Recent Submissions

  • First report of Myroides phaeus bacteraemia identified by Polymerase chain reaction and genetic sequencing

    Pérez-Lazo, G.; Morales-Moreno, A.; Soto-Febres, F.; Jove-Químper, H.; Morales-Castillo, L.; Palomares-Reyes, C.; Del Valle-Mendoza, J.; Aguilar-Luis, M.; Silva-Caso, W. (lsevier Ltd, 2020-01-01)
    We report the first case of Myroides phaeus isolated from blood, causing bacteremia in an immunocompromised patient using the automated MicroScan Walk Away 96 system, followed by bacterial identification by amplification-sequencing of the 16S rDNA. The sequences obtained were compared with the reference sequence of the BLAST ® platform - National Library of Medicine, USA, and the isolation was identified as Myroides phaeus strain with 99.67 % identity in Blast report. In the literature we did not find previous reported cases of infections by this bacterium, however its pathogenic role is still controversial; therefore, this isolation alerts us to carry out an exhaustive surveillance of other possible acquisition routes.
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  • Gut microbiota in hospitalized children with acute infective gastroenteritis caused by virus or bacteria in a regional Peruvian hospital

    Taco-Masias, Andre Alonso; Fernandez-Aristi, Augusto R.; Cornejo-Tapia, Angela; Aguilar-Luis, Miguel Angel; Del Valle, Luis J.; Silva-Caso, Wilmer; Zavaleta-Gavidia, Victor; Weilg, Pablo; Cornejo-Pacherres, Hernán; Bazán-Mayra, Jorge; Puyen, Zully M.; del Valle-Mendoza, Juana (PeerJ Inc., 2020-11-03)
    Background. Acute infective gastroenteritis (AIG) is a leading cause of mortality in children worldwide. In Peru, more than 40% of cases of AIG occurring in children under 5 years old. The disruption of the gut microbiota can increase risk for several health complications especially in patients with gastric infections caused by viruses or bacteria. Objective. The main objective of this study was to describe the prevalence of 13 representative bacteria from the gut microbiota (GM) in stools samples from children under 5 years of age with acute infective gastroenteritis. Results. The most commonly isolated bacteria from the GM were Firmicutes (63.2% 74/117) Bacteriodetes (62.4%; 73/117), Lactobacillus (59.8%; 70/117), Prevotella (57.2%; 67/117), Proteobacterium (53.8%; 63/117), regardless of the etiological agent responsible for the AIG. Interestingly, despite the high prevalence of Firmicutes, Bacteroidetes, Lactobacillus and Prevotella across all samples, a visible reduction of these agents was observed especially among patients with a single bacterial infection or even bacteria–bacteria coinfections when compared to viral etiologies. Patients with exclusive or mixed breastfeeding registered the highest amount of gut microbiota bacteria, in contrast to infants who received formula or were not breastfed.
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  • Prevalence of venous thromboembolism in admissions and readmissions with and without syncope: A nationwide cohort study

    Kadri, Amer N.; Zawit, Misam; Al-Adham, Raed; Hader, Ismail; Nusairat, Leen; Almahmoud, Mohamed F.; Senussi, Mourad; Altibi, Ahmed; Barakat, Amr; Hernandez, Adrian V.; Masri, Ahmad (Oxford University Press, 2021-01-01)
    Aims: The Pulmonary Embolism in Syncope Italian Trial reported 17.3% prevalence of pulmonary embolism (PE) in patients admitted with syncope. We investigated the prevalence of venous thromboembolism [VTE, including PE and deep vein thrombosis (DVT)] in syncope vs. non-syncope admissions and readmissions, and if syncope is an independent predictor of VTE. Methods and results: We conducted an observational study of index admissions of the 2013-14 Nationwide Readmission Database.
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  • Perception about chagas disease and the risk of oral transmission in Andoas, Loreto, Peru

    Cabrera, Rufino; Valderrama, Yadira; Meza, Juan Ramón (Instituto Nacional de Salud, 2020-01-01)
    Carta al editor.
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  • Let’s Talk About Sex: The Impact of Partnership Contexts on Communication About HIV Serostatus and Condom Use Among Men Who Have Sex with Men (MSM) and Transgender Women (TW) in Lima, Peru

    Ayer, Amrita; Perez-Brumer, Amaya; Segura, Eddy R.; Chavez-Gomez, Susan; Fernandez, Rosario; Arroyo, Cecilia; Barrantes, Alex; Lake, Jordan E.; Cabello, Robinson; Clark, Jesse L. (Springer, 2021-01-01)
    Sexual communication with partners informs risk assessment and sexual practices. We evaluated participant, partner, and network factors associated with communication about condom use and HIV serostatus and explored their relationships with condomless anal intercourse (CAI) among 446 men who have sex with men (MSM) and 122 transgender women (TW) in Lima, Peru. Generalized estimating equations assessed contextual influences on communication and practices with recent sexual partners. More frequent HIV communication was reported by MSM who: identified as heterosexual, compared to bisexual or gay; characterized partnerships as stable, compared to casual, anonymous, or commercial; or discussed HIV/STIs with close social contacts (p < 0.05). TW in concurrent partnerships discussed condom use more frequently than those in monogamous relationships (p < 0.05). Condom use discussions and alcohol use among MSM were associated with CAI (p < 0.05). Findings highlight complexity in sexual decision-making and call for further study of conversation content and practices to inform HIV prevention messaging.
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  • Electrohydraulic lithotripsy for the treatment of stone impacted in a lumen-apposing metal stent in a patient with endoscopic cholecystoduodenostomy

    Guzmán-Calderón, Edson; Martínez-Moreno, Belén; Casellas, Juan A.; Aparicio, José Ramó (2021-01-01)
    Resumen no disponible.
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  • Factors Associated with Health Anxiety in Medical Students at a Private University in Lima, Peru

    Robles-Mariños, Rodrigo; Angeles, Andrea I.; Alvarado, Germán F. (Elsevier Doyma, 2021-01-01)
    Introduction: There are few studies that examine the factors associated with the different levels of health anxiety in medical students. The objective was to determine the factors associated with the levels of health anxiety in medical students in 2018. Methods: An analytical cross-sectional study was carried out with 657 medical students from a private Peruvian university. Participants answered a questionnaire from which information was collected regarding levels of health anxiety (SHAI). For the analysis, linear regression was used to calculate crude and adjusted betas, and their 95% confidence intervals. Results: The mean health anxiety score was 14 ± 6.7. An association between health anxiety and the year of study is reported, with the second year showing the highest scores. In addition, an association between health anxiety and smoking is highlighted, as there are higher levels in occasional smokers, as well as a weak inverse correlation with age. No association was found with sex, place of birth, or having a first-degree relative that is a doctor or health worker. Conclusions: The present study showed that age, year of studies and smoking are associated with health anxiety levels. More studies are required, especially of a longitudinal nature.
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  • PrEP Awareness, Use, Intention to Use, and Information Source Among Geosocial Networking Application Users in Mexico in 2018–2019

    Blair, Kevin J.; Segura, Eddy R.; Garner, Alex; Lai, Jianchao; Ritterbusch, Amy; Leon-Giraldo, Sebastian; Guilamo-Ramos, Vincent; Lake, Jordan E.; Clark, Jesse; Holloway, Ian W. (Springer, 2021-01-01)
    Pre-exposure prophylaxis (PrEP) has limited availability across Latin America, though access is increasing. We explored PrEP uptake in Mexico via an online survey completed by Spanish-speaking, Hornet geosocial networking application (GSN app) users without HIV (n = 2020). Most (81.3%) had heard of PrEP, 3.5% were current users, and 34.2% intended to take PrEP within six months. Current PrEP use was associated with PrEP eligibility (aOR 26.07 [95%CI 13.05–52.09], p < 0.001), recent STI testing (aOR 3.79 [95%CI 1.10–13.11], p = 0.035), and recent chemsex (aOR 3.02 [95%CI 1.02–8.93], p = 0.046). Recent STI testing was associated with hearing about PrEP from a doctor (aOR 3.26 [95%CI 1.98–5.36], p < 0.001), and those who lived in large cities were less likely to have learned about PrEP via Hornet (aOR 0.52 [95%CI 0.32–0.85], p = 0.009). Interventions to increase PrEP uptake in Mexico should build upon existing health networks and utilize GSN apps for PrEP information dissemination, particularly in less populated areas.
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  • Novel 2019 coronavirus infection in children

    Llaque Quiroz, Patricia Beatriz (Instituto Nacional de Salud, 2020-01-01)
    COVID-19 is rarely reported in children and they are mildly affected in most cases. The most common clinical presentation of COVID-19 is cough, fever and sore throat; severe cases show tachypnea. The course of the disease is from one to two weeks. Laboratory findings are nonspecific; lymphopenia, elevation of C-reactive protein and procalcitonin have been described. Early chest X-ray is usually normal, and the most common tomographic findings are consolidations with halo, ground-glass opacities and tiny nodules which mainly affects subpleural areas. Management of the disease is supportive; in severe cases, it should be focused on respiratory support. It is recommended to limit the handling of respiratory secretions and to follow the same preventive measures provided to adults.
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  • Surgical Treatment and Reconstruction of Nasal Defects According to the Aesthetic Subunits Principles

    Núñez-Castañeda, José Miguel; Chang-Grozo, Silvana Lucia (Springer, 2021-01-01)
    The aim of this study was to determine the prevalence of nasal skin cancer, its location by facial aesthetic subunits and the type of reconstructive procedures performed for each nasal subunit after excision for nasal skin tumors. Observational cross-sectional study of all consecutive patients with the diagnosis of skin tumor located in the nasal unit, treated from 2018 to 2019 by the department of head and neck surgery of a general hospital. 60 patients were treated with nasal skin tumors excisions. A total of 52 patients (86,6%) had basal cell skin cancer, 7 (11,6%) had squamous cell skin cancer and 1 (1,6%) had melanoma. Fifty-nine patients (98.33%) presented a primary tumor and just 1 case (1,66%) recived a previous surgical treatment. Regardless of the type of tumor, the tip subunit was the most often involved with 29 (48,33%) cases in total. Despite of the nasal aesthetic subunit affected, the most frequent type of procedure used for reconstruction was the rotation or advancement flap, based on aesthetic nasal subunits, which was performed in 39 cases (65%). Nasal reconstruction after skin cancer can be very complex, especially since all patients have high expectations about the results. In order to achieve good results, there is a necessity for careful analysis of the defect, correct planning and excellent technical execution of the procedures Frequently, staged procedures will be needed to achieve an optimal result.
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  • Vasoactive agents for the management of acute variceal bleeding: A systematic review and meta-analysis

    Huaringa-Marcelo, Jorge; Huaman, Mariella R.; Brañez-Condorena, Ana; Villacorta-Landeo, Pamela; Pinto-Ruiz, Diego F.; Urday-Ipanaqué, Diana; García-Gomero, David; Montes-Teves, Pedro; Miranda, Adelina Lozano (Romanian Society of Gastroenterology, 2021-01-01)
    Background & Aims: Vasoactive agents with endoscopic therapy are used to treat acute variceal bleeding (AVB). There are two main groups of vasoactive agents: terlipressin and vasopressin (T-V), and octreotide and somatostatin (O-S). However, the benefit/harm balance is unclear. Our aim was to assess the efficacy and safety of T-V versus O-S for the management of AVB. Methods: We performed a systematic search for randomized controlled trials (RCTs) in PubMed, Scopus, and CENTRAL. Our main outcomes were mortality and adverse events. Secondary outcomes were bleeding control, rebleeding, blood transfusion, hospital stay. We evaluated the certainty of evidence using GRADE methodology. Results: We included 21 RCTs. The risk of mortality (RR: 1.01; 95%CI: 0.83-1.22), bleeding control (RR: 0.96; 95%CI: 0.91-1.02; I2=53%), early rebleeding (RR: 0.91; 95%CI: 0.66-1.24: I2=0%), late rebleeding (RR: 0.94; 95 CI: 0.56-1.60; I2=0%), blood transfusion (MD: 0.04; 95%CI:-0.31-0.39; I2=68%) and hospital stay (MD:-1.06; 95%CI:-2.80-0.69; I2=0%) were similar between T-V and O-S groups. Only 15 studies reported adverse events, which were significantly higher in the T-V compared to the O-S group (RR 2.39; 95%CI: 1.58-3.63; I2=57%). The certainty of evidence was moderate for the main outcomes, and low or very low for others. Conclusions: In cirrhotic patients with AVB, those treated with T-V had similar mortality risk compared to O-S. However, the use of T-V showed an increased risk of adverse events compared to O-S.
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  • Hepatocellular carcinoma in a woman with 34 weeks gestation and chronic hepatitis b

    Sato-Espinoza, Karina; Ferrer, Javier Díaz; Ventura, Yessica Mitzy Jaramillo (Sociedad Argentina de Gastroenterologia, 2021-01-01)
    A 24-year-old pregnant woman arrived at the emergency service at 34 weeks of gestational age with intermittent right upper abdominal pain. An abdominal ultrasound was performed showing signs of hepatopathy with multiple neo-formative nodules with mild ascites and fetal biometry confirmed at 34 weeks gestation. During her hospitalization, an emergency caesarean was induced with favorable result in the survival of the mother and the baby.
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  • Olga and olgim stage distribution according to age and helicobacter pylori status in a public hospital in Lima, Peru

    Ronquillo, Andrea Carlin; León, Alex Ventura; Ríos, Jorge L.Espinoza; Paredes, Eduar A.Bravo; Hinojosa, Paúl Gómez; Solis, Shirley Alva; Valdivia, José L.Pinto; Silva-Caso, Wilmer (Sociedad Argentina de Gastroenterologia, 2021-01-01)
    Introduction. The operative link for gastritis assessment (OLGA) and the operative link on gastric intestinal meta-plasia assessment (OLGIM) staging systems have been sug-gested to provide risk of assessment for gastric cancer. Objec-tive. To evaluate the distribution of OLGA and OLGIM staging by age and Helicobacter pylori status. Material and methods. We studied 197 subjects undergoing elective upper gastrointestinal endoscopy. The presence of the H. pylori and histological changes were evaluated using the updated Sydney system. Stages III and IV of OLGA/OLGIM were considered high risk stages. Results. The H. pylori rate was 56.85% (112/197). High-risk OLGA/OLGIM cases were rare: 7/112 (6.5%) cases of OLGA in the H. pylori positive group and 6/85 (7%) in the H. pylori negative group; 5 (4.4%) cases of OLGIM in the H. pylori positive and 6 (7%) in the H. pylori negative. The proportion of advanced stages of OLGA and OLGIM increased with age (p < 0.001). High-risk OLGA was not found before age 40 regardless of the presence of H. pylori, but increased to 16.2%, 10.3%, 17.3% and 40.8% in subjects in the fourth, fifth, sixth and seventh decade of life respectively. The OLGIM high risk showed a similar trend: 0% before 40 years and up to 22.6% in people of 70 years. Conclusions. High-risk OLGA/OLGIM cases are infrequent before age 40 and increase significantly with age. No relation was found with the presence of the H. pylori. According to these protocols, only a fifth of the patients would strictly require endoscopic control.
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  • Cross-sectional study of the clinical characteristics and outcomes of children hospitalized with COVID-19 in Lima, Peru

    Domínguez Rojas, Jesús; Estupiñan Vigil, Matilde; Garcés-Ghilardi, Raquel; Alvarado-Gamarra, Giancarlo; Del Águila, Olguita; Lope Tenorio, Adanida Flor; Ayón Dejo, Carmen Cecilia; Chonlon Murillo, Kenny; Boluarte Baca, Sebastián; Stapleton Herbozo, Angie; Seminario Aliaga, Ricardo; Reyes Florian, Giuliana; Dávila Riega, Diana; Fernández Suárez, Sarah; Coronado Muñoz, Álvaro (NLM (Medline), 2021-01-20)
    Introduction: Coronavirus 2019 (SARS-CoV-2) infection in children occurred in Peru as of March 2020, leading to pediatric patients' hospitalization in areas adapted for this purpose at the Edgardo Rebagliati Martins National Hospital. In the beginning, the demand for hospitalization was low, but it increased gradually. Consistent with international reports, the majority of patients presented mild or moderate symptoms. Nonetheless, there were also severe cases, even fatal ones. Objectives: To describe the characteristics and clinical outcome of pediatric patients with COVID-19 hospitalized in a referral hospital in Lima, Peru, between March and August 2020. Methods: A descriptive and inferential cross-sectional study was carried out. The population includes all hospitalized patients in the Department of Pediatrics, with clinical and surgical diagnoses associated with COVID-19. Results: We included 100 patients, with an average age of 83.4 ± 54 months, with a predominance of male patients (55%). Hospitalized patients were grouped into five categories: respiratory failure (17%), multisystemic inflammatory syndrome (MIS-C) (31%), neurological presentation (19%), acute abdomen (20%), and patients with oncological problems (13%). Most of the patients (74%) had comorbidities. Regarding the presenting symptoms, intestinal pain predominated in the appendicitis group (90%, p < 0.001), fever was present in most patients with respiratory failure (64.7%); multisystemic inflammatory syndrome (90.3%), neurological manifestations (15.8%), acute abdomen (50%) and oncological conditions (61.5%) were also present in these patients. Kawasaki symptoms were found in 38.7% of the patients with multisystemic inflammatory syndrome. Mortality was 4%. Respiratory problems (29.4%) and multisystemic inflammatory syndrome (22.6%) required admission to intensive care, more frequently than the other presentations (p = 0.008). Conclusions: We conclude that the vulnerability in the pediatric population is the one that has preexisting conditions. We divided our patients according to presentation, diagnosis, and complications, which were predominantly respiratory. We also had oncological patients with COVID-19.
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  • Clinical characteristics and molecular detection of in hospitalized children with a clinical diagnosis of whooping cough in Peru.

    Del Valle-Mendoza, Juana; del Valle-Vargas, Cristina; Aquino-Ortega, Ronald; Del Valle, Luis J; Cieza-Mora, Erico; Silva-Caso, Wilmer; Bazán-Mayra, Jorge; Zavaleta-Gavidia, Victor; Aguilar-Luis, Miguel Angel; Cornejo-Pacherres, Hernán; Martins-Luna, Johanna; Cornejo-Tapia, Angela (Tehran University of Medical Sciences, 2021-01)
    Pertussis is an infectious disease caused by the Gram-negative bacterium Bordetella pertussis. In Peru, actual public health programs indicate that vaccination against B. pertussis must be mandatory and generalized, besides all detected cases must be reported. The objective of this study was to determine the prevalence of B. pertussis among children under five years of age with a presumptive diagnosis of whopping cough in Cajamarca, a region located in northern Peru.
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  • Multifaceted Mechanism of Amicoumacin A Inhibition of Bacterial Translation

    Maksimova, Elena M.; Vinogradova, Daria S.; Osterman, Ilya A.; Kasatsky, Pavel S.; Nikonov, Oleg S.; Milón, Pohl; Dontsova, Olga A.; Sergiev, Petr V.; Paleskava, Alena; Konevega, Andrey L. (Frontiers Media S.A., 2021-02-12)
    Amicoumacin A (Ami) halts bacterial growth by inhibiting the ribosome during translation. The Ami binding site locates in the vicinity of the E-site codon of mRNA. However, Ami does not clash with mRNA, rather stabilizes it, which is relatively unusual and implies a unique way of translation inhibition. In this work, we performed a kinetic and thermodynamic investigation of Ami influence on the main steps of polypeptide synthesis. We show that Ami reduces the rate of the functional canonical 70S initiation complex (IC) formation by 30-fold. Additionally, our results indicate that Ami promotes the formation of erroneous 30S ICs; however, IF3 prevents them from progressing towards translation initiation. During early elongation steps, Ami does not compromise EF-Tu-dependent A-site binding or peptide bond formation. On the other hand, Ami reduces the rate of peptidyl-tRNA movement from the A to the P site and significantly decreases the amount of the ribosomes capable of polypeptide synthesis. Our data indicate that Ami progressively decreases the activity of translating ribosomes that may appear to be the main inhibitory mechanism of Ami. Indeed, the use of EF-G mutants that confer resistance to Ami (G542V, G581A, or ins544V) leads to a complete restoration of the ribosome functionality. It is possible that the changes in translocation induced by EF-G mutants compensate for the activity loss caused by Ami.
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  • Sweating blood: A case series of 2 siblings with hematohidrosis

    Hoover, Alex; Fustino, Nicholas; Sparks, Andrea Olivares; Rokes, Christopher (Lippincott Williams and Wilkins, 2021-03-01)
    Hematohidrosis is a condition that presents with the excretion of blood from intact skin. Reported cases suggest emotional stress reactions as the most common inciting events. The pathogenesis of the condition is not well understood. We describe a 9-year old boy and his 6-month old half-sister with a history of bleeding episodes from the ears, eyes, and scalp, as well as other sites. Symptoms in both children have shown a positive response to propranolol, with decreased frequency and severity of bleeding. There are no prior reports of siblings with hematohidrosis, suggesting a possible genetic predisposition.
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  • Maternal depressive symptoms are not associated with child anaemia: A cross-sectional population study in Peru, 2015

    Alarcón-Guevara, Samuel; Peñafiel-Sam, Joshua; Chang-Cabanillas, Sergio; Pereyra-Elías, Reneé (Blackwell Publishing Ltd., 2021-03-01)
    Introduction: Approximately, one in three Peruvian children aged 6 to 59 months old have anaemia. Maternal depression, which may be disabling and affect the proper care of children, is associated with chronic malnutrition in their offspring. Therefore, the aim of this study is to evaluate if there is an association between depressive symptoms of mothers with the presence of anaemia in their children. Methods: Analytical cross-sectional study of the Peruvian Demographic Health Survey 2015, which is nationally representative. Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) using a score of 10 as cut-off. The presence of anaemia was measured using HemoCue® and was considered positive when the haemoglobin was less than 11 g/dl. Results: Crude and adjusted prevalence ratios (PR and aPR) were calculated with 95% confidence interval (CI), using generalized linear models of the Poisson family. We analysed 6683 mother–child binomials. The prevalence of anaemia in the children and depressive symptoms in women were 28.7% (95% CI: 27.3–30.2) and 6.9% (95% CI: 6.1–7.9), respectively. We found no statistically significant association between these variables in the bivariable analysis or in the different multivariable models (aPR: 1.05, 95% CI: 0.85–1.30). The sample did not have moderate or severe malnutrition. Conclusions: There is no statistically significant difference between the prevalence of anaemia in children of mothers with or without depressive symptoms. We recommend continuing research in this field to determine more associate factors to childhood anaemia in order to improve primary prevention interventions. Ideally, conducting longitudinal studies such as prospectives cohorts to determine risk factors should be done.
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  • Vaccination coverage and preventable diseases in Peru: Reflections on the first diphtheria case in two decades during the midst of COVID-19 pandemic

    Mezones-Holguin, Edward; Al-kassab-Córdova, Ali; Maguiña, Jorge L.; Rodriguez-Morales, Alfonso J. (Elsevier Inc., 2021-03-01)
    Carta al editor.
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  • Failure to recognize Low non-treponemal titer syphilis infections in pregnancy May lead to widespread under-treatment

    Swayze, Emma Jane; Nielsen-Saines, Karin; Segura, Eddy R.; Saad, Eduardo; Yue, Dahai; Comulada, Warren Scott; Cambou, Mary Catherine (Elsevier B.V., 2021-03-01)
    Objectives: Rates of maternal syphilis have increased five-fold in Brazil in the past decade. While penicillin remains the only appropriate treatment for maternal syphilis, we hypothesized that low non-treponemal titers (<1:16) may lead to reduced penicillin treatment in Brazil. Methods: Using Brazilian Ministry of Health data on women diagnosed with maternal syphilis between January 1, 2010, and December 31, 2018, we conducted a random-effects logistic regression model with a cluster correction at the state level to evaluate predictive factors of penicillin treatment. Results: We observed yearly increases in cases of pregnant women with syphilis from 2010 to 2018. There was significant variation by state: 52,451 cases were reported in São Paulo, followed by 26,838 in Rio de Janeiro. Among 215,937 cases of maternal syphilis, 91·3% received penicillin. In the random-effects model, a non-treponemal titer ≥1:16 was associated with 1·44 higher odds of receiving penicillin (95% confidence interval [CI]: 1·391·48), and prenatal care was associated with a 2·12 increased odds of receiving penicillin (95% CI: 2·022·21). Although there is an association between the absence of prenatal care and inadequate treatment for syphilis, 83·2% of women in this cohort who did not receive penicillin were engaged in prenatal care. Conclusions: Providers may inappropriately exclude low non-treponemal titers and thereby fail to use penicillin treatment in maternal syphilis. While the cause of the maternal syphilis epidemic in Brazil is multifactorial, we believe our findings can be used to develop targeted interventions throughout Brazil as well as shape public health initiatives globally.
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