In 2016, Venezuela faced a large diphtheria outbreak that extended until 2019. Nasopharyngeal or oropharyngeal samples were prospectively collected from 51 suspected cases and retrospective data from 348 clinical records was retrieved from 14 hospitals between November 2017 and November 2018. Confirmed pathogenic Corynebactrium isolates were biotyped. Multilocus Sequence Typing (MLST) was performed followed by next-generation-based core genome-MLST and minimum spanning trees were generated. Subjects between 10 and 19 years of age were mostly affected (n = 95; 27.3%). Case fatality rates (CFR) were higher in males (19.4%), as compared to females (15.8%). The highest CFR (31.1%) was observed among those under 5, followed by the 40 to 49 age-group (25.0%). Nine samples corresponded to C. diphtheriae and 1 to C. ulcerans. Two Sequencing Types (ST), ST174 and ST697 (the latter not previously described) were identified among the eight C. diphtheriae isolates from Carabobo state. Cg-MLST revealed only one cluster also from Carabobo. The Whole Genome Sequencing analysis revealed that the outbreak seemed to be caused by different strains with C. diphtheriae and C. ulcerans coexisting. The reemergence and length of this outbreak suggest vaccination coverage problems and an inadequate control strategy.

The objective of this work was to investigate the epidemiology of pneumocystosis in Venezuelan patients utilizing a retrospective study during a six year period. One hundred and twenty nine clinical samples collected from patients with AIDS, cancer and non-AIDS-non-cancer low respiratory tract infection patients were processed by direct immunofluorescence technique. Pneumocystosis was diagnosed in 30 patients with a general frequency of 23.3%, which varied according to the patient's group: 36.6% in AIDS patients, 38% in cancer patients, and 10.4% in non-AIDS-non-cancer low respiratory tract infection patients. This study demonstrated the existence of differences in pneumocystosis frequency related to the patient's underlying disease, and that the illness is an important health problem in immunocompromised patients in Venezuela. Pneumocystosis must be suspected in non-immunocompromised patients with signs and symptoms of low respiratory tract infection, and the study of this illness must include COPD and cancer patients. Direct immunofluorescence is a useful technique for pneumocystosis diagnosis, however, it requires an optimal sample and skilled personnel in the laboratory.

Previous studies carried out in an endemic semiarid region northwest of Venezuela at Falcon State have shown a prevalence of 15.4/1000 of chromoblastomycosis following traumatisms with xenophile vegetation infected with Cladophialophora carrionii. We performed high-resolution DNA typing of human leukocyte antigen (HLA)-A, -B and -C and major histocompatibility complex class I chain related gene A (MICA) alleles and segregation analysis in 49 members of one extended family with 12 affected individuals, who have lived for approximately 70 years in this endemic zone. None of the alleles, haplotypes or genotypes is shared by all the patients. No deviation from the expected HLA haplotype distribution or association of chromoblastomycosis with HLA-A, -B and -C haplotypes was observed. Further, a haplotype-sharing transmission/disequilibria testing of 11 nuclear families did not give enough evidence to claim linkage (P = 0.398), suggesting that genes located in the short arm of chromosome 6 may not be relevant in the immune response toward infection with C. carrionii in this Venezuelan endemic zone. Deleted MICA alleles on HLA-B*4802 haplotypes were present among several members of the extended family, but only two of them were affected.

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Pneumocystis jirovecii pneumonia (PCP) is one of the most frequentopportunistic infections in immunocompromised patients. The objective of thisstudy was to know the P. jirovecii epidemiology in Venezuelan patients with HumanImmunodeficiency Virus (HIV) infection and suspected pneumonia, through passivesurveillance at a national reference laboratory during six years. Laboratory recordsof patients with HIV infection, who were hospitalized with acute lower respiratorytract infection (ALRTI), and presumptive clinical diagnosis of PCP, were reviewedbetween January 2007 and December 2012, at the Mycology Department of theInstituto Nacional de Higiene Rafael Rangel. Several respiratory specimens werereceived and the direct immunofluorescence assay (DIF) and nested polymerasechain reaction (nPCR) diagnostic techniques were used. One hundred and sixty-onerespiratory samples were processed and P. jirovecii was detected in 76 samples byDIF and in 20 by nPCR. PCP’s frequency in Venezuelan patients with HIV is high andit has been sustained throughout time. Colonization by P. jirovecii has uncertainclinical significance, but this study provides evidence that the state of advancedimmunosuppression increases the probability of colonization. DIF and nPCR arevery useful techniques for PCP diagnosis, but are of limited access in many hospitalcenters, especially in developing countries. We recommend the use of DIF with spontaneoussputum specimens as the first diagnostic line for PCP in patients with HIVinfection. The results obtained by nPCR should be interpreted with caution, takinginto account the patient’s clinical symptoms.

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