeast Argentina. Between 2008-2011, three human VL cases were reported in Salta province, but the presence of Lu. longipalpis was not recorded. Captures of Phlebotominae were made in Tartagal, Salta, in 2013, and the presence of Lu. longipalpis was first recorded in northwest Argentina at that time. Systematic sampling is recommended to observe the distribution and dispersion patterns of Lu. longipalpis and consider the risk of VL transmission in the region.
PubMed | Puerta Of Hierro Hospital, Institute of Tropical Medicine and Fundacion Mundo Sano
Type: | Journal: Global health action | Year: 2016
In Europe, Spain has the highest number of people with Chagas disease (CD). Bolivian migrants account for 81% of the reported cases. One of the priorities in controlling the disease is prevention of mother-to-child transmission. Despite under-diagnosis in Spain being estimated at 90%, there are currently few studies that explore the social and cultural dimensions of this disease.The aim of this study was to explore the knowledge and experiences of Bolivian women with CD, in order to generate a useful understanding for the design and implementation of public health initiatives.Qualitative study based on semi-structured interviews, triangular groups, and field notes.Fourteen Bolivian women with CD living in Madrid.The participants were aware that the disease was transmitted through the vector, that it could be asymptomatic, and that it could also be associated with sudden death by heart failure. They opined that the treatment as such could not cure the disease but only slow it down. There was a sense of indifference along with a lack of understanding of the risk of contracting the disease. Participants who presented with symptoms, or those with relatives suffering from the disease, were concerned about fatalities, cardiac problems, and possible vertical transmission. There was also a fear of being rejected by others. The disease was described as something that affected a large number of people but only showed up in a few cases and that too after many years. There was a widespread assumption that it was better not to know because doing so, allows the disease to take hold.Disease risk perception was very low in Bolivian women living in Madrid. This factor, together with the fear of being screened, may be contributing to the current rate of under-diagnosis.
Socias M.E.,Fundacion Mundo Sano
Medicina | Year: 2014
A systematic review of surveys performed between 1980 and 2011 (published in MEDLINE/Pubmed and/or LILACS indexed journals, available in the baseline data from a Mass Deworming National Program (MDNP, 2005) was used to identify the prevalence, distribution and detection of risk areas for soil transmitted helminth infections (STH) in Argentina. We found 310 publications in the database using the pre-defined key-words (medical subject headings) for research purposes. Only 24 articles with 26 surveillance sites in 8 provinces and a total of 5495 surveyed individuals fulfilled the inclusion criteria. Frequency rates for STH had a wide range: Ascaris lumbricoides: 0-67%, hookworms: 0-90%, Trichuris trichiura: 0-24.6 and Strongyloides stercoralis: 0-83%. The estimated combined incidence varied from 0.8% to 88.6%. Baseline surveys from the MDNP reporting on 1943 children from 12 provinces confirmed the heterogeneity, with combined STH frequency rates ranging from 0 to 42.7%. Surveys included in this review showed that the distribution of STH in Argentina is not homogeneous, with areas of high incidence (> 20%) in the northeastern and northwestern provinces where mass deworming activities would be highly beneficial. In several surveys, the high overall incidence was mostly due to hookworms and S. stercoralis, a situation to be considered when selecting diagnostic and therapeutic control strategies. The scarcity or absence of data from various provinces and the availability of less than 8000 surveyed individuals should be considered.
Garelli F.M.,Laboratorio Of Eco Epidemiologia |
Espinosa M.O.,Fundacion Mundo Sano |
Gurtler R.E.,Laboratorio Of Eco Epidemiologia
Journal of Medical Entomology | Year: 2012
Understanding the processes that affect Aedes aegypti (L.) (Diptera: Culicidae) may serve as a starting point to create and /or improve vector control strategies. For this purpose, we performed statistical modeling of three entomological surveys conducted in Clorinda City, northern Argentina. Previous 'basic' models of presence or absence of larvae and/or pupae (infestation) and the number of pupae in infested containers (productivity), mainly based on physical characteristics of containers, were expanded to include variables selected a priori reflecting water use practices, vector-related context factors, the history of chemical control, and climate. Model selection was performed using Akaike's Information Criterion. In total, 5,431 water-holding containers were inspected and 12,369 Ae. aegypti pupae collected from 963 positive containers. Large tanks were the most productive container type. Variables reflecting every putative process considered, except for history of chemical control, were selected in the best models obtained for infestation and productivity. The associations found were very strong, particularly in the case of infestation. Water use practices and vector-related context factors were the most important ones, as evidenced by their impact on Akaike's Information Criterion scores of the infestation model. Risk maps based on empirical data and model predictions showed a heterogeneous distribution of entomological risk. An integrated vector control strategy is recommended, aiming at community participation for healthier water use practices and targeting large tanks for key elements such as lid status, water addition frequency and water use. © 2012 Entomological Society of America.
Garelli F.M.,University of Buenos Aires |
Espinosa M.O.,Fundacion Mundo Sano |
Gurtler R.E.,University of Buenos Aires
Acta Tropica | Year: 2013
The objective of this study was to analyze the spatio-temporal patterns of Aedes aegypti immatures based on four entomological surveys that inspected over 6000 households in a large neighborhood of the city of Clorinda between 2007 and 2008. Global and local spatial point pattern analyses of immature presence or absence, habitat quality (estimated using a previously obtained statistical model) and pupal production were performed. Global analyses showed aggregation of both infestation and habitat quality up to 10 times bigger than previously described, ranging from 150 to 400. m between surveys. Pupal production was also clustered but at smaller scales than infestation presence/absence. The location of the clusters was temporally unstable between surveys. There was no spatial structure related to the control strategy; lots treated with temephos and lots uninspected (i.e., closed or refusing) were randomly distributed. These results suggest a combination of exogenous (the aggregation of better quality habitats) and endogenous (dispersal) processes explaining the observed patterns of larger-scale infestation. A spatial targeting strategy at the neighborhood scale would not be as cost-effective in Clorinda as in other sites where stable smaller-scale clusters permit the identification of key premises. © 2013 Elsevier B.V.
PubMed | Fundacion Mundo Sano
Type: Journal Article | Journal: Geospatial health | Year: 2016
The main objective of this study was to obtain and analyse the space-time dynamics of Aedes aegypti breeding sites in Clorinda City, Formosa Province, Argentina coupled with landscape analysis using the maximum entropy approach in order to generate a dengue vector niche model. In urban areas, without vector control activities, 12 entomologic (larval) samplings were performed during three years (October 2011 to October 2014). The entomologic surveillance area represented 16,511 houses. Predictive models for Aedes distribution were developed using vector breeding abundance data, density analysis, clustering and geoprocessing techniques coupled with Earth observation satellite data. The spatial analysis showed a vector spatial distribution pattern with clusters of high density in the central region of Clorinda with a well-defined high-risk area in the western part of the city. It also showed a differential temporal behaviour among different areas, which could have implications for risk models and control strategies at the urban scale. The niche model obtained for Ae. aegypti, based on only one year of field data, showed that 85.8% of the distribution of breeding sites is explained by the percentage of water supply (48.2%), urban distribution (33.2%), and the percentage of urban coverage (4.4%). The consequences for the development of control strategies are discussed with reference to the results obtained using distribution maps based on environmental variables.