Background Pregnant women are particularly vulnerable to malaria infections, increasing the risk of maternal–fetal complications, mainly in high-endemicity areas. However, few studies of malaria in pregnancy (MiP) have been carried out in Latin America, a region with low endemicity and transmission of both, Plasmodium falciparum and Plasmodium vivax. Despite the high malaria burden in Venezuela in the last years, no recent studies of MiP have been conducted. Hence, epidemiological and clinical characteristics of pregnant women with malaria in southern Venezuela are described herein. Methods A retrospective study in pregnant women attending at the “Ruíz y Páez” University Hospital Complex, Bolivar state, Venezuela, was carried out between February and October, 2019. Epidemiological, clinical, and laboratory information was analysed. Results Thirty-seven out of 52 pregnant women analysed were infected with P. vivax. Age ranged between 15 and 39 years, and adolescent pregnancies were common. Malaria infection was diagnosed mainly during the third trimester of pregnancy (63.4%). The distribution of symptoms and signs as well as clinical laboratory values was similar among Plasmodium spp. Although uncomplicated malaria was most frequent, 30% (13/52) had severe anaemia. A high proportion of studied women (44%) presented at least one complication during the pregnancy or delivery. Spontaneous abortion was recorded in four women, and three fetal deaths were observed. Six women had preterm delivery without any further complication. Conclusions A high prevalence of maternal–fetal complications was found in the studied population, highlighting the requirement for a careful medical follow up during the prenatal check-ups, which should include routinary malaria tests. Preventive measures as distribution of insecticide-treated mosquito net for pregnant women at risk should also be implemented. Those measures can help to reduce the negative impact of malaria on the newborn and mother.

Background Malaria remains a significant public health problem worldwide. Simultaneous infections with other pathogens complicate its diagnosis and can also change the clinical course of the disease. The similarities in the clinical presentation of malaria and other infections and the superimposed endemicity result in underdiagnosis of coinfections and increase mortality. No studies have focused on the presence of coinfections in patients with malaria in Venezuela. Methods Between June and November 2018, we conducted a cross-sectional study in patients with malaria who presented to any of the three reference medical centers in Ciudad Bolívar, Venezuela. A clinical and laboratory evaluation searching for coinfections with Dengue (DENV), Chikungunya (CHIKV), Viral Hepatitis (VH) (A, B, and C), and Leptospirosis (LEP) was performed using ELISA to test each patient. Results We studied a total of 161 patients of whom 106 (65.8%) presented P. vivax infection, 43 (26.7%) P. falciparum, and 12 (7.5%) had mixed malaria infections. Coinfections were found in 55/161 (34.2%) patients and were more frequent in patients with P. falciparum (48.8%) than in those with P. vivax (29.2%), or mixed infection (25%) [OR = 2.43; 95% CI = 1.39–4.25; p = 0.018]. The most prevalent coinfection was with DENV (14.9%), followed by HAV (11.8%), HBV (6.2%), CHIKV (5.5%), and LEP (3.7%). Coinfection with HCV was absent. Complicated malaria was significantly more frequent in coinfected individuals (56.4%) than those without coinfection (35.8%) [OR: 2.31; 95% CI = 1.18–4.92; p = 0.013]. Conclusion We found a high prevalence of coinfections in patients with malaria in this region, which was related to a worse outcome. Further prospective studies with samples at different points of infection and the use of molecular tools are needed.

Objetivo Describir y analizar la actividad científica sobre la COVID-19 en Latinoamérica.Materiales y Métodos Mediante una revisión sistemática de la literatura en PubMed, LILACS y los repositorios preimpresos BioRxiv y medRxiv, se recuperaron todos los documentos disponibles sobre la COVID-19 en Latinoamérica desde el primero de enero hasta el 24 de abril de 2020, para su análisis bibliométrico.Resultados Un total de 29 publicaciones fueron incluidas en el análisis. El país con más producción científica fue Brasil (10/29; 34,4%), seguido de Colombia (6/29; 20,6%) y México (6/29; 20,6%). La universidad con más artículos fue la Universidad Tecnológica de Pereira, Colombia (5/29; 17,24%). El 41,3% de las publicaciones fueron documentos preimpresos. La mayoría de los estudios excluidos fueron comentarios editoriales u opiniones de expertos. Tres de cada cuatro investigaciones tenían un enfoque epidemiológico (21/29; 72,4%); limitados estudios sobre el diagnóstico (5/29; 17,2%), la fisiopatogenia (2/29; 2,8%) y los aspectos terapéuticos (1/29; 3,4%) fueron encontrados.Conclusión Pese al crecimiento exponencial de publicaciones en el mundo, existe una limitada cantidad de información sobre el comportamiento de esta infección en Latinoamérica. Se requiere la publicación de estudios con alta calidad metodológica, que aporten conocimiento sobre el impacto de la pandemia en la región.

Numerous reports of neuropsychiatric symptoms highlighted the pathologic potential of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its relationship the onset and/or exacerbation of mental disease. However, coronavirus disease 2019 (COVID-19) treatments, themselves, must be considered as potential catalysts for new-onset neuropsychiatric symptoms in COVID-19 patients. To date, immediate and long-term neuropsychiatric complications following SARS-CoV-2 infection are currently unknown. Here we report on five patients with SARS-CoV-2 infection with possible associated neuropsychiatric involvement, following them clinically until resolution of their symptoms. We will also discuss the contributory roles of chloroquine and dexamethasone in these neuropsychiatric presentations.

Background: The deterioration of Venezuela's health system in recent years undoubtedly contributes to an increased impact of the COVID-19 pandemic. Understanding healthcare workers' (HCWs) knowledge, attitudes, and practices (KAPs) toward COVID-19 in the early stages of the pandemic could inform their medical training and improve their preparedness.Methods: A online national cross-sectional survey was conducted between May 26th and May 30th, 2020, to assess KAPs among HCWs in Venezuela.Results: A total of 1,441 HCWs from all 24 regions of the country responded to the survey. The mean age of the HCWs was 44 (SD [standard deviation] 14) years; most were women (66.4%). Most HCWs were specialized doctors (48%), followed by nurses (13%) and resident doctors (12.3%). The majority of HCWs had good knowledge (76.3%), obtained information mainly from scientific literature (85.4%); had negative attitudes (53.6%), felt uncomfortable with their work during the current pandemic (59.8%); and reported appropriate practices (76.9%). However, participation in COVID-19 related training was absent in more than half of the HCWs. Positive attitudes were significantly more frequent in frontline workers than in non-frontline workers (p = 0.001). Bioanalysts, students, and doctors were more likely to have good knowledge; participating in training was a predictor for positive attitudes and older age was an appropriate practice predictor.Conclusions: HCWs, knowledge in Venezuela could be improved by strengthening education and training programs. Strategies should focus on reducing fear and improving attitudes toward the care of COVID-19 patients, as well as the promotion of preventive practices.

No abstract

Background Venezuela accounted for 55% of the cases and 73% of the malaria deaths in the Americas in 2019. Bolivar state, in the southeast, contributes > 60% of the country's Plasmodium vivax and Plasmodium falciparum cases every year. This study describes the clinical–epidemiological characteristics of clinical malaria patients in this high-transmission area. Methods A prospective study was conducted on patients seeking medical attention in three medical centres in the state capital, Ciudad Bolivar, between June and October 2018. Malaria diagnosis was carried out using microscopy following national standards. Malaria-positive patients were examined for clinical symptoms, and haematological tests were performed at the time of diagnosis. Patients were followed up by telephone to evaluate malaria recurrences. Results Out of 287 patients, 200 (69.7%) were positive for P. vivax, 69 (24%) for P. falciparum, and 18 (6.3%) had mixed (P. vivax/P. falciparum) infections. Patients' median age was 33 years (IQR 20), 168 (69%) were men, and 40% practiced gold mining as the main occupation. Fever (96.5%), chills (91.3%), and headaches (90.6%) were the most frequent symptoms. At least one symptom associated with severe malaria was observed in 69 out of 161 patients with complete clinical evaluation (42.9%). Plasmodium vivax infections were found in 42 out of 69 (60.9%) severe cases; by contrast, P. falciparum and mixed malaria caused 34.8% (24/69) and 4.4% (3/69) of infections, respectively. Two patients died of cerebral malaria. Mean hemoglobin was lower in the patients infected with P. falciparum than those infected with P. vivax. Regardless of the parasite causing the infection, patients presented high levels of total bilirubin, aminotransferases (AST, ALT), and lactate dehydrogenase (LDH). Out of the 142 patients followed up by phone for three months (49.5% of the 287 patients), 35 (24.7%) reported recurrences. Conclusions The high malaria prevalence among young male adults practicing gold mining suggests that this occupation is a significant risk factor. The unexpected high prevalence of P. vivax patients with at least one criteria of severe clinical disease is a matter of concern. Whether it is the result of a lack of timely diagnosis and effective treatment should be explored.

Background Amoebiasis is a parasitic disease caused by Entamoeba histolytica, which affects people living in low- and middle-income countries and has intestinal and extraintestinal manifestations. To date, knowledge on coronavirus disease 2019 (COVID-19) coinfection with enteric parasites is limited, and E. histolytica coinfection has not been previously described. Here we present the case of a patient with COVID-19 who, during hospitalisation, presented a clinical picture consistent with an amoebic liver abscess (ALA). Case presentation A 54-year-old man, admitted as a suspected case of COVID-19, presented to our hospital with dyspnoea, malaise, fever and hypoxaemia. A nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction. After 7 days, he developed diarrhoea, choluria and dysentery. An abdominal ultrasound showed a lesion compatible with a liver abscess; stool examination revealed E. histolytica trophozoites, and additional serology for E. histolytica was positive. After 12 days of treatment with metronidazole, ceftazidime and nitazoxanide, the patient reported acute abdominal pain, and an ultrasound examination revealed free liquid in the abdominal cavity. An emergency exploratory laparotomy was performed, finding 3000 mL of a thick fluid described as “anchovy paste”. Computed tomography scan revealed a second abscess. He ended up receiving 21 days of antibiotic treatment and was discharged with satisfactory improvement. Conclusion Here we present, to the best of our knowledge, the first report of ALA and COVID-19 co-presenting. Based on their pathophysiological similarities, coinfection with SARS-CoV-2 and E. histolytica could change the patient’s clinical course; however, larger studies are needed to fully understand the interaction between these pathogens.