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Kawatsu L, Uchimura K, Schwalb A, Houben R. New perspectives on the secular trend in pulmonary TB in post-war Japan (1953-1980). Int J Tuberc Lung Dis 2024; 28:207-209. [PMID: 38563337 DOI: 10.5588/ijtld.23.0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Affiliation(s)
| | - K Uchimura
- Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Japan
| | - A Schwalb
- TB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - R Houben
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
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2
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Schwalb A, Kayumba K, Houben RMGJ, Bothamley GH. Recent Travel and Tuberculosis in Migrants: Data From a Low-Incidence Country. Clin Infect Dis 2024; 78:742-745. [PMID: 37939790 PMCID: PMC10954334 DOI: 10.1093/cid/ciad672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023] Open
Abstract
Tuberculosis (TB) incidence rates among migrants are higher than those in low-incidence countries. We evaluated smear-positive, pulmonary TB notifications of foreign-born individuals, comparing time since arrival and time since last return travel to the country of origin. TB incidence suggests a time course consistent with recent infection during travel.
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Affiliation(s)
- Alvaro Schwalb
- TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kumvana Kayumba
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rein M G J Houben
- TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Graham H Bothamley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Respiratory Medicine, Homerton University Hospital, London, United Kingdom
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3
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Schwalb A, Emery JC, Dale KD, Horton KC, Ugarte-Gil CA, Houben RMGJ. Impact of Reversion of Mycobacterium tuberculosis Immunoreactivity Tests on the Estimated Annual Risk of Tuberculosis Infection. Am J Epidemiol 2023; 192:1937-1943. [PMID: 36749011 PMCID: PMC10691197 DOI: 10.1093/aje/kwad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/26/2022] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
A key metric in tuberculosis epidemiology is the annual risk of infection (ARI), which is usually derived from tuberculin skin test (TST) and interferon-γ release assay (IGRA) prevalence surveys carried out in children. Derivation of the ARI assumes that immunoreactivity is persistent over time; however, reversion of immunoreactivity has long been documented. We used a deterministic, compartmental model of Mycobacterium tuberculosis (Mtb) infection to explore the impact of reversion on ARI estimation using age-specific reversion probabilities for the TST and IGRA. Using empirical data on TST reversion (22.2%/year for persons aged ≤19 years), the true ARI was 2-5 times higher than that estimated from immunoreactivity studies in children aged 8-12 years. Applying empirical reversion probabilities for the IGRA (9.9%/year for youths aged 12-18 years) showed a 1.5- to 2-fold underestimation. ARIs are increasingly underestimated in older populations, due to the cumulative impact of reversion on population reactivity over time. Declines in annual risk did not largely affect the results. Ignoring reversion leads to a stark underestimation of the true ARI in populations and our interpretation of Mtb transmission intensity. In future surveys, researchers should adjust for the reversion probability and its cumulative effect with increasing age to obtain a more accurate reflection of the burden and dynamics of Mtb infection.
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Affiliation(s)
- Alvaro Schwalb
- Correspondence to Dr. Alvaro Schwalb, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom (e-mail: )
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Schwalb A, Houben RMGJ. Schwalb and Houben Respond to "The Winding Road to ARTI". Am J Epidemiol 2023; 192:1947-1948. [PMID: 37477042 PMCID: PMC10691196 DOI: 10.1093/aje/kwad163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 06/13/2023] [Accepted: 07/18/2023] [Indexed: 07/22/2023] Open
Affiliation(s)
- Alvaro Schwalb
- Correspondence to Dr. Alvaro Schwalb, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom (e-mail: )
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5
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Schwalb A, Bergstrom M, Woodd S, Rehman AM, PrayGod G, Kasonka L, Koethe JR, Filteau S, Houben RMGJ. Impact of micro- and macronutrient status on the incidence of tuberculosis: An examination of an African cohort initiating antiretroviral therapy. PLOS Glob Public Health 2023; 3:e0002007. [PMID: 37440476 DOI: 10.1371/journal.pgph.0002007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/23/2023] [Indexed: 07/15/2023]
Abstract
Macronutrient and micronutrient deficiencies are associated with tuberculosis (TB) incidence. However, evidence is limited on the impact of micronutrient (vitamins and minerals) supplementation among underweight individuals. We conducted a secondary data analysis of a randomised controlled trial of lipid nutritional supplements with and without high-dose vitamin and mineral supplementation (LNS-VM vs LNS) for underweight (Body Mass Index [BMI] <18.5 kg/m2) adults with human immunodeficiency virus (HIV) initiating antiretroviral therapy (ART) in Tanzania and Zambia (2011-2013). Incident TB disease diagnoses were extracted from trial records. We used multivariable Cox regression to estimate hazard ratios (HR) for the impact of receiving LNS-VM on TB incidence, and the dose-response relationship between baseline BMI and TB incidence. Overall, 263 (17%) of 1506 participants developed TB disease. After adjusting for age, sex, CD4 count, haemoglobin, and C-reactive protein, receiving LNS-VM was not associated with TB incidence (aHR [95%CI] = 0.93 [0.72-1.20]; p = 0.57) compared to LNS alone. There was strong evidence for an association between lower BMI and incident TB (aHR [95%CI]: 16-16.9kg/m2 = 1.15 [0.82-1.62] and <16kg/m2 = 1.70 [1.26-2.30] compared to 17-18.5kg/m2; linear trend p<0.01). There was strong evidence that the rate of developing TB was lower after initiating ART (p<0.01). In conclusion, the addition of micronutrient supplementation to LNS was not associated with lower TB incidence in this underweight ART-naive population.
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Affiliation(s)
- Alvaro Schwalb
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- TB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Malin Bergstrom
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Susannah Woodd
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Andrea M Rehman
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - George PrayGod
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | | | - John R Koethe
- Vanderbilt Institute of Global Health, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Suzanne Filteau
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rein M G J Houben
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- TB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
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6
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Llanos-Cuentas A, Schwalb A, Quintana JL, Delfin B, Alvarez F, Ugarte-Gil C, Guerra Gronerth RI, Lucchetti A, Grogl M, Gotuzzo E. Hydroxychloroquine to prevent SARS-CoV-2 infection among healthcare workers: early termination of a phase 3, randomised, open-label, controlled clinical trial. BMC Res Notes 2023; 16:22. [PMID: 36849996 PMCID: PMC9970848 DOI: 10.1186/s13104-023-06281-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/30/2023] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE To assess the effectiveness and safety of hydroxychloroquine (HCQ) prophylaxis for the prevention of SARS-CoV-2 infection in healthcare workers (HCW) on duty during the COVID-19 pandemic. RESULTS A total of 68 HCWs met the eligibility criteria were randomly allocated to receive HCQ (n = 36) or not (n = 32). There were no significant differences between groups in respects to age, gender, or medical history. Eight participants met the primary efficacy endpoint of SAR-CoV-2 infection during the study period; there was no difference in incidence of SARS-CoV-2 infections between both study arms (HCQ: 5 vs Control: 3, p = 0.538). The relative risk of SARS-CoV-2 infection in the HCQ arm was 1.69 compared to the control group (95%CI 0.41-7.11, p = 0.463); due to poor participant accrual, the resulting statistical power of the primary efficacy outcome was 11.54%. No serious adverse events occurred; however, two (2/36, 5.6%) participants no longer wished to participate in the study and withdrew consent due to recurring grade 1 and 2 adverse events. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT04414241. (Registered on June 4, 2020).
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Affiliation(s)
- Alejandro Llanos-Cuentas
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres, 15102, Lima, Peru.
| | - Alvaro Schwalb
- grid.11100.310000 0001 0673 9488Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres, 15102 Lima, Peru
| | - Juan Luis Quintana
- grid.11100.310000 0001 0673 9488School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Brian Delfin
- grid.414881.00000 0004 0506 242XDepartment of Infectious Diseases, Hospital Cayetano Heredia, Lima, Peru
| | - Fiorela Alvarez
- grid.11100.310000 0001 0673 9488Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres, 15102 Lima, Peru
| | - César Ugarte-Gil
- grid.11100.310000 0001 0673 9488Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres, 15102 Lima, Peru ,grid.11100.310000 0001 0673 9488School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rosio I. Guerra Gronerth
- Centro Médico Naval Cirujano Mayor Santiago Tavara, Callao, Peru ,grid.430666.10000 0000 9972 9272School of Medicine, Universidad Científica del Sur, Lima, Peru
| | - Aldo Lucchetti
- grid.441917.e0000 0001 2196 144XSchool of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru ,Department of Infectious Diseases, Hospital Nacional Arzobispo Loayza, Lima, Peru
| | - Max Grogl
- grid.415929.20000 0004 0486 6610U.S. Naval Medical Research Unit No. 6, Lima, Peru
| | - Eduardo Gotuzzo
- grid.11100.310000 0001 0673 9488Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres, 15102 Lima, Peru
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Affiliation(s)
- A Schwalb
- TB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, UK, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J C Emery
- TB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, UK, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - R M G J Houben
- TB Modelling Group, TB Centre, London School of Hygiene & Tropical Medicine, London, UK, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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8
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Schwalb A, Cachay R, Wright A, Phillips PPJ, Kaur P, Diacon AH, Ugarte-Gil C, Mitnick CD, Sterling TR, Gotuzzo E, Horsburgh CR. Factors associated with screening failure and study withdrawal in multidrug-resistant TB. Int J Tuberc Lung Dis 2022; 26:820-825. [PMID: 35996282 DOI: 10.5588/ijtld.21.0729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Multidrug-resistant TB (MDR-TB) clinical trial in Lima, Peru and Cape Town, South Africa.OBJECTIVE: To identify baseline factors associated with screening failure and study withdrawal in an MDR-TB clinical trial.DESIGN: We screened patients for a randomized, blinded, Phase II trial which assessed culture conversion over the first 6 months of treatment with varying doses of levofloxacin plus an optimized background regimen (ClinicalTrials.gov: NCT01918397). We identified factors for screening failure and study withdrawal using Poisson regression to calculate prevalence ratios and Cox proportional hazard regression to calculate hazard ratios. We adjusted for factors with P < 0.2.RESULTS: Of the 255 patients screened, 144 (56.5%) failed screening. The most common reason for screening failure was an unsuitable resistance profile on sputum-based molecular susceptibility testing (n = 105, 72.9%). No significant baseline predictors of screening failure were identified in the multivariable model. Of the 111 who were enrolled, 33 (30%) failed to complete treatment, mostly for non-adherence and consent withdrawal. No baseline factors predicted study withdrawal in the multivariable model.CONCLUSION: No baseline factors were independently associated with either screening failure or study withdrawal in this secondary analysis of a MDR-TB clinical trial.
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Affiliation(s)
- A Schwalb
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - R Cachay
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - A Wright
- Vanderbilt University Medical Center, Vanderbilt Tuberculosis Center, Nashville, TN, USA
| | - P P J Phillips
- University of California San Francisco Center for Tuberculosis, San Francisco, CA, USA
| | - P Kaur
- Boston University, Departments of Epidemiology, Biostatistics, Global Health and Medicine, Boston, MA, USA
| | - A H Diacon
- TASK Applied Science and Stellenbosch University, Cape Town, South Africa
| | - C Ugarte-Gil
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - C D Mitnick
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - T R Sterling
- Vanderbilt University Medical Center, Vanderbilt Tuberculosis Center, Nashville, TN, USA
| | - E Gotuzzo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - C R Horsburgh
- Boston University, Departments of Epidemiology, Biostatistics, Global Health and Medicine, Boston, MA, USA
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Abstract
Worldwide, nations have struggled during the coronavirus disease 2019 (COVID-19) pandemic. However, Latin America and the Caribbean faced an unmatched catastrophic toll. As of March 2022, the region has reported approximately 15% of cases and 28% of deaths worldwide. Considering the relatively late arrival of SARS-CoV-2, several factors in the region were determinants of the humanitarian crisis that ensued. Pandemic unpreparedness, fragile healthcare systems, forthright inequalities, and poor governmental support facilitated the spread of the virus throughout the region. Moreover, reliance on repurposed and ineffective drugs such as hydroxychloroquine and ivermectin-to treat or prevent COVID-19-was publicised through misinformation and created a false sense of security and poor adherence to social distancing measures. While there were hopes that herd immunity could be achieved after the region's disastrous first peak, the emergence of the Gamma, Lambda, and Mu variants made this unattainable. This review explores how Latin America and the Caribbean fared during the first 2 years of the pandemic, and how, despite all the challenges, the region became a global leader in COVID-19 vaccination, with 63% of its population fully vaccinated.
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Affiliation(s)
- Alvaro Schwalb
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.,London School of Hygiene and Tropical Medicine, London, UK
| | - Eleonora Armyra
- Health Innovation Lab, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Melissa Méndez-Aranda
- Facultad de Ciencias y Filosofía, Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - César Ugarte-Gil
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.,London School of Hygiene and Tropical Medicine, London, UK.,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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Dale KD, Schwalb A, Houben RMGJ. Estimating annual risk of infection with Mycobacterium tuberculosis. Lancet Infect Dis 2022; 22:1275-1276. [PMID: 36029780 DOI: 10.1016/s1473-3099(22)00452-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/23/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Katie D Dale
- Victorian Tuberculosis Program, Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital, Melbourne, VIC, Australia.
| | - Alvaro Schwalb
- TB Modelling Group, TB Centre, and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rein M G J Houben
- TB Modelling Group, TB Centre, and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Affiliation(s)
- Alvaro Schwalb
- 1Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, Peru
| | - Paloma M. Carcamo
- 2School of Medicine, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, Peru
| | - Carlos Seas
- 1Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, Peru
- 2School of Medicine, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, Peru
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12
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Cachay R, Schwalb A, Acevedo-Rodriguez JG, Merino X, Talledo M, Suarez-Ognio L, Pezzi L, de Lamballerie X, Guerra H, Jaenisch T, Gotuzzo E. Zika Virus Seroprevalence in Two Districts of Chincha, Ica, Peru: A Cross-Sectional Study. Am J Trop Med Hyg 2022; 106:192-198. [PMID: 34814106 PMCID: PMC8733524 DOI: 10.4269/ajtmh.20-1339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 07/09/2021] [Indexed: 01/03/2023] Open
Abstract
In 2017, a major outbreak of Zika virus (ZIKV) infection took place in Chincha Province, Peru, where arboviral circulation had never been reported before. We conducted a cross-sectional survey (March-May 2019) in two districts of Chincha Province: Pueblo Nuevo and Chincha Baja. We included residents who were 20 to 40 years old and who had lived in these districts for at least 1 year. Serological testing combined screening with a commercial NS1 protein-based Zika IgG ELISA, and confirmation by a cytopathic effect-based virus neutralization test (VNT). Prevalence ratios (PRs) were calculated using Poisson regression with robust error variance. Four hundred participants, divided equally among districts, were enrolled. Anti-ZIKV IgG ELISA was positive for 42 participants (10.5%) and borderline for 12 (3%). Fifty-two of these 54 samples were confirmed positive by ZIKV VNT (13% of the total population). The Pueblo Nuevo district exhibited a greater ZIKV seroprevalence based on VNT results than the Chincha Baja district (23.5% versus 2.5%), with participants from the Pueblo Nuevo district being 9.4 times more likely to have a positive ZIKV VNT result. Average monthly income greater than the minimum wage and adequate water storage were found to be protective factors (PR, 0.29 and 0.24, respectively). In multivariate analysis, living in the Pueblo Nuevo district and a personal history of fever and rash were strong predictors of ZIKV positivity by VNT. The low ZIKV seroprevalence should prompt health authorities to stimulate interventions to prevent potential future outbreaks. In the Pueblo Nuevo district, the seroprevalence was greater but presumably not sufficient to ensure protective herd immunity.
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Affiliation(s)
- Rodrigo Cachay
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru;,Address correspondence to Rodrigo Cachay, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru. E-mail:
| | - Alvaro Schwalb
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Xiomara Merino
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru;,Unidad de Epidemiología Molecular, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Michael Talledo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru;,Unidad de Epidemiología Molecular, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis Suarez-Ognio
- Facultad de Medicina, Universidad Peruana Ciencias Aplicadas, Lima, Peru
| | - Laura Pezzi
- Unité des Virus Émergents, Aix-Marseille University, Marseille, France
| | | | - Humberto Guerra
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Thomas Jaenisch
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany;,Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
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Rickman HM, Kamchedzera W, Schwalb A, Phiri MD, Ruhwald M, Shanaube K, Dodd PJ, Houben RMGJ, Corbett EL, MacPherson P. Know your tuberculosis epidemic-Is it time to add Mycobacterium tuberculosis immunoreactivity back into global surveillance? PLOS Glob Public Health 2022; 2:e0001208. [PMID: 36962621 PMCID: PMC10021854 DOI: 10.1371/journal.pgph.0001208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tuberculosis (TB) still causes 1.5 million deaths globally each year. Over recent decades, slow and uneven declines in TB incidence have resulted in a falling prevalence of TB disease, which increasingly concentrates in vulnerable populations. Falling prevalence, while welcome, poses new challenges for TB surveillance. Cross-sectional disease surveys require very large sample sizes to accurately estimate disease burden, and even more participants to detect trends over time or identify high-risk areas or populations, making them prohibitively resource-intensive. In the past, tuberculin skin surveys measuring Mycobacterium tuberculosis (Mtb) immunoreactivity were widely used to monitor TB epidemiology in high-incidence settings, but were limited by challenges with both delivering and interpreting the test. Here we argue that the shifting epidemiology of tuberculosis, and the development of new tests for Mtb infection, make it timely and important to revisit the strategy of TB surveillance based on infection or immunoreactivity. Mtb infection surveys carry their own operational challenges and fundamental questions, for example: around survey design and frequency; which groups should be included; how the prevalence of immunoreactivity in a population should be used to estimate force of infection; how individual results should be interpreted and managed; and how surveillance can be delivered efficiently and ethically. However, if these knowledge gaps are addressed, the relative feasibility and lower costs of Mtb infection surveillance offer a powerful and affordable opportunity to better "know your TB epidemic", understand trends, identify high-risk and underserved communities, and tailor public health responses to dynamic epidemiology.
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Affiliation(s)
- Hannah M Rickman
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | | | - Alvaro Schwalb
- TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mphatso D Phiri
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Morten Ruhwald
- FIND, the Global Alliance for Diagnostics, Geneva, Switzerland
| | | | - Peter J Dodd
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Rein M G J Houben
- TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elizabeth L Corbett
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | - Peter MacPherson
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Schwalb A, Cachay R, Meza E, Cáceres T, Blackman A, Maruri F, Sterling TR, Gotuzzo E. Fluoroquinolone susceptibility in first-line drug-susceptible M. tuberculosis isolates in Lima, Peru. BMC Res Notes 2021; 14:413. [PMID: 34776013 PMCID: PMC8591909 DOI: 10.1186/s13104-021-05832-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
Objective To determine at two distinct time points the prevalence of resistance to ofloxacin (OFX), the representative class drug of fluoroquinolones (FQs), in M. tuberculosis isolates susceptible to first-line drugs. Results There were 279 M. tuberculosis isolates from the two cohorts (2004–2005: 238 isolates; 2017: 41 isolates) that underwent OFX drug-susceptibility testing (critical concentration: 2 µg/ml). Of 238 isolates in Cohort 1, no resistance to OFX was detected (95% CI 0–0.016); likewise, in Cohort 2, no resistance to OFX was detected in 41 isolates (95% CI 0–0.086). Our findings suggest that FQ use remains a viable option for the treatment of first-line drug-susceptible TB in Peru.
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Affiliation(s)
- Alvaro Schwalb
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres, 15102, Lima, Peru.
| | - Rodrigo Cachay
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres, 15102, Lima, Peru
| | - Ericka Meza
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres, 15102, Lima, Peru
| | - Tatiana Cáceres
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres, 15102, Lima, Peru
| | - Amondrea Blackman
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Fernanda Maruri
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Timothy R Sterling
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres, 15102, Lima, Peru
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15
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Cachay R, Gil-Zacarias M, Watanabe-Tejada T, Schwalb A, Mejía F, Gayoso O, Gotuzzo E. Clinical, Radiological and Functional Characteristics of Pulmonary Diseases among HTLV-1 Infected Patients without Prior Active Tuberculosis Infection. Pathogens 2021; 10:pathogens10070895. [PMID: 34358045 PMCID: PMC8308839 DOI: 10.3390/pathogens10070895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 11/24/2022] Open
Abstract
The lifelong infection with the human T lymphotropic virus type 1 (HTLV-1) has been associated with a variety of clinical manifestations; one of the less-explored is HTLV-1-associated pulmonary disease. Imaging of lung damage caused by the HTLV-1 hyperinflammatory cascade can be similar to sequelae from TB infection. Our study aims to describe the pulmonary lesions of HTLV-1-positive patients without past or current active TB and evaluate pulmonary function. We found that nine out of fourteen patients with no known TB disease history presented bronchiectasis, mainly found bilaterally while five presented pulmonary fibrosis. A normal pattern was found in most patients with a pulmonary functional test. Furthermore, there was no association between the PVL and the chest-CT scan findings, nor with spirometry results. However, the sample size was insufficient to conclude it.
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Affiliation(s)
- Rodrigo Cachay
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, Peru; (M.G.-Z.); (T.W.-T.); (A.S.); (F.M.); (O.G.); (E.G.)
- Alberto Hurtado School of Medicine, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
- Correspondence:
| | - Marcela Gil-Zacarias
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, Peru; (M.G.-Z.); (T.W.-T.); (A.S.); (F.M.); (O.G.); (E.G.)
- Alberto Hurtado School of Medicine, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | - Takashi Watanabe-Tejada
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, Peru; (M.G.-Z.); (T.W.-T.); (A.S.); (F.M.); (O.G.); (E.G.)
- Alberto Hurtado School of Medicine, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | - Alvaro Schwalb
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, Peru; (M.G.-Z.); (T.W.-T.); (A.S.); (F.M.); (O.G.); (E.G.)
- Alberto Hurtado School of Medicine, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | - Fernando Mejía
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, Peru; (M.G.-Z.); (T.W.-T.); (A.S.); (F.M.); (O.G.); (E.G.)
- Infectious, Tropical and Dermatological Diseases, Hospital Cayetano Heredia, Lima 15102, Peru
| | - Oscar Gayoso
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, Peru; (M.G.-Z.); (T.W.-T.); (A.S.); (F.M.); (O.G.); (E.G.)
- Alberto Hurtado School of Medicine, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
- Pulmonology Service, Hospital Cayetano Heredia, Lima 15102, Peru
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, Peru; (M.G.-Z.); (T.W.-T.); (A.S.); (F.M.); (O.G.); (E.G.)
- Alberto Hurtado School of Medicine, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
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16
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Schwalb A, Cachay R, Curisinche-Rojas M, Gotuzzo E, Ríos J, Ugarte-Gil C. Tuberculosis Scientific Conferences in Peru: Sharing local evidence for local decisions. J Clin Tuberc Other Mycobact Dis 2021; 23:100232. [PMID: 33869808 PMCID: PMC8044673 DOI: 10.1016/j.jctube.2021.100232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction International conferences on tuberculosis (TB) have been held since the 19th century. In Peru, the TB Scientific Conferences have been held annually in Lima since 2013 as a means of developing a national TB research network and setting the stage for researchers and institutions to present and share new findings from studies conducted in Peru. Methods Systematization of information on speakers and presentations from TB Scientific Conferences in Peru. Presentation files and official agendas for the conferences from 2013 to 2019 were obtained from the Tuberculosis Prevention and Control Directorate's website. Results A total of 426 scientific presentations have been delivered by 230 speakers, with a steady annual increase. 37.1% of the talks were given by female speakers. To date, 61.4% of the research presented has been published. Out of all the studies, 10.9% (30/275) were part of international, multicentric research projects. Main research lines were epidemiology (40.1%), drug-resistance (29.6%) and treatment (22.1%). Conclusions TB Scientific Conferences serve as a platform to share region-specific TB evidence between local stakeholders (health officials, academics, and others) who aim to facilitate the implementation of measures with the goal of reducing the national gaps towards the End TB Strategy goals.
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Affiliation(s)
- Alvaro Schwalb
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, 15102 Lima, Peru
| | - Rodrigo Cachay
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, 15102 Lima, Peru
| | - Maricela Curisinche-Rojas
- Dirección de Prevención y Control de Tuberculosis, Ministerio de Salud, Av. Horacio Urteaga 900, Jesús María, 15072 Lima, Peru
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, 15102 Lima, Peru.,School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, 15102 Lima, Peru
| | - Julia Ríos
- Dirección de Prevención y Control de Tuberculosis, Ministerio de Salud, Av. Horacio Urteaga 900, Jesús María, 15072 Lima, Peru
| | - César Ugarte-Gil
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, 15102 Lima, Peru.,School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, 15102 Lima, Peru
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17
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Abstract
Despite the early adoption of a national lockdown and other restrictions, Peru has been severely impacted by the COVID-19 pandemic. Having reached a milestone of more than 1,200 deaths per one million inhabitants by February 2021, important messages can be learned from how the pandemic was handled. Possible explanations for poor outcomes are a fragmented and already overwhelmed public health sector, lack of infrastructure and specialized personnel to tackle the pandemic, and deficient leadership from health authorities.
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Affiliation(s)
| | - Carlos Seas
- Address correspondence to Carlos Seas, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres, Lima 15102, Peru. E-mail:
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18
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Mejía F, Medina C, Cornejo E, Morello E, Vásquez S, Alave J, Schwalb A, Málaga G. Oxygen saturation as a predictor of mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru. PLoS One 2020; 15:e0244171. [PMID: 33370364 PMCID: PMC7769479 DOI: 10.1371/journal.pone.0244171] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/06/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Peru is among the top ten countries with the highest number of coronavirus disease 2019 (COVID-19) cases worldwide. The aim of the study was to describe the clinical features of hospitalized adult patients with COVID-19 and to determine the prognostic factors associated with in-hospital mortality. METHODS We conducted a retrospective cohort study among adult patients with COVID-19 admitted to Hospital Cayetano Heredia; a tertiary care hospital in Lima, Peru. The primary outcome was in-hospital mortality. Multivariate Cox proportional hazards regression was used to identify factors independently associated with in-hospital mortality. RESULTS A total of 369 patients (median age 59 years [IQR:49-68]; 241 (65.31%) male) were included. Most patients (68.56%) reported at least one comorbidity; more frequently: obesity (42.55%), diabetes mellitus (21.95%), and hypertension (21.68%). The median duration of symptoms prior to hospital admission was 7 days (IQR: 5-10). Reported in-hospital mortality was 49.59%. By multiple Cox regression, oxygen saturation (SaO2) values of less than 90% on admission correlated with mortality, presenting 1.86 (95%CI: 1.02-3.39), 4.44 (95%CI: 2.46-8.02) and 7.74 (95%CI: 4.54-13.19) times greater risk of death for SaO2 of 89-85%, 84-80% and <80%, respectively, when compared to patients with SaO2 >90%. Additionally, age >60 years was associated with 1.88 times greater mortality. CONCLUSIONS Oxygen saturation below 90% on admission is a strong predictor of in-hospital mortality in patients with COVID-19. In settings with limited resources, efforts to reduce mortality in COVID-19 should focus on early identification of hypoxemia and timely access to hospital care.
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Affiliation(s)
- Fernando Mejía
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Hospital Cayetano Heredia, Lima, Peru
- * E-mail:
| | - Carlos Medina
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Hospital Cayetano Heredia, Lima, Peru
| | - Enrique Cornejo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Hospital Cayetano Heredia, Lima, Peru
| | | | | | - Jorge Alave
- Hospital Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Unión, Lima, Peru
| | - Alvaro Schwalb
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
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19
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Cachay R, Schwalb A, Watanabe T, Guzman D, Jaenisch T, Guillén-Pinto D, Gotuzzo E. Case Report: Multiorgan Involvement with Congenital Zika Syndrome. Am J Trop Med Hyg 2020; 103:1656-1659. [PMID: 32723426 DOI: 10.4269/ajtmh.20-0421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We report the case of an infant born with congenital Zika syndrome (CZS). During the largest Zika virus (ZIKV) outbreak in Peru, the mother presented with fever and rash that were confirmed to be due to ZIKV by real-time PCR. The infant was born with severe microcephaly. Imaging revealed corpus callosum dysgenesis, lissencephaly, ventriculomegaly, and calcifications. Mild hypertrophic cardiomyopathy with diastolic dysfunction was reported in the echocardiogram. Valgus deviation of the lower extremities and a left clubfoot were diagnosed at birth. The hip ultrasound showed incipient signs of Graf type II dysplasia. The findings confirm that CZS is a multiorgan phenotype in which microcephaly is merely the tip of the iceberg. A multidisciplinary approach is needed for the evaluation of these children.
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Affiliation(s)
- Rodrigo Cachay
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alvaro Schwalb
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Takashi Watanabe
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Thomas Jaenisch
- Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany
| | | | - Eduardo Gotuzzo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
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20
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Carcamo PM, Schwalb A, Seas C. Chromoblastomycosis: A Case of a Verrucous Plaque from the Tropics. Am J Trop Med Hyg 2020; 103:547-548. [PMID: 32758344 PMCID: PMC7410413 DOI: 10.4269/ajtmh.20-0243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Paloma M Carcamo
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alvaro Schwalb
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos Seas
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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21
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Julca-Copello P, Schwalb A, Cachay R, Tipismana M, Alvarez C, Mejía F, González-Lagos E, Gotuzzo E. Impact of fractures and orthopedic surgeries in patients with HTLV-1 associated myelopathy/tropical spastic paraparesis. Rev Soc Bras Med Trop 2020; 53:e20200101. [PMID: 32935782 PMCID: PMC7491556 DOI: 10.1590/0037-8682-0101-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/17/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In patients with HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) gait disturbance is a predominant feature that leads to falls and fractures, which can further aggravate disability. We sought to evaluate the impact of fractures and orthopedic surgeries in patients with HAM/TSP. METHODS We retrieved the medical records of HAM/TSP patients enrolled in our study center's HTLV-1 clinical cohort between 1989-2018. The selection criteria included: (1) diagnosis of HTLV-1 infection using two enzyme-linked immunosorbent assays and/or a confirmatory test, (2) clinical diagnosis of HAM/TSP by neurological assessment, and (3) fractures associated with HAM/TSP. RESULTS We identified 24 cases of fractures, 70% of which were females. The median age at the time of fracture was 60 years (IQR=24). Six cases reported fractures in patients under 45 years old. Ten patients (42%) had hip/coccyx fractures, seven (29%) were in the lower extremities, and four (17%) in the upper extremities. Half of these patients reported the use of wheelchairs. Five patients who had previously used canes required the use of wheelchairs after the reported fracture. Eight patients underwent corrective orthopedic surgery as a result of the fracture. CONCLUSIONS For HAM/TSP patients, fractures are a complication that can exacerbate their severe impairment.
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Affiliation(s)
| | - Alvaro Schwalb
- Universidad Peruana Cayetano Heredia, Instituto de Medicina Tropical Alexander von Humboldt, Lima, Perú
| | - Rodrigo Cachay
- Universidad Peruana Cayetano Heredia, Instituto de Medicina Tropical Alexander von Humboldt, Lima, Perú
| | - Martín Tipismana
- Universidad Peruana Cayetano Heredia, School of Medicine, Lima, Perú.,Universidad Peruana Cayetano Heredia, Instituto de Medicina Tropical Alexander von Humboldt, Lima, Perú.,Hospital Cayetano Heredia, Neurology Department, Lima, Perú
| | - Carolina Alvarez
- Universidad Peruana Cayetano Heredia, Instituto de Medicina Tropical Alexander von Humboldt, Lima, Perú
| | - Fernando Mejía
- Universidad Peruana Cayetano Heredia, School of Medicine, Lima, Perú.,Universidad Peruana Cayetano Heredia, Instituto de Medicina Tropical Alexander von Humboldt, Lima, Perú
| | - Elsa González-Lagos
- Universidad Peruana Cayetano Heredia, School of Medicine, Lima, Perú.,Universidad Peruana Cayetano Heredia, Instituto de Medicina Tropical Alexander von Humboldt, Lima, Perú
| | - Eduardo Gotuzzo
- Universidad Peruana Cayetano Heredia, School of Medicine, Lima, Perú.,Universidad Peruana Cayetano Heredia, Instituto de Medicina Tropical Alexander von Humboldt, Lima, Perú
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22
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Affiliation(s)
- Alvaro Schwalb
- Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru
| | - Carlos Seas
- Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru
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23
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Schwalb A, Cachay R, de la Flor A, García C, Seas C. Adherence to standards of care and mortality in the management of Staphylococcus aureus bacteraemia in Peru: A prospective cohort study. Int J Infect Dis 2020; 96:601-606. [PMID: 32505877 DOI: 10.1016/j.ijid.2020.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite high mortality rates, physicians can alter the course of the Staphylococcus aureus bacteraemia (SAB) by following recommended standards of care. We aim to assess the adherence of these guidelines and their impact on mortality. METHODS Substudy from a prospective cohort of hospitalized patients with SAB from three hospitals from Peru. Hazard ratios were calculated using Cox proportional regression to evaluate the association between 30-day mortality and the performance of standards of care: removal of central venous catheters (CVC), follow-up blood cultures, echocardiography, correct duration, and appropriate definitive antibiotic therapy. RESULTS 150 cases of SAB were evaluated; 61.33% were MRSA. 30-day attributable mortality was 22.39%. CVC removal was done in 42.86% of patients. Follow-up blood cultures and echocardiograms were performed in 8% and 29.33% of cases, respectively. 81.33% of cases had appropriate empirical treatment, however, only 22.41% of MSSA cases were given appropriate definitive treatment, compared to 93.47% of MRSA. The adjusted regression for all-cause mortality found a substantial decrease in hazards when removing CVC (aHR 0.28, 95% CI: 0.10 - 0.74) and instituting appropriate definitive treatment (aHR 0.27, 95% CI: 0.08 - 0.86), while adjusting for standards of care, qPitt bacteraemia score, comorbidities, and methicillin susceptibility; similar results were found in the attributable mortality model (aHR 0.24, 95% CI: 0.08 - 0.70 and aHR 0.21, 95% CI: 0.06 - 0.71, respectively). CONCLUSIONS Deficient adherence to standards of care was observed, especially definitive treatment for MSSA. CVC removal and the use of appropriate definitive antibiotic therapy reduced the hazard mortality of SAB.
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Affiliation(s)
- Alvaro Schwalb
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Rodrigo Cachay
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Coralith García
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Cayetano Heredia, Lima, Peru
| | - Carlos Seas
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Cayetano Heredia, Lima, Peru
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24
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Carrasco-Escobar G, Schwalb A, Tello-Lizarraga K, Vega-Guerovich P, Ugarte-Gil C. Spatio-temporal co-occurrence of hotspots of tuberculosis, poverty and air pollution in Lima, Peru. Infect Dis Poverty 2020; 9:32. [PMID: 32204735 PMCID: PMC7092495 DOI: 10.1186/s40249-020-00647-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/05/2020] [Indexed: 12/03/2022] Open
Abstract
Growing evidence suggests pollution and other environmental factors have a role in the development of tuberculosis (TB), however, such studies have never been conducted in Peru. Considering the association between air pollution and specific geographic areas, our objective was to determine the spatial distribution and clustering of TB incident cases in Lima and their co-occurrence with clusters of fine particulate matter (PM2.5) and poverty. We found co-occurrences of clusters of elevated concentrations of air pollutants such as PM2.5, high poverty indexes, and high TB incidence in Lima. These findings suggest an interplay of socio-economic and environmental in driving TB incidence.
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Affiliation(s)
- Gabriel Carrasco-Escobar
- Health Innovation Lab, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Infectious Diseases, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Alvaro Schwalb
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kelly Tello-Lizarraga
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Cesar Ugarte-Gil
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
- TB Centre, London School of Hygiene and Tropical Medicine, London, UK.
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25
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Ruiz-Grosso P, Cachay R, de la Flor A, Schwalb A, Ugarte-Gil C. Association between tuberculosis and depression on negative outcomes of tuberculosis treatment: A systematic review and meta-analysis. PLoS One 2020; 15:e0227472. [PMID: 31923280 PMCID: PMC6953784 DOI: 10.1371/journal.pone.0227472] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/19/2019] [Indexed: 12/19/2022] Open
Abstract
Background Depression is a common comorbidity of tuberculosis (TB) and is associated with poor adherence to treatment of multiple disorders. We conducted a systematic review to synthesize the existing evidence on the relationship between depression and negative outcomes of TB treatment. Methods We systematically reviewed studies that evaluated depressive symptoms (DS) directly or indirectly through psychological distress (PD) and measured negative treatment outcomes of drug-sensitive pulmonary TB, defined as death, loss to follow-up, or non-adherence. Sources included PubMed, Global Health Library, Embase, Scopus and Web of Science from inception to August 2019. Results Of the 2,970 studies initially identified, eight articles were eligible for inclusion and two were used for the primary outcome meta-analysis. We found a strong association between DS and negative TB treatment outcomes (OR = 4.26; CI95%:2.33–7.79; I2 = 0%). DS were also associated with loss to follow-up (OR = 8.70; CI95%:6.50–11.64; I2 = 0%) and death (OR = 2.85; CI95%:1.52–5.36; I2 = 0%). Non-adherence was not associated with DS and PD (OR = 1.34; CI95%:0.70–2.72; I2 = 94.36) or PD alone (OR = 0.92; CI95%:0.81–1.05; I2 = 0%). Conclusions DS are associated with the negative TB treatment outcomes of death and loss to follow-up. Considerable heterogeneity exists in the definition of depression and outcomes such as non-adherence across the limited number of studies on this topic.
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Affiliation(s)
- Paulo Ruiz-Grosso
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rodrigo Cachay
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Alvaro Schwalb
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar Ugarte-Gil
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- TB Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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Cachay R, Schwalb A, Mora R, Cáceres T, Gotuzzo E. [Infection by human T-cell lymphotropic virus type 1 in patients diagnosed with multidrug-resistant tuberculosis]. ACTA ACUST UNITED AC 2019; 36:150-151. [PMID: 31116332 DOI: 10.17843/rpmesp.2019.361.4232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/06/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Rodrigo Cachay
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Perú.,Unidad de Investigación de Tuberculosis, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Alvaro Schwalb
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Perú.,Unidad de Investigación de Tuberculosis, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Romina Mora
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Perú.,Unidad de Virología, Unidad de Epidemiología Molecular, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Tatiana Cáceres
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Perú.,Unidad de Investigación de Tuberculosis, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Perú
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