Search Results (9)

Amphimerus, a liver fluke, is the causative agent of amphimeriasis, a foodborne disease acquired thought the consumption of infected raw or undercooked river fish—a practice embedded in traditional culinary customs. Amphimeriasis represents a significant public health issue and has been endemic in Ecuador since 2011, particularly among the Chachi Amerindians and Montubios populations residing in tropical ecoregions. By employing a mixed-methods research design, we conducted a community-based, cross-sectional study. A survey comprising of 63 questions on KAP was administrated in person to community members, health personnel, and academic staff in the two populations. Additionally, 67 semi-structured interviews were performed. Microscopy was achieved on 273 human and 80 dog fecal samples to detect Amphimerus eggs. A total of 86 questionnaires (54 Chachi) and 67 interviews (44 Chachi), out of 300 residents, were completed. Among the respondents, 31.4% were aware of Amphimerus, locally referred to as “liver worm”. Although 79.1% reported not consuming raw fish, most admitted eating raw fish with lime juice and salt, a preparation known as “curtido”, and 59.3% reported consuming smoked fish. Here, 86.1% of participants considered “liver worm” a serious disease, and 55.8% recognized raw or marinated fish as a potential transmission route. The Chachi showed a preference for smoked fish, whereas the Montubios favoured “curtido”. The prevalence of Amphimerus infection was 23% in humans and 16.2% in dogs. Differences in KAP were observed between infected and non-infected individuals. Local health and academic personnel demonstrated insufficient knowledge about amphimeriasis. Some religious individuals refrained from participating, stating that they were “with God”. Despite the high prevalence of Amphimerus infection in both humans and dogs, knowledge about the parasite, the disease, and its transmission routes remains limited. Health education initiatives should be designed to modify the population’s KAP. It is crucial for national and local health authorities, as well as religious leaders, to be informed and actively involved in the prevention and control of amphimeriasis. Full article

Ecuador has gone through a significant reduction in new cases from 2000 (106) to 2023 (12), suggesting a trend towards zero leprosy. An ecological spatiotemporal study design was used to describe the epidemiological distribution of the disease in the country during 2000–2023. Leprosy cases registered by the surveillance system of the Ecuadorian Ministry of Public Health were the data utilized for the study. From January 2000 to December 2023, 1539, incidence cases were diagnosed with leprosy in Ecuador. At the time of diagnosis, the median age was 54 years. Most of the cases were males (71.5%). The proportion of incidence cases in subjects over 50 years was 63% and 1.5% in children ≤ 15 years old. The yearly incidence rate ranged from 8.5/1,000,000 population in 2000 to 0.68/1,000,000 population in 2023, remaining within the low-endemic parameter. In total, 35 cantons reported newly detected leprosy cases in the year 2000. By the end of 2023, only eight cantons actively reported cases of leprosy. High-risk clusters for leprosy were detected in the tropical coastal region of Ecuador. The provinces with the highest number of cases during the study period were Guayas (44.8%) and Los Rios (15.7%), with zero cases being found in the Galapagos Islands. Our study is unique in that it documents a retrospective dataset over a two-decade timespan from a South American country that has effectively applied global guidelines for the control and elimination of leprosy. Full article

Humans can be infected with anthroponotic (Ancylostoma duodenale and Necator americanus) and with zoonotic (Ancylostoma ceylanicum, A. caninum, A. braziliense, and Uncinaria stenocephala) hookworms from dogs. Anthroponotic species are usually thought not to infect dogs. We used the internal transcribed spacer–1 (ITS1) gene in a quantitative PCR to detect anthroponotic and zoonotic hookworm species in fecal samples from 54 children and 79 dogs living in an indigenous community in tropical Northwestern Ecuador. Hookworm DNA was detected in 59.3% of children and 92.4% of dogs. Among samples from children, zoonotic hookworms were detected in 24.1% (A. ceylanicum 14.8%, A. caninum 11.1%, and A. braziliense 1.9%), whilst in dog samples, anthroponotic species were detected in 19.0% (N. americanus 12.4% and A. duodenale 6.3%). Sanger sequencing was performed successfully on 60 qPCR-positive samples (16 from children and 44 from dogs), and consensus sequences were obtained with >98% homology to GenBank references for hookworm spp. Phylogenetic analysis showed a close relationship between anthroponotic and zoonotic Ancylostoma species and no heterogeneity between A. duodenale and A. caninum; in human samples, we found A. ceylanicum but not A. braziliense sequences and we were unable to identify N. americanus in the dog samples. No infections with U. stenocephala were detected. Our data provide evidence for high rates of hookworm infections in indigenous children and dogs in a marginalized rural setting in coastal Ecuador. We also found evidence for potential cross-transmission of hookworm spp. between humans and dogs that represent a potential domestic reservoir for zoonotic and anthroponotic hookworms. Full article

While conducting research in a protected ecological reserve within Ecuador’s subtropical rainforest, a 49-year-old biologist, residing in an Andean city, contracted hookworm-related cutaneous larva migrans (Hr-CLM) in the vesiculobullous clinical form. Since there were no domestic dogs or cats in the reserve, it is likely that wild animals carrying Ancylostoma sp. larvae infected the patient. She was effectively treated with two doses of oral ivermectin, administered 31 days after getting the infection. This case was diagnosed in a temperate city; therefore, a comprehensive travel history and clinical assessments are crucial for an accurate diagnosis and timely treatment. Full article

Histoplasmosis is an endemic mycosis in the Americas. However, its diagnosis is challenging due to the complexity and limited availability of conventional laboratory techniques—antigen tests, culture, and staining. Microscopic preparations often confuse with other pathogens, such as Leishmania spp. The genus Histoplasma capsulatum comprises three varieties: var. capsulatum, var. duboissi, and var. farciminosum, which cannot be distinguished using conventional techniques. An infant from a tropical region of Ecuador was hospitalized for fever, bloody diarrhea, and anemia persisting for two months. Upon admission, he received antibiotics and immunosuppressants. Histopathological examination of the lymph nodes, intestines, and bone marrow aspirate reported the presence of Leishmania-like amastigotes, and treatment was initiated with meglumine antimoniate and conventional amphotericin B. However, subsequent analysis of samples using PCR and DNA sequencing identified H. capsulatum var. capsulatum but not Leishmania. Despite fluconazole and amphotericin B, the infant succumbed to the disease. The delay in clinical and laboratory diagnosis of histoplasmosis and the use of nonspecific and ineffective drugs such as fluconazole led to disease dissemination and, ultimately, death. Implementing molecular diagnosis and antigen tests in laboratories located in endemic regions and reference hospitals is crucial. Full article

Few studies have addressed drug resistance of Enterobacterales in rural communities in developing countries. This study aimed to determine the coexistence of extended-spectrum β-lactamase (ESBL) and carbapenemase genes in Escherichia coli and Klebsiella pneumoniae strains carrying the mcr-1 gene in rural communities in Ecuador from healthy humans and their backyard animals. Sixty-two strains, thirty E. coli and thirty-two K. pneumoniae strains carrying the mcr-1 gene were selected from a previous study. PCR were performed for the presence of ESBLs and carbapenemase genes. The strains were further characterized, and the genetic relationship was studied with multi-locus sequencing typing (MLST) of seven housekeeping genes. Fifty-nine of the sixty-two mcr-1 isolates (95%) harbored at least on β-lactam resistance gene. The most prevalent ESBL genes were the bla_TEM genes (present in in 80% of the E. coli strains) and the bla_SHV gene (present in 84% of the K. pneumoniae strains). MSLT analysis revealed 28 different sequence types (ST); 15 for E. coli and 12 for K. pneumoniae, with most ST never described in humans and animals. The coexistence of mcr-1 and β-lactams resistant genes in E. coli and K. pneumoniae strains is alarming and threatens the efficacy of last-resort antibiotics. Our findings highlight backyard animals as a reservoir of mcr-1/β-lactams resistant genes. Full article

The location of Ecuador—an equatorial nation—favors the multiplication and dispersal of the Leptospira genus both on the Pacific Coast and in the Amazon tropical ecoregions. Nevertheless, leptospirosis epidemiology has not been fully addressed, even though the disease has been recognized as a significant public health problem in the country. The purpose of this literature review is to update knowledge on the epidemiology and geographical distribution of Leptospira spp. and leptospirosis in Ecuador to target future research and develop a national control strategy. A retrospective literature search using five international, regional, and national databases on Leptospira and leptospirosis including humans, animals, and environmental isolations of the bacteria and the disease incidence in Ecuador published between 1919 and 2022 (103 years) with no restriction on language or publication date was performed. We found and analyzed 47 publications including 22 of humans, 19 of animals, and two of the environments; three of these covered more than one of these topics, and one covered all three (i.e., One Health). Most (60%) of the studies were conducted in the Coastal ecoregion. Twenty-four (51%) were published in international journals, and 27 (57%) were in Spanish. A total of 7342 human and 6314 other animal cases were studied. Leptospirosis was a frequent cause of acute undifferentiated febrile illness in the Coast and Amazon and was associated with rainfall. All three major clusters of Leptospira—pathogenic, intermediate, and saprophytic—were identified from both healthy and febrile humans, the environment, and animals; moreover, nine species and 29 serovars were recorded over the three Ecuadorian ecoregions. Leptospira infections were diagnosed in livestock, companion, and wild animals from the Amazon and the Coast regions along with sea lions from the Galápagos Islands. Microscopic-agglutination test was the diagnostic tool most widely used. Three reviews covering national data on outpatients and inpatients determined the varied annual incidence and mortality rate, with males being more commonly affected. No human cases have been reported in the Galápagos Islands. Genomic sequences of three pathogenic Leptospira were reported. No studies on clinical ground, antibiotic resistance, or treatment were reported, nor were control programs or clinical-practice guidelines found. The published literature demonstrated that leptospirosis was and still is an endemic disease with active transmission in the four geoclimatic regions of Ecuador including the Galápagos Islands. Animal infections, distributed in mainland and insular Ecuador, pose a significant health risk for humans. Nationwide epidemiological surveys—encouraging more research on the fauna and environment with appropriate sampling design on risk factors for human and animal leptospirosis, Leptospira genotyping, increased laboratory capability, and readily available official data—are required to improve our understanding of transmission patterns and to develop effective national intervention strategies with the intention of applying One Health approaches. Full article

Since the beginning of the COVID-19 pandemic, communication technology has demonstrated its usefulness in sharing and receiving health data and communicating with the public. This study evaluated the accessibility of 199 websites containing official COVID-19 information related to medical schools, governments, ministries, and medical associations, obtained from the Geneva Foundation for Medical Education and Research website. We used the Web Content Accessibility Guidelines 2.1 to evaluate web accessibility, using a six-phase process with an automatic review tool. The study results reveal that the highest number of barriers encountered are concentrated in the perceivable principle with 6388 errors (77.8%), followed by operability with 1457 (17.7%), then robustness with 291 (3.5%), and finally understandability with 78 errors (0.9%). This study concludes that most COVID-19-related websites that provide information on the context of the pandemic do not have an adequate level of accessibility. This study can contribute as a guide for designing inclusive websites; web accessibility should be reviewed periodically due to technological advances and the need to adapt to these changes. Full article

Background: Antimicrobial resistance is a serious public-health problem throughout the world. Escherichia coli, the most common Gram-negative microorganism, has developed different resistance mechanisms, making treating infections difficult. Colistin is considered a last-resort drug in the treatment of infections caused by E. coli. Plasmid-mediated mobile-colistin-resistant (mcr) genes in E. coli, now disseminated globally, are considered a major public-health threat. Humans, chickens, and pigs are the main reservoirs for E. coli and the sources of antibiotic resistance. Hence, an up-to-date and precise estimate of the global prevalence of mcr resistance genes in these reservoirs is necessary to understand more precisely the worldwide spread and to more effectively implement control and prevention strategies. Methodology: Publications were identified in the PubMed database on the basis of the PRISMA guidelines. English full-text articles were selected from December 2014 to March 2021. Descriptive statistics and a meta-analysis were performed in Excel and R software, respectively. Colistin resistance was defined as the molecular-genetic detection of the mcr genes. The crude and estimated prevalence were calculated for each host and continent. The studies were divided into two groups; community-based when they involved isolates from healthy humans, chickens, or pigs, and clinical studies when they involved only hospital, outpatient, or laboratory isolates. Results: A total of 1278 studies were identified and 218 were included in this systematic review and meta-analysis, divided into community studies (159 studies) and clinical studies (59 studies). The general prevalence of mcr-mediated colistin-resistant E. coli (mcrMCRE) was 6.51% (n = 11,583/177,720), reported in 54 countries and on five continents; Asia with 119 studies followed by Europe with 61 studies registered the most articles. Asia reported the major diversity of mcr-variants (eight of nine, except mcr-2). Worldwide, chickens and pigs proved to be the principal reservoir of mcr with an estimated prevalence of 15.8% and 14.9%, respectively. Healthy humans and clinical isolates showed a lower prevalence with 7.4% and 4.2% respectively. Conclusions: In this systematic review and meta-analysis, the worldwide prevalence of mcr in E. coli isolated from healthy humans, chickens, and pigs was investigated. A wide prevalence and distribution of mcr genes was demonstrated on all continents in E. coli isolates from the selected reservoirs. Understanding the epidemiology and occurrence in the reservoirs of mcr in E. coli on different continents of the world facilitates tracing how mcr genes are transmitted and determining the infection risks for humans. This knowledge can be used to reduce the incidence of zoonotic transmission by implementing the appropriate control programs. Full article