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Loxoscelismo en Chile: estudios epidemiológicos, clínicos y experimentales

Se presenta un enfoque panoramico de estudios epidemiologicos, clinicos y experimentales referentes a Loxosceles laeta y loxoscelismo efectuados en 1955-1988 en Santiago, Chile. Se estudiaron 216 casos de loxoscelismo. Los hechos mas relevantes fueron: 52,8% correspondio a mujeres; edad entre 7 meses y 78 anos; 84,3% fue loxoscelismo cutaneo (LO y 15,7% loxoscelismo cutaneo-visceral (LCV); 73,6% sucedio en epoca calurosa; en 86,6% el accidente ocurrio en la vivienda, especialmente en dormitorios, mientras la persona dormia o se vestia. La arana fue vista en 60,2% de los casos e identificada en laboratorio como L. laeta en 17,7% (10,6% de los 216 casos). Los sitios mas frecuen temente afectados fueron las extremidades con 67,6%, lancetazo urente fue el sintoma inicial mas frecuente. Dolor, edema y placa livedoide, la cual posteriormente se transformaria en escara necrotica, fueron las manifestaciones locales predominantes. En LCV hematuria y hemoglobinuria fueron constantes, ictericia, fiebre y compromiso de conciencia se presentaron en la mayoria de los casos. Tratamiento: LC con antihistaminicos o corticoides inyectables, LCV con corti-coides inyectables. La condicion de los pacientes en el ultimo control fue: curacion completa en 75,5%, curacion con secuela cicatrizal en 8,3%, muerte en 3,7% (todos con LCV) y abandono en 12,5%. Adicionalmente, se ha efectuado una serie de estudios experimentales, tanto in vivo como in vitro para esclarecer aspectos basicos sobre el veneno de L. laeta y el tratamiento del loxoscelismo.A panoramic sight of epidemiological, clinical and experimental studies, referring to Loxosceles laeta and loxoscelism, carried out in 1955-1988, in Santiago, Chile is presented. Two-hundred and sixteen cases of loxosce lism were studied. The most relevant features were: 84.3% corresponded to cutaneous loxosce lism (CD and 15.7% to viscerocutaneous loxos celism (VCD; 73.6% ocurred in hot season; in 86.6% of cases the accident happened in the hou se, particularly in bedrooms, while the people were sleeping or dressing. The spider was seen in 60.2%r of cases and identified in the laboratory as L. laeta in 10.69c of all cases. The sites more frequently bitten were the limbs with 67.6% ; a burning stinging was the most frequent initial symptom. Pain, edema and livedoid plaque, which developed later into a necrotic eschar, we re the predominant local manifestations. In VCL, hematuria and hemoglobinuria were cons tant, while jaundice, fever and sensorial involve ment were present in most of the cases. CL patients were parenterally treated with antihistamine drugs or corticoids, while VCL ones were treated with corticoids by injection. The condition of patients in the last follow up was: complete cure in 75.5% , cure with a scarfed sequela in 8.3%, death in 3.7% (all VCL) and abandonment in 12.5%. Additionally, a series of experimental studies, both in vivo and in vitro, has been performed in order to clarify basic aspects on L. laeta venom and the treatment of loxoscelism.

Seroepidemiology of human toxoplasmosis in Chile

A series of already published and unpublished seroepidemiological surveys for toxoplasmosis, carried out in Chile in 1982-1994, is reviewed, expanded and analyzed. The surveys included 76,317 apparently healthy individuals of different ages (0.57% of the countrys total population), from 309 urban and rural-periurban localities. Urban groups were integrated by blood donors, delivering mothers and middle grade schoolchildren, while rural-periurban individuals corresponded to unselected family groups. Blood samples were collected in filter paper. The presence of antibodies to Toxoplasma gondii was determined by the indirect hemagglutination test (IHAT), titers > or = 16 were considered positive. The test resulted positive in 28,124 (36.9%) of the surveyed people. Two hundred and six (0.3%) individuals presented IHAT titers > or = 1000, probably corresponding to acute or reactivated infections. A progressive increase of positive IHAT from northern to southern regions of the country was noted, phenomenon probably related to geographical conditions and to a higher production and consumption of different types of meat in the latter regions. It is postulated that ingestion of T gondii cysts by humans is epidemiologically as important as ingestion of oocysts. The result presented stress the epidemiological importance of toxoplasmosis in humans, and warn about eventual implications in immunocompromised patients and in transplacental transmission, organ transplants and transfusions.

Congenital Chagas disease of second generation in Santiago, Chile. Report of two cases

Congenital Chagas disease (CChD) has been reported in different countries, mostly in Latin America. In 1987 a fatal case of CChD of second generation (CChDSG) was published. Within a period of six months--1989-1990--two cases of CChDSG were diagnosed and studied in the city of Santiago. Two premature newborns, sons of two sisters, with moderate liver and spleen enlargement, were found to have positive serology for Chagas disease and xenodiagnoses. The mothers, urban residents all their lives, without antecedents of triatomine bugs contact or blood transfusions, showed positive serology and xenodiagnoses. Their mother (grandmother of the infants), lived 20 years in a Northern rural Chagas disease endemic locality, in a triatomine infested house. Afterwards, she moved to Santiago, where she married and has resided up to now. Serology and xenodiagnoses were also positive. All the Trypanosoma cruzi infected individuals were successfully treated with nifurtimox.

Hidatidosis humana en Chile. Seroprevalencia y estimación del número de personas infectadas

Chile is located in the southwestern border of South America. The country is 4,329 km long and 96-342 wide. From north to south it is divided into five marked different biogeographical zones: deserts, steppes, bushes, forests (cattle raising) and austral (sheep raising). Population (June1999) 15,017,760 (14.6% rural). Human hydatidosis is endemic in Chile. According to Ministry of Health information about 320 cases are registered each year. In order to find out the likely prevalence of human hydatidosis in Chile,a series of serosurveys was carried out in 1988-1997 throughout the total country. By using the indirect hemagglutination reaction and ELISA for hydatidosis (tests with good sensibility and specificity) 60,790 unselected apparently healthy persons: 41,399 from urban areas (16,428 blood donors, from 13,894 delivering mothers and 11,077 middle grade school children) and 19,361 from rural areas - from randomly selected family groupings-were studied. A total individuals 82 (136/100,000) resulted positive: 36 (87/100,000) urban and 46 (241/100,000) rural, being the prevalence higher in rural areas, particularly in the southern austral zone (mean 1068/100,00). These figures agree with those observed in clinical epidemiological studies. In conformity with the present results, in the whole country 17,002 individuals should have hydatidosis: 10,318 urban and 6,784 rural. All these possible infected people, not necessarily should present pathology in the future, as it has been observed in autopsies from unselected individuals, performed at the Medico-Legal Service in Santiago, in whom 71.3% of diagnosed hydatosis with hydatid cysts in many different locations, was an autopsy finding

Chronic Chagas disease: PCR-xenodiagnosis without previous microscopic observation is a useful tool to detect viable Trypanosoma cruzi

UNLABELLED We evaluate the elimination of the microscopic stage of conventional xenodiagnosis (XD) to optimize the parasitological diagnosis of Trypanosoma cruzi in chronic Chagas disease. To this purpose we applied under informed consent two XD cages to 150 Chilean chronic chagasic patients. The fecal samples (FS) of the triatomines at 30, 60 and 90 days post feeding were divided into two parts: in one a microscopic search for mobile trypomastigote and/or epimastigote forms was performed. In the other part, DNA extraction-purification for PCR directed to the conserved region of kDNA minicircles of trypanosomes (PCR-XD), without previous microscopic observation was done. An XD was considered positive when at least one mobile T. cruzi parasite in any one of three periods of incubation was observed, whereas PCR-XD was considered positive when the 330 bp band specific for T. cruzi was detected. 25 of 26 cases with positive conventional XD were PCR-XD positive (concordance 96.2%), whereas 85 of 124 cases with negative conventional XD were positive by PCR-XD (68.5%). Human chromosome 12 detected by Real-time PCR used as exogenous internal control of PCR-XD reaction allowed to discounting of PCR inhibition and false negative in 40 cases with negative PCR-XD. CONCLUSION PCR-XD performed without previous microscopic observation is a useful tool for detection of viable parasites with higher efficiency then conventional XD.

Enfermedad de Chagas crónica.Ausencia de Triatoma infestans intradomiciliario y persistencia de Trypanosoma cruzi circulante post-terapia

Trypanosoma cruziIn 1999 Chile declare no vectorial transmission of Chagas disease. On the other hand, thedevelopment of dwelling policy which include endemic rural zones, have obtained important advancesin human groups with height deficiency of habitability. This epidemiological situation was studied 10years after therapy, in 37 chronic chagasic patients from rural zones of the VI Region, by anepidemiologic inquest (pre and post-therapy) and parasitological evolution (post therapy). The inquestincluded: knowledge of the vector, presence of triatomines in the dwelling antecedents of have beenbitten by triatomines, and construction materials of the dwellings. The parasitological evolution wasperformed by xenodiagnosis (XD) (37 cases) and Polimerase Chain Reaction (PCR) in periphericalblood (34 cases). The results of the epidemiological survey evidenced important changes of the qualityof the rural dwelling of the treated chagasic patients, while, in relation to parasitemia, circulant

Comparación de la infección por Trypanosoma cruzi en niños menores de 10 años de la V Región, Chile. 1982-1995

Evaluation of desinsectation programs carried out in the two Health Services from the V Region, was undertaken by comparing serologic prevalences of T. cruzi in age groups exposed to the risk of infection in rural areas during the antivectorial campaign activities. (1982 vs 1995). Thus, were studied 2,193 blood samples from children under 10 years of age, proceeding rfrom six chagasic endemic provinces in which antitriatomic domiciliary insecticide sprayings had been performed. Indirect hemagglutination and ELISA tests were carried out to each of the blood samples. A total de 42 (1.9%) children resulted positive. As in five counties no positive case were detected in the last five years it is possible to assume that vector trasmission of T. cruzi should have been interrupted in them. When comparing prevalences existing in 1982 with the present ones, it is possible to observe a 63.5% of reduction of transmission in the V Region, been this reduction higher in the Aconcagua Health Service with 79.6% and lower in the Vina del Mar - Quillota Health Service with 55.6%. According to these results, comparison of prevalence of T. cruzi infection in children less than 10-year-old in diverse periods, allows evaluate the vectorial control of Triatoma infestans programs