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Ocular toxoplasmosis (OT) is a retinochoroiditis that evolves with several episodes of inflammation and can occur both in the congenital or acquired form of the disease, Aim: To describe the frequency and clinical characteristics of OT in infants aged 0 to 12 months, children of mothers with positive serology for toxoplasmosis in the perinatal period.Cross-sectional descriptive, ambispective study.Infants from 0 to 12 months of age, whose mothers had positive serology for toxoplasmosis in the perinatal period, referred to the pediatric ophthalmology service for evaluation, were admitted. Demographic variables, maternal and infant serology and the results of the ophthalmological examination were collected. Data were analyzed in SPSS v21 Results: 46.4% of 125 infants had OT, of them 67.2% were female, (p = 0.04) the median age was 6 months, 41% had IgG and IgM positive. The lesions were bilateral in 82.8%, central in 86.2%, and inactive in 81%. Retinochoroiditis was accompanied by strabismus in 41%.The frequency of OT in this population of infants with congenital toxoplasmosis was high. more than 80% of the eye lesions were inactive, centrally located and bilaterally involved.

COVID-19, caused by the severe acute respiratory syndrome virus type-2 (SARS-CoV-2), was declared a pandemic in March 2020. Seroprevalence studies are useful to estimate the proportion of the population previously infected, quantify the magnitude of transmission, estimate the fatality rate, evaluate the effect of interventions, and estimate the degree of immunity of the population.To determine the extension of the infection and the cumulative incidence of age-specific infection, determined by seropositivity in the population of the sanitary regions of Asunción and the Central Department of Paraguay.Population-based cohort study. In Asunción 126 households and in the Central Department 609 were surveyed between December 2020 to March 2021. Three visits were made to the selected households.The testing rate was 66.6%, 1,699 people (324 in Asunción and 1,375 in Central) of the 2,553 people registered. In the first, second and third rounds, seroprevalences were 15.5%, 15.4% and 14.3% in Asunción, respectively; in Central 23.1%, 27.8% and 26.9%, respectively. There was a seroconversion between the first and second rounds of 5.9%, and in the third round 6.5%; the accumulated global seroprevalence was 26.9% (95% CI: 24.8-19.1); in Asunción 23.1% (95% CI: 18.9-28.0) and in Central 27.8% (95% CI: 25.5-30.2). 8.5% of the participants reported symptoms; of them, 54.2% had positive serology.The sero-prevalence was high with a low proportion of people with symptoms.

We present a clinical case of keratitis caused by M. abscessus in a 76-year-old female patient, resident in the city of Asunción, without trauma or previous ocular surgery and with a history of herpetic keratouveitis. Because it is a keratitis caused by a rare etiological agent and because of the importance of a correct and timely diagnosis for the establishment of appropriate treatment, the present case is reported, the first of Mycobacteria keratitis in Paraguay.

Leprosy, a chronic infectious disease, is one of the major causes of preventable disability. Early treatment prevents neurological damage and disability.To identify prognostic factors of disability in individuals with multibacillary and paucibacillary leprosy who completed a drug treatment between 2011 and 2017 in Paraguay.A case-control study was carried out on 34 patients, of them 9 were cases and 25 controls. Cases were those patients with Grade 1, presented lack of sensation in lower or upper limbs, and those of Grade 2 lagophthalmos, rigidity, visible deformity ulcerations, passive claw, active claw. Controls had no disabilities.Mean age of the patients was 53 ± 15.2 years, 55.9% were male, and 58.9% had primary education or no formal education. Multibacillary leprosy was found in 58.8% of patients; and 64.7% were diagnosed after consulting with two or more physicians. Diagnosis delay of more than one year was significantly (p = 0.047) greater in the cases than in the controls (77.8% vs 12%; OR: 7.44; 95% CI: 1.02-67.86).In this study, a diagnosis delay of more than one year is a prognostic factor for disability.

Pityriasis versicolor is a frequent pathology in Paraguay; however, its epidemiology is unknown.To determine the frequency of Malassezia species causing pityriasis versicolor and the epidemiological characteristics of the population.Samples from patients with a presumptive diagnosis of pityriasis versicolor were collected. Laboratory diagnosis was carried out by fresh examination and culture in modified Dixon agar and chromogenic Chromagar Malassezia®, incubated at 32° C, and identification by macro and micromorphological features, biochemical and physiological tests.102 patients were included (51% female) from 1 month to 63 years of age, the predominant age group was 11-20 years (35.3%). The most frequent location was on the back (60.8%). Hipocromic clinical forms (48%) predominated. The most frequent species was M. globosa (52.9%), followed by M. furfur (24.5%), M. sympodialis (18.6%) and M. slooffiae (6.9%).The observed epidemiology is similar to other South American studies, with no sex distinction, predominantly hypochromic clinical form and as primary responsible species appears M. globosa. This is the first report on species causing pityriasis versicolor in Paraguay and the characteristics of the affected population.

Coagulase-negative staphylococci have been reported to be the most frequent cause of bacterial postoperative endophthalmitis. Biofilm formation is the major virulence factor of Staphylococcus epidermidis and is often associated with methicillin resistance. This study aims at evaluating the presence of biofilm-producing and methicillin resistance genes (mecA) in S. epidermidis. S. epidermidis isolated from clinically infected sites (group 1) and from normal human conjunctiva (group 2) were studied. All the isolates were tested for their ability to produce biofilm by the conventional Christensen´s method and the presence of mecA by PCR using the 22-mer oligonucleotides as primers. In total 20 isolates from group 1 and 22 from group 2 were studied. Biofilm and mecA were detected in 15 (75 %) and in 14 (70 %) in group 1 as compared to 8 (36.3 %) and 4 (18.2 %) in group 2 (p = 0.016). Simultaneously, biofilm production and presence of mecA genes were observed in 13/20 (65.0 %) in group 1, and 4/22 (18.2 %) in group 2 (p = 0.002). Multi-resistance was observed in 55 % in group 1 and 9 % in group 2 (p = 0.002); 57 % of the biofilm-producing strains was multi-resistant in contrast to none of the non-producing strains. In all multi-resistant strains, biofilm production was seen. Biofilm formation capacity was widely distributed, particularly among mecA (+) S. epidermidis strains, which also displayed a high diversity of antibiotic resistance profiles.

To compare the efficacy of 3 treatment options in patients with chronic blepharitis.An experimental, randomized, controlled study was conducted on 45 patients (female 67%; Mean age: 40.5 years) diagnosed with chronic blepharitis, in order to compare the effectiveness of three treatment options. Group 1: eyelid hygiene with neutral shampoo three times/day; group 2: neutral shampoo eyelid hygiene plus topical metronidazole gel 0.75% twice/day; group 3: neutral eyelid hygiene with shampoo plus neomycin 3.5% and polymyxin 10% antibiotic ointment with 0.5% dexamethasone 3 times/day. The symptoms and signs were assessed by assigning scores from 0: no symptoms and/or signs; 1: mild symptoms and/or signs, 2: moderate symptoms and/or signs; and 3: severe symptoms and/or signs.A significant improvement was observed in the signs and symptoms in all 3 treatment groups. While groups 1 and 2 had more improvement in all variables studied (P.05), Group 3 showed no clinical improvement for itching (P=.16), dry eye (P=.29), eyelashes falling (P=.16), and erythema at the eyelid margin (P=.29).Shampoo eyelid hygiene neutral and neutral shampoo combined with the use of metronidazole gel reported better hygiene results than neutral shampoo lid with antibiotic ointment and neomycin and polymyxin dexamethasone.

Currently, Paraguay has no data on the prevalence of soil-transmitted geohelminth infection in schoolchildren aged 6 to 12 years.To determine the prevalence and intensity of infection by Ascaris lumbricoides, Trichuris trichiura and hookworms and the socio-cultural-environmental characteristics of the affected population.Descriptive, cross-sectional study, in three semi-tropical climatic zones: continental, semi steppe and humid. A total of 1,404 schoolchildren from 20 schools in eight departments were selected from the country's three climate zones. Copro-parasitological exams were analyzed in situ with the Kato-Katz method.The national prevalence for geohelminthiasis was 3.73% (95% CI = 2.8-4.8). The risk factors found were consumption of well water OR: 2.88 (95% CI = 1.64-2.07), ground floor in housing OR: 2.56 (95% CI = 1.45-4.50) and lack of flushing water baths in households OR: 2.29 (95% CI = 1.23-4.28).Although the national prevalence of geohelminthiasis was low, it is recommended to promote good hygienic practices, use of footwear, and safe water consumption, as well as designing interventions with all relevant sectors to improve access to safe water and improved basic sanitation facilities.

To describe the clinical and epidemiological characteristics of patients with severe infectious keratitis in Asunción, Paraguay between April 2009 and September 2011. All patients with the clinical diagnosis of severe keratitis (ulcer ≥2 mm in size and/or central location) were included. Empiric treatment consisted of topical antibiotics and antimycotics; in cases of advanced keratitis, fortified antibiotics were used. After microbiological analysis, treatment was changed if indicated. In total 48 patients (62.5 % males, 25 % farmers) were included in the analysis. A central ulcer was found in 81.3 % (n = 39). The median delay between onset of symptoms and time of first presentation at our institution was 7 days (range 1-30 days). Fungal keratitis was diagnosed in 64.5 % (n = 31) of patients, of which Fusarium sp. (n = 17) was the most common. Twenty-one patients (43.8 %) reported previous trauma to the eye. The globe could be preserved in all cases. While topical therapy only was sufficient in most patients, a conjunctival flap was necessary in six patients suffering from fungal keratitis. The high rate of fungal keratitis in this series is remarkable, and microbiological analysis provided valuable information for the appropriate treatment. In this setting, one has to be highly suspicious of fungal causes of infectious keratitis.

Dengue is an infection of great global importance with different clinical presentations.To establish the seroprevalence of infection by the dengue virus in a district of the Paraguayan Chaco.Cross-sectional study in 418 inhabitants of three villages in the district of Villa Hayes, Paraguay, using a probabilistic household sampling, a questionnaire and blood sampling. Antibodies were determined by the ELISA capture IgG anti dengue method and factors associated with seroprevalence were evaluated.The overall seroprevalence for dengue virus infection was 24,2% (CI95%: 20,2%-28,6%); 34% (n: 142) of respondents reported history of dengue in the previous 10-year period. Of the 276 people (66%) who reported no history of dengue infection, 37 (13%) tested positive, which points out asymptomatic individuals. The main factors associated with infection were: males with significantly higher prevalence than women (31%); to be over 60 years of age (44%), be residents of Villa Hayes (31,1%). No association with educational level or monthly income of the participants, nor housing condition, drinking water source or type of bathroom were observed. The larval infestation rate was 0,51%.The relatively low seroprevalence of infection by the dengue virus is consistent with the small size of the district and highlights the potential risk of infection in future epidemics.

Toxoplasmosis is a worldwide disease; it can cause decreased vision or even blindness. The route of transmission in humans may vary according to the habits of the region; probably the ingestion of raw or undercooked meat is the main source of infection.To determine the seroprevalence of toxoplasmosis in an eye clinic, the frequency of ocular toxoplasmosis (OT) and risk habits for acquiring the infection.Adult patients consulting in the Retina Department of the Teaching Hospital of the National University of Asuncion, Paraguay between August and September, 2014 were included. Prior informed consent, socio-demographic and epidemiological data related to T. gondii infection were obtained. In addition a blood sample for the determination of anti T. gondii IgG antibodies by the ELISA method was taken and ophthalmologic evaluation for the diagnosis of OT was made.A total of 80 patients with mean ± SD age of 53 ± 20 years were studied, with slight predominance of women (55%). The seroprevalence of toxoplasmosis was 84% (67/80) and OT was detected in 8.9% of the 67 seropositive persons. The habit of not washing vegetables with sodium hypochlorite and eat meat from wild animals was related to higher risk of infection in this population.It is important to conduct research at the population level to establish the epidemiology of toxoplasmosis in our country. Information on prophylactic measures to prevent infection by T. gondii should be given to the population.

Leptospirosis is a serious infectious disease that has been linked to occupational activities such as farmers, sewer workers, garbage collectors, butchers and veterinarians. It is acquired through contact with major reservoirs like rodents, pets, or the environment contaminated by their urine. In Paraguay, there are no published reports on the seroprevalence of leptospirosis related to work activity.To determine the seroprevalence and factors associated with transmission of leptospirosis in urban sanitation workers.Descriptive transversal study. The study included workers from the Department of Urban Cleanliness of the City of Asuncion, who had completed at least one month on the job and who agreed to particípate in the study. Sampling was stratified and proportional to the number of workers. After informed consent was obtained, participants were surveyed and a blood sample was taken for detection of Leptospira IgG antibodies by ELISA.Leptospirosis seroprevalence was 8.6% (29/339), all positive cases were male and prevalence was statistically higher in workers of the collection area than in those of other work areas.We found a lower than expected seroprevalence. However, conditions observed at work and at home are conducive to transmission of infection. We recommend the improvement of prevention strategies and health promotion in this population.

To determine the spectrum of normal conjunctival flora in newborns in two hospital centers in North Argentina and Paraguay.In this prospective observational study, conjunctival specimens were obtained from the right eyes of newborns prior to the application of any topical medications. Culture samples were also obtained from the cervicovaginal secretions of the infants' mothers. All samples were directly inoculated into culture media and all growth were identified and quantified.Among the 190 newborns studied, 126 were delivered vaginally and 64 via caesarean section (C-section). A total of 180 different bacterial strains were acquired from the vaginally delivered infants and 77 from the C-section group (P=0.078, Student's t-test). Conjunctival cultures obtained within one hour of birth showed that 85 out of 101 samples (84%) from both the vaginal and C-section group had positive cultures, compared to 84 out of 89 samples (94%) obtained more than 1 h after birth (P0.001). Among the vaginally delivered newborns, the most common bacteria isolated were coagulase-negative Staphylococcus (in 69 samples, 38%), Propionibacterium spp (36, 20%) and Corynebacterium spp (29, 16%). In the CES, the most common isolates were coagulase-negative Staphylococcus (39, 51%), Propionibacterium spp (22, 29%) and Staphylococcus aureus (6, 8%). There was a significantly higher proportion of gram-positive rods (P=0.017) isolated from infants delivered vaginally (16%) than from those delivered by C-section (5%). No Neisseria gonorrhoeae were isolated in conjunctival samples. Among the 130 organisms isolated from cervicovaginal secretions in 81 out of 189 mothers, the most common organisms were Lactobacillus spp. (47%), Corynebacterium spp (21%), Gardnerella vaginalis (15%), and Candida spp (14%). No Neisseria gonorrhoeae or Chlamydia trachomatis were found in cervicovaginal samples.The most common conjunctival bacteria in newborns delivered by either vaginal birth or C-section were coagulase-negative Staphylococcus. The proportion of positive conjunctival cultures was higher for infants delivered vaginally than for C-section delivery.

This is a retrospective, chart-reviewed study of patients diagnosed with infectious corneal ulcers at the Ophthalmology Department of the National University of Asunción in Paraguay. The microbiological culture results are described, as well risk factors for the development of fungal keratitis.After obtaining approval from the Institutional Review Board, an analysis of medical charts from 1988 to 2001 was conducted and 660 patients were identified to have been diagnosed with infectious corneal ulcers due to bacteria or fungi. Demographic data were recorded, including age, gender, occupation and geographic location of their home and work (city or rural). Other information collected included the history of the presenting illness, past and current use of ocular medications and whether or not they had a history of trauma or contact lens use. Each patient had an eye examination performed by an ophthalmologist and corneal scrapings were obtained for cultures in all cases. Microbiologic culture results were analyzed.Twenty-one percent (136/660) of the specimens collected from the patients' conjunctiva and cornea were sterile in all culture media. Of the 524 (79%) positive cultures, 267 were due to bacteria (51%), 136 to fungi (26%), and 121 (23%) cultures yielded both fungi and bacteria. Of the 430 isolated bacteria approximately 25% (103) were coagulase negative Staphylococcus, followed by 23% (94) Staphylococcus aureus, 14% (60) Pseudomonas aeruginosa and 13% (56) Streptococcus pneumoniae. Acremonium species accounted for 40% (79) of all fungi identified, followed by Fusarium species (15%) (41). Approximately two-thirds of the patients were male (n = 435). For those patients for whom a history was available, approximately half had a history of trauma. Of these, half of these again involved foreign bodies. Over-the-counter medications were used commonly, and most of those patients had a delay in diagnosis of over 1 week. Risk factors for fungal keratitis as opposed to bacterial keratitis were male gender, agricultural occupation, age between 30 and 59, history of trauma and self-medication.The results of this study provide demographic data on patients with infectious corneal ulcers in Paraguay. Common causes of such ulcers are both bacteria and fungi. Most patients had self-medicated, and most had delayed seeking professional medical care.

To estimate the incidence of HIV in the adult population of Paraguay for 2014 and analyze its distribution and associated uncertainty according to risk behavior. METHODS The UNAIDS model was applied according to modes of transmission (MoT). Data were obtained from a detailed review of documents prepared between 1996 and 2013. Uncertainty of the estimated values was analyzed.The estimated incidence for 2014 was 0.091% (3,081 new infections). Both the percentage of new infections (74.75%, CI95%: 64.19%-81.47%) and the incidence rate per 10,000 population (9,518) were greater in the group of men who have sex with men (MSM). The second most affected group was made up of those who have stable heterosexual sex (9.9%). Heterosexual transmission accounted for 23% of new cases and 8% corresponded to couples (men and women) who engaged in high-risk behavior for HIV transmission. Female sex workers and intravenous drug users accounted for 1%.The resulting estimate of the incidence of HIV and its distribution among groups at risk is consistent with national-level reports and with the characteristics of the MSM population, which accounts for the greatest number of cases in the epidemic. Preventive actions should be aimed at this group in order to have a significant impact on the course of the epidemic in the country. Furthermore, it is recommended that preventive activities aimed at stable couples in at-risk groups and the general population be expanded and strengthened.

Blepharitis is a very common disease in the ophthalmologic practice generally taking a chronic course with intermittent exacerbations. Several studies have linked the presence of Demodex folliculorum with chronic blepharitis, since the mite has the capacity to perpetuate the follicular inflammatory process. The prevalence of infection by Demodex spp. is variable depending on the population. In Paraguay, information on the frequency of the infestation in patients with chronic blepharitis is not available.To determine the frequency of Demodex spp, and the ocular microbiota in patients with chronic blepharitis attending the Department of Ophthalmology at the Teaching Hospital of the National University of Asuncion.Consecutively, 28 patients with chronic blepharitis, who agreed to participate in the study, were included. Eyes lashes from the upper and lower eyelids were extracted for immediate mite search by direct observation under a light microscope. Samples from eyelids were taken with Kimura spatula and then cultured on blood agar and in enrichment media and incubated in 5% CO2 at 35° C for 72 hours.Among participants, females were more frequent (64%), the age ranged from 17 to 87 years (mean: 38.0; SD: ± 13.5 years). The prevalence of Demodex sp was 54%. Bacteria were isolated 92.9% of cases, most frequently coagulase-negative staphylococci (75%). No association was found between socio-demographic or clinical characteristics and the presence of Demodex sp.The observed high prevalence of infestation by Demodex spp in patients with chronic blepharitis is consistent with other studies.

We report a case of mycotic keratitis caused by Lasiodiplodia theobromae in a 60-year-old man with a history of ocular trauma with vegetable matter. Ophthalmological assessment with slit-lamp and microbiological evaluation of the corneal ulcer by conventional microbiological techniques were performed. Mycology study of the corneal scraping showed the presence of fungal filaments and the isolate was identified as Lasiodiplodia theobromae. Patient was treated with natamycin 5% and fluconazole 0.2% for 37 days. The infection was controlled but the corneal scars required a cornea transplant. This is the first case of keratitis by Lasiodiplodia theobromae in Paraguay. Difficulties in the management of these cases, which often requires surgical procedures, are discussed.

Twenty-one #Trypanosoma cruzi$ stocks from humans, domiciliary triatomines and one sylvatic animal of different areas of Paraguay were subjected to isoenzyme analysis. Thirteen enzyme systems (15 loci in total) were studied. MN c12 (clonets 39) and SO34 c14 (clonets 20) were used as references. Relationships between stocks were depicted by an UPGMA dendogram constructed using the Jaccard's distances matrix. Among the Paraguayan stocks 14 zymodemes were identified (Par 1 to Par 14), Par 5 being the most frequent. Polymorphism rate and clonal diversity were 0.73 and 0.93, respectively. Average number of alleles per polymorphic locus was 2.5 (range 2-4). These measurements show a high diversity, which is confirmed by the dendrogram topology. All stocks belong to the same lineage, as MN cl2 reference strain (#T. sruzi$ II). Moreover, three distinct subgroups were identified and two of them correspond to Brazilian and Bolivian zymodemes, respectively. The third subgroup, the most common in Paraguay, is related to Tulahuen stock. The large geographical distribution of some zymodemes agrees with the hypothesis of clonality for #T. cruzi$ populations. However sample size was not adequate to detect genetic recombination in any single locality. (Résumé d'auteur)

Chagas' disease is a serious public health problem in Paraguay, however, the immunoepidemiology of the disease has not been well documented. A preliminary cross-sectional survey was carried out in two villages of the Paraguayan Chaco region and in five villages of the Oriental region to assess the endemicity of Trypanosoma cruzi infections. Thereafter, a subset of individuals (ages ranging from 23 to 65 years) participated in a follow-up study to evaluate clinical and parasitological parameters. Physical examinations and electrocardiograms (ECG) were conducted and blood samples collected for parasite detection and serology. The most frequent ECG abnormalities which were observed among chagasic individuals were left anterior hemifascicular block and right bundle branch block. Thirty-two of these subjects, seropositive and non-parasitemic from the high endemic Chaco (n = 16) and low endemic Oriental (n = 16) regions, were randomly selected for an analysis of T. cruzi-induced expression of cytokines IL-2, IFN-gamma, IL-4 and IL-10 by RT-PCR. The individuals were grouped (n = 8) according to the presence or absence of abnormal ECG. In subjects that exhibited abnormal ECG profiles, five of eight (63%) individuals from the high endemic area showed a dominant type 2 (IL-4) response, whereas a comparable number (63%) of subjects from the low endemic area expressed a strong type 1 (IFN-gamma) response; the remainder (37%) presented a Th0-type (IFN-gamma, IL-4) response. Subjects with normal ECG showed a defined cytokine profile according to endemicity. All subjects from the high endemic region showed a Th0 response, whereas 100% of the individuals from the low endemic area demonstrated a type 1 response. In most chagasic patients regardless of ECG profile and endemicity, IL-2 expression was depressed, while IL-10 mRNA transcripts were consistently elevated. Taken together, these data indicate that chronic human chagasic disease is associated with increased systemic production of type 2 cytokines in response to T. cruzi infection and may be involved in the reciprocal down-regulation of IL-2 production.

Report preliminary results of the application of the BONIS system in community tele-epidemiological surveillance in Paraguay.A study of viability and implementation carried out in the Family Health Unit located in Bañado Sur in the city of Asunción by the Paraguay River. The system automatically records personal data and symptoms of individuals who make telephone reports, and suspected cases of dengue are classified and prioritized. This information goes to community agents for follow-up and to specialists in charge of epidemiological surveillance.From April 2010 to August 2011, 1 028 calls to the system were logged. Of 157 reported cases of fever, home visits were made to 140 (89.2%); of these, fever and headache or body ache were confirmed in 52 (37.1%) cases, and headache or body ache without fever in 58 (41.4%) cases. Community agents referred 49 (35.0%) of them for medical consultation and blood tests, and they took blood samples in the homes of 19; of these, 56 (82.3%) were positive for dengue and 12 (17.4%) for influenza.Paraguay has a low-cost community tele-epidemiological surveillance system based on information and communication technologies and open-source software, which is scalable to other health symptoms and disorders of interest. To enable its acceptance and application, education programs should be developed to strengthen the management and promotion of community health.

Coagulase-negative staphylococci have emerged as responsible for a large number of infections. However, it is often difficult to assess its pathogenic role or to discard it as a contaminant.The goal of this study was to identify clinically significant coagulase-negative staphylococci to the species level and their virulence factors. Isolates came from patients consulting at the San Roque Laboratory from 2009 to 2011.Species identification was performed by De Paulis et al simplified method. Production of biofilm, hemolysins, lipases, lecithinases and DNase were determined by conventional methods; methicillin-resistance by diffusion method and mecA and Panton-Valentine genes, by multiplex PCR.Out of 64 isolates, 40.6% were S. epidermidis; 20.3%, S. haemolyticus, and 15.6%, S. lugdunensis. Biofilm production was detected in 73.1% of S. epidermidis, 53.8% of S. haemolyticus and 40% of S. lugdunensis. mecA gene was identified in 69.2% of S. epidermidis, 92.3% of S. haemolyticus and none of S. lugdunensis. 83% of mecA (+) S. epidermidis isolates were biofilm producers as compared to 50% of the mecA (-).The frequency of S. lugdunensis, the most virulent coagulase-negative staphylococci species, was relatively high. The main virulence factor in S. epidermidis was biofilm production, being higher in those resistant to methicillin.

OBJETIVO: Determinar a prevalencia e causas de cegueira em Piribebuy, Paraguay. METODOS: Um estudo populational foi conduzido de setembro a novembro de 2007 em Piribebuy, Paraguay. Baseado no mapa da cidade, sete agrupamentos foramaleatoriamente selecionados, contendo 22 a 36 quarteiroes (423 a 578 casas) cada, onde todos os individuos > 40 anos de idade, que concordaram em participar, foram incluidos no estudo. A acuidade visual (AV) conforme apresentada foi obtida para cada olho, com Tabela de Snellen a 6 metros do paciente, com luz apropriada. Olhos com AV

The characteristics of the corneal endothelium in patients with/without pseudoexfoliation syndrome (PEX) with senile cataract in Paraguay are unknown.Endothelial density, mean coefficient of variation (%) in cell size and mean cell hexagonality (%) were measured using automated specular microscopy. Multivariate general linear model analysis was used to determine the effect of age, gender and PEX on endothelial characteristics. Analysis of variance tests analysed the effect of age on endothelial variables without regard to PEX status. Categories of2000 andor =2000 cells/mm(2) were compared in the presence/absence of PEX using age as covariate to calculate odds ratios for corneal decompensation.Out of 468 eligible patients, 51 were excluded. Sixty-one patients had PEX. Unadjusted mean endothelial cell density was 2451 cells/mm(2); cell size coefficient of variation was 34.3; and the mean percentage of hexagonal cells was 57.7. Adjusting for age, only the mean difference between the groups with and without PEX for endothelial cell density was significant (PEX = 2315, no PEX = 2482, P = 0.002). Of the total study population, at-risk endothelial cell densities were found in 46 eyes (11%); and 13 (28%) of those were found to have PEX. When PEX was present, the calculated odds ratio for corneal decompensation following surgery was 1.90 after adjustment for age.Endothelial cell density data were consistent with published literature. Because Paraguay has a high prevalent of PEX, it is suggested that specular microscopy screening be carried out for all patients scheduled for intraocular surgery where feasible.

PURPOSE: To determine the conjunctival bacterial flora in cataract surgery patients and the effect of presurgical irrigation with 5% povidone-iodine solution. METHODS: Three samples from the inferior conjunctival fornix of the eye to be operated were obtained at baseline before washing (T0) with 10 ml 5% povidone-iodine solution, immediately after washing (T1), and upon completion of surgery (T2). Bacteria from the samples were inoculated in blood agar, chocolate agar, and thioglycolate broth. RESULTS: A total of 221 patients (n=224 eyes) with a mean age of 67 ± 13 years were included in the study. Bacteria from the (T0) samples were successfully grown in 73.2% of the thioglycolate agars, 21.0% of the blood agars, and 19.2% of the chocolate agars. Compared with T1 samples, the use of povidone-iodine wash translated into a 60.8% reduction (from 73.2% to 12.5%) in colonization of the conjunctiva (p

Antimicrobial resistance is one of the main obstacles for an effective eradication of H. pylori infection.To determine the susceptibility of H. pylori strains obtained from gastric biopsies to metronidazole, clarithromycin and amoxicillin.Susceptibility to metronidazole, clarithromycin and amoxicillin was determined using E-test in 46 isolates of H. pylori obtained from gastric biopsies of 54 adult patients.Thirty three percent of isolates were resistant to metronidazole and 2% were resistant to clarithromycin and amoxicillin. One isolate was resistant to metronidazole and clarithromycin.The antimicrobial susceptibility of these strains of H. pylori obtained from Paraguayan patients, may help to decide the initial therapy to eradicate this infection.

Both parasite and host immune factors may contribute to the development and progression of chronic chagasic cardiomyopathy during Trypanosoma cruzi infections. The present study targeted infected children (5-14 years of age) from an endemic area of Paraguay in an analysis of T. cruzi-specific cytokine profiles. This age group is characteristically the most affected by the early phases of infection. Trypanosoma cruzi-induced cytokine gene expression (interleukin-2 [IL-2], and interferon-gamma [IFN-gamma], IL-4, and IL-10) was studied in 25 seropositive children categorized as being either acute, symptomatic, with Romana's sign (n = 2), or early, indeterminate (postacute, n = 23). Acutely infected children showed a distinct T helper cell-1 (Th1)-type (IFN-gamma) cytokine response to infection. The cytokine pattern that was observed in the seropositive, asymptomatic (early, indeterminate) group was of the Th0 type (expression of both IFN-gamma and IL-4). We hypothesize that selective induction of a Th0-type cytokine pattern is important for development of cell-mediated and humoral immune responses that suppress parasite burden, thereby prolonging the onset or limiting the severity of chronic Chagas' disease later in life.Trypanosoma cruzi, the causative agent of Chagas' disease, is an important cause of heart disease in Latin America. Children are the group most likely to be affected by the early phases of infection. A cross-sectional study conducted in elementary schools in two endemic areas of Paraguay (Potrero and Calle-Poi) detected a T. cruzi seroprevalence of 5.3%. 25 seropositive children in the acute (n = 2) or early indeterminate (n = 23) stage of infection participated in a follow-up study aimed at characterizing the T. cruzi-induced cytokine profile. The acute asymptomatic children showed a distinct T-helper cell-1 (Th1)-type cytokine response to infection with minimal interleukin-4 production, while early indeterminate children showed a pattern of the Th0 type regardless of their parasitemic status. These findings suggest that, once acute symptomatic infections with patent parasitemias are cleared by type 1 immune mechanisms, multiple Th0 responses suppress parasite burdens to subpatent levels as parasites sequester in target organs. Infected persons then remain asymptomatic until the cumulative immunopathogenetic effects of persistent, localized inflammatory responses result in chronic disease.

Sera from 38 Paraguayans with positive skin tests to Leishmania braziliensis panamensis and 51 sera from Paraguayan patients in different stages of Chagas' disease were analyzed by Western blotting using antigen from Trypanosoma cruzi Y strain epimastigotes and from L. b. panamensis promastigotes. Using a single serum sample, distinctive patterns of IgG antibody response to both antigens were identified allowing the differentiation between T. cruzi infection, Leishmania infection, and probable double infection. Sera from patients with T. cruzi infections consistently recognized bands of ∼25 kDa, 38 kDa, and >97 kDa in T. cruzi antigen lysates and recognized a band of 38 kDa in Leishmania lysates. Sera from patients with Leishmania infections recognized a band of 66 kDa in Leishmania antigen lysates but did not consistently recognize any bands using T. cruzi antigen. Sera from patients with probable double infections recognized all bands normally detected by individual sera from patients infected with either T. cruzi or Leishmania. In our study population, T. cruzi infection among leishmaniasis patients was as frequent as among individuals free of leishmaniasis.

trans-Sialidase inhibition assay (TIA) was employed in a population at high risk of Trypanosoma cruzi infection. From 20 serum samples that were negative by conventional serologic and parasitologic assays, 18 (90%) were reactive in TIA, providing further evidence of the higher sensitivity of TIA and suggesting that the actual prevalence of T. cruzi infection might be underestimated. The American trypanosomiasis, Chagas’ disease, is a chronic illness that affects about 16 million people in the Americas. After the acute phase of the disease, parasites are rarely found in the blood and diagnosis is mainly based on serology. Conventional serology employs crude preparations of parasites, although some relevant antigens have been cloned and tested as diagnostic tools (9). Serology seems to be equally sensitive to or even more sensitive than PCR for detecting infection in patients (2, 13). A new serological test, trans-sialidase inhibition assay (TIA), is under development (6‐8). The assay is based on the detection of antibodies able to inhibit the activity of the trans-sialidase, a virulence factor from Trypanosoma cruzi (12). The enzyme is absent in other protozoan parasites, such as Trypanosoma rangeli, Leishmania spp., and Plasmodium spp., that are frequently found in geographical regions where T. cruzi is present. These neutralizing antibodies are detected during both the acute and chronic phases of the human infection (7, 8, 10). Epidemiological surveys of the population at risk of infection are performed through conventional serology. Very often, when people living in the same house are tested, only some of them are recorded as infected even though all were exposed to similar risk factors. Since TIA seems to be a more sensitive technique (7, 8), it was employed in a population at very high risk of infection but which was serologically negative when tested by conventional T. cruzi assays. TIA employs a recombinant trans-sialidase (3, 4) that is preincubated with the serum to be tested, and then the remnant ability to transfer the sialyl residue from sialyllactose to [ 14 C]lactose is evaluated. At present we have tested about 60 normal human sera obtained from the regions of endemicity; they show variable degrees of trans-sialidase inhibition, ranging from 210 to 30%, as reported previously (7, 8). To perform TIA with experimental samples, normal human pooled serum was employed as a negative control and the value of inhibition obtained was taken as 0% (6‐8). Blood samples were obtained from the Sanapa and Angaite Amerindian communities in western Paraguay (150 samples). The seroprevalence of T. cruzi infection among this group was 82%. The people of this group live in houses built with palm leaves, where large numbers of infected vector bugs (70 to 300 triatomines per house) are present. However, some people in the community are consistently negative by the normally employed enzyme-linked immunosorbent and immunofluorescence tests, and also by parasitological tests (xenodiagnosis and hemoculture). Sera from 20 such serologically negative persons (20 to 40 years old) that had been living in the same place for the last 14 to 30 years were further analyzed by TIA and by a dot spot assay employing recombinant T. cruzi antigens that

Objetivo: Determinar se a taxa de cirurgia é a principal barreira para a adesão à cirurgia de catarata no Paraguai. Métodos: Foi realizado um estudo de coorte com pacientes identificados na Avaliação Rápida da Cegueira Evitável (RAAB) de 2011, que haviam informado ser a taxa para a cirurgia a principal barreira para se submeter à cirurgia de catarata no Paraguai. Todos os pacientes com catarata operável a partir do estudo RAAB, cujos números de telefone foram registrados, foram entrevistados por telefone e foi oferecida a cirurgia gratuitamente. Aqueles pacientes que não compareceram para a cirurgia foram então re-entrevistados por telefone para confirmar as suas razões para não fazer a cirurgia. Resultados: Das 122 pessoas identificadas no estudo RAAB com barreiras para a cirurgia de catarata, 69 (56,6%) relataram a taxa cirúrgica como a principal barreira para a cirurgia; 52 (75,4%) destes indivíduos tiveram seus números de telefone registrados. Trinta e seis (69,2%) pacientes não residiam na área metropolitana de Assunção. Seis pacientes (12%) aceitaram se submeter à cirurgia gratuita, todos eles de Assunção. Dos 46 pacientes que não aceitaram a cirurgia gratuita, as duas principais razões para o não comparecimento foi o custo de transporte (n=31, 67%) e os custos de viagem de seu companheiro (n=6, 13%). Conclusão: A taxa de cirurgia de catarata per se não foi a barreira principal. Local de residência e outras despesas pessoais indiretas, como transporte e custos relacionados à companhia parecem ser mais relevantes. Embora mais estudos sejam necessários para avaliar se a redução do custo do transporte vai melhorar a adesão, os resultados sugerem que um pacote cirúrgico que inclua todos os custos deve ser oferecido aos pacientes dos programas de cirurgia de catarata a fim de aumentar a cobertura da cirurgia de catarata no Paraguai.

Eleven Paraguayan strains of Trypanosoma cruzi, from Chagas' disease patients and the bug vectors, were examined by restriction endonuclease analysis of kinetoplast DNA using Hae III, Msp I, Eco RI, Hinf I, Taq I and Rsa I. Four schizodeme-profile groups were identified. Group 1 had much simpler profiles than groups 2, 3 and 4 and, although there were homogeneous profiles in the latter three groups, each group could be distinguished from the others. The profiles of group 1 could not be matched with any of the standard strains from Brazil, Chile and Colombia included in the schizodeme comparison. The profiles of groups 3 and 4 shared most features with those standards of the Brazilian Z2 zymodeme.