Risk factors associated with Chagas disease in pregnant women in Santander, a highly endemic Colombian area

OBJECTIVE

To determine the prevalence and risk factors associated with Chagas disease in pregnant women in an endemic area of Santander, Colombia.

METHODS

Cross-sectional study included 23 municipalities of Santander, Colombia. Serological IFAT and ELISA tests were undertaken to detect IgG anti- Trypanosoma cruzi. A questionnaire was conducted for assessing the risk factors of each participant. Newborns were evaluated at birth and followed up to 1 year of age to determine congenital infection.

RESULTS

An overall prevalence of 3.2% (95% CI 2.4-4.2) among 1518 pregnant women was detected. Prevalences by provinces were as follows: Guanentina: 6.0% (95% CI 4.1-8.5), García Rovira: 2.9% (95% CI: 1.5-4.8) and Comunera: 0.4% (0.4-2.3). The main risk factors identified were age >32 years old (OR: 2.1; 95% CI: 1.1-3.9); currently having a thatched roof (OR: 11.8; CI95% 2.2-63.2) and a thatched roof during childhood (OR: 3.0; 95% CI: 1.4-6.6); having below primary school education level (OR: 4.6; 95% CI: 2.2-9.5); and a history of a close contact with the vector (triatomine bugs) at least once during their lifetime (OR: 6.9; 95% CI: 3.7-12.9). No congenital cases were detected by parasitological or serological techniques.

CONCLUSIONS

Prevalence of Chagas disease in pregnant women is a potential source of infection in this Colombian endemic area. The main risk factors associated with seropositivity were related to conditions favouring the contact with the vector. The results show that it is necessary to continue an active surveillance in order to offer diagnosis and treatment to mothers and their newborns in addition to screening to pregnant women from endemic areas.

Prevalence and impact of cardiovascular risk factors in Bucaramanga, Colombia: results from the Countrywide Integrated Noncommunicable Disease Intervention Programme (CINDI/CARMEN) baseline survey

BACKGROUND

Although cardiovascular diseases are the main cause of death in the region, there are few data on the prevalence of cardiovascular risk factors in Latin American. We studied the distribution and impact of cardiovascular risk factors in Bucaramanga, Colombia.

METHODS

We conducted a cross-sectional study in a random sample of 2989 subjects 15-64 years old. Population attributable risks were estimated from Framingham risk scores.

RESULTS

Smoking prevalence was 16.2% (men 26.3%; women 10.5%). Hypertension prevalence was 9.9% in women and 8.8% in men, but reached 50% in those 60-64 years old. After adjustment for body mass index, men were more likely to be hypertensive, but only if under 40 years old. Obesity was more frequent in women (15.7%) than in men (8.7%), even after age-adjustment. About 46% of the participants were overweight or obese. Women also had higher prevalence of high total cholesterol (19.7 versus 15.7%) and high low-density lipoprotein-cholesterol (23.9 versus 19.5%), but lower prevalence of low high-density lipoprotein (HDL)-cholesterol (22.2 versus 37.6%). Only low-HDL prevalence was significantly different after body mass index and age-adjustment. The prevalence of diabetes was similar in men and women (4%), but age and body mass index-adjusted impaired fasting glucose prevalence was 60% higher in women. Population attributable risks were larger and similar for high total cholesterol, hypertension, and large waist-to-hip ratio (19%).

CONCLUSIONS

Women had higher prevalence of all risk factors with the exception of smoking and low-HDL. Reduction in cholesterol levels, blood pressure and obesity is a priority to control the ongoing epidemic of cardiovascular diseases in this population.

Liver abscess caused by Ascaris lumbricoides: case report

A case is reported of a woman who lived in a rural area with a chronic illness that consisted of weight loss and abdominal pain in the epigastrium and upper right quadrant. The initial diagnosis was a mass in the liver, which was later, demonstrated, both by direct and histological examination, to be an abscess caused by Ascaris lumbricoides. Eggs of Ascaris lumbricoides and abundant Charcot-Leyden Crystals were found.

Paracoccidioidomycosis in Colombia: an ecological study

The natural habitat of Paracoccidioides brasiliensis, agent of paracoccidioidomycosis (PCM), remains unknown. This study is aimed at establishing associations between the ecological variables present in all Colombian municipalities and the incidence of PCM. Records of 940 patients were studied and several ecological variables analysed, as well as their association to amount of patients per total rural population in each municipality, determined through a multivariate analysis. All 940 patients came from 216 municipalities (20-3%), out of which, 93 were birthplace and place of long-term residence for 121 patients. The Incidence Rate Ratio (IRR) was determined for these 93 municipalities. The following variables fitted the model: altitude from 1,000 to 1,499 metres above sea level (IRR = 6.37), rainfall from 2000 to 2999 mm (IRR = 2.15), presence of humid forests (Holdridge) (IRR = 1.79) and coffee (IRR = 1.95), tobacco (IRR = 3.59) crops. These results indicate that these municipalities constitute reservareas for P. brasiliensis (Borelli).

Iatrogenic Mycobacterium abscessus infection: histopathology of 71 patients

The histopathology is described of 190 skin biopsies from 71 patients who presented during an epidemic of nodules and abscesses in the periumbilical region and buttocks, secondary to the application of xylocaine injections. Positive cultures for Mycobacterium abscessus were obtained from the specimens and from the xylocaine solution. The severe inflammatory lesions involved the dermis and the hypodermis and had three main histopathological patterns: (i) granulomatous nodular or diffuse inflammation with mixed granulomas in 57 (80%) of the cases; (ii) prevailing abscesses with mild granulomatous reaction in 28 (15%) of the biopsies; and (iii) deep dermal and subcutaneous granulomatous inflammation with no neutrophil component in three (4%) of cases. Bacilli were detected in 51 (27%) of the specimens, frequently forming small clumps at the centre of clear spaces or vacuoles and which were lipid-like structures in 156 (82%) of the abscesses or granulomas. This series represents one of the largest reported outbreaks caused by atypical mycobacteria and in which the source of infection was confirmed. The results emphasize the essential role of skin biopsies in determining the histopathological substrate, in helping to detect the atypical mycobacterial origin and in encouraging the practice of cultures for the identification of micro-organisms.

Iatrogenic outbreak of M. chelonae skin abscesses

We describe an outbreak of skin lesions due to Mycobacterium chelonae subsp. abscessus associated with injections of lidocaine (lignocaine) given by a 'bioenergetic' (a practitioner of alternative medicine) in Colombia. The lidocaine carpules and the lesions of the patients yielded mycobacteria with identical biochemical characteristics. Using the methodology of Sartwell and a case control design we examined the incubation period and assessed risk factors. Of 667 potentially exposed individuals, a total of 298 patients were interviewed, of whom 232 had skin lesions. The median incubation period was 30.5 days (range 15-59 days). Male sex (OR 2.85, 95% CI 1.26-6.51), increasing age (OR 1.25, 95% CI 1.03-1.53), subcutaneous injection route (OR 3.72, 95% CI 1.09-12.7) and number of injections (OR 1.01, 95% CI 1.00-1.03) were risk factors for disease. To our knowledge, this is the largest reported outbreak of M. chelonae infection, the first in which the organism has been isolated from the putative vehicle of infection, and the first in which the incubation period could be determined.

[Quality of sputum microscopy in the network of tuberculosis bacteriology laboratories in Colombia]

The objective of this study was to evaluate the technical quality of sputum microscopy carried out for diagnostic purposes in the Network of Tuberculosis Bacteriology Laboratories in Colombia. The National Central Reference Laboratory received 6,529 slides for reexamination from the network of 513 sectional, regional, and local laboratories, which contributed 33.2%, 27.6%, and 39.2%, respectively, of the slides. These included all the positive (3,283) and negative (3,246) smears processed during a 4-month period. The reexamination was carried out by six laboratory workers who did not know the origin of the slides or the original diagnosis. When qualitative problems were detected, a second reexamination was done, which significantly increased the percentage of agreement for both the positive results (93.9%) and the negative (98.7%). Overall, the level of agreement was 96.3%. A significant correlation was found (P < 0.05) between good slide preparation and staining and agreement in the readings, as well as between thin smears, presence of fuchsin precipitates, and deficient coloration and conflicting readings (P < 0.05). The highest percentages of agreement were associated with laboratories that performed the largest number of sputum examinations each month (96.5%), and with readings done by experienced, university-trained bacteriologists (96.6%). It is concluded that indirect technical supervision and ongoing training of laboratory personnel are important determinants of the impact of the tuberculosis control program.

Distribution of liposomes in tuberculous mice

The dynamics of the distribution of liposomes for use as drug carriers for the treatment of tuberculosis is studied. While the free radiolabel injected into mice was rapidly excreted by the kidneys, the same label trapped within liposomes was retained for longer periods in the liver, spleen and lung. There were variations in the distribution and retention times of liposomes of different composition. When the distribution of liposomes in healthy and tuberculous mice was compared, a greater accumulation in the liver, spleen and lungs of healthy mice was observed, although the retention time in tuberculous mice was longer. These findings merit consideration in the design of therapies based on liposome-entrapped drugs as the dynamics of distribution and retention differ between normal and infected animals.

The use of rifampicin and isoniazid entrapped in liposomes for the treatment of Murine tuberculosis

Liposomes loaded with rifampicin and isoniazid were used experimentally to treat mice with severe tuberculosis. The animals were distributed in four groups. The control group and the group treated with unloaded liposomes showed the severest disease. Both groups showed the lowest accumulated survival, about 50% after 30 days. The numbers of colony-forming-units (CFU) and root specific lung weight (RSLW) were the highest and the histopathology of the lung showed marked diffuse lesions. However, the group treated with unloaded liposomes showed significantly higher growth of M. tuberculosis compared with the control. The group treated with drug and drug loaded liposomes showed a higher survival, about 85% after 30 days, and the lowest values of CFU and RSLW. The lung histology revealed considerably less inflammation which was focal. The parameters evaluated indicated a significantly better response in the group of animals treated with rifampicin and isoniazid entrapped in liposomes.

A simple technique for entrapping rifampicin and isoniazid into liposomes

A method for the preparation of liposomes loaded with rifampicin and isoniazid is described. Optimal conditions were established; the lipid suspension was mixed with the aqueous solution of the drugs and was sonicated in a bath for 30 min at 50 degrees C. The optimum composition tested was phosphatidyl choline, cholesterol and cardiolipin in a molar ratio of 7:2:1. The separation of unloaded drug was performed by centrifugation through three successive Sephadex G-25 columns. The liposomes were multilamellar vesicles with a size ranging from 100-300 nm. The drugs were trapped in concentrations from 6.5-9.5 mg/ml. This method is suitable for preparation of liposomes in small laboratories.