Disease In Chile Research Articles

Neurocisticercosis: una enfermedad desatendida en Chile

Neurocysticercosis (NCC) is not a notifiable disease in Chile and has received little attention on the national medical literature. In order to evaluate the relevance and clinical features of the disease, we performed a retrospective analysis in a general hospital of five cases of NCC during a 11 years period. Age ranged from 3 to 63 years and all had history of living or visiting southern Chile. Three patients had a solitary parenchymal cyst in vesicular or granulomatous stages and presented with generalized seizures. Their outcome was favorable after anticonvulsant and albendazole therapy and cysts reduced in size and calcified during follow-up. The other 2 patients had extra-parenchymal or mixed forms, including a pregnant woman with intraventricular cysts who developed endocraneal hypertension and recurrent dysfunction of her ventriculoperitoneal shunt. This patient died after discharge despite an initial favorable evolution with steroids and high-dose albendazole. This case series showed that NCC is still an epidemiological and clinical problem in Chile, affects patients within a wide range of age including children, requires multidisciplinary therapeutic interventions, and has two clinical presentations with different prognosis including one malignant form. To control this infection, a surveillance or reporting system should be initiated.

Mannose-Binding Lectin and Toll-Like Receptor Polymorphisms and Chagas Disease in Chile

Mannose-binding lectin (MBL) and Toll-like receptor (TLR) polymorphisms may influence susceptibility and manifestation of Trypanosoma cruzi infection. In northern Chile, we examined 61 asymptomatic patients with chronic Chagas disease (CD), 64 patients with chronic Chagas cardiomyopathy (CCC), and 45 healthy individuals. Low-producer MBL2*B genotypes were more common in CD patients (48%) than healthy individuals (31%; adjusted odds ratio = 2.3, 95% confidence interval = 1.01-5.4, P = 0.047) but did not differ with manifestation. In contrast, the heterozygous Toll-like receptor 4 (TLR4)-deficiency genotype D299G/T399I occurred more frequently in asymptomatic (14.8%) than CCC patients (3.1%; P = 0.02). TLR1-I602S, TLR2-R753Q, TLR6-S249P, and MAL/TIRAP-S180L did not associate with CD or CCC. These findings support the complement system to be involved in defense against Trypanosoma cruzi infection and indicate that curbed TLR4 activation might be beneficial in preventing CCC.

La podredumbre de hospital

Hospital gangrene refers to a historical presentation of septic wounds, which was associated to situation with a multitude of wounded patients. Later, it was proven that hospital overcrowding together with inadequate wound treatment options aggravated the spread of the infection by nurses and surgeons as well as contaminated wound dressings resulting in high morbidity and mortality in the affected hospitals and lazarettos. This article, which reviews the historical situation of this disease in Chile, mainly bases on reports of the physicians Rafael Wormald and Jacinto Ugarte, who reported on this topic in 1852 and 1873, respectively, and on outbreak occurring between 1860 and 1870 at Hospital San Juan de Dios in Santiago.

Field assessment of Trypanosoma cruzi infection and host survival in the native rodent Octodon degus

Chagas disease is a zoonosis caused by the flagellated parasite Trypanosoma cruzi and transmitted by triatomine insects to several mammalian species acting as reservoir hosts. In the present study, we assess T. cruzi-prevalence, survivorship and T. cruzi-infection rate of the endemic rodent Octodon degus from a hyper-endemic area of Chagas disease in Chile. Parasite detection is performed by PCR assays on blood samples of individuals captured in austral summer of 2010, and on non-infected individuals recaptured in 2011 as well as on new captures. Results show a high infection level in this species (up to 70%). Infected O. degus have the same chance of surviving to the next reproductive season as uninfected individuals, irrespective of sex. We suggest that O. degus, an abundant long-lived rodent with high dispersal capability, could be considered an important native reservoir of T. cruzi in the wild transmission cycle of Chagas disease in Chile.

Hematoma subcapsular esplénico en paciente portador de rasgo falciforme

Drepanocytic anemia is an uncommon hereditary disease in Chile. The heterozygous state of drepanocytic anemia or "sickle trait" has a frequency of 8% among Afro-Americans. A small number of patients carrying hemoglobin S are homozygous, with clinical manifestations of hemolytic anemia and thrombotic disease. Sickle trait is usually asymptomatic. We report a 59-year-old male who presented an acute abdominal pain and dyspnea while staying at high altitude. Six days later, an angio CAT scan showed the presence of a subcapsular splenic hematoma that was managed conservatively. Sickle cell induction with sodium metabisulphite was positive. Hemoglobin electrophoresis confirmed the sickle trait.

Rising hospitalization rates of Kawasaki Disease in Chile between 2001 and 2007

Incidence of Kawasaki disease (KD) varies geographically, with highest rates in East Asia and comparatively lower rates in Europe and United States. Population-based epidemiologic studies of KD in Latin American countries have not been done. The purpose of this study is to determine demographic characteristics, hospitalization rates and estimated incidence of KD in Chile. We performed a retrospective review of national hospital discharge databases between 2001 and 2007 for patients younger than 18 years of age with KD (ICD10 code M30.3). Seven hundred and eighty-six hospitalizations with discharge diagnosis of KD were identified, representing 0.03% of hospitalizations. Median age of diagnosis was 1 year, and 85% of patients were younger than 5 years. Male-to-female ratio was 1.6:1. Highest hospitalization rates occurred in late winter/spring (August-November) with a smaller peak in summer (March). KD-associated hospitalization rate was 7.6 per 100,000 children younger than 5 years (95% CI 7.0-8.1). Hospitalization rates increased 47% between 2001-2004 and 2005-2007 periods: 6.3 (95% CI 5.6-7.0) to 9.3 (95% CI 8.3-10.3), (P < 0.001). Estimated incidence of KD, assuming 10% readmission rates, was 6.8 (95% CI 6.3-7.4), increasing from 5.7 (95% CI 5.0-6.3) in 2001-2004 to 8.4 (95% CI 7.4-9.3) in 2005-2007 (P < 0.001). In conclusion, demographic characteristics of Chilean patients with KD are similar to international data. There has been an increase in hospitalization rates and estimated incidence of KD in Chile between 2001 and 2007. This may reflect a true increase in cases or improved awareness.

A national online survey applied to patients with celiac disease in Chile

Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten in genetically susceptible individuals. Its prevalence in Europe and the USA is 0.5 to 1%. To analyze epidemiological aspects and degree of compliance with gluten-free diet (GFD) among Chilean individuals with CD. Subjects with confirmed or suspected CD were invited to answer an online survey published on the web at www.fundacionconvivir.cl. The answers were reinforced with a telephone interview. The survey was answered by 1212 subjects (79% females). Median age at diagnosis was 25.8 years (range 1 to 84 years), with a bimodal curve with two peaks at less than 3 years and at 20 to 40 years of age. The diagnosis was made only by serologic markers in 9%, only by intestinal biopsy in 17.5%, and by a combination of both methods in 70%o. Conditions associated with CD were reported by 30% > of subjects and 20% > had relatives with CD. The GFD was strictly adhered to by 70% >, occasionally by 27% > and never by 3% >. Seventy five percent of subjects with a strict adherence to GFD had a favorable clinical response compared with 42% > of those with incomplete or lack of adherence (odds ratio 4.0, 95% > confidence intervals 2.8-5.7p < 0.01). In 30% of respondents, the diagnosis of CD was not confirmed according to international guidelines that require serology and duodenal biopsy. One third of subjects recognized a poor compliance with GFD. Those with a strict adherence to it had a more favorable clinical course. However, 25% > did not experience a clinical improvement despite a strict GFD, a finding which requires further study.

Manejo paliativo del cáncer de vesícula biliar irresecable o metastásico: Conclusiones del Consenso Latinoamericano de Manejo del Cáncer de Vesícula Biliar

Gallbladder cancer is a rare disease in Western developed countries, but it is a highly prevalent and lethal disease in Chile and other countries in Latin America. No randomized controlled trials have been performed in gallbladder cancer to establish standard treatments. We therefore performed the first Latin American consensus meeting for the management of gallbladder cancer. In this article we present the conclusions of the panel of experts for the palliative treatment of unresectable or metastatic gallbladder cancer based on a review of the literature, the discussion of the participating experts and the opinion of the assistants. The topics reviewed included: (1) Gallbladder cancer and cholangiocarcinoma--are they the same disease?; (2) Palliative chemotherapy: indications, drugs and schedules; (3) Palliative radiotherapy; (4) Palliative Surgery; (5) Management of malignant biliary obstruction.

Mortalidad por cardiopatía isquémica en Chile: quiénes, cuántos y dónde

To describe the characteristics of mortality from ischemic heart disease in Chile and its trend over time, and to identify the factors associated with extra-hospital mortality from this pathology between 1997 and 2007. A time-series study was conducted using the mortality database of the Department of Health Statistics and Information for 1997 to 2007. Of the total of 917,029 deaths reported in this period, those whose primary cause was ischemic heart disease (ICD-10 codes I20-I25) were selected. Crude and adjusted rates were calculated by age and sex in order to analyze the trend. Mortality characteristics were analyzed by the place of death, evaluating potential factors associated with extra-hospital mortality (death at home or elsewhere outside a hospital or clinic). The factors considered, using binomial regression, were age, rurality, marital status, education, and sex, as well as the effect of the incorporation of acute myocardial infarction into the explicit health guarantees law. During the period in question, 87,342 deaths from ischemic heart disease were reported, 57.7% of which were in males and 59.5% outside the hospital. The age-standardized mortality rate declined from 52.9 to 40.4 per 100,000 population. Factors related to extra-hospital mortality in men were rurality, relative risk (RR) 1.24 (1.21-1.27); age of over 70 years, RR 1.03 (1.01-1.05); and being single, RR 1.10 (1.08-1.12). In women, the respective values were rurality, 1.13 (1.10-1.18); advanced age, 1.31 (1.27-1.36); and being single, 1.07 (1.04-1.09). Passage of the explicit health guarantees law was associated with an increase in the percentage of in-hospital deaths in women, RR 0.95 (0.92-0.97). Mortality from ischemic heart disease in Chile has declined. The majority of deaths from this cause occur outside hospitals or clinics. The factors associated with extra-hospital mortality in both sexes were advanced age, being single, and rurality.

Pesquisa del virus diarrea viral bovina desde un cuadro respiratorio atípico en novillo

In July of 1993 a steer with respiratory distress, died within 48 hours of the onset of respiratory disease. There was not nasal discharge, oral erosions and diarrhea. The animal was examined post mortem for gross lesions. Widespread hemorrhage was observed in thorax cavity.Virus isolation was carried out in primary cell cultures of bovine embryo lungs and MDBK cell line. No cytopathic effect was found in these cells through four consecutive passages, but the indirect immunoperoxidase test and direct immunofuorescent test were positive to BVDV in hang cells. The isolation was considered as noncytopathic strain of BVDV This is the first isolation of BVDV from respiratory disease in Chile.

Temporal Variation ofTrypanosoma cruziInfection in Native Mammals in Chile

In the present study, we compared Trypanosoma cruzi infection in four native mammals from a hyperendemic area of Chagas disease in Chile for two different periods to assess the occurrence of interannual variation (1999-2000 vs. 2005-2006). Parasite detection in mammals is performed by polymerase chain reaction assays and confirmed by Southern blot analysis and hybridization test with a universal probe. Results showed significant differences in the levels of T. cruzi infection between the compared periods. We suggest that the major El Niño event occurred in 1997-1998, a large-scale global climatic fluctuation, could be indirectly explaining the extremely high T. cruzi infection in 1999-2000 by means of a time-lag response of the wild transmission cycle of Chagas disease in semiarid Chile after the irruption of small rodent populations.

Air pollution and hospitalization for venous thromboembolic disease in Chile.

Ambient air pollution is a risk factor for stroke and myocardial infarction, possibly because of alterations in coagulation that influence the arterial circulation. Whether air pollution influences diseases associated with peripheral venous thrombogenesis remains largely unknown. To determine the association between air pollution and venous thromboembolic disease (VTE) in a sample of the general population. A time-series analysis was used to test the association between daily air pollution and VTE hospitalizations in Santiago between 2001 and 2005. Results were adjusted for long-term trends, day of the week and average daily humidex. From a population of 5.4 million, there were, on average, 2.3 admissions for VTE per day. Pooled estimates of relative risk (RR) [95% confidence interval (CI)] of hospitalization for venous disease were: 1.07 (1.05, 1.09) for a 58.4 p.p.b. increase in ozone (O(3)); 1.06 (1.02, 1.09) for a 5.85 p.p.b. increase in sulphur dioxide (SO(2)); 1.08 (1.03, 1.12) for a 29.25 microg/m(3) increase in nitrogen dioxide (NO(2)); and 1.05 (1.03, 1.06) for a 20.02 microg/m(3) increase in particulate matter < or = 2.5 microm in mean aerodynamic diameter (PM(2.5)). For pulmonary embolism (PE) results were: 1.10 (1.07, 1.13) for O(3); 1.05 (1.02, 1.08) for SO(2); 1.07 (1.04, 1.09) for NO(2); and 1.05(1.03, 1.06) for PM(2.5), respectively. Air pollution appears to be a risk factor for venous thrombosis and PE, a disease with a significant fatality rate.

Molecular Epidemiology of Chagas Disease in the Wild Transmission Cycle: The Evaluation in the Sylvatic Vector Mepraia spinolai from an Endemic Area of Chile

The sylvatic transmission cycle of Chagas disease in Chile is composed of wild mammals and insects of the genus Mepraia. We determined infection rates and Trypanosoma cruzi genotypes in Mepraia spinolai. We collected 227 insects from two ecologically contrasting areas to assess T. cruzi infection. Polymerase chain reaction (PCR)-amplified minicircle DNAs were characterized by Southern blot and hybridization tests with genotype-specific probes. Infection in insects from the more fertile area was almost 2-fold higher than in the poorer area. The genotype TCI was the most prevalent and other genotypes such as TCIIb, TCIId, and TCIIe were found at lower rates. The areas differed in their genotype distribution but not in their genotype diversity. We suggest that the difference in abundance and richness of mammals between the areas may be producing the detected infection levels in vectors. Our results are compared with those reported for mammals from the same area.

Phytoplasmas Associated with Grapevine Yellows Disease in Chile.

An extensive survey was performed from 2002 to 2006 to detect and identify phytoplasmas associated with Chilean grapevines. Nested polymerase chain reaction assays using phytoplasma universal primer pairs P1/P7 and R16F2n/R2 detected phytoplasmas in 34 out of the 94 samples tested (36%). Restriction fragment length polymorphism (RFLP) analyses, cloning, and sequencing allowed identification of phytoplasmas belonging to ribosomal subgroups 16SrI-B, 16SrI-C, 16SrVII-A, and 16SrXII-A. The 16SrVII-A phytoplasma represents a new finding in grapevine; moreover, variability of the RFLP profile was observed in some of the 16SrXII-A phytoplasmas, indicating possible new ribosomal subgroups. Mixed phytoplasma infections and infections of phytoplasmas together with one or more viruses also occurred.

European Rabbits (Oryctolagus cuniculus) are Naturally Infected with Different Trypanosoma cruzi Genotypes

Trypanosoma cruzi, the etiologic agent of Chagas disease, presents a complex life cycle, cycling between reduviid vectors and wild and domestic mammals. The European rabbit is an introduced species in America, but its role as reservoir in the wild transmission cycle of Chagas disease remains unknown. We used polymerase chain reaction, Southern blot, and hybridization tests to detect infection and characterize genotypes in rabbits from a hyperendemic area of Chagas disease in Chile. Results show 38% of infection with different genotypes. We provide evidence that rabbits are naturally infected with T. cruzi, which may have important epidemiologic consequences for the wild transmission cycle.

Comparative population dynamics of the bug Mepraia spinolai, a sylvatic vector of Chagas’ disease, in different hosts

The aim of this work was to determine the impact of specific hosts on a population of Mepraia spinolai (Porter) (Hemiptera, Reduviidae), a sylvatic vector of Chagas' disease in Chile. We assessed whether a recently introduced host could be an important epidemiological factor in maintaining Chagas' disease in Chile. The study stressed the variations in survival, individual weight and fecundity in the insect population when the vector was raised with a species-specific food supply. The study compared the European rabbit Oryctolagus cuniculus, introduced in Chile <or= 150 years ago, with a wild endemic rodent, Octodon degus. Hosts were placed separately in experimental glass chambers. Groups of insects maintained with rabbits had greater fecundity than those raised with rodents, but both groups had similar survival times and average weights. Both O. degus and the European rabbit appear to be suitable hosts for M. spinolai, but the rabbit is better than the rodent. Additional research is needed to determine which factors of O. cuniculus produce the observed results.

Botulismo infantil: Comunicación de un caso clínico y revisión de la literatura

Botulism is a rare disease in Chile and of the known clinical presentation, infant botulism is the most common. We report the case of a previously healthy seven month old male infant with a two weeks history of rinorrea, cough, fatigue, constipation and progressive weakness after the consumption of honey. Stool cultures were positive for Clostridium botulinum group 1 type A and electromyography was compatible with the diagnosis. The patient evolved with arterial hypertension, interpreted as secondary to autonomic dysfunction, which responded to calcium channel blockers. Muscle tone improved progressively during the following four weeks. Infant botulism is a potentially fatal disease; diagnosis can be difficult given the broad clinical manifestations. Prevention should focus on education of parents of infants as well as medical personnel.

Characterization of Cladosporium Rot in Grapevines, a Problem of Growing Importance in Chile

Cladosporium rot (Cladosporium spp.) of grapevine (Vitis vinifera) is a common disease in Chile, particularly in Cabernet Sauvignon and other red wine grape cultivars. It is favored by delayed harvest to obtain the phenolic maturity necessary for high-quality red wine. This study expands on previous investigations of the specific causal agents, the histopathological host:pathogen relationship, and the population dynamics of Cladosporium spp. during the seasonal development of grape clusters. Over 100 isolates were obtained and identified as C. cladosporioides and C. herbarum, confirming previous results. The identity of a subset of isolates was confirmed by molecular analysis. Isolates of both C. cladosporioides and C. herbarum from grapevines were pathogenic on inoculated table grapes and wine grapes. These pathogens were reisolated, fulfilling Koch's postulates. Berry injuries and total soluble solids content above 15% were necessary for Cladosporium spp. to infect wine grapes. The mycelia of C. cladosporioides and C. herbarum grew between 0 and 30°C, but no growth was obtained at 35°C in vitro. The histological studies showed that Cladosporium spp. superficially colonize mature V. vinifera berries, invading the epidermis but scarcely penetrating the hypodermis. The Cladosporium populations obtained on apparently healthy berries of V. vinifera cvs. Cabernet Sauvignon and Chardonnay were significantly larger (P = 0.05) than the populations obtained under similar conditions on berries of V. champini cv. Ramsey and hybrids Kober 5BB and Couderc 1613. Considering the importance of Cladosporium rot in Chile compared with other grape production areas, the development of control strategies is needed to prevent high disease severity, which affects both yield and wine quality.

Combatiendo la epidemia de enfermedad coronaria en Chile: Potencialidades y problemas en el control de los factores de riesgo

In this issue of the journal Lanas et al report an estimation of population attributable risk (PAR) for myocardial infarction (MI) derived from different risk factors in Chile. Cigarette smoking, dyslipidemia and hypertension accounted for 71% of total PAR. Mortality from MI has decreased in Chile, but epidemiologic surveys carried out in different hospitals across the country, strongly support that most of this effect comes from better treatment of MI. Recent changes in public health policies, favoring the treatment of hypertension and diabetes may help control cardiovascular morbidity and mortality. However, a really significant impact will be obtained when the development of the disease may be halted. To evaluate this possibility, newer methods to diagnose atherosclerosis non invasively may come to our rescue. On the other hand, pharmacologic treatment of dyslipidemia and hypertension continue to offer the most powerful way to decrease levels of cardiovascular risk factors. According to current knowledge, wise balance of non pharmacologic and pharmacologic means of primary prevention, with due respect for ethic aspects, is the most effective way to curve the epidemic of coronary artery disease in Chile.

Typhoid fever: rise, peak and fall of an infectious disease in Chile

This article presents the history of typhoid fever in Chile since its definition as a clinical entity until our days. From this history is evident the long lasting confusion with typhus (rickettsial spotted fever) in Chile although the identity and characteristics of typhoid fever had been established in the first half of nineteenth century in Europe. This confusion could be explained because some clinical features are similar in both diseases (high fever and delirium) and because of its occurrence in poor hygienic conditions. This misconception was resolved only during 1918 on occasion of a major typhus outbreak that allowed physicians to clearly diagnose this rickettsial disease. Once typhoid fever was recognized it was possible to describe its epidemiological pattern with high endemic incidence mainly in urban districts, with summer increases and epidemic cycles. In the contemporary history of typhoid fever it is remarkable a huge outbreak during 1976-1985, associated to abrupt socioeconomical and environment crisis, as well as an abrupt diminution of the disease in 1992, with a marked reduction that persists until now. This last phenomenon was the consequence of a quasi-experimental public health intervention and sanitary education conducted in 1992 to avoid the cholera epidemic that was spreading in Perú, a neighboring country. We conclude that, although the hypothesis of environment contamination as the cornerstone in typhoid persistence was present since the recognition of the disease in 1894, it was faced efficiently only and perhaps in a definitely manner only almost 100 years later.