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Biomedical subjects

Ana Flisser

Publications and source records attributed to Ana Flisser.

30 records · Page 2Linked to original sources

The U.S.-Mexico Border Infectious Disease Surveillance project: establishing bi-national border surveillance.

In 1997, the Centers for Disease Control and Prevention, the Mexican Secretariat of Health, and border health officials began the development of the Border Infectious Disease Surveillance (BIDS) project, a surveillance system for infectious diseases along the U.S.-Mexico border. During a 3-year period, a binational team implemented an active, sentinel surveillance system for hepatitis and febrile exanthems at 13 clinical sites. The network developed surveillance protocols, trained nine surveillance coordinators, established serologic testing at four Mexican border laboratories, and created agreements for data sharing and notification of selected diseases and outbreaks. BIDS facilitated investigations of dengue fever in Texas-Tamaulipas and measles in California-Baja California. BIDS demonstrates that a binational effort with local, state, and federal participation can create a regional surveillance system that crosses an international border. Reducing administrative, infrastructure, and political barriers to cross-border public health collaboration will enhance the effectiveness of disease prevention projects such as BIDS.

Communicable Disease Control↗

Kinetics of Taenia solium antibodies and antigens in experimental taeniosis.

Two groups of hamsters were infected with Taenia solium cysticerci, one of which was suppressed with methyl-prednisolone acetate on the day of infection and every 14 days thereafter. The other did not receive steroid treatment. Faecal and serum samples were taken prior to infection and then at weekly intervals. Parasite circulating- and coproantigens were detected by a capture ELISA with rabbit polyclonal antibodies against T. solium tapeworms. IgG antibodies in serum and in faecal supernatants were detected by ELISA with excretory-secretory products of T. solium adults recovered from hamsters. Infections remained up to 17 weeks in suppressed hamsters, but after week 11 no tapeworms were found in non-suppressed hosts. T. solium coproantigens in both groups of hamsters were positive from the 1st week post-infection (wpi) until the tapeworms were rejected. Circulating antigens were detected only in non-suppressed hamsters from the 3rd wpi until 1 week before T. solium was eliminated. All infected hamsters developed serum IgG antibodies against tapeworms which were detected from the 2nd wpi and decreased slowly after T. solium expulsion. Specific IgG in faecal supernatants was detected from the 3rd wpi only in non-suppressed hamsters. When suppression was stopped, coproantibodies could also be detected. The presence of IgG antibodies indicates that tapeworms induced an immune response in the experimental host and that when hamsters were suppressed with corticosteroids the immune response was impaired and did not allow the detection of IgG coproantibodies. This indicates, in addition, that the passage of T. solium antigens from the small intestine to the circulation was blocked.

Animals↗

Inflammatory responses in the intestinal mucosa of gerbils and hamsters experimentally infected with the adult stage of Taenia solium.

The inflammatory response in gerbils and hamsters harbouring experimental infections with Taenia solium adult parasites as well as worm burden and duration of infections were examined. For this purpose, non-suppressed or immunosuppressed rodents were infected with eight cysticerci and necropsied at different times up to 35 days post-infection. Cells in the mucosa surrounding the implantation site of T. solium scolices (duodenum-jejunum) and in ileum were counted in stained sections. A competitive enzyme linked immunosorbent assay was used to determine histamine concentration in intestinal fluid. In non-suppressed hosts, an inflammatory reaction developed with scarce macrophages, a slight increase of plasma cells, lymphocytes and fibroblasts, a moderate increase of eosinophils and neutrophils, and high numbers of goblet and mast cells. Goblet cells began to increase at 6 days post-infection and peaked at 13 days post-infection with a four-fold increase with respect to the control group. Mast cells only increased in gerbils starting at 9 days post-infection with an eight-fold increase when cells peaked between 11 and 19 days post-infection. Histamine concentration in intestinal fluid of gerbils had a similar behaviour to mast cells. Minimal increase of mast cells was seen in hamsters. The recovery of tapeworms was inversely related to the number of both cell types, which decreased when tapeworms were eliminated. Infections lasted up to 25 days in gerbils and up to 46 days in hamsters. Worms measured only 1-2 cm in gerbils and up to 40 cm in hamsters. When gerbils were suppressed with the steroid methyl predinisolone, tapeworms could be recovered up to 35 days post-infection and tapeworms measured up to 22 cm, a minor increase of goblet and mast cells was observed and histamine concentration was similar to that in non-infected animals. Our results suggest that expulsion of T. solium in gerbils and hamsters may be related to the increase of goblet cells and mast cells, but these cells may have different roles in each rodent model of taeniosis.

Animals↗

Current consensus guidelines for treatment of neurocysticercosis.

Taenia solium neurocysticercosis is a common cause of epileptic seizures and other neurological morbidity in most developing countries. It is also an increasingly common diagnosis in industrialized countries because of immigration from areas where it is endemic. Its clinical manifestations are highly variable and depend on the number, stage, and size of the lesions and the host's immune response. In part due to this variability, major discrepancies exist in the treatment of neurocysticercosis. A panel of experts in taeniasis/cysticercosis discussed the evidence on treatment of neurocysticercosis for each clinical presentation, and we present the panel's consensus and areas of disagreement. Overall, four general recommendations were made: (i) individualize therapeutic decisions, including whether to use antiparasitic drugs, based on the number, location, and viability of the parasites within the nervous system; (ii) actively manage growing cysticerci either with antiparasitic drugs or surgical excision; (iii) prioritize the management of intracranial hypertension secondary to neurocysticercosis before considering any other form of therapy; and (iv) manage seizures as done for seizures due to other causes of secondary seizures (remote symptomatic seizures) because they are due to an organic focus that has been present for a long time.

Animals↗

Antigenic diversity and distribution of rabies virus in Mexico.

Rabies remains a public health problem in the Americas because of the great diversity of wild reservoirs that maintain the virus in nature. Here we report the antigenic characterization of 254 rabies viruses isolated from 148 nonreservoir and 106 reservoir hosts collected in 27 states of Mexico. Nine out of 11 antigenic variants previously reported in the United States were detected in Mexico by using the limited panel of monoclonal antibodies donated by the Centers for Disease Control and Prevention. Some rabies virus variants were isolated from their natural reservoirs, which were also taxonomically identified. Terrestrial reservoirs included stray dogs with V1, Urocyon cineroargenteus (gray foxes) with V7, and two subspecies of Spilogale putorius (spotted skunks) with different viral variants (V8 and V10). Aerial hosts included Tadarida brasiliensis mexicana and Desmodus rotundus, which harbored V9 and V4 and harbored V11, respectively. All variants, with the exception of V9, were isolated from nonreservoir hosts, while V3, V4, and V5 were not isolated from their natural reservoirs but only from livestock. Rabies virus antigenic typing allowed us to determine rabies reservoirs and their distribution in Mexico, data which will probably improve prevention and control of the illness in humans and in the reservoir hosts.

Animals↗

Echinococcus granulosus cattle strain identification in an autochthonous case of cystic echinococcosis in central Mexico.

Echinococcosis is a frequent hepatic parasitic disease in several countries but it is practically absent in Mexico. A cattle strain of Echinococcus granulosus was identified by RAPD, PCR-RFLP and mitochondrial CO1 gene analysis in an autochthonous case. The parasite was obtained after a laparoscopic excision of a liver cyst from a patient that was symptomatic for 6 years but mis-diagnosed before hospitalization.

Adult↗

Infectious diseases in Mexico. A survey from 1995-2000.

Data obtained at a central laboratory for emerging, re-emerging, and other infectious diseases in Mexico from 1995-2000 are presented. An outstanding increase of DEN-3 circulation was identified. Aedes aegypti, the dengue vector, is widely distributed. Leptospirosis has become the most important differential diagnosis for dengue. Identification of rabies virus variants allowed cataloging of new transmitters of rabies. Rotavirus showed a clear seasonal distribution, while different proportions of pathogenic classes of Escherichia coli under endemic and outbreak conditions were seen. Serotypes of several bacteria are reported as well as the sources of isolation and frequency of Shigella, Salmonella, and Vibrio cholerae. Rise and disappearance of cholera could be followed along the past decade. Influenza strains were identified, as were several pathogens causing sexually transmitted infections. Laboratory support was important for surveillance after Hurricane Mitch. Multidrug-resistant strains of Mycobacterium tuberculosis are emerging and primary resistance is very high. It is now mandatory to search for antibodies to Trypanosoma cruzi in blood banks. Triatoma barberi, a peridomestic bug, is the main vector of Chagas disease. Localized cutaneous leishmaniosis increased in regions having a guerrilla element in Chiapas. Modern immunodiagnostic techniques are used for control studies of cysticercosis and similar techniques were recently standardized for Trichinella spiralis detection. Low iodine values in children's urine were found in several Mexican states; therefore, use of iodized salt should be encouraged.

Animals↗

Implementation and evaluation of a national external quality control program for cervical cytology in Mexico.

OBJECTIVE: To evaluate cytology laboratories and the performance of cytotechnologists for establishing efficient external quality control for Mexico's National Program for the Prevention and Control of Cervical Cancer. MATERIAL AND METHODS: During January and February 1998, an onsite evaluation of all cytology laboratories of the Ministry of Health found that only 70% of the microscopes were in adequate working conditions, reagents were out of date, and working conditions were sub-optimal. A program for external quality control based on proficiency testing was established for cytotechnologists. Fifty slide sets with 20 Papanicolaou slides and 10 photographic slides were prepared. The sets were given to the cytotechnologists for evaluation and again one year later by courier. RESULTS: Twenty-one percent of microscopes were repaired and 9% replaced; reagents were distributed and laboratory facilities improved. Only 16% of cytotechnologists passed the initial proficiency test. Cytotechnologists received a refresher training course: one year later 67% of them passed the proficiency test. To ascertain that each slide was correctly diagnosed, 41 sets were rescreened by expert cytopathologists or cytologists and their diagnoses compared to the original ones. Thirty-seven sets had 86% to 96% concordance. CONCLUSIONS: This new system for external quality control of cervical cytology allowed the opportune and reliable evaluation of the performance of cytotechnologists.

Diagnostic Errors↗

[Splenic hydatid cyst. Case report of a pregnant woman].

Hydatid disease is caused by larvae of the platyhelminth parasite called Echinococcus; it generally lodges in liver and lung, and less commonly in spleen. In Mexico, hydatid disease has a very low frequency; only few cases of lung disease have been reported. In this paper, case of a 7 weeks pregnant female patient with a simple cyst in spleen identified by ultrasound and tomography is reported. The patient underwent splenectomy. Diagnosis of hydatid cyst was confirmed by histopathology. This case suggests that hydatid disease should be considered as differential diagnosis in every patient with a cystic mass of the spleen.

Adult↗

[Identification and integral management of a case of autochthonous hydatidosis in Mexico].

OBJECTIVE: To describe a case of hydatid disease in Mexico. BACKGROUND: Liver hydatid disease is the most frequent hepatic parasitic disease in developed countries and is considered practically absent in Mexico. METHODS: In this paper we report identification, clinical management, and epidemiologic parasitologic, and molecular biological studies of an autochthonous case of hydatid disease in Mexico. RESULTS: Hepatic cyst was identified by imaging techniques. The patient received cestocidal treatment and the parasite was excised by laparoscopy. It was not possible to identify the origin of the Echinococcus strain neither by epidemiologic studies performed in the patient's household nor by RAPD pattern obtained with DNA of the protoscolices. Infection of a dog with protoscolices was not successful probably because they were damaged by the cestocidal drug. CONCLUSIONS: Care should be taken in the future to identify other possible autochthonous patients harboring liver hydatid cysts to treat them in an adequate and timely fashion, and to identify the strain of Echinococcus granulosus that infects patients in Mexico.

Animals↗