Background: Chronic Chagas cardiomyopathy (CChC) is the most common cause of death related to Chagas disease (CD). The aim of this study was to assess the feasibility of a combined rapid diagnostic test (RDT) and electrocardiographic (ECG) screening in a remote rural village of the Bolivian Chaco, with a high prevalence of CChC. Methods: Consecutive healthy volunteers > 15 years were enrolled in the community of Palmarito (municipality of Gutierrez, Santa Cruz Department, Bolivia) in February 2019. All patients performed an RDT with Chagas Stat-Pak® (CSP, Chembio Diagnostic System, Medford, NY, USA) and an ECG by D-Heart® technology, a low-cost, user-friendly smartphone-based 8-lead Bluetooth ECG. RDTs were read locally while ECGs were sent to a cardiology clinic which transmitted reports within 24 h from recording. Results: Among 140 people (54 men, median age 38(interquartile range 23–54) years), 98 (70%) were positive for Trypanosoma cruzi infection, with a linear, age-dependent, increasing trend (p < 0.001). Twenty-five (18%) individuals showed ECG abnormalities compatible with CD. Prevalence of ECG abnormalities was higher in infected individuals and was associated with higher systolic blood pressure and smoking. Following screening, 22 (16%) individuals underwent clinical evaluation and chest X-ray and two were referred for further evaluation. At multivariate analysis, positive CSP results (OR = 4.75, 95%CI 1.08–20.96, p = 0.039) and smoking (OR = 4.20, 95%CI 1.18–14.92, p = 0.027) were independent predictors of ECG abnormalities. Overall cost for screening implementation was <10 $. Conclusions: Combined mobile-Health and RDTs was a reliable and effective low-cost strategy to identify patients at high risk of disease needing cardiologic assessment suggesting potential future applications.

Previous studies on commensal Escherichia coli from healthy children in the Bolivian Chaco have shown remarkable resistance rates to the old antibiotics since the early 1990s, and the emergence of resistance to newer drugs (fluoroquinolones and expanded-spectrum cephalosporins) in the 2000s. Here we report the results of a new survey conducted in 2011 in the same setting. Rectal swabs were obtained from 482 healthy children (aged 6-72 months) from three urban areas of the Bolivian Chaco. Screening for antibiotic-resistant E. coli was performed by a direct plating method, as in the previous studies. The blaCTX-M genes were investigated by PCR/sequencing, and CTX-M-producing isolates were subjected to genotyping and detection of several plasmid-mediated quinolone resistance mechanisms. Results showed high rates of resistance to nalidixic acid (76%), ciprofloxacin (44%) and expanded-spectrum cephalosporins (12.4%), demonstrating a relentless increase of resistance to those drugs over the past two decades. CTX-M-type extended-spectrum beta-lactamases were found to be widespread (12%, 97% of extended-spectrum beta-lactamase producers). Compared with the previous studies, CTX-M-producing E. coli underwent a dramatic dissemination (120-fold increase since early 2000s) and a radical change of dominant CTX-M groups (CTX-M-1 and CTX-M-9 groups versus CTX-M-2 group). Most CTX-M producers were not susceptible to quinolones (91%), and 55% carried plasmid-mediated quinolone resistance genes (different combinations of aac(6')-Ib-cr, qnrB and qepA). This study shows the rapid and remarkable increasing trend for resistance to fluoroquinolones and expanded-spectrum cephalosporins in one of the poorest regions of Latin America, and underscores the need for urgent control strategies aimed at preserving the efficacy of those drugs in similar settings.

Chagas disease, a neglected tropical disease that due to population movements is no longer limited to Latin America, threatens a wide spectrum of people(travellers, migrants, blood or organ recipients,newborns, adoptees) also in non-endemic countries where it is generally underdiagnosed. In Italy, the available epidemiological data about Chagas disease have been very limited up to now, although the country is second in Europe only to Spain in the number of residents from Latin American. Among 867 at-risk subjectsscreened between 1998 and 2010, the Centre for Tropical Diseases in Negrar (Verona) and the Infectious and Tropical Diseases Unit, University of Florence found 4.2% patients with positive serology for Chagas disease (83.4% of them migrants, 13.8% adoptees).No cases of Chagas disease were identified in blood donors or HIV-positive patients of Latin American origin. Among 214 Latin American pregnant women,three were infected (resulting in abortion in one case).In 2005 a case of acute Chagas disease was recorded in an Italian traveller. Based on our observations, we believe that a wider assessment of the epidemiological situation is urgently required in our country and public health measures preventing transmission and improving access to diagnosis and treatment should be implemented.

A Angheben (andrea.angheben@sacrocuore.it)1,2, M Anselmi1,2, F Gobbi1,2, S Marocco1, G Monteiro1, D Buonfrate1,2, S Tais3, M Talamo4, G Zavarise5, M Strohmeyer6,2, F Bartalesi6, A Mantella6, M Di Tommaso7, K H Aiello7, G Veneruso8, G Graziani9, M M Ferrari10, I Spreafico10, E Bonifacio11, G Gaiera12, M Lanzafame13, M Mascarello13, G Cancrini14, P Albajar-Viñas15, Z Bisoffi1,2, A Bartoloni6,2 1. Centre for Tropical Diseases, Sacro Cuore – Don Calabria Hospital, Negrar, Italy 2. COHEMI project (COordinating resources to assess and improve HEalth status of MIgrants from Latin America) 3. Service of Epidemiology and Laboratory for Tropical Diseases, Sacro Cuore – Don Calabria Hospital, Negrar, Italy 4. Infectious Disease Unit, G. Rummo Hospital, Benevento, Italy 5. Paediatric Division, Sacro Cuore – Don Calabria Hospital, Negrar, Italy 6. Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy 7. Obstetric and Gynaecologic Department, Careggi University Hospital, Florence, Italy 8. Infectious Diseases Unit, Anna Meyer Children’s University Hospital, Florence, Italy 9. Immunohaematology and Transfusion Unit, Careggi University Hospital, Florence, Italy 10. Obstetrics and Gynaecology Clinic, L. Mangiagalli Hospital, Milan, Italy 11. Obstetrics and Gynaecology Division, Sacro Cuore – Don Calabria Hospital, Negrar, Italy 12. Infectious Diseases Division, San Raffaele Hospital, Milan, Italy 13. Infectious Diseases Division, G.B. Rossi University Hospital, Verona, Italy 14. Public Health Sciences Department, La Sapienza University, Rome, Italy 15. WHO Programme on Control of Chagas disease, Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland

The assessment of antimicrobial resistance among commensal bacteria is an indicator of the spread of antimicrobial resistance. Rapid screening methods for detection of antimicrobial-resistant faecal Escherichia coli directly on MacConkey plates have been successfully adopted but suffer from lack of standardisation. The purpose of this study was to evaluate a direct plating method (DPM) for detection of antimicrobial-resistant faecal E. coli and to compare it with a conventional method. Faecal samples were collected from 71 healthy children from Peru and Bolivia. In the DPM, a faecal swab was directly plated onto a MacConkey agar plate and antimicrobial disks were applied onto the seeded plate. Raw data were obtained by direct reading of the plate and were subjected to confirmatory analysis. Good concordance between the DPM and a conventional method was observed in detecting carriage of resistant E. coli, with a higher sensitivity for the DPM. Analysis of the results allowed interpretive criteria to be defined for DPM raw data. The DPM showed good sensitivity and specificity at very low cost (ten times cheaper than the conventional method) to investigate the faecal carriage of drug-resistant E. coli. It may represent a useful tool to conduct large-scale resistance surveillance studies and to monitor resistance control programmes cost effectively, particularly in low-resource countries.

In a very remote rural Bolivian community where the use of antimicrobials has been minimal and where exchanges with the exterior are very limited, 67% of subjects were found to be carriers of fecal Escherichia coli with acquired resistance to >/=1 antimicrobial agent(s); the highest rates were observed for tetracycline (64%), ampicillin (58%), trimethoprim-sulfamethoxazole (50%), and chloramphenicol (41%). The most relevant implication of these findings is that, in certain settings, the spread and maintenance of antimicrobial resistance can occur, regardless of whether selective pressure generated by the use of antimicrobials is present.

OBJECTIVE To determine specificity, sensitivity and predictive values of a rapid immunochromatographic assay (ICT tuberculosis) for the diagnosis of tuberculosis (TB) in an Italian clinical setting, and to identify tentative new guidance for the interpretation of test results. METHODS The ICT tuberculosis test is an immunochromatographic test based on the detection of IgG antibodies directed against five highly purified antigens secreted by Mycobacterium tuberculosis during active growth. Sera from 60 patients with active pulmonary (48 sputum smear-positive and six sputum smear-negative cases) and extrapulmonary (six cases) TB were obtained. Personal, anamnestic and clinical data were investigated and recorded for each patient. The control groups comprised 156 subjects: 40 healthy individuals, half of them Mycobacterium bovis BCG-vaccinated, and 116 patients with mycobacterial diseases other than TB (five cases), with nonmycobacterial lung diseases (30 cases), with nonmycobacterial nonlung diseases (30 cases), with nonmycobacterial diseases and rheumatoid factors positivity (30 cases), and with asymptomatic HIV infection (21 cases). For 21 individuals the test was simultaneously performed with both serum and whole blood sample. Each positive result of the ICT test was reported with regard to the number (1-4), position (A, B, C, D) and color intensity (+ to ++++) of the evidenced lines in order to assess the quality of the antibody response. RESULTS The overall sensitivity and specificity were 56.7% and 90.4%, respectively. The sensitivity for pulmonary TB patients was 61.1% (66.7% for smear-positive and 16.7% for smear-negative cases) and 16.7% for extrapulmonary TB patients. The difference between ICT results in pulmonary TB patients and control subjects was statistically significant (P < 0.0001). The analysis of the positive ICT tests revealed that samples with strong color intensity (>/=++) and specific antibodies bound to antigens immobilized on line D were significantly more frequent in TB patients than in controls (P = 0.001 and P= 0.027, respectively). ICT test results with the presence of at least three visible lines were more often observed in the TB patients than in controls, although not reaching statistical significance (P = 0.052). No difference was observed between the results of the ICT test performed both on serum and whole blood sample. CONCLUSIONS The ICT tuberculosis test was confirmed to be rapid and easy to perform without requiring special equipment, both on serum and whole blood sample. Our data, in accordance with those obtained in a previous study conducted in extra-European countries, confirmed higher sensitivities for the smear-positive TB patients than for the smear-negative TB patients, and for pulmonary TB patients than for the extrapulmonary TB patients. Data obtained on the quality of antibody response in the ICT positive samples, might be used to improve the performance of the test.

Journal Article ParaSightTM-F test for malaria diagnosis: a reply Get access Joseph B. Perrone Joseph B. Perrone Becton Dickinson BD Biosciences 7 Loveton Circle Sparks, MD 21152, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 94, Issue 2, March-April 2000, Pages 227–228, https://doi.org/10.1016/S0035-9203(00)90289-X Published: 01 April 2000

An open, multicenter study with 144 patients, aged between 18 and 94 years, was performed to compare the efficacy and safety of meropenem with imipenem/cilastatin in the hospital treatment of community-acquired pneumonia. Patients were randomized to receive either intravenous meropenem (500 mg every 8 h) or intravenous imipenem/cilastatin (1,000 mg every 12 h). The primary end point was considered to be clinical efficacy and the secondary end points were bacteriological response and safety assessment. At the end of therapy, cure or improvement in signs and symptoms as a satisfactory clinical response was observed in 57 of 64 (89.1%) meropenem-treated patients and in 60 of 66 (90.9%) imipenem/cilastatin patients. The mean duration of treatment was 10 days for meropenem and 9.7 days for imipenem/cilastatin. In patients who were followed up for weeks 2-4, the response was satisfactory (100%) for both treatments. A satisfactory bacteriological response, defined as either presumed or confirmed eradication of all pathogens, was found in eight patients who had received meropenem and in 14 patients who had received imipenem/cilastatin. Response was considered satisfactory in 100% of the meropenem group and in 92.9% of the imipenem/cilastatin group and at follow-up, it was 100% for both treatments. Drug-related adverse events were reported in three (4.2%) meropenem-treated patients and in eight (11.0%) imipenem/cilastatin-treated patients. None of these events was classified as serious. The results of this study show that the clinical and bacteriological efficacy and tolerability of meropenem (500 mg every 8 h) are similar to that of imipenem/cilastatin (1,000 mg every 12 h) in the hospital treatment of community-acquired pneumonia.

Journal Article False positive ParaSight™-F test for malaria in patients with rheumatoid factor Get access Alessandro Bartoloni, Alessandro Bartoloni ∗ aClinica Malattie Infettive, Università di Firenze, Italy ∗Address for correspondence: Dr Alessandro Bartoloni, Clinica Malattie Infettive, Università di Firenze, Nuovo Ospedale San Giovanni di Dio, Via di Torregalli 3, 50143 Firenze, Italy; phone +39 55 7192 539, fax +39 55 7192 505. infdis@cesit1.unifit.it Search for other works by this author on: Oxford Academic PubMed Google Scholar Marianne Strohmeyer, Marianne Strohmeyer aClinica Malattie Infettive, Università di Firenze, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar Guido Sabatinelli, Guido Sabatinelli bLaboratorio di Parassitologia, Istituto Superiore di Sanità, Roma, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar Maurizio Benucci, Maurizio Benucci cDivisione di Reumatologia, USL 10, Firenze, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar Umberto Serni, Umberto Serni cDivisione di Reumatologia, USL 10, Firenze, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar Franco Paradisi Franco Paradisi aClinica Malattie Infettive, Università di Firenze, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 92, Issue 1, January-February 1998, Pages 33–34, https://doi.org/10.1016/S0035-9203(98)90945-2 Published: 01 January 1998 Article history Received: 11 August 1997 Accepted: 17 September 1997 Published: 01 January 1998