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Dengue virus (DENV) is the most common mosquito-borne disease worldwide. This study aimed to characterize an outbreak of DENV infection in Cajamarca, Peru. Also, to identify the most common serotypes involved and describe the applicability of different diagnostic tests in the diagnosis of primary and secondary cases. The study was performed in the region of Cajamarca, in northern Peru. We included patients attending outpatient health centers with an acute febrile illness (AFI), defined as a temperature of 38°C or higher for up to 7 days, without an identifiable source of infection and presenting at least one of the following symptoms: arthralgia, myalgia, headache, retro-ocular pain, low back pain, cutaneous rash, nausea, vomiting, diarrhea, and conjunctival injection. Serum samples were collected and diagnostic tests were performed including: reverse-transcriptase polymerase chain reaction (RT-PCR), NS1 antigen, IgM and IgG antibodies ELISA-based assays. Primary infection was diagnosed by the detection of NS1 antigen ELISA and/or RT-PCR and/or IgM ELISA in the absence of IgG ELISA. Secondary infection was determined by the presence of IgG ELISA and a positive NS1 antigen ELISA and/or RT-PCR and/or IgM ELISA. A total of 359 serum samples were collected in the study period. Dengue infection was diagnosed in 37.9% (136/359) of the patients, being 107 primary infections and 29 secondary infections. The most common serotype was DENV-3 in 77.5% of the cases. Differences were observed in the diagnostic performance of IgM ELISA (17.6% vs 55.2%, p≤0.01) and RT-PCR (74.8% and 31.0%, p≤0.01) in primary and secondary infections respectively. The combination of NS1 and IgM performed better than the other assays in detecting primary (91.9%) and secondary infections (96.6%). The most frequent symptoms associated with DENV infection were headaches, myalgias, and arthralgias. We report an important outbreak of dengue infection caused by DENV-3 in Cajamarca, Peru. Our findings encourage the use of NS1 antigen and IgM co-detection. These findings demonstrate an increasing expansion of DENV-3 in Peru and highlight the importance of molecular diagnosis and serotype characterization among febrile patients to strengthen the Peruvian epidemiological surveillance. [ABSTRACT FROM AUTHOR]

The Chikungunya virus (CHIKV) is an arboviral disease with increasing expansion in Peru. The aim of this study was to evaluate the prevalence, clinical presentation, and seasonality of acute febrile illness (AFI) due to Chikungunya virus in Jaen-Cajamarca, Peru. A consecutive cross-sectional study was performed in febrile patients attending primary healthcare centers from April 2020 through June 2021. This study was performed alongside the epidemiological surveillance of acute febrile illness (AFI). Patients were included if they presented with AFI, defined as an axillary temperature greater than or equal to 38°C within at least 7 days prior to consultation without an identifiable source of infection. The signs and symptoms were assessed and recorded by the attending physician in a standardized questionnaire. Blood samples were collected and sent to a central laboratory, where PCR analysis for the molecular detection of CHIKV was performed. A total of 88 CHIKV cases were identified from 1047 patients with acute febrile illness, with a prevalence of (8.40%). The main clinical characteristics identified in CHIKV positive patients were headache 81.82%, myalgia 70.45%, arthralgia 65.91% and retro-ocular pain 48.86%. No cases of severe disease were identified. Most of the infected patients were adults between 18-39 years (45.45%) and 40-59 years (25.00%). A 50% were male and 44.32% female, the rest were not classified in the clinical record. The majority of the CHIKV cases occurred in February-March (32.95%), May (14.77%) and July (13.64%). The Chikungunya virus is still an ongoing emerging disease at the high jungle of northern Peru. It is an important cause of AFI, presenting non-specific clinical symptoms, thus the development of accurate and precise molecular techniques is important. Patients require precise and point of care laboratory diagnosis. The seasonality is probably related to the rain season and its consequence on the life cycle of the vector. Infections by this virus may go unnoticed in the national surveillance system. [ABSTRACT FROM AUTHOR]

The rapid expansion of the novel SARS-CoV-2 virus has raised serious public health concerns due to the possibility of misdiagnosis in regions where arboviral diseases are endemic. We performed the first study in northern Peru to describe the detection SARS-CoV-2 IgM antibodies in febrile patients from an endemic zone for dengue virus (DENV) and chikungunya virus (CHIKV). A cross-sectional study was performed in febrile patients attending primary healthcare centers from April 2020 through March 2021. This study was carried out jointly with the national surveillance system for the etiological identification of acute febrile illness (AFI). Patients are included if they attended outpatient clinics with AFI (axillary temperature greater than or equal to 38°C in the previous 7 days) along with one or more of the following symptoms: headache, myalgias, arthralgias, retro-ocular pain, lumbar pain, arthritis, nausea, rash, among others. Serum samples were collected from each patient, for the molecular and serological detection of DENV and CHIKV by RT-PCR and IgM ELISA-based assay, respectively. Also, the detection of IgM antibodies against SARS-CoV-2 with an ELISA-based assay was performed. 464 patients were included during the study period, of which 188 (40.51%) were positive for one pathogen, meanwhile 32 (6.90%) presented co-infections between 2 or more pathogens. The majority of patients with monoinfections were positive for SARS-CoV-2 IgM with 73.40%, followed by DENV 18.09% and CHIKV 8.51%. The most frequent co-infection was DENV + SARS-CoV-2 with 65.63%, followed by DENV + CHIKV and DENV + CHIKV + SARS-CoV-2, both with 12.50%. The presence of polyarthralgias in hands (p<0.01) and feet (p=0.05) were more frequently reported in patients with CHIKV monoinfection. Also conjunctivitis was more common in patients positive for SARS-CoV-2 IgM (p<0.01). The rest of the symptoms were similar among all the study groups. In conclusion, a high prevalence of SARS-CoV-2 IgM antibodies were frequently detected in acute sera from febrile patients with a clinical suspicion of arboviral disease. These results highlight the need to consider SARS-CoV-2 infection as a differential diagnosis of AFI in endemic areas for arbovirosis, as well as consider co-infections between these pathogens. [ABSTRACT FROM AUTHOR]

The impact of respiratory coinfections in COVID-19 is still not well understood. This study sought to identify the respiratory pathogens causing coinfections in patients with moderate/severe SARS-CoV-2 pneumonia from a hospital in Peru. Also, to describe the clinical characteristics and outcomes of coinfected and non-coinfected patients. A descriptive study was conducted on hospitalized patients with a confirmed diagnosis of moderate/severe pneumonia due to SARS-CoV-2 infection. The selection criteria included patients older than 18 years of age who were admitted to the Guillermo Almenara Irigoyen Hospital in Lima, Peru during the period July-November 2020. Pregnant women were excluded from the study. A nasopharyngeal swab sample was obtained from the patients included in the study. Diagnosis of SARS-CoV-2 infection was performed by reverse-transcriptase polymerase chain reaction (RT-PCR). The detection of the following respiratory viruses was performed by RT-PCR: Influenza A and B, Respiratory syncitial virus (RSV) A and B; and Adenovirus. The detection of atypical bacteria, Mycoplasma pneumoniae and Chlamydia pneumoniae was carried out using conventional polymerase chain reaction. A total of 295 patients with confirmed SARS-CoV-2 infection were enrolled during the study period. A coinfection with one or more respiratory pathogen was detected in 154 (52.20%) patients at hospital admission. The most common coinfections were Mycoplasma pneumoniae (28.12%), Chlamydia pneumoniae (8.81%) and with both bacteria (11.53%); followed by Adenovirus (1.70%), Mycoplasma pneumoniae/Adenovirus (0.71%), Chlamydia pneumoniae/Adenovirus (0.71%), RSV-B/ Chlamydia pneumoniae (0.32%), Mycoplasma pneumoniae/Chlamydia pneumoniae/Adenovirus (0.32%). Sepsis was more frequent among coinfected patients than non coinfected (33.12% vs 20.57%, p = 0.018). Expectoration was less frequent in coinfected individuals compared to non coinfected (5.84% vs 12.77%, p = 0.045). We could highlight that the majority of patients were administered an antibiotic (69.50%). The correlation between the empirical use of macrolides in patients with Mycoplasma pneumoniae and Chlamydia pneumoniae was observed in 41% of the cases. Mycoplasma pneumoniae and Chlamydia pneumoniae were the main microorganisms associated with SARS-CoV-2 coinfection at hospital admission. The presence of multiple coinfections was described in some patients. Antibiotics should be carefully prescribed, as high rates of antibiotic use was found, particularly with macrolides. [ABSTRACT FROM AUTHOR]

Acute respiratory infections (ARIs) continue to be the leading cause of child mortality in Peru. Data on the epidemiology of Acinetobacter baumannii and its role in respiratory infection among pediatric patients is still scarce. This study aimed to determine the prevalence of A. baumannii in children aged less than one year hospitalized with a clinical diagnosis of whooping cough. A prospective cross-sectional study was conducted in five hospitals in Lima, Peru. Patients under 1 year old admitted with a clinical diagnosis of whooping cough were included in the study. Nasopharyngeal samples were obtained from each patient upon admission and the presence of A. baumanii was determined using a polymerase chain reaction (PCR) assay for the detection of the OXA-51 gene. Also co-infections with other respiratory pathogens was evaluated by molecular methods, including Bordetella pertussis, Mycoplasma pneumoniae, Chlamydia pneumoniae, Influenza A and B and Adenovirus. A total of 225 nasopharyngeal samples were studied. The presence of A. baumanii was detected in 20.89% (47/225) of the nasopharyngeal swab samples. The samples were obtained upon admission to the hospital, therefore, infection by A. baumanii may have occurred in the community. Among the 47 patients with A. baumanii : 5 were diagnosed with A. baumanii monoinfection, 17 co-infection with bacteria, 7 co-infection with virus and 18 co-infection with bacteria + virus. It was observed that children between 29 days and 3 months old had the highest prevalence with 53.3%. The most common co-infecting pathogens were Bordetella pertussis in 55.3%, Adenovirus in 42.6% and Mycoplasma pneumoniae in 23.4%. In conclusion, this is the first report describing the presence of community-acquired A. baumannii in nasopharyngeal samples of children under 1 year old with whooping cough. Co-detection with multiple pathogens is frequent, with up to 6 respiratory infectious agents at the same time, being A. baumannii and B. pertussis co-infection the most prevalent. Further studies are required to determine the role of A. baumannii infections in acute respiratory infections in young children, particularly in those with non-critical disease and outside of intensive care units. [ABSTRACT FROM AUTHOR]

Acute respiratory infections (ARIs) remain the leading cause of death in children in Peru; however, the epidemiology of many respiratory pathogens has not been described. The objective of this study was to assess the prevalence of Rhinovirus and its most common genotypes in nasopharyngeal swab samples of children with a clinical diagnosis of acute respiratory infection (ARI) in Lima, Peru. We performed a secondary analysis on nasopharyngeal swab samples collected from a cross-sectional study in children younger than 17 years old with a clinical diagnosis of ARI from the Hospital Nacional Cayetano Heredia between the years 2009-2010 in Lima, Peru. The original study recruited 767 hospitalized patients with ARI; however, due to conservation of the samples only 559 samples were included in the current study. The detection of Rhinovirus (RV) and their specific genotypes (RVA, RVB and RVC) was performed by RT-PCR. Epidemiological and clinical characteristics were registered using the clinical charts. A total of 234 (41.86%) cases were diagnosed with RV, of which 73.07% were RVC, 16.67% were RVB and 10.26% were RVA. Infections caused by RV were more common in male patients (57.26%) and in the 0 - 5 months group (48.72%). The group with the least cases detected was 11- 17 years old (3.76%). The 88.46% (207/234) of positive cases for RV were hospitalized. The most common clinical symptoms found in the present study were cough 73.08% (171/234), followed by fever 68.80% (161/234), rhinorrea 67.95% (159/234) and respiratory distress 61.54% (144/234). An association between RVC infection and some signs and symptoms were found: cough (p= 0.012), wheezing (p=0.003) and headache (p=0.030). A peak in the cases of infections was observed in March (42 cases of RV and 32 RVC) and June (38 cases of RV and 27 RVC). In conclusion, we found a high prevalence of Rhinovirus in pediatric patients, being RVC the most common genotype. The majority of cases corresponded to male pediatric patients younger than 6 months old. A peak in the cases of infections was observed in March and June, which corresponds to the fall season in Peru. [ABSTRACT FROM AUTHOR]

The epidemiology of human papillomavirus (HPV) and co-infections with other sexually transmitted infections (STIs) remains poorly characterized in Peru. The aim of this study was to identify HPV infections and the presence of co-infections by other important STIs (Chlamydia trachomatis, Trichomonas vaginalis , and Herpes simplex virus) in women attending the public health system in northern Peru. We conducted a prospective cross-sectional study in asymptomatic women attending the cervical cancer screening program in a public hospital of Cajamarca, Peru. Exclusion criteria were: pregnancy, recent gynecological bleeding, previous hysterectomy, previous history of HPV-related disease including cervical intraepithelial lesions, cancer, warts and cutaneous manifestations. A cervical swab was collected from each patient using a disposable cytobrush. Detection of sexually transmitted pathogens was performed by polymerase chain reaction (PCR). The pathogens evaluated were: HPV, Chlamydia trachomatis, Trichomonas vaginalis , and Herpes simplex virus 1 (HSV-1) and 2 (HSV-2). A total of 300 asymptomatic women were enrolled in the current study. The pooled prevalence of HPV detected in our study was 19.33% (16.33% as single infection and 3.00% in co-infections) from the total samples. Co-infections between the different pathogens were also observed in 15 cases, being HPV and T. vaginalis the most frequent with 10 cases (66.67%). The most frequent type identified in HPV monoinfections were HPV-16 (16.33%), HPV-52 (14.29%) and HPV-31 (8.16%). Co-infection by multiple HPV types were also identified with up to 4 genotypes at the same time in a single patient The majority of patients with high-risk HPV were between 18 - 39 years old (60.87%) and had a sexual partner in the last 6 months (93.48%). Also, the majority of the patients with high-risk types did not report frequent condom use (89.13%). We found an important prevalence of HPV in asymptomatic women from northern Peru. The most common genotypes were HPV-16, HPV-52 and HPV-31. Among the STIs studied, T. vaginalis was the most common pathogen detected in co-infections with HPV. Education on condom use and timely screening should be encouraged in the Peruvian population to prevent the expansion of HPV and other sexually transmitted pathogens. [ABSTRACT FROM AUTHOR]

Background: The Chikungunya virus (CHIKV) is an emerging arthropod-borne virus (arbovirus) that causes undifferentiated acute febrile illness. Cases of CHIKV may be under-reported in Peru, given the various difficulties in diagnosing it, such as lack of diagnostic tests in remote areas, the passive nature of epidemiological surveillance, and co-circulation of other arthropod-borne pathogens. Therefore, a study was conducted in the high jungle of northern Peru to determine the prevalence of CHIKV among febrile patients and describe their clinical characteristics., Methods: A cross-sectional study was conducted in the province of Jaen, Cajamarca, located in the high jungle of northern Peru. Patients attending primary healthcare centers within Cajamarca's Regional Health Directorate were enrolled. The study took place from June 2020 through June 2021. Patients were eligible if they sought outpatient healthcare for a clinical diagnosis of acute febrile illness (AFI). Serum samples were collected from all patients, and the diagnosis of CHIKV was determined using real-time RT-PCR, as well as the detection of IgM antibodies by ELISA. A logistic regression model was employed to identify the risk factors for CHIKV, and the odds ratios (ORs) were calculated, along with their corresponding 95% confidence intervals (95% CI)., Results: A total of 1 047 patients with AFI were included during the study period. CHIKV was identified in 130 patients of 1 047 (12.4%). Among the CHIKV positive cases, 84 of 130 (64.6%) were diagnosed by RT-PCR, 42 of 130 (32.3%) by IgM ELISA detection, and 4 of 130 (3.1%) by both assays. The majority of patients with CHIKV infection fell within the 18-39 years age group (50.0%), followed by the 40-59 years age group (23.9%) and those with 60 years or older (10.8%). The most common clinical symptoms observed in patients with CHIKV infection were headache (85.4%), myalgias (72.3%), and arthralgias (64.6%). The highest number of positive CHIKV cases occurred in May (23.1%), followed by March (20.0%) and February (13.8%) of 2021., Conclusion: The study reports a considerable frequency of CHIKV infections among patients with AFI from the high jungle of northern Peru. These findings highlight the importance of recognizing CHIKV as an ongoing pathogen with continuous transmission in various areas of Peru. It is crucial to enhance epidemiological surveillance by implementing reliable diagnostic techniques, as the clinical symptoms of CHIKV infection can be nonspecific., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Aguilar-Luis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Human rhinovirus is a major cause of acute respiratory infections (ARIs) worldwide. Epidemiological data on human rhinovirus (RV) in Peru is still scarce, as well as its role in respiratory infections in children. Therefore, the aim of this study was to describe the prevalence of rhinovirus and to identify the circulating species in nasopharyngeal swabs from children with acute respiratory infections., Materials and Methods: We analyzed nasopharyngeal swab samples that were collected from children younger than 17 years old, who had a clinical diagnosis of ARI from the "Hospital Nacional Cayetano Heredia" between May 2009 and December 2010. The original study recruited 767 inpatients with ARI, 559 samples of which were included and analyzed in the current study. Detection of rhinovirus and determination of rhinovirus species were characterized by PCR., Results: Rhinovirus was detected in 42.22% samples (236/559), RV-A was detected in 10.17% (24/236) of the cases, RV-B in 16.53% (39/236), and RV-C in 73.31% (173/236). The age group with the highest number of cases was the 0-5 months group with 45.97%, followed by the 1-5 years group with 25.22%. Most of the positive RV cases, i.e., 86.44% (204/236), were hospitalized. The most common signs and symptoms found in patients who tested positive for RV were cough (72.88%), fever (68.64%), rhinorrhea (68.22%), and respiratory distress (61.44%). Infection with RV-A was associated with wheezing (p = 0.02). Furthermore, RV-C was related to cough (p = 0.01), wheezing (p = 0.002), and conjunctival injection (p = 0.03). A peak in RV-C cases was found in March (32 cases in 2010); June (18 cases in 2009 and 12 cases in 2010), which corresponds to the fall season in Peru; and also November (17 cases in 2009 and 4 cases in 2010), which corresponds to spring. RV-A and RV-B cases were constant throughout the year., Conclusion: In conclusion, we found a high prevalence of rhinovirus C infection among pediatric patients with acute respiratory infections in Lima, Peru. This viral infection was more common in children between 0 to 5 months old, and was associated with cough, wheezing, and conjunctival injection. Epidemiological surveillance of this virus should be strengthened/encouraged in Peru to determine its real impact on respiratory infections., Competing Interests: The authors have declared that no competing interests exist.

Introduction: The rapid expansion of the novel SARS-CoV-2 virus has raised serious public health concerns due to the possibility of misdiagnosis in regions where arboviral diseases are endemic. We performed the first study in northern Peru to describe the detection of SARS-CoV-2 IgM antibodies in febrile patients with a suspected diagnosis of dengue and chikungunya fever., Materials and Methods: A consecutive cross-sectional study was performed in febrile patients attending primary healthcare centers from April 2020 through March 2021. Patients enrolled underwent serum sample collection for the molecular and serological detection of DENV and CHIKV. Also, serological detection of IgM antibodies against SARS-CoV-2 was performed., Results: 464 patients were included during the study period, of which (40.51%) were positive for one pathogen, meanwhile (6.90%) presented co-infections between 2 or more pathogens. The majority of patients with monoinfections were positive for SARS-CoV-2 IgM with (73.40%), followed by DENV 18.09% and CHIKV (8.51%). The most frequent co-infection was DENV + SARS-CoV-2 with (65.63%), followed by DENV + CHIKV and DENV + CHIKV + SARS-CoV-2, both with (12.50%). The presence of polyarthralgias in hands (43.75%, p<0.01) and feet (31.25%, p = 0.05) were more frequently reported in patients with CHIKV monoinfection. Also, conjunctivitis was more common in patients positive for SARS-CoV-2 IgM (11.45%, p<0.01). The rest of the symptoms were similar among all the study groups., Conclusion: SARS-CoV-2 IgM antibodies were frequently detected in acute sera from febrile patients with a clinical suspicion of arboviral disease. The presence of polyarthralgias in hands and feet may be suggestive of CHIKV infection. These results reaffirm the need to consider SARS-CoV-2 infection as a main differential diagnosis of acute febrile illness in arboviruses endemic areas, as well as to consider co-infections between these pathogens., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Metabolic associated steatohepatitis (MASH) is one of the most frequent causes of chronic liver disease. Liver transaminases are important biomarkers to measure liver injury, however, a proportion of patients with MASH may present with normal levels of transaminases. The levels of serum transaminases may not correlate with the severity of histopathological changes., Objective: We aimed to identify the frequency of normal transaminases in obese patients with MASH, as well as to describe the clinical, biochemical and histological characteristics in this specific group of patients., Materials and Methods: A retrospective cross-sectional study was conducted in the bariatric surgery service of a private clinic. Obese patients older than 18 years with a body mass index (BMI) >30Kg/m2 and 2 co-morbidities undergoing a gastric sleeve surgery were included. Measurement of biochemical routine laboratory exams was performed. Insulin resistance was calculated using the homeostasis evaluation model (HOMA-IR). All patients underwent liver biopsies prior to surgery and the diagnosis of MASH was based on the Brunt criteria., Results: 159 obese patients with MASH were included, of which 47.2% had normal transaminases and 52.8% elevated transaminases. Factors associated with alteration in transaminases were: being male OR=4.02 (95% CI: 2.03- 7.96; p<0.01), diagnosis of type 2 diabetes mellitus OR=4.86 (95% CI: 1.97- 11.95; p<0.01) and levels of GGT >50 IU/L OR=7.50 (95% CI: 3.40-16.56; p<0.01). The values of HOMA-IR and GGT were significantly higher in the group of high transaminases (p<0.01). Differences in the degree of fibrosis were not associated with transaminases levels., Conclusion: In conclusion we found that the frequency of normal transaminases was 47.2% in obese patients with MASH. Factors associated with elevation in liver enzymes were being male, diagnosis of diabetes mellitus and elevation in GGT levels. The degree of fibrosis was not associated with elevations in liver transaminases. These findings suggest that transaminases levels alone are not accurate markers to assess liver injury, as they do not necessarily correlate with histological liver damage.

Objective: This study aimed to determine the prevalence of A. baumannii in children aged less than 1 year admitted with a clinical diagnosis of whooping cough., Results: A total of 225 nasopharyngeal samples from children under 1 year old hospitalized with clinical diagnosis of whooping cough were studied from January 2010 to July 2012. The presence of A. baumannii was detected in 20.89% (47/225) of the nasopharyngeal swab samples. Among the 47 patients with A. baumannii: 5 were diagnosed with A. baumannii monoinfection, 17 co-infection with bacteria, 7 co-infection with virus and 18 co-infection with bacteria + virus. It was observed that 51.6% (116/225) were children between 29 days and 3 months old, this same group had the highest overall prevalence with 53.3%. The most common co-infecting pathogens were Bordetella pertussis in 55.3%, Adenovirus in 42.6% and Mycoplasma pneumoniae in 23.4%., (© 2021. The Author(s).)

Objective: This study was carried out to determine the prevalence of leptospirosis among febrile patients with a suspicious clinical diagnosis of dengue fever in northern Peru., Results: A total of 276 serum samples from patients with acute febrile illness (AFI) and suspected diagnosis for dengue virus (DENV) were analyzed. We identified an etiological agent in 121 (47.5%) patients, DENV was detected in 30.4% of the cases, leptospirosis in 11.2% and co-infection by both pathogens was observed in 5.9% of the patients. In this study the most common clinical symptoms reported by the patients were: headache 89.1%, myalgias 86.9% and arthralgias 82.9%. No differences in symptomatology was observed among the different study groups.

Objective: To determine the general and genotype-specific prevalence of HPV and to identify potential risk factors for the infection in a population-based screening of Peruvian women., Results: A total of 524 samples were analyzed by PCR and a total of 100 HPV positive samples were found, of which 89 were high-risk, 19 were probably oncogenic, 9 were low-risk and 27 other HPV types. The 26-35 and 36-45 age groups showed the highest proportion of HPV positive samples with a total of 37% (37/100) and 30% (30/100), respectively. Moreover, high-risk HPV was found in 33.7% of both groups and probably oncogenic HPV in 52.6% and 31.6%, respectively. High-risk HPV were the most frequent types identified in the population studied, being HPV-52, HPV-31 and HPV-16 the most commonly detected with 17.6%, 15.7% y 12.9%, respectively. Demographic characteristics and habits were assessed in the studied population. A total of 62% high-risk HPV were detected in married/cohabiting women. Women with two children showed the highest proportion (33.8%) of high-risk HPV, followed by women with only one child (26.9%). Those women without history of abortion had a higher frequency of high-risk HPV (71.9%), followed by those with one abortion (25.8%).

Introduction: COVID-19 affects the liver, causing alteration in liver biochemistry tests such as aspartate transferase (AST), alanine transferase (ALT), alkaline phosphatase (ALP), total bilirubin and albumin., Objective: To determine the prevalence of alteration in liver functions tests and associated factors for severity among Peruvian COVID-19 patients., Materials and Methods: A descriptive, retrospective and cross-sectional study was performed in 4 public hospitals in Peru. Patients admitted to hospitalization wards and intensive care units with a diagnosis COVID-19 were enrolled. The evaluation of AST, ALT, ALP, totalbilirubin and albumin was performed. Associations with demographic and medical data were assessed., Results: 1,100 patients were enrolled, of which 81.7% had altered liver function tests. Only 2.8% of the patients had cirrhosis and 2.1% hepatitis B/C virus. AST and ALT were altered at admission in 64.7% and 63.7%, of the patients respectively. Factors associated with liver injury were: being female OR=0.53 (95% CI: 0.39-0.73; p<0.01), dyslipidemia OR=1.72 (95% CI: 1.10-2.70; p=0.01), previous medication OR=1.56 (95% CI: 1.12 -2.16, p<0.01) and fever OR=1.43 (95% CI: 1.03-1.199, p=0.03). Disease severity was associated with levels of AST and ALT (p<0.01). Patients taking self-medication OR=1.56 (95% CI: 1.12-2.16; p<0.01) and paracetamol OR= 1.41 (95% CI:1.01-1.98; p=0.04) had higher risk of liver injury. Meanwhile, corticosteroids OR=0.55 (95% CI: 0.38-0.78; p<0.01) and enoxaparin OR=0.53 (95% CI: 0.35- 0.81; p<0.01) were protective factors., Conclusions: Peruvian patients with COVID-19 presented high prevalence of alteration in liver function tests, high levels of AST and ALT were related to disease severity.

Objective: To describe frequency and clinical characteristics of MAYV infection in Piura, as well as the association of this pathogen with DENV., Results: A total of 86/496 (17.3%) cases of MAYV were detected, of which 54 were MAYV mono-infection and 32 were co-infection with DENV, accounting for 10.9% and 6.4%, respectively. When evaluating monoinfection by MAYV the main groups were 18-39 and 40-59 years old, with 25.9% and 20.4% respectively. Co-infections were more common in the age group 18-39 and those > 60 years old, with 34.4% and 21.9%, respectively. The most frequent clinical presentation were headaches (94.4%, 51/54) followed by arthralgias (77.8%, 42/54). During the 8-month study period the most cases were identified in the months of May (29.1%) and June (50.0%).

Objective: To characterize the cervicovaginal microbiota of HPV-positive and HPV-negative asymptomatic Peruvian women, by identifying the presence of 13 representative bacteria genus., Results: A total of 100 HPV-positive and 100 HPV-negative women were matched by age for comparison of microbiota. The following bacteria were more frequently identified in HPV-positive patients compared to HPV-negative: Eubacterium (68 vs 32%), Actinobacteria (46 vs 33%), Fusobacterium (11 vs 6%) and Bacteroides (20 vs 13%). A comparison between high-risk and low-risk genotypes was performed and differences were found in the detection of Actinobacteria (50 vs 33.33%), Bifidobacterium (50 vs 20.83%) and Enterococcus (50 vs 29.17%).

Objective: To describe the prevalence of dengue virus serotypes, as well as other viral and bacterial pathogens that cause acute febrile illness during an outbreak in Cajamarca in 2016., Results: Dengue virus (DENV) was the most frequent etiologic agent detected in 25.8% of samples (32/124), followed by Rickettsia spp. in 8.1% (10/124), Zika virus in 4.8% (6/124), Chikungunya virus 2.4% (3/124) and Bartonella bacilliformis 1.6% (2/124) cases. No positive cases were detected of Oropouche virus and Leptospira spp. DENV serotypes identification was only achieved in 23% of the total positive for DENV, two samples for DENV-2 and four samples for DENV-4. During the 2016 outbreak in Cajamarca-Peru, it was observed that in a large percentage of positive samples for DENV, the infecting serotype could not be determined by conventional detection assays. This represents a problem for the national surveillance system and for public health due to its epidemiological and clinical implications. Other viral and bacterial pathogens responsible for acute febrile syndrome were less frequently identified.

Objective: To evaluate the frequency of infection caused by the Oropouche virus (OROV) in 496 patients with acute febrile disease (AFI), whose samples were obtained for the analysis of endemic arboviruses in a previous investigation carried out in 2016., Results: OROV was detected in 26.4% (131/496) of serum samples from patients with AFI. Co-infections with Dengue virus (7.3%), Zika virus (1.8%) and Chikungunya (0.2%) were observed. The most common clinical symptoms reported among the patients with OROV infections were headache 85.5% (112/131), myalgia 80.9% (106/131), arthralgia 72.5% (95/131) and loss of appetite 67.9% (89/131). Headache and myalgia were predominant in all age groups. Both OROV infections and co-infections were more frequent in May, June and July corresponding to the dry season of the region.

Objective: To determine the geographical distribution and risk stratification of dengue infection in an endemic region of Peru, and its relationship with the presence of El Niño Southern Oscillation (ENSO)., Results: For the analysis, the definition and information about the ENSO events in Peru was obtained from the SENAMHI and IGP reports. The geographical distribution of dengue cases in the territory comprising the 11 districts is homogeneous. There were 1 498 confirmed cases of dengue reported, the highest incidence was determined in Puerto Inca where it reached an incidence of 3210.14/100,000 hab. Of the 11 districts, 2 were classified as a high risk of transmission, 3 as moderate risk, 3 as low risk and in 3 of them the risk of virus transmission could not be determined.