Protozoan parasites of genus Leishmania are the causative agents of leishmaniasis. Leishmania promastigotes primarily infect macrophages in the host, where they transform into amastigotes and multiply. Lipophosphoglycan (LPG), the most abundant surface molecule of the parasite, is a virulence determinant that regulates the host immune response. Promastigotes are able to modulate this effect through LPG, creating a favourable environment for parasite survival, although the mechanisms underlying this modulation remain unknown. We analysed the participation of TLR2 and TLR4 in the production of cytokines and explored the possible phosphorylation of ERK and/or p38 MAP kinase signalling cascades in human macrophages stimulated with Leishmania mexicana LPG. The results show that LPG induced the production of TNF-α, IL-1β, IL-12p40, IL-12p70 and IL-10 and led to phosphorylation of ERK and p38 MAP kinase. Specific inhibitors of ERK or p38 MAP kinases and mAbs against TLR2 and TLR4 reduced cytokine production and phosphorylation of both kinases. Our results suggest that L. mexicana LPG binds TLR2 and TLR4 receptors in human macrophages, leading to ERK and MAP kinase phosphorylation and production of pro-inflammatory cytokines.

Background. To know the current status of the epidemiological and geographic distribution of tuberculosis and its complication meningeal tuberculosis in Mexico, this work analyzes national surveillance data (ten years) issued by the General Directorate of Epidemiology (GDE). Methods. An observational and retrospective analysis of monthly and annual reports of pulmonary and meningeal tuberculosis cases from January 2007 to December 2017 was performed on the annual reports issued by the GDE in Mexico. The number of cases and incidence were classified by year, state, age group, gender, and seasons. Results. A national case distribution map of pulmonary and meningeal tuberculosis incidence was generated. During this period, a total of 184,003 and 3,388 cases were reported with a median of 16,727.5 and 308 cases per year for pulmonary and meningeal tuberculosis diseases, respectively. The number of cases and incidence of pulmonary and meningeal tuberculosis per year showed that male gender presented a continuous increase in both parameters. The geographic analysis of the distribution of cases of tuberculosis showed that states like Guerrero, Tabasco, and Veracruz presented higher means of tuberculosis cases during this period. Northern states had the highest number of cases in the country compared to other states. In Mexico, pulmonary tuberculosis and meningeal tuberculosis are seasonal. Interestingly, cases of meningeal tuberculosis show an increase during October and November (autumn). Conclusions. In Mexico, during the years 2007–2017, there has been an increase in the proportion of male TB patients. It remains necessary to implement strategies to detect TB in the adult population, especially among men, because tuberculosis could be difficult to recognize in an early stage in the population, and the appearance of resistant strains can cause an increase in the incidence of the disease.

Background Campylobacter infection is the main cause of diarrheal disease, however it is recognized as a risk factor for developing Guillain Barré syndrome, which has been previously corroborated in our population after analyzing the incidence of the syndrome during arboviral outbreaks of 2016-2018, resulting that 75% of the cases were due to infection by Campylobacter. Furthermore, of these patients, 83% did not present gastrointestinal symptoms, constituting an asymptomatic campylobacteriosis at the intestinal level, and Guillain Barré syndrome could be its primary manifestation. Reason why the need arose to look in this population for cases of asymptomatic campylobacteriosis. Methods Analytical, observational and prospective study. 200 healthy and asymptomatic individuals over 18 years of age were selected in the Veracruz Norte branch of the Mexican Institute of Social Security during September to December 2019, who were asked for a stool sample, which was subjected to a study to search for Campylobacter through a chromatographic immunoassay test for the qualitative detection of said bacteria (Certest). Patients who were positive to the Certest test underwent stool culture (Campy-bap) in order to typify the identified Campylobacter species. Results In the search for Campilobacter, the Certest was positive in 6 (3.0%); In 5 (83.3%) subjects some variety of Campylobacter could be isolated by stool culture, in 4 (66.7%) Campylobacter Jejuni was isolated and in 1 (16.7%) Campylobacter Coli was isolated. The positive result of Certest was similar between women and men [4 (3.8%) women vs 2 (2.1%) men; p = 0.684)]. However, in relation to the culture, there was the percentage of women in whom the culture was positive for Campilobacter Jejuní was statistically significant [4 (100%) VS 0 (0.0%); p = 0.038]. Positive cases of campylobacter Positive cases by Certest and Campy-bap Conclusion Asymptomatic positive cases of Campilobacter were identified in this study population in 3%, mainly isolating Campilobacter jejuni, which leads to the conclusion that there are cases of asymptomatic Campylobacteriosis that could act as a risk factor for the development of acute neurological syndromes related to the presence of the bacteria Disclosures All Authors: No reported disclosures

No abstract

Background: Patients affected by COVID-19 pneumonia who present severe symptoms with manifest hypoxemia and cytokine storm have a high mortality rate, which is why therapies focused on reducing inflammation and improving lung function have been used, being one of them Baricitinib Material and methods: Patients who presented data of severe pneumonia due to COVID-19 with data of severe hypoxemia and cytokine storm were selected, from June to August 2020, to whom the SaO2/FiO2 ratio is measured at the beginning, intermediate and end of treatment. Results: We included data from 30 patients, 22 (73%) men, with a median age of 58.5 years. 77% had comorbidities: hypertension (43%), obesity (30%), diabetes (27%). The medians of D-Dimer 982ng/mL, Ferritin 1,375ng/mL and CRP 10mg/dL. 97% patients had treatment: azithromycin (77%), ivermectin (53%) and dexamethasone (47%). The initial pulseoximetry (SaO2) with room air had a median of 80.5% and the median SaO2/FiO2 (SAFI) was 134; 90% had moderate ARDS and 10% had severe ARDS. All received Baricitinib 4 mg/day by 14 days. SaO2 at 7 days had a median of 93.0% and the median SAFI was 310; the median SaO2 at 14 days was 95% and the median SAFI was 452. In comparative analysis, baseline SaO2/SAFI was significantly lower compared to 7 and 14 days (p = 0.001 for both comparisons). 90% patients improved and 10% died. Conclusion: Baricitinib therapy in these patients presented good results by improving clinical status and pulmonary failure, with patients being cared for at home and avoiding mechanical ventilation.

Background Baricitinib is a treatment authorized by the FDA for the treatment of moderate to severe COVID-19, despite this there are few approved drugs; polymerized type I collagen (PTIC) is a drug that has been used in Mexico with great potential for treating moderate to severe cases of COVID-19. Methods Comparative, descriptive and retrospective analysis of two populations of adult patients affected by COVID-19 confirmed by antigen test or RT-PCR as well as CO-RADS 6 CT, who consented to be treated between 2020 and 2021, a population using oral baricitinib at a dose of 4mg/day/14 days and another using polymerized type I collagen intramuscularly at a dose of 1.5ml every 12 hours for 3 days, followed by 1.5ml every 24 hours for 4 days; The most affected age and gender, comorbidities and laboratory abnormalities are analyzed, as well as improvement in inflammatory and oxygenation indices measured by pulse oximetry and SAFI (SpO2/FiO2), finally the outcome of the patients and the presence of adverse events. Results 80 patients for each group, the most affected gender was male; the average age in the PTIC group was 51 years and in the baricitinib group it was 56 years; the main comorbidities were obesity, diabetes and hypertension in both groups; the decrease in acute phase reactants such as CRP, D-dimer and ferritin was greater in the PTIC group compared to the baricitinib group, the latter drug requiring a regimen of more days to achieve the objectives of the first drug (PTIC 7 days and baricitinib 14 days); Similarly, in oxygenation measured, the PTIC group reached goals in less time compared to the baricitinib group, which required twice as many days of treatment to achieve adequate oxygenation; Regarding the outcomes, there was a higher mortality in the baricitinib group compared to the PTIC group (6.25% vs 3.75%). Regarding adverse events reported for the PTIC group, they were minor and related to the intramuscular administration of the drug in 7 patients, while in the baricitinib group, 5 patients were reported with added bacterial pneumonia. Conclusion Polymerized type I collagen has anti-inflammatory and immunomodulatory potential similar to baricitinib in cases of moderate to severe COVID-19, even reaching treatment goals in less time both in inflammatory indices and in oxygenation indices. Disclosures All Authors: No reported disclosures.

Background Since the beginning of the pandemic and its passage through the different affected continents, there have been differences in the presentation depending in part on the characteristics of each population, so it is important to know how it behaves in the local population. Methods Clinical-epidemiological study in adults hospitalized for suspected COVID-19 at the General Hospital 71 of the City of Veracruz, Mexico, from April to December 2020. Demographic and clinical characteristics are studied, as well as a comparative and stratified analysis was performed by intubation and death. Results 1212 patients are included, 53% are men, average age 49 years. 20.5% reported sudden onset of symptoms; the most frequent: fever (79.8%), headache (75.2%), cough (71%), myalgia (62%), arthralgia (58%) and dyspnea (46.3%). Comorbidities were reported in 54.7%, the most frequent: Hypertension (29.2%), Diabetes (29.1%) and obesity (13.9%). Regarding the outcomes, 120 (9.9%) required intubation and 300 (25%) died. Men requiring intubation were significantly older than women [62.5 vs 37.5%; p = 0.027]. The mean age of the intubated patients was higher compared to that of the non-intubated [60.5 vs 44.8 years; p = 0.001]. The male gender had a risk association for intubation. The group aged 60 years or older compared to those aged 59 years or younger had a higher risk of intubation. Clinical variables that had a risk association with intubation were: dyspnea, chest pain and prostration. Among comorbidities, hypertension and diabetes had a risk association with intubation. Female gender and headache had a protective association for intubation. In addition, odynophagia, rhinorrhea, and abdominal pain showed a protective association for intubation. There was no difference in terms of gender by death. The mean age of the patients who died was significantly older [64.5 vs 43.8 years; p = 0.001]. The clinical variables that had a risk association with death were: dyspnea, chest pain, polypnea, cyanosis and prostration. The protective variables were: rhinorrhea, odynophagia, headache and conjunctivitis. Conclusion By studying a population affected by COVID, its own characteristics and inherent risks can be known to help take local diagnosis and treatment strategies that ensure a better outcome for those affected. Disclosures All Authors: No reported disclosures.

This syndrome is characterized by necrohemorrhage of the adrenal glands in the course of a serious infectious disease, which is characterized by septic shock with multiple organ failure (prevailing neurological, renal and hematological failure even with criteria for disseminated intravascular coagulation), disseminated purpura and data on acute adrenal insufficiency. Initially described by an English physician in 1911, Dr. Rupert Waterhouse and later studied further by a Danish pediatrician, Dr. Carl Friderichsen in 1917 [1-3].