Instituto Nacional Of Salud Ins

Bogotá, Colombia

Instituto Nacional Of Salud Ins

Bogotá, Colombia
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Sanchez-Camargo C.L.,Médecins Sans Frontières | Sanchez-Camargo C.L.,Autonomous University of Barcelona | Sanchez-Camargo C.L.,Antonio Nariño University | Albajar-Vinas P.,WHO Program on Control of Chagas Disease | And 13 more authors.
Journal of Clinical Microbiology | Year: 2014

Chagas disease is one of the main public health issues in Latin America. Increasingly during the past few decades, Trypanosoma cruzi infection has been detected in North America, Europe, and the Western Pacific, mainly as a result of population movement. The limited availability of rapid serological diagnostic tests hinders rapid diagnosis and early treatment in areas of endemicity and nonendemicity. In collaboration with 11 national reference laboratories (NRLs) from different geographical areas, we evaluated the performances of commercialized serological rapid diagnostic tests (RDT) for T. cruzi infection. Eleven commercialized T. cruzi infection RDTs were evaluated on a total of 474 samples extensively tested with at least three different techniques for Chagas disease, maintained at controlled low temperatures, and stored in the serum banks of the 11 NRLs. We measured the sensitivity, specificity, and concordance of each RDT and provided an additional questionnaire to evaluate its ease of use. The selected RDTs in this study were performed under controlled laboratory conditions. Out of the 11 RDTs, we found 8 of them to be useful, with the cassette format favored over the strip. We did not observe significant differences in RDT performances in the different regions. Overall, the performance results were lower than those disclosed by the manufacturers. The results of this evaluation validate the possibility of using RDTs to diagnose Chagas disease, thereby decreasing the time to treatment at a primary health care facility for patients who are willing to be treated. Further studies should be conducted in the laboratory and in the field to confirm these data, expressly to evaluate reproducibility in resource-limited settings, or using whole blood in clinical settings in areas of endemicity and nonendemicity. Copyright © 2014, American Society for Microbiology. All Rights Reserved.


Fitzwater S.P.,Cayetano Heredia Peruvian University | Sechler G.A.,Cayetano Heredia Peruvian University | Jave O.,Estrategia Sanitaria Nacional de Prevencion Y Control de la Tuberculosis | Coronel J.,Cayetano Heredia Peruvian University | And 5 more authors.
European Respiratory Journal | Year: 2013

Multidrug-resistant tuberculosis (TB) threatens TB control worldwide. The microscopic observation drug susceptibility (MODS) assay is a low-cost, high-performance TB diagnostic tool for rapid liquid culture and direct isoniazid and rifampicin drug susceptibility testing (DST). The objective of this study was to explore the potential for extending the MODS assay to rapid second-line DST and to identify critical concentrations of candidate drugs for prospective testing. Sputum samples from 94 TB culture-positive patients receiving second-line TB agents were cultured following standardised MODS protocols, with a range of titrations of antimicrobial drugs added. Critical concentrations were determined using a modified Kaplan-Meier survival curve analysis. Candidate critical concentrations were determined for capreomycin (10 μg·mL-1), ciprofloxacin (1.25 μg·mL -1), cycloserine (40 μg·mL-1), ethambutol (10 μg·mL-1), ethionamide (5 μg·mL-1), kanamycin (5 μg·mL-1), para-aminosalicylic acid (10 μg·mL-1) and streptomycin (10 μg·mL -1). No cut-off point was identified for the other second-line drugs or for pyrazinamide. At particular concentrations of some second-line TB drugs this novel Kaplan-Meier analysis clearly differentiated populations that were susceptible or resistant. These candidate critical concentrations should now be tested in a range of epidemiological settings to define the performance of direct, second-line TB DST with MODS, offering potential low-cost second-line TB DST capacity. Copyright©ERS 2013.


Caicedo Y.,Hospital Universitario del Valle | Paez A.,Instituto Nacional Of Salud Ins | Kuzmin I.,Centers for Disease Control and Prevention | Kuzmin I.,Medical College of Wisconsin | And 7 more authors.
Pediatric Infectious Disease Journal | Year: 2015

Background: Rabies is an acute fatal encephalitis caused by all members of the Lyssavirus genus. The first human rabies survivor without benefit of prior vaccination was reported from Milwaukee in 2005. We report a second unvaccinated patient who showed early recovery from rabies and then died accidentally during convalescence, providing an unparalleled opportunity to examine the histopathology as well as immune and virological correlates of early recovery from human rabies. Methods: Case report, rapid fluorescent focus inhibition test, enzyme-linked immunosorbent assay, indirect and direct fluorescent antibody assays, reverse-transcriptase polymerase chain reaction, phylogenetic reconstruction, isolation in tissue culture, pathology and immunohistochemistry. Results: The 9 year old died 76 days after presenting with rabies of vampire bat phylogeny transmitted by cat bite. Antibody response in serum and cerebrospinal fluid was robust and associated with severe cerebral edema. No rabies virus was cultured at autopsy. Rabies virus antigen was atypical in size and distribution. Rabies virus genome was present in neocortex but absent in brainstem. Conclusions: Clinical recovery was associated with detection of neutralizing antibody and clearance of infectious rabies virus in the central nervous system by 76 days but not clearance of detectable viral subcomponents such as nucleoprotein antigen or RNA in brain. © 2015 Wolters Kluwer Health, Inc.


PubMed | Calle, Instituto Nacional Of Salud Ins and Centro Internacional Of Entrenamiento E Investigaciones Medicas Cideim
Type: | Journal: Acta tropica | Year: 2015

The expansion of transmission of cutaneous leishmaniasis from sylvatic ecosystems into peri-urban and domestic settings has occurred as sand flies have adapted to anthropogenic environmental modifications. Assessment of the intradomiciliary presence of sand flies in households of the settlement La Cabaa, in the Department of Risaralda, Colombia, revealed an abundance of Warileya rotundipennis. This unexpected observation motivated further analyses to evaluate the participation of this species in the transmission of cutaneous leishmaniasis. Collections using CDC light traps were conducted during two consecutive nights in May and August 2011.The total of 667 sand flies collected were classified into five species: W. rotundipennis (n=654; 98.05%), Nyssomyia trapidoi (n=7; 1.04%); Lutzomyia (Helcocyrtomyia) hartmanni (n=3; 0.44%); Lutzomyia lichyi (n=2; 0.29%) and Psychodopygus panamensis (n=1; 0.14%). The striking predominance of W. rotundipennis within households during both wet (May) and dry (August) seasons, anthropophilic behavior demonstrated by human blood in 95.23% (60/63) evaluable blood-engorged specimens, and natural infection (5/168-3%) with genetically similar parasites of the Leishmania (Viannia) subgenus observed in a patient in this community, support the involvement of W. rotundipennis in the domestic transmission of cutaneous leishmaniasis in La Cabaa.


Sanchez L.V.,University Militar Nueva Granada | Bautista D.C.,University Militar Nueva Granada | Corredor A.F.,University Militar Nueva Granada | Herrera V.M.,Autonomous University of Bucaramanga | And 5 more authors.
Microbes and Infection | Year: 2013

Chagas disease caused by Trypanosoma cruzi is a public health problem in Latin America. This parasite displays a high genetic diversity evidenced in six Discrete Typing Units (DTUs) namely TcI-TcVI. The aim of this study was to observe the temporal variation of the DTUs in asymptomatic patients at three different times (10 days interval). The results showed that intermittence is the rule in the bloodstream of Chagas disease patients. The patients showed different detectable DTUs with short time intervals, which favors the clonal histiotropic model and the multiclonality structure of this parasite. © 2013 .


Ramirez J.D.,University Militar Nueva Granada | Ramirez J.D.,Instituto Nacional Of Salud | Sanchez L.V.,University Militar Nueva Granada | Bautista D.C.,University Militar Nueva Granada | And 4 more authors.
Infection, Genetics and Evolution | Year: 2014

Blastocystis is a common enteric protist colonizing probably more than 1 billion people along with a large variety of non-human hosts. This protist has been linked to symptoms and diseases such as abdominal pain, constipation, diarrhea, flatulence and irritable bowel syndrome (IBS). Remarkable genetic diversity has been observed, leading to the subdivision of the genus into multiple subtypes (ST), some of which are exclusively found in non-human hosts. The aim of this study was to determine the distribution of Blastocystis STs in different Colombian hosts. We obtained fecal samples positive for Blastocystis by microscopy from 277 humans, 52 birds, and 117 mammals (25 cattle, 40 opossums, 40 dogs, 10 rats and 2 howler monkeys). The samples were submitted to DNA extraction, PCR and sequencing using primers targeting the small subunit rRNA gene, and ST identification was performed according to DNA barcoding. We observed the occurrence of ST1 (34%) and ST2 (23%) and lower proportions of STs 3 (11.4%), 4 (0.8%), 6 (19.8%) and 8 (10.5%). Domesticated mammals shared the same STs as those usually seen in humans (ST1, ST2, ST3), while birds and marsupials had STs, which are usually rare in humans (ST6, ST8). Further studies implementing high-resolution molecular markers are necessary to understand the phylodynamics of Blastocystis transmission and the role of this stramenopile in health and disease in Colombian populations, and to expand on the phylogeographic differences observed so far with a view to exploring and understanding host-parasite co-evolution. © 2013 Elsevier B.V.


Hurtado A.P.,Instituto Nacional Of Salud Ins | Rengifo A.C.,Instituto Nacional Of Salud Ins | Torres-Fernandez O.,Instituto Nacional Of Salud Ins
International Journal of Morphology | Year: 2015

The microtubule-associated protein MAP-2 is an integral part of the cytoskeleton and plays an important role in neural morphogenesis. This protein is an essential component of the dendritic cytoskeleton, especially in the adult brain, and its expression can be altered under experimental or pathological conditions. The purpose of this study was to evaluate the effect of infection with the rabies virus on MAP-2 immunoreactivity in the cerebral cortex of mice. The mice were inoculated with the rabies virus and the animals were sacrificed when the disease reached its advanced stage, together with uninfected animals of the same age. The brains were extracted after being previously perfusion-fixed with paraformaldehyde; coronal sections were obtained with a vibratome. The coronal sections were processed by immunohistochemistry to reveal the presence of the MAP-2 protein in neurons of the motor area of the cerebral cortex. Rabies-infected mice showed an increase in the immunoreactivity of the somata and apical dendrites in pyramidal neurons of the motor cortex. This is an unexpected result, as dendritic pathology has been previously demonstrated in rabies, and some studies on neurological disorders associate dendritic alterations with loss of expression of the MAP-2 protein. Therefore, whatever the alteration in the expression of this protein, decrease or increase, it could be causing a biochemical imbalance in the integrity and stability of the neuronal cytoskeleton. © 2015, Universidad de la Frontera. All rights reserved.


Ramirez J.D.,University of Los Andes, Colombia | Guhl F.,University of Los Andes, Colombia | Messenger L.A.,Instituto Nacional Of Salud Ins | Lewis M.D.,Instituto Nacional Of Salud Ins | And 4 more authors.
Molecular Ecology | Year: 2012

Clonal propagation is considered to be the predominant mode of reproduction among many parasitic protozoa. However, this assumption may overlook unorthodox, infrequent or cryptic sexuality. Trypanosoma cruzi, which causes Chagas disease, is known to undergo non-Mendelian genetic exchange in the laboratory. In the field, evidence of extant genetic exchange is limited. In this study, we undertook intensive sampling of T. cruzi Discrete Typing Unit I in endemic eastern Colombia. Using Fluorescence-activated cell sorting, we generated 269 biological clones from 67 strains. Each clone was genotyped across 24 microsatellite loci. Subsequently, 100 representative clones were typed using 10 mitochondrial sequence targets (3.76 Kbp total). Clonal diversity among humans, reservoir hosts and vectors suggested complex patterns of superinfection and/or coinfection in oral and vector-borne Chagas disease cases. Clonal diversity between mother and foetus in a congenital case demonstrates that domestic TcI genotypes are infective in utero. Importantly, gross incongruence between nuclear and mitochondrial markers is strong evidence for widespread genetic exchange throughout the data set. Furthermore, a confirmed mosaic maxicircle sequence suggests intermolecular recombination between individuals as a further mechanism of genetic reassortment. Finally, robust dating based on mitochondrial DNA indicates that the emergence of a widespread domestic TcI clade that we now name TcIDOM (formerly TcIa/VEN Dom) occurred 23 000 ± 12 000 years ago and was followed by population expansion, broadly corresponding with the earliest human migration into the Americas. © 2012 Blackwell Publishing Ltd.


Ramirez J.D.,University of Los Andes, Colombia | Duque M.C.,University of Los Andes, Colombia | Montilla M.,Instituto Nacional Of Salud Ins | Cucunuba Z.M.,Instituto Nacional Of Salud Ins | Guhl F.,University of Los Andes, Colombia
Infection, Genetics and Evolution | Year: 2012

Chagas disease represents a serious problem in public health. This zoonotic pathology is caused by the kinetoplastid Trypanosoma cruzi which displays a high genetic diversity falling into six Discrete Typing Units (TcI-TcVI). In Colombia, the prevalent DTU is TcI with findings of TcII, TcIII and TcIV in low proportions. The aim of this work was to observe the genetic variability within TcI using a multilocus PCR-RFLP strategy. We analyzed 70 single-celled clones from triatomines, reservoirs and humans that were amplified and restricted via ten PCR-RFLPs targets across TcI genome, the restriction fragments were used to construct phylograms according to calculated genetic distances. We obtained five polymorphic targets (1f8, HSP60, HSP70, SAPA and H1) and the consensus tree constructed according to these regions allowed us to observe two well-defined groups with close association to the transmission cycles (domestic/peridomestic and sylvatic) of Chagas disease in Colombia. Our findings allowed us to corroborate the previous reported genotypes based on the intergenic region of mini-exon gene. More studies examining the genetic diversity among T. cruzi I populations must be conducted in order to obtain a better understanding in regions where this DTU is endemic. © 2012 Elsevier B.V.


PubMed | Instituto Nacional Of Salud Ins, National University of Colombia, Antonio Nariño University and El Rosario University
Type: | Journal: Acta tropica | Year: 2016

This studys main objective was to evaluate the action of larval therapy derived from Lucilia sericata and Sarconesiopsis magellanica (blowflies) regarding Leishmania panamensis using an in vivo model. Eighteen golden hamsters (Mesocricetus auratus) were used; they were divided into 6 groups. The first three groups consisted of 4 animals each; these, in turn, were internally distributed into subgroups consisting of 2 hamsters to be used separately in treatments derived from each blowfly species. Group 1 was used in treating leishmanial lesions with larval therapy (LT), whilst the other two groups were used for evaluating the used of larval excretions and secretions (ES) after the ulcers had formed (group 2) and before they appeared (group 3). The three remaining groups (4, 5 and 6), consisting of two animals, were used as controls in the experiments. Biopsies were taken for histopathological and molecular analysis before, during and after the treatments; biopsies and smears were taken for assessing parasite presence and bacterial co-infection. LT and larval ES proved effective in treating the ulcers caused by the parasite. There were no statistically significant differences between the blowfly species regarding the ulcer cicatrisation parameters. There were granulomas in samples taken from lesions at the end of the treatments. The antibacterial action of larval treatment regarding co-infection in lesions caused by the parasite was also verified. These results potentially validate effective LT treatment against cutaneous leishmaniasis aimed at using it with humans in the future.

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