27 results on '"Armién B"'
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2. Evolución en el trópico: los amerindios de Costa Rica y Panamá
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Armién Blas
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Medicine ,Public aspects of medicine ,RA1-1270 - Published
- 1995
3. Choclo virus (CHOV) recovered from deep metatranscriptomics of archived frozen tissues in natural history biorepositories.
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Salazar-Hamm PS, Johnson WL, Nofchissey RA, Salazar JR, Gonzalez P, Goodfellow SM, Dunnum JL, Bradfute SB, Armién B, Cook JA, Domman DB, and Dinwiddie DL
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- Animals, Rats, Humans, Phylogeny, Rodentia, Biological Specimen Banks, Sigmodontinae, Orthohantavirus
- Abstract
Background: Hantaviruses are negative-stranded RNA viruses that can sometimes cause severe disease in humans; however, they are maintained in mammalian host populations without causing harm. In Panama, sigmodontine rodents serve as hosts to transmissible hantaviruses. Due to natural and anthropogenic forces, these rodent populations are having increased contact with humans., Methods: We extracted RNA and performed Illumina deep metatranscriptomic sequencing on Orthohantavirus seropositive museum tissues from rodents. We acquired sequence reads mapping to Choclo virus (CHOV, Orthohantavirus chocloense) from heart and kidney tissue of a two-decade old frozen museum sample from a Costa Rican pygmy rice rat (Oligoryzomys costaricensis) collected in Panama. Reads mapped to the CHOV reference were assembled and then validated by visualization of the mapped reads against the assembly., Results: We recovered a 91% complete consensus sequence from a reference-guided assembly to CHOV with an average of 16X coverage. The S and M segments used in our phylogenetic analyses were nearly complete (98% and 99%, respectively). There were 1,199 ambiguous base calls of which 93% were present in the L segment. Our assembled genome varied 1.1% from the CHOV reference sequence resulting in eight nonsynonymous mutations. Further analysis of all publicly available partial S segment sequences support a clear relationship between CHOV clinical cases and O. costaricensis acquired strains., Conclusions: Viruses occurring at extremely low abundances can be recovered from deep metatranscriptomics of archival tissues housed in research natural history museum biorepositories. Our efforts resulted in the second CHOV genome publicly available. This genomic data is important for future surveillance and diagnostic tools as well as understanding the evolution and pathogenicity of CHOV., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Salazar-Hamm 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.)
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- 2024
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4. Hantavirus in Panama: Twenty Years of Epidemiological Surveillance Experience.
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Armién B, Muñoz C, Cedeño H, Salazar JR, Salinas TP, González P, Trujillo J, Sánchez D, Mariñas J, Hernández A, Cruz H, Villarreal LY, Grimaldo E, González S, Nuñez H, Hesse S, Rivera F, Edwards G, Chong R, Mendoza O, Meza M, Herrera M, Kant R, Esquivel R, Estripeaut D, Serracín D, Denis B, Robles E, Mendoza Y, Gonzalez G, Tulloch F, Pascale JM, Dunnum JL, Cook JA, Armién AG, Gracia F, Guerrero GA, and de Mosca I
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- Animals, Panama epidemiology, Rodentia, Sigmodontinae, Communicable Diseases, Hantavirus Infections epidemiology, Hantavirus Pulmonary Syndrome epidemiology, Hemorrhagic Fever with Renal Syndrome, Orthohantavirus
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Twenty years have passed since the emergence of hantavirus zoonosis in Panama at the beginning of this millennium. We provide an overview of epidemiological surveillance of hantavirus disease (hantavirus pulmonary syndrome and hantavirus fever) during the period 1999-2019 by including all reported and confirmed cases according to the case definition established by the health authority. Our findings reveal that hantavirus disease is a low-frequency disease, affecting primarily young people, with a relatively low case-fatality rate compared to other hantaviruses in the Americas (e.g., ANDV and SNV). It presents an annual variation with peaks every 4-5 years and an interannual variation influenced by agricultural activities. Hantavirus disease is endemic in about 27% of Panama, which corresponds to agroecological conditions that favor the population dynamics of the rodent host, Oligoryzomys costaricensis and the virus ( Choclo orthohantavirus ) responsible for hantavirus disease. However, this does not rule out the existence of other endemic areas to be characterized. Undoubtedly, decentralization of the laboratory test and dissemination of evidence-based surveillance guidelines and regulations have standardized and improved diagnosis, notification at the level of the primary care system, and management in intensive care units nationwide.
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- 2023
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5. Leptospirosis: Epidemiological and Clinical Characteristics at the National Reference Hospital in Panama.
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Vazquez Guillamet LJ, Arauz AB, Suárez JA, González E, Domingo de Obaldía J, Moreno D, Henostroza G, and Armién B
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- Middle Aged, Humans, Male, Serogroup, Incidence, Hospitals, Leptospira, Leptospirosis diagnosis, Leptospirosis drug therapy, Leptospirosis epidemiology
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Leptospirosis represents a public health problem in Panama, with an incidence rate of 1 in 100,000 inhabitants in 2014. Despite active surveillance and reports of outbreaks in the news, publications about human leptospirosis in Panama are scarce. The objective of this study was to describe the epidemiological and clinical features of leptospirosis in a cohort of patients admitted to the national reference hospital from January 2013 to December 2018. A total of 188 patients with suspected leptospirosis were identified, but only 56.9% (107 of 188) of the medical records could be retrieved. Microagglutination assays were completed in 45% (48 of 107) of the patients, confirming leptospirosis in 29.2% (14 of 48) of the patients. The most prevalent serogroup identified was Leptospira interrogans icterohemorrhagiae (4 of 14, 28.6%). The majority of patients with confirmed disease were middle-aged (36.4 ± 15.7 years), male (11 of 14, 78.6%), and symptomatic for 6.8 ± 0.7 days before admission. The predominant clinical presentation was fever (13 of 14, 92.9%), abdominal pain (7 of 14, 50%), and jaundice (8 of 14, 57.1%). Respiratory failure (8 of 14, 57.1%), elevated creatinine levels on admission (8 of 14, 57.1%), transfusion of blood-derived products (6 of 14, 42.9%), and required use of vasopressors (4 of 14, 28.6%) were common complications. Mortality was 28.6% (4 of 14). Empiric antibiotic therapy was initiated in almost all patients (10 of 12, 83.3%), and was appropriate in 90% (9 of 10) of them. Our study highlights the high prevalence of severe disease and reveals the diagnostic challenges concealing the true burden of leptospirosis in Panama. However, the small number of confirmed patients limits the generalization of these findings.
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- 2022
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6. Case Report: First Confirmed Case of Coinfection of SARS-CoV-2 With Choclo orthohantavirus .
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Hesse S, Nuñez H, Salazar JR, Salinas TP, Barrera E, Chong R, Torres S, Cumbrera A, Olivares I, Junco A, Matteo C, González C, Chavarría O, Moreno A, Góndola J, Ábrego L, Díaz Y, Pitti Y, Franco D, Martínez-Montero M, Pascale JM, López-Vergès S, Martínez AA, and Armién B
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The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a major international public health concern. The World Health Organization (WHO) declared the pandemic of coronavirus disease 2019 (COVID-19) on March 11, 2020. In Panama, the first SARS-CoV-2 infection was confirmed on March 9, 2020, and the first fatal case associated to COVID-19 was reported on March 10. This report presents the case of a 44-year-old female who arrived at the hospital with a respiratory failure, five days after the first fatal COVID-19 case, and who was living in a region where hantavirus pulmonary syndrome cases caused by Choclo orthohantavirus (CHOV), are prevalent. Thus, the clinical personnel set a differential diagnosis to determine a respiratory disease caused by the endemic CHOV or the new pandemic SARS-CoV-2. This case investigation describes the first coinfection by SARS-CoV-2 and CHOV worldwide. PCR detected both viruses during early stages of the disease and the genomic sequences were obtained. The presence of antibodies was determined during the patient's hospitalization. After 23 days at the intensive care unit, the patient survived with no sequelae, and antibodies against CHOV and SARS-CoV-2 were still detectable 12 months after the disease. The detection of the coinfection in this patient highlights the importance, during a pandemic, of complementing the testing and diagnosis of the emergent agent, SARS-CoV-2, with other common endemic respiratory pathogens and other zoonotic pathogens, like CHOV, in regions where they are of public health concern., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Hesse, Nuñez, Salazar, Salinas, Barrera, Chong, Torres, Cumbrera, Olivares, Junco, Matteo, González, Chavarría, Moreno, Góndola, Ábrego, Díaz, Pitti, Franco, Martínez-Montero, Pascale, López-Vergès, Martínez and Armién.)
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- 2021
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7. Endemic and Epidemic Human Alphavirus Infections in Eastern Panama: An Analysis of Population-Based Cross-Sectional Surveys.
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Carrera JP, Cucunubá ZM, Neira K, Lambert B, Pittí Y, Liscano J, Garzón JL, Beltran D, Collado-Mariscal L, Saenz L, Sosa N, Rodriguez-Guzman LD, González P, Lescano AG, Pereyra-Elías R, Valderrama A, Weaver SC, Vittor AY, Armién B, Pascale JM, and Donnelly CA
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- Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Alphavirus immunology, Alphavirus Infections epidemiology, Alphavirus Infections immunology, Alphavirus Infections physiopathology, Animals, Antibodies, Viral immunology, Chikungunya Fever epidemiology, Chikungunya Fever immunology, Chikungunya Fever physiopathology, Chikungunya virus immunology, Child, Child, Preschool, Cross-Sectional Studies, Depression physiopathology, Dizziness physiopathology, Encephalitis Virus, Eastern Equine immunology, Encephalitis Virus, Venezuelan Equine immunology, Encephalomyelitis, Eastern Equine immunology, Encephalomyelitis, Eastern Equine physiopathology, Encephalomyelitis, Venezuelan Equine immunology, Encephalomyelitis, Venezuelan Equine physiopathology, Endemic Diseases, Epidemics, Fatigue physiopathology, Female, Housing statistics & numerical data, Humans, Immunoglobulin G, Immunoglobulin M, Male, Middle Aged, Mosquito Vectors virology, Panama epidemiology, Semliki forest virus immunology, Seroepidemiologic Studies, Sleep Initiation and Maintenance Disorders physiopathology, Young Adult, Encephalomyelitis, Eastern Equine epidemiology, Encephalomyelitis, Venezuelan Equine epidemiology, Farmers statistics & numerical data
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Madariaga virus (MADV) has recently been associated with severe human disease in Panama, where the closely related Venezuelan equine encephalitis virus (VEEV) also circulates. In June 2017, a fatal MADV infection was confirmed in a community of Darien Province. We conducted a cross-sectional outbreak investigation with human and mosquito collections in July 2017, where sera were tested for alphavirus antibodies and viral RNA. In addition, by applying a catalytic, force-of-infection (FOI) statistical model to two serosurveys from Darien Province in 2012 and 2017, we investigated whether endemic or epidemic alphavirus transmission occurred historically. In 2017, MADV and VEEV IgM seroprevalences were 1.6% and 4.4%, respectively; IgG antibody prevalences were MADV: 13.2%, VEEV: 16.8%, Una virus (UNAV): 16.0%, and Mayaro virus: 1.1%. Active viral circulation was not detected. Evidence of MADV and UNAV infection was found near households, raising questions about its vectors and enzootic transmission cycles. Insomnia was associated with MADV and VEEV infections, depression symptoms were associated with MADV, and dizziness with VEEV and UNAV. Force-of-infection analyses suggest endemic alphavirus transmission historically, with recent increased human exposure to MADV and VEEV in Aruza and Mercadeo, respectively. The lack of additional neurological cases suggests that severe MADV and VEEV infections occur only rarely. Our results indicate that over the past five decades, alphavirus infections have occurred at low levels in eastern Panama, but that MADV and VEEV infections have recently increased-potentially during the past decade. Endemic infections and outbreaks of MADV and VEEV appear to differ spatially in some locations of eastern Panama.
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- 2020
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8. Integrating Biodiversity Infrastructure into Pathogen Discovery and Mitigation of Emerging Infectious Diseases.
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Cook JA, Arai S, Armién B, Bates J, Bonilla CAC, Cortez MBS, Dunnum JL, Ferguson AW, Johnson KM, Khan FAA, Paul DL, Reeder DM, Revelez MA, Simmons NB, Thiers BM, Thompson CW, Upham NS, Vanhove MPM, Webala PW, Weksler M, Yanagihara R, and Soltis PS
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- 2020
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9. Implementation of bamboo and monkey-pot traps for the sampling cavity-breeding mosquitoes in Darién, Panama.
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Santos M, Collado Mariscal L, Henríquez B, Garzón J, González P, Carrera JP, Tello J, Koo S, Pascale JM, Burkett-Cadena N, Armién B, and Valderrama A
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- Aedes physiology, Aedes virology, Animals, Female, Male, Sasa, Mosquito Control methods, Mosquito Vectors virology, Yellow Fever transmission
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Despite the importance of Aedes, Haemagogus and Sabethes in the transmission of yellow fever virus (YFV) and the public health impacts of recent YFV epidemics in the Americas, relatively little has been reported on the biology and ecology of these vectors. Many Aedes, Haemagogus and Sabethes spp. in the American tropics inhabit and develop in the forest canopy and are difficult to sample with conventional entomological surveillance methods. We tested the utility of two previously developed phytotelmata-style oviposition traps (bamboo Guadua angustifolia) and (monkey-pot Lecythis minor), for collecting immature forms of these mosquitoes in a forest near the community of Aruza Abajo, Darién Province, Panama. Our results showed distribution of mosquito species emerging from the two types of traps was found to be significantly different (X
2 = 210.23; df = 14; P < 0.001), with significantly greater numbers of Sabethes (Peytonulus) aurescens (Lutz) and Sabethes (Peytonulus) undosus (Coquillett) emerging from the bamboo traps. More females of Sabethes (Sabethes) cyaneus (Fabricius) were captured in the monkey-pot traps, although the difference was not significant. No differences were observed in the average time to emergence for the two traps. These results suggest that various phytotelmata-style traps, including monkey-pot and bamboo, could be used to improve entomological surveillance of YFV vectors in the American tropic., Competing Interests: Declaration of Competing Interest The authors declare there are no competing interests., (Copyright © 2020 Elsevier B.V. All rights reserved.)- Published
- 2020
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10. Sociocultural determinants of adoption of preventive practices for hantavirus: A knowledge, attitudes, and practices survey in Tonosí, Panama.
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Harris C and Armién B
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- Adolescent, Adult, Aged, Cross-Sectional Studies, Female, Hantavirus Infections epidemiology, Health Knowledge, Attitudes, Practice, Humans, Male, Middle Aged, Panama epidemiology, Young Adult, Hantavirus Infections prevention & control
- Abstract
Introduction: Hantaviruses are a group of single-stranded RNA viruses carried by small rodent reservoirs, transmitted to humans through inhalation of aerosolized particles of rodent feces, urine, or saliva. In Panama, the Choclo orthohantavirus has been associated with Hantavirus Pulmonary Syndrome (n = 54) and Hantavirus Fever (n = 53). In 2018, there were 107 cases of hantavirus diseases, the majority in the Tonosí district, and 4 deaths. As there is no vaccine or treatment for hantavirus, proper prevention measures by community members is key to stopping outbreaks., Methodology and Principal Findings: We investigated hantavirus knowledge, attitudes, and practices in one corregimiento of Tonosí, Panama to determine what factors influence uptake of prevention practices and high level of knowledge. We conducted a cross-sectional survey with 124 residents covering hantavirus knowledge, attitudes based in the Health Belief Model (perceived severity, perceived susceptibility, perceived obstacles, perceived benefits, and cues to action) and prevention practices. There was an overall high level of knowledge (median score: 4/6), though 20% did not know the route of transmission. The mean number of reported practices performed per person was 8.4 (range: 4-12). Most people had heard of hantavirus through other community members. In linear regression, lower perceived obstacles predicted higher preventive practice score. Reported obstacles to preventive practices included physical restrictions, such as age and health state. In ordinal logistic regression, higher education level and knowing more people who had previously been sick with hantavirus contributed to higher knowledge score., Conclusions: Future interventions should focus on removing barriers to performing preventive practices. As most people learned of hantavirus through community members, interventions should be community-based and involve those who have experienced the disease. Any future education materials should address confusions about route of transmission and be targeted at those with a lower education level., Competing Interests: The authors have declared that no competing interests exist.
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- 2020
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11. Molecular Epidemiology of Dengue in Panama: 25 Years of Circulation.
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Díaz Y, Chen-Germán M, Quiroz E, Carrera JP, Cisneros J, Moreno B, Cerezo L, Martinez-Torres AO, Moreno L, Barahona de Mosca I, Armién B, Chen R, Vasilakis N, and López-Vergès S
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- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Dengue epidemiology, Dengue Virus classification, Dengue Virus genetics, Female, Genotype, Humans, Infant, Male, Middle Aged, Molecular Epidemiology, Panama epidemiology, Phylogeny, Retrospective Studies, Young Adult, Dengue virology, Dengue Virus isolation & purification
- Abstract
Dengue virus (DENV) is the most prevalent arbovirus in terms of human public health importance globally. In addition to DENV epidemiological surveillance, genomic surveillance may help investigators understand the epidemiological dynamics, geographic distribution, and temporal patterns of DENV circulation. Herein, we aimed to reconstruct the molecular epidemiology and phylogeny of DENV in Panama to connect the epidemiological history of DENV dispersal and circulation in Latin America. We retrospectively analyzed the epidemiological data obtained during 25 years of DENV surveillance in Panama. DENV was reintroduced in Panama in 1993 after a 35 year absence of autochthonous transmission. The increase in the number of total dengue cases has been accompanied by an increase in severe and fatal cases, with the highest case fatality rate recorded in 2011. All four serotypes were detected in Panama, which is characterized by serotype replacement and/or co-circulation of multiple serotypes. Phylogenetic analysis of datasets collected from envelope (E) gene sequences obtained from viruses isolated from human sera demonstrated that circulating viruses were highly diverse and clustered in distinct clades, with co-circulation of clades from the same genotype. Our analyses also suggest that Panamanian strains were related to viruses from different regions of the Americas, suggesting a continuous exchange of viruses within the Americas.
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- 2019
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12. Dengue with Hemorrhagic Manifestations and Acute Pancreatitis: Case Report and Review.
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Correa R, Ortega-Loubon C, Zapata-Castro LE, Armién B, and Culquichicón C
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Dengue fever is an acute viral disease transmitted by arthropods, which has become a major public health problem, especially in tropical and subtropical areas. We found 17 reported cases of dengue complicated with pancreatitis in the world literature, 13 cases were found in Asia, one in Europe, and two in Latin America. This is the first and an unusual case of dengue with hemorrhagic manifestations complicated with acute pancreatitis in Panama. A 37-year-old woman with an unknown past medical history presented to Santo Tomas Hospital (Panama City, Panama) with sudden abdominal pain in the epigastrium and left hypochondrium, described as a burning-like pain radiating towards the back. Five days before the admission, the patient had fever, chills, headache, retro-orbital pain, dizziness, arthralgia, loss of appetite, and fatigue. In the emergency room, a diagnosis of acute pancreatitis was made and the patient was hospitalized. Physical examination showed bleeding gums, and laboratory tests show leukopenia and thrombocytopenia, which suggested an infection caused by the dengue virus. The dengue infection was confirmed using quantitative polymerase chain reaction (qPCR) and enzyme-linked immunosorbent assay (ELISA). The patient received supportive treatment and the symptoms resolved. She was discharged on the ninth day of hospitalization without any sequela. The final diagnosis was hemorrhagic dengue complicated by acute pancreatitis., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2019
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13. Building an integrated infrastructure for exploring biodiversity: field collections and archives of mammals and parasites.
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Galbreath KE, Hoberg EP, Cook JA, Armién B, Bell KC, Campbell ML, Dunnum JL, Dursahinhan AT, Eckerlin RP, Gardner SL, Greiman SE, Henttonen H, Jiménez FA, Koehler AVA, Nyamsuren B, Tkach VV, Torres-Pérez F, Tsvetkova A, and Hope AG
- Abstract
Museum specimens play an increasingly important role in predicting the outcomes and revealing the consequences of anthropogenically driven disruption of the biosphere. As ecological communities respond to ongoing environmental change, host-parasite interactions are also altered. This shifting landscape of host-parasite associations creates opportunities for colonization of different hosts and emergence of new pathogens, with implications for wildlife conservation and management, public health, and other societal concerns. Integrated archives that document and preserve mammal specimens along with their communities of associated parasites and ancillary data provide a powerful resource for investigating, anticipating, and mitigating the epidemiological, ecological, and evolutionary impacts of environmental perturbation. Mammalogists who collect and archive mammal specimens have a unique opportunity to expand the scope and impact of their field work by collecting the parasites that are associated with their study organisms. We encourage mammalogists to embrace an integrated and holistic sampling paradigm and advocate for this to become standard practice for museum-based collecting. To this end, we provide a detailed, field-tested protocol to give mammalogists the tools to collect and preserve host and parasite materials that are of high quality and suitable for a range of potential downstream analyses (e.g., genetic, morphological). Finally, we also encourage increased global cooperation across taxonomic disciplines to build an integrated series of baselines and snapshots of the changing biosphere. Los especímenes de museo desempeñan un papel cada vez más importante tanto en la descripción de los resultados de la alteración antropogénica de la biosfera como en la predicción de sus consecuencias. Dado que las comunidades ecológicas responden al cambio ambiental, también se alteran las interacciones hospedador-parásito. Este panorama cambiante de asociaciones hospedador-parásito crea oportunidades para la colonización de diferentes hospedadores y para la aparición de nuevos patógenos, con implicancias en la conservación y manejo de la vida silvestre, la salud pública y otras preocupaciones de importancia para la sociedad. Archivos integrados que documentan y preservan especímenes de mamíferos junto con sus comunidades de parásitos y datos asociados, proporcionan un fuerte recurso para investigar, anticipar y mitigar los impactos epidemiológicos, ecológicos y evolutivos de las perturbaciones ambientales. Los mastozoólogos que recolectan y archivan muestras de mamíferos, tienen una oportunidad única de ampliar el alcance e impacto de su trabajo de campo mediante la recolección de los parásitos que están asociados con los organismos que estudian. Alentamos a los mastozoólogos a adoptar un paradigma de muestreo integrado y holístico y abogamos para que esto se convierta en una práctica estándarizada de la obtención de muestras para museos. Con este objetivo, proporcionamos un protocolo detallado y probado en el campo para brindar a los mastozoólogos las herramientas para recolectar y preservar materiales de parásitos y hospedadores de alta calidad y adecuados para una gran variedad de análisis subsecuentes (e.g., genéticos, morfológicos, etc.). Finalmente, también abogamos por una mayor cooperación global entre las diversas disciplinas taxonómicas para construir una serie integrada de líneas de base y registros actuales de nuestra cambiante biosfera.
- Published
- 2019
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14. Costs of multiple sclerosis in Panama from societal, patient perspectives and health-related quality of life.
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Gracia F, Larreategui M, Rodríguez G, Benzadón A, Ortiz M, Morales D, Domínguez C, Carrillo RE, Valderrama C, Lizán L, and Armién B
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- Adult, Cross-Sectional Studies, Disease Progression, Female, Health Care Costs, Humans, Male, Middle Aged, Multiple Sclerosis epidemiology, Multiple Sclerosis therapy, Panama epidemiology, Quality of Life, Retrospective Studies, Surveys and Questionnaires, Cost of Illness, Multiple Sclerosis economics
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The purpose of this work is to estimate the costs associated with managing patients with MS in Panama and evaluating the impact of the disease on their health-related quality of life (HRQoL). Multicentric observational, retrospective, cross-sectional study. The costs were estimated from societal and patient perspectives and expressed in USD, 2015. The focus of the study is based on prevalence and on a "bottom-up" approach. To estimate the total cost per patient, annual reported use for each resource was multiplied by its unit cost. To evaluate HRQoL, patients completed the EQ-5D-3L questionnaire. 108 patients took part in the study. 82.41% were women with 44.78 (SD: 12.27) years. 61.11% presented mild (EDSS = 0-3.5), 25.93% moderate (EDSS = 3.5-6) and 12.96%, severe disability (EDSS≥6.5). The mean annual cost from the patient's perspective was estimated at 777.99 USD (SD: 1,741.45) per patient. The mean cost from a societal perspective was estimated at 23,803.21 USD (SD: 13,331.83) per patient. Disease-modifying therapies (DMT) accounted for the main component of the cost. A deterioration in HRQoL was observed as the disease advances and as disability increases, with mobility and usual activities being the areas most affected by its progression. From both perspective, the cost per MS patient in Panama is high. In addition to the high economic impact, MS also exerts a negative impact on patient HRQoL, which increases as the disease advances., Competing Interests: This study was partially supported by Dirección de Investigación, Universidad Interamericana de Panama (DI-UIP633800) and Novartis Pharmaceutical, S.A (AC) under unrestricted research grants, in collaboration with patients with MS. Blas Armién is a member of the SNI (Sistema Nacional de Investigación from SENACYT of Panamá). Participant Neurologist did not receive an honorarium or any other form of financial support related to the development of this manuscript. These competing interests do not alter our adherence to PLOS ONE policies on sharing data and materials.
- Published
- 2018
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15. The reintroduction of DENV-2 in 2011 in Panama and subsequent outbreak characteristic.
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Díaz Y, Cisneros J, Guzmán H, Cordoba P, Carrera JP, Moreno B, Chen R, Mewa JC, García L, Cerezo L, da Rosa AT, Gundacker ND, Armién B, Weaver SC, Vasilakis N, López-Vergès S, and Tesh R
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- Adolescent, Adult, Child, Child, Preschool, Dengue mortality, Disease Outbreaks, Female, Genotype, Humans, Infant, Male, Middle Aged, Panama epidemiology, Phylogeny, Severe Dengue epidemiology, Severe Dengue physiopathology, Young Adult, Dengue epidemiology, Dengue physiopathology, Dengue Virus genetics
- Abstract
The circulation of the South-east Asian/American (AS/AM) dengue 2 virus (DENV-2) genotype in the Americas has been associated with a high rate of severe disease. From 1993, the year DENV was reintroduced in Panama, until 2011 there were 29 dengue-associated deaths, 17 of which occurred in 2011, the most severe outbreak with a case fatality rate (CFR) of 44% (17 deaths out of 38 severe dengue cases). During this outbreak DENV-2 was reintroduced into the country, whereas over the prior five years DENV-1 and -3 were predominant. Herein, we describe the 2011 Panama outbreak and genetically characterize the Panamanian DENV-2 strains, which were associated with severe dengue disease in Panama. Our results suggest that the DENV-2 isolates from this outbreak belonged to the AS/AM genotype sub-clade 2BI and were genetically close to viruses described in the outbreaks in Nicaragua, Honduras, Guatemala and Mexico from 2006-2011. Sub-clade 2BI has previously been associated with severe disease in Nicaragua during outbreaks from 2005-2007., (Copyright © 2017 Elsevier B.V. All rights reserved.)
- Published
- 2018
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16. Unusual pattern of chikungunya virus epidemic in the Americas, the Panamanian experience.
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Carrera JP, Díaz Y, Denis B, Barahona de Mosca I, Rodriguez D, Cedeño I, Arauz D, González P, Cerezo L, Moreno L, García L, Sáenz LE, Atencio MA, Rojas-Fermin E, Vizcaino F, Perez N, Moreno B, López-Vergès S, Valderrama A, and Armién B
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- Antibodies, Viral blood, Chikungunya Fever pathology, Chikungunya virus classification, Chikungunya virus genetics, Cluster Analysis, Genotype, Incidence, Panama epidemiology, Sequence Analysis, DNA, Viral Envelope Proteins genetics, Chikungunya Fever epidemiology, Epidemics
- Abstract
Background: Chikungunya virus (CHIKV) typically causes explosive epidemics of fever, rash and polyarthralgia after its introduction into naïve populations. Since its introduction in Panama in May of 2014, few autochthonous cases have been reported; most of them were found within limited outbreaks in Panama City in 2014 and Puerto Obaldia town, near the Caribbean border with Colombia in 2015. In order to confirm that Panama had few CHIKV cases compared with neighboring countries, we perform an epidemiological analysis of chikungunya cases reported from May 2014 to July 2015. Moreover, to understand this paucity of confirmed CHIKV cases, a vectorial analysis in the counties where these cases were reported was performed., Methods: Chikungunya cases were identified at medical centers and notified to health authorities. Sera samples were analyzed at Gorgas Memorial Institute for viral RNA and CHIKV-specific antibody detection., Results: A total of 413 suspected cases of CHIKV infections were reported, with incidence rates of 0.5 and 0.7 per 100,000 inhabitants in 2014 and 2015, respectively. During this period, 38.6% of CHIKV cases were autochthonous with rash and polyarthralgia as predominant symptoms. CHIKV and DENV incidence ratios were 1:306 and 1:34, respectively. A phylogenetic analysis of E1/E2 genomic segment indicates that the outbreak strains belong to the Asian genotype and cluster together with CHIKV isolates from other American countries during the same period. Statistical analysis of the National Vector Control program at the district level shows low and medium vector infestation level for most of the counties with CHIKV cases. This index was lower than for neighboring countries., Conclusions: Previous training of clinical, laboratory and vector workers allowed a good caption and detection of the chikungunya cases and fast intervention. It is possible that low/medium vector infestation level could explain in part the paucity of chikungunya infections in Panama.
- Published
- 2017
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17. Febrile or Exanthematous Illness Associated with Zika, Dengue, and Chikungunya Viruses, Panama.
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Araúz D, De Urriola L, Jones J, Castillo M, Martínez A, Murillo E, Troncoso L, Chen M, Abrego L, Armién B, Pascale JM, Sosa N, López-Verges S, and Moreno B
- Subjects
- Humans, Panama epidemiology, Chikungunya virus classification, Chikungunya virus genetics, Chikungunya virus isolation & purification, Dengue Virus classification, Dengue Virus genetics, Dengue Virus isolation & purification, Exanthema epidemiology, Exanthema virology, Fever epidemiology, Fever virology, Zika Virus classification, Zika Virus genetics, Zika Virus isolation & purification
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- 2016
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18. HIV-1 Antiretroviral Drug Resistance Mutations in Treatment Naïve and Experienced Panamanian Subjects: Impact on National Use of EFV-Based Schemes.
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Mendoza Y, Castillo Mewa J, Martínez AA, Zaldívar Y, Sosa N, Arteaga G, Armién B, Bautista CT, García-Morales C, Tapia-Trejo D, Ávila-Ríos S, Reyes-Terán G, Bello G, and Pascale JM
- Subjects
- Adult, Aged, Alkynes, Benzoxazines pharmacology, Cyclopropanes, Female, Genotype, HIV Infections epidemiology, HIV Infections virology, HIV Reverse Transcriptase genetics, Humans, Male, Middle Aged, Nevirapine pharmacology, Panama, Prevalence, Retrospective Studies, Young Adult, Anti-HIV Agents pharmacology, Drug Resistance, Viral genetics, HIV Infections drug therapy, HIV-1 genetics, Mutation
- Abstract
The use of antiretroviral therapy in HIV infected subjects prevents AIDS-related illness and delayed occurrence of death. In Panama, rollout of ART started in 1999 and national coverage has reached 62.8% since then. The objective of this study was to determine the level and patterns of acquired drug resistance mutations of clinical relevance (ADR-CRM) and surveillance drug resistance mutations (SDRMs) from 717 HIV-1 pol gene sequences obtained from 467 ARV drug-experienced and 250 ARV drug-naïve HIV-1 subtypes B infected subjects during 2007-2013, respectively. The overall prevalence of SDRM and of ADR-CRM during the study period was 9.2% and 87.6%, respectively. The majority of subjects with ADR-CRM had a pattern of mutations that confer resistance to at least two classes of ARV inhibitors. The non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations K103N and P225H were more prevalent in both ARV drug-naïve and ARV drug-experienced subjects. The nucleoside reverse transcriptase inhibitor (NRTI) mutation M184V was more frequent in ARV drug-experienced individuals, while T215YFrev and M41L were more frequent in ARV drug-naïve subjects. Prevalence of mutations associated to protease inhibitors (PI) was lower than 4.1% in both types of subjects. Therefore, there is a high level of resistance (>73%) to Efavirenz/Nevirapine, Lamivudine and Azidothymidine in ARV drug-experienced subjects, and an intermediate to high level of resistance (5-10%) to Efavirenz/Nevirapine in ARV drug-naïve subjects. During the study period, we observed an increasing trend in the prevalence of ADR-CRM in subjects under first-line schemes, but not significant changes in the prevalence of SDRM. These results reinforce the paramount importance of a national surveillance system of ADR-CRM and SDRM for national management policies of subjects living with HIV.
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- 2016
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19. Spatial-Temporal Distribution of Hantavirus Rodent-Borne Infection by Oligoryzomys fulvescens in the Agua Buena Region--Panama.
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Armién B, Ortiz PL, Gonzalez P, Cumbrera A, Rivero A, Avila M, Armién AG, Koster F, and Glass G
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- Animals, Ecosystem, Female, Hantavirus Infections epidemiology, Hantavirus Infections virology, Humans, Longitudinal Studies, Male, Panama epidemiology, Seasons, Sigmodontinae physiology, Zoonoses epidemiology, Zoonoses transmission, Zoonoses virology, Disease Reservoirs virology, Orthohantavirus physiology, Hantavirus Infections transmission, Sigmodontinae virology
- Abstract
Background: Hotspot detection and characterization has played an increasing role in understanding the maintenance and transmission of zoonotic pathogens. Identifying the specific environmental factors (or their correlates) that influence reservoir host abundance help increase understanding of how pathogens are maintained in natural systems and are crucial to identifying disease risk. However, most recent studies are performed at macro-scale and describe broad temporal patterns of population abundances. Few have been conducted at a microscale over short time periods that better capture the dynamical patterns of key populations. These finer resolution studies may better define the likelihood of local pathogen persistence. This study characterizes the landscape distribution and spatio-temporal dynamics of Oligoryzomys fulvescens (O. fulvescens), an important mammalian reservoir in Central America., Methods: Information collected in a longitudinal study of rodent populations in the community of Agua Buena in Tonosí, Panama, between April 2006 and December 2009 was analyzed using non-spatial analyses (box plots) and explicit spatial statistical tests (correlograms, SADIE and LISA). A 90 node grid was built (raster format) to design a base map. The area between the nodes was 0.09 km(2) and the total study area was 6.43 km(2) (2.39 x 2.69 km). The temporal assessment dataset was divided into four periods for each year studied: the dry season, rainy season, and two months-long transitions between seasons (the months of April and December)., Results: There were heterogeneous patterns in the population densities and degrees of dispersion of O. fulvescens that varied across seasons and among years. The species typically was locally absent during the late transitional months of the season, and re-established locally in subsequent years. These populations re-occurred in the same area during the first three years but subsequently re-established further south in the final year of the study. Spatial autocorrelation analyses indicated local populations encompassed approximately 300-600 m. The borders between suitable and unsuitable habitats were sharply demarcated over short distances., Conclusion: Oligoryzomys fulvescens showed a well-defined spatial pattern that evolved over time, and led to a pattern of changing aggregation. Thus, hot spots of abundance showed a general shifting pattern that helps explain the intermittent risk from pathogens transmitted by this species. This variation was associated with seasonality, as well as anthropogenic pressures that occurred with agricultural activities. These factors help define the characteristics of the occurrence, timing, intensity and duration of synanthropic populations affected by human populations and, consequently, possible exposure that local human populations experience.
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- 2016
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20. Chikungunya virus infection: first detection of imported and autochthonous cases in Panama.
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Díaz Y, Carrera JP, Cerezo L, Arauz D, Guerra I, Cisneros J, Armién B, Botello AM, Araúz AB, Gonzalez V, López Y, Moreno L, López-Vergès S, and Moreno BA
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- Adult, Chikungunya Fever epidemiology, Chikungunya Fever virology, Chikungunya virus classification, Female, Humans, Male, Middle Aged, Panama epidemiology, Phylogeny, Young Adult, Chikungunya Fever diagnosis, Chikungunya virus isolation & purification
- Abstract
Chikungunya virus (CHIKV) is a mosquito-borne pathogen that was only endemic in Africa and south Asia until 2005 and 2006, when the virus spread into the Indian Ocean islands, Europe, and Asia. Autochthonous CHIKV transmission in the Caribbean islands was reported in December of 2013. In Panama, two febrile cases were detected in May of 2014: one traveling from Haiti, and the other traveling from the Dominican Republic. After other imported cases were detected, the first autochthonous case was reported in August of the same year. We detected CHIKV viral RNA and isolated the virus from serum samples. The phylogenetic analysis of the two imported isolates and one autochthonous CHIKV isolate indicated that the viruses belong to the Asian lineage in the Caribbean clade and are related to viruses recently identified in Saint Martin island, British Virgin Islands, China, and the Philippines. Although the circulating CHIKV lineages in the Americas have not yet been described, our results suggest that the Asian lineage is circulating in most American countries reporting autochthonous infection., (© The American Society of Tropical Medicine and Hygiene.)
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- 2015
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21. Human immunodeficiency virus type 1 (HIV-1) subtype B epidemic in Panama is mainly driven by dissemination of country-specific clades.
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Mendoza Y, Martínez AA, Castillo Mewa J, González C, García-Morales C, Avila-Ríos S, Reyes-Terán G, Armién B, Pascale JM, and Bello G
- Subjects
- HIV Infections virology, HIV-1 classification, Humans, Panama epidemiology, Phylogeny, HIV Infections epidemiology, HIV-1 isolation & purification
- Abstract
The Human immunodeficiency virus type-1 (HIV-1) subtype B is the most predominant clade in Central America; but information about the evolutionary history of this virus in this geographic region is scarce. In this study, we reconstructed the spatiotemporal and population dynamics of the HIV-1 subtype B epidemic in Panama. A total of 761 HIV-1 subtype B pol sequences obtained in Panama between 2004 and 2013 were combined with subtype B pol sequences from the Americas and Europe. Maximum Likelihood phylogenetic analyses revealed that HIV-1 subtype B infections in Panama derived from the dissemination of multiple founder viruses. Most Panamanian subtype B viruses (94.5%) belong to the pandemic viral strain proposed as originated in the US, whereas others (5.5%) were intermixed among non-pandemic Caribbean strains. The bulk (76.6%) of subtype B sequences from Panama grouped within 12 country-specific clades that were not detected in other Central American countries. Bayesian coalescent-based analyses suggest that most Panamanian clades probably originated between the early 1970s and the early 1980s. The root location of major Panamanian clades was traced to the most densely populated districts of Panama province. Major Panamanian clades appear to have experienced one or two periods of exponential growth of variable duration between the 1970s and the 2000s, with median growth rates from 0.2 to 0.4 year(-1). Thus, the HIV-1 subtype B epidemic in Panama is driven by the expansion of local viral strains that were introduced from the Caribbean and other American countries at an early stage of the AIDS pandemic.
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- 2014
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22. Hantavirus infection and habitat associations among rodent populations in agroecosystems of Panama: implications for human disease risk.
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Armién AG, Armién B, Koster F, Pascale JM, Avila M, Gonzalez P, de la Cruz M, Zaldivar Y, Mendoza Y, Gracia F, Hjelle B, Lee SJ, Yates TL, and Salazar-Bravo J
- Subjects
- Animals, Antibodies, Viral blood, Crops, Agricultural virology, Female, Hantavirus Infections epidemiology, Hantavirus Infections transmission, Humans, Male, Panama, Wounds and Injuries virology, Ecosystem, Hantavirus Infections veterinary, Rodent Diseases epidemiology, Rodentia virology, Zoonoses virology
- Abstract
Hantavirus cardiopulmonary syndrome (HCPS), which is caused by infection with Choclo virus, is uncommon in Panama, yet seropositivity among rural residents is as high as 60%. To clarify the environmental risk factors favoring rodent-to-human transmission, we tested serum from 3,067 rodents captured over a five-year period for antibodies against recombinant N protein of hantavirus by enzyme immunoassay and strip immunoblot. Among 220 seropositive rodents, Oligoryzomys fulvescens, the reservoir of Choclo virus, had the highest overall seroprevalence (23.5%); more abundant rodents (Zygodontomys brevicauda and Sigmodon hirsutus) had lower seroprevalences. In the mixed (combined modern and traditional) productive agroecosystem, the highest seroprevalence was among O. fulvescens captured in residences and in crops grown within 40 meters of a residence, with significantly lower seroprevalence in adjacent pasture and non-productive vegetation. Thus, crop habitats may serve as refugia for invasion into adjacent human residences and suggests several interventions to reduce human infection.
- Published
- 2009
23. Experimental evidence for reduced rodent diversity causing increased hantavirus prevalence.
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Suzán G, Marcé E, Giermakowski JT, Mills JN, Ceballos G, Ostfeld RS, Armién B, Pascale JM, and Yates TL
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- Animals, Communicable Diseases, Emerging veterinary, Disease Reservoirs veterinary, Population Dynamics, Species Specificity, Animals, Wild virology, Biodiversity, Communicable Diseases, Emerging virology, Disease Reservoirs virology, Orthohantavirus pathogenicity, Rodentia virology
- Abstract
Emerging and re-emerging infectious diseases have become a major global environmental problem with important public health, economic, and political consequences. The etiologic agents of most emerging infectious diseases are zoonotic, and anthropogenic environmental changes that affect wildlife communities are increasingly implicated in disease emergence and spread. Although increased disease incidence has been correlated with biodiversity loss for several zoonoses, experimental tests in these systems are lacking. We manipulated small-mammal biodiversity by removing non-reservoir species in replicated field plots in Panama, where zoonotic hantaviruses are endemic. Both infection prevalence of hantaviruses in wild reservoir (rodent) populations and reservoir population density increased where small-mammal species diversity was reduced. Regardless of other variables that affect the prevalence of directly transmitted infections in natural communities, high biodiversity is important in reducing transmission of zoonotic pathogens among wildlife hosts. Our results have wide applications in both conservation biology and infectious disease management.
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- 2009
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24. The effect of habitat fragmentation and species diversity loss on hantavirus prevalence in Panama.
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Suzán G, Marcé E, Giermakowski JT, Armién B, Pascale J, Mills J, Ceballos G, Gómez A, Aguirre AA, Salazar-Bravo J, Armién A, Parmenter R, and Yates T
- Subjects
- Animals, Disease Reservoirs, Panama, Prevalence, Rodentia virology, Species Specificity, Ecosystem, Orthohantavirus isolation & purification
- Abstract
Habitat fragmentation and diversity loss due to increased conversion of natural habitats to agricultural uses influence the distribution and abundance of wildlife species and thus may change the ecology of pathogen transmission. We used hantaviruses in Panama as a research model to determine whether anthropogenic environmental change is associated with changes in the dynamics of viral transmission. Specifically, we wanted to determine whether hantavirus infection was correlated with spatial attributes of the landscape at both large and small scales or whether these changes are mediated by changes in community composition. When analyzed at coarse spatial scales, hantavirus reservoirs were more commonly found in disturbed habitats and edge habitats than in forested areas. At local scales, reservoir species dominance was significantly correlated with the slope of the terrain. To evaluate the effect of small-mammal diversity loss on infection dynamics, we implemented an experiment with selective species removal at experimental sites. Seroprevalence of hantavirus was higher in the community of small mammals and increased through time in the experimental sites. The higher seroprevalence in experimental plots suggests that greater diversity likely reduces encounter rates between infected and susceptible hosts. Our studies suggest that habitat loss and fragmentation and species diversity loss are altering hantavirus infection dynamics in Panama. Our work represents a multidisciplinary approach toward disease research that includes biodiversity concerns such as environmental change and degradation, human settlement patterns, and the ecology of host and nonhost species, work that may be especially important in tropical countries.
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- 2008
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25. Modeling hantavirus reservoir species dominance in high seroprevalence areas on the Azuero Peninsula of Panama.
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Suzán G, Giermakowski JT, Marcé E, Suzán-Azpiri H, Armién B, and Yates TL
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- Animals, Biodiversity, Environment, Geography instrumentation, Geography methods, Humans, Mice, Panama epidemiology, Population Density, Rodentia virology, Satellite Communications, Seroepidemiologic Studies, Sigmodontinae physiology, Sigmodontinae virology, Zoonoses epidemiology, Zoonoses virology, Disease Reservoirs virology, Orthohantavirus, Hantavirus Infections epidemiology, Models, Biological, Rodentia physiology
- Abstract
Habitat fragmentation commonly influences distribution of zoonotic disease reservoirs. In Panama, populations of rodent hosts of hantaviruses are favored by small habitat fragments isolated by agricultural lands. We expected a similar relationship between landscape characteristics and host distribution at fine geographical scales in southern Panama. The relative abundance of Zygodontomys brevicauda, the primary host for "Calabazo" virus, and other rodents was assessed at 24 sites within the Azuero Peninsula. We used satellite imagery to produce several spatial variables that described landscape; however, only slope was consistently related to abundances of the two most dominant rodent species. Using regression, we constructed a spatial model of areas of Z. brevicauda dominance, which in turn relates to higher infection rates. The model predicts highest abundances of Z. brevicauda in flat areas, where humans also dominate. These predictions have important ecological and conservation implications that associate diversity loss, topography, and human land use.
- Published
- 2006
26. Community ecology of small mammal populations in Panamá following an outbreak of Hantavirus pulmonary syndrome.
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Ruedas LA, Salazar-Bravo J, Tinnin DS, Armién B, Cáceres L, García A, Díaz MA, Gracia F, Suzán G, Peters CJ, Yates TL, and Mills JN
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- Animal Husbandry, Animals, Ecology, Environment, Female, Forestry, Humans, Male, Panama epidemiology, Population Dynamics, Risk Factors, Disease Outbreaks, Orthohantavirus pathogenicity, Hantavirus Pulmonary Syndrome epidemiology, Hantavirus Pulmonary Syndrome transmission, Muridae
- Abstract
In late 1999 and early 2000, an outbreak of hantavirus pulmonary syndrome (HPS) occurred in and around Los Santos, on the Azuero Peninsula of southwestern Panamá. This HPS episode, resulting in 22% case fatality, was linked to the Costa Rican pigmy rice rat, Oligoryzomys fulvescens costaricensis, which harbored a then undescribed hantavirus, Choclo virus. In addition, Cherrie's cane rat, Zygodontomys brevicauda cherriei, was identified as carrying a distinct hantavirus, Calabazo virus with no known pathogenicity to humans. Herein we present the ecological results of the outbreak investigations in the Azuero region. A total of 164 animals were captured, of which 126 were potential small, non-volant mammal hosts of a hantavirus: rodents in the family Muridae. There were significant differences in small mammal community structure between case sites and a negative control site. Differences were manifest in ecological measures of species diversity and in species evenness and heterogeneity measures, as indicated by Pairwise Euclidian distances and Morisita indices of community similarity. Our analyses suggest that human activities (i.e., deforestation for cattle ranching) coupled with environmental factors (i.e., increased precipitation) may have synergistically coalesced for an increased risk of HPS to area residents.
- Published
- 2004
27. Serosurvey of wild rodents for hantaviruses in Panama, 2000-2002.
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Salazar-Bravo J, Armién B, Suzán G, Armién A, Ruedas LA, Avila M, Zaldívar Y, Pascale JM, Gracia F, and Yates TL
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- Animals, Animals, Wild, Enzyme-Linked Immunosorbent Assay veterinary, Female, Orthohantavirus isolation & purification, Hantavirus Infections epidemiology, Immunoblotting veterinary, Male, Panama epidemiology, Polymerase Chain Reaction veterinary, Rodentia, Seroepidemiologic Studies, Antibodies, Viral blood, Orthohantavirus immunology, Hantavirus Infections veterinary, Rodent Diseases epidemiology
- Abstract
Five hundred fifty-six samples representing 24 species of small mammals (two species of marsupials and 22 rodents) were collected in Panama between February 2000 and July 2002. The samples were examined for antibodies to hantaviruses by means of enzyme-linked immunosorbent assay or immunoblot assays. The serologic results indicated that several rodent species might act as hantaviral reservoirs in Panama: Costa Rican pygmy rice rat (Oligoryzomys fulvescens costaricensis), four positive of 72 tested (5.6%); Cherrie's cane rat (Zygodontomys brevicauda cherriei), five of 108 (4.6%); Mexican deer mouse (Peromyscus mexicanus), one of 22 (5%); Mexican harvest mouse (Reithrodontomys mexicanus), one of seven (14%); Chiriquí harvest mouse (Reithrodontomys creper), one of two (50%); and Sumichrast's harvest mouse (Reithrodontomys sumichrasti), three of four (75%). Hantavirus infection in Peromyscus mexicanus and the three species of Reithrodontomys was caused by Rio Segundo hantavirus, a species of virus not previously reported from Panama. At least three hantaviruses, therefore, are known to infect populations of wild rodents in the country. However, given the total number of animals tested, the role of these rodent species in the epidemiology and epizootiology of hantavirus infections remains unclear.
- Published
- 2004
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