El dengue, causado por el virus del dengue (DENV), se encuentra entre las enfermedades causadas por arbovirus más importantes del mundo y en Paraguay, representa un importante problema de salud pública. Existen estudios que indican que los pacientes con enfermedades autoinmunes y una infección aguda por DENV pueden presentar un cuadro clínico complicado.
OBJETIVO: Determinar la frecuencia del virus de papiloma humano de alto riesgo oncogénico (HR-HPV) por captura híbrida II (r) (CH II(r)) según hallazgos citológicos en mujeres tratadas por lesiones escamosas intraepiteliales (SIL) de cuello uterino. MATERIAL Y MÉTODO: Estudio descriptivo de corte transverso de una serie de casos, en donde se incluyeron 122 mujeres tratadas, 79 (65%) por SIL de bajo grado (LSIL) y 43 (35%) por SIL de alto grado (HSIL) que concurrieron al Laboratorio de HPV del Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, para realizarse un control post-tratamiento, periodo 2006/2010. RESULTADOS: Se observó un total del 28% (34/122) de mujeres tratadas por SIL positivas para HR-HPV, detectándose infección viral en un 20% de las mujeres con ausencia de SIL (NSIL) (22/108), 83% de las mujeres con LSIL (10/12) y 100% de las mujeres con HSIL (2/2). De las 34 mujeres positivas para HR-HPV, 10 mujeres (29%) presentaron valores altos (100 pg/mL o más) de carga viral relativa, detectándose un aumento de casos positivos con la severidad de la lesión (28% NSIL, 30% LSIL, 50% HSIL). CONCLUSION: La detección de HR-HPV por CH II(r), así como los valores de carga viral relativa altos, en especial en mujeres con NSIL podrían ayudar a identificar mujeres tratadas con riesgo a desarrollar recidivas, contribuyendo así a fortalecer el programa de prevención de cáncer de cuello uterino.
Abstract Background Dengue is one of the most important re-emerging viral diseases and the most common human arthropod-borne viral infection worldwide. Any of the four Dengue virus serotypes (DENV-1 to 4) can cause asymptomatic infections or clinical manifestations that range in severity from a mild, self-limited illness, to a severe disease characterized by a shock syndrome that can lead to death. Paraguay suffers periodic epidemic outbreaks of dengue since 1988 when the DENV-1 was introduced in the country. Epidemics caused by all four serotypes have been reported and the country. Although dengue is endemic in Paraguay, few studies have described the molecular epidemiology of DENV in the country, which is important to understand the local and global spread, as well as the evolution of this pathogen. Methods This was a cross-sectional study of a convenience sample. Suspected dengue patients of any age were recruited from the Emergency Laboratory of the Central Hospital of the Institute of Social Welfare, Asuncion, Paraguay, from February to June of 2011. A DENV antigen test was used to confirm the infection. The protein E gene sequences of isolated viruses were sequenced for phylogenetic analysis. Results Dengue was confirmed in 55.1% of the participants (n = 98/178). The most frequent clinical findings were fever, headache, and myalgia. Identity analyses of the protein E gene sequence of 56 viruses isolated showed the circulation of DENV-1 (n = 45) and DENV-2 (n = 11) in the Asuncion metropolitan area in 2011. Molecular epidemiology analyses suggest that DENV-1 was introduced into Paraguay from Argentina, while the DENV-2 from Brazil, replacing previous virus lineages. Conclusions We have analyzed the molecular epidemiology of DENV-1 and DENV-2 isolated in Paraguay in 2011. We found strong evidence that DENV-1 was introduced into Paraguay from Argentina, while the DENV-2 from Brazil, replacing previous virus lineages. Molecular epidemiology studies are of great interest to analyze the dynamic of DENV spread, which are useful for early implementation of containment measures to reduce the risk of explosive epidemics caused by this virus.
Background.In 2018, Paraguay experienced a large dengue virus (DENV) outbreak.The primary objective of this study was to characterize dengue cases in the Central Department, where the majority of cases occur, and identify factors associated with DENV infection.Methods.Patients were enrolled from January-May 2018 if they presented with a suspected arboviral illness.Acute-phase specimens (≤8 days after symptom onset) were tested using rRT-PCR, a rapid diagnostic test for DENV nonstructural protein 1 (NS1) and anti-DENV IgM and IgG, and ELISA for IgG against NS1 from Zika virus (ZIKV).Results.231 patients were enrolled (95.2% adults) at two sites: emergency care and an outpatient clinical site.Patients included 119 (51.5%) dengue cases confirmed by rRT-PCR (n=115, 96.6%) and/or the detection of NS1 and anti-DENV IgM (n=4, 3.4%).DENV-1 was the predominant serotype (109/115, 94.8%).Epidemiologically, dengue cases and non-dengue cases were similar, though dengue cases were less likely to reside in a house/apartment or report a previous dengue case.Clinical and laboratory findings associated with dengue included red eyes, absence of sore throat, leucopenia and thrombocytopenia.At an emergency care site, 26% of dengue cases (26/100) required hospitalization.In univariate analysis, hospitalization was associated with increased viral load, anti-DENV IgG, and thrombocytopenia.Among dengue cases that tested positive for IgG against ZIKV NS1, the odds of DENV NS1 detection in the acute phase were decreased 10-fold (OR 0.1, 0.0-0.3). Conclusions.Findings from a predominantly adult population demonstrate clinical and laboratory factors associated with DENV infections and the potential severity of dengue in
La anemia es la concentracion de la hemoglobina por debajo de los valores limites establecidos. Las comunidades indigenas de la etnia Nivacle que habitan el Chaco paraguayo viven bajo condiciones de extrema pobreza, careciendo de asistencia sanitaria y de programas de control de enfermedades. Este estudio descriptivo de corte transversal realizado de junio de 2001 a marzo de 2002, tuvo como objetivo establecer la prevalencia y distribucion de anemia en hombres y mujeres de 15 a 65 anos, de la etnia Nivacle que habitan en el Chaco paraguayo. Se incluyo a todos los indigenas voluntarios sanos presentes en el momento del estudio que aceptaron participar, previo consentimiento informado. La concentracion de hemoglobina se determino en 379 indigenas Nivacle. La OMS considera que existe anemia en los adultos (a partir de 15 anos), cuando la concentracion de hemoglobina es inferior a 130 g/L para el sexo masculino y menor a 120g/l para el femenino. La prevalencia de anemia en mujeres n= 217 fue de 49,8 % (con media hemoglobina de 117,67 12,16 g/L); y en los hombres n= 162 resulto de 33,3 % (promedio de hemoglobina de 132,62 11,65 g/L). La elevada prevalencia de anemia observada, especialmente en mujeres, se deberia a una pobre nutricion, lo que conlleva a una mala salud que justifica la incorporacion de estrategias de atencion primaria de salud que se adapten a la cultura y a las condiciones de estas comunidades.
Additional file 1. Alignment of DENV-1. The E gene sequences of the DENV-1 (n = 15) obtained in this study were aligned with the E gene sequences of representative DENV-1 (n = 381) isolated worldwide. The alignment was performed with the CLC Main Workbench software (QIAGEN, USA).
Dengue is the most widespread arbovirus worldwide. In Paraguay, it reappeared in 1988-1989, with one of the largest epidemic outbreaks occurring in 2011.To evaluate the performance of the dengue epidemiological surveillance system in Paraguay between 2009 and 2011.We conducted an ecological study with secondary epidemiological surveillance data. We analyzed notified cases of the disease based on the distribution expected by Benford's law. To this end, we used the first and second digits from the global records stratified by region, season, population density, indicators of housing conditions and heads of cattle.The epidemiological surveillance system performed better during non-epidemic periods and in the states with better housing conditions and fewer heads of cattle.Given that a difference in the performance existed, we recommended that the system remains operating at the same high alert level even during periods when fewer cases are expected. The technology used by the method proposed to monitor the notification of cases is easy to transfer to operational staff.
The incidence of cervical cancer in Paraguay is among the highest in the world, with the human papillomavirus (HPV) being a necessary factor for cervical cancer. Knowledge about HPV infection among indigenous women is limited. This cross-sectional study analyzed the frequency of HPV and other genital infections in indigenous Paraguayan women of the Department of Presidente Hayes.This study included 181 sexually active women without cervical lesions. They belonged to the following ethnicities: Maká (n = 40); Nivaclé (n = 23); Sanapaná (n = 33); Enxet Sur (n = 51) and Toba-Qom (n = 34). The detection of HPV and other gynecological infectious microorganisms was performed by either molecular methods (for Mycoplasma hominis, Ureaplasma urealyticum, Chlamydia trachomatis), gram staining and/or culture (for Gardnerella vaginalis, Candida sp, Trichomonas vaginalis, Neisseria gonorrhoeae), serological methods (for Treponema pallidum, human immunodeficiency virus [HIV]) or cytology (cervical inflammation).A high prevalence (41.4%) of women positive for at least one sexually transmitted infection (STI) was found (23.2% any-type HPV, 11.6% T pallidum, 10.5% T vaginalis, 9.9% C trachomatis and 0.6% HIV) with 12.2% having more than one STI. HPV infection was the most frequent, with 16.1% of women positive for high-risk HPV types. There was a statistically significant association observed between any-type HPV and C trachomatis (p = 0.004), which indicates that the detection of one of these agents should suggest the presence of the other. There was no association between any-type HPV and other genital infections or cervical inflammation, suggesting that other mechanism could exist to favor infection with the virus.This multidisciplinary work suggests that STIs are frequent, making it necessary to implement control measures and improve diagnosis in order to increase the number of cases detected, especially in populations with poor access to health centers.
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