Detection of the mosquito-borne flaviviruses, West Nile, Dengue, Saint Louis Encephalitis, Ilheus, Bussuquara, and Yellow Fever in free-ranging black howlers (Alouatta caraya) of Northeastern Argentina

Several medically important mosquito-borne flaviviruses have been detected in Argentina in recent years: Dengue (DENV), St. Louis encephalitis (SLEV), West Nile (WNV) and Yellow Fever (YFV) viruses. Evidence of Bussuquara virus (BSQV) and Ilheus virus (ILHV) activity were found, but they have not been associated with human disease. Non-human primates can act as important hosts in the natural cycle of flaviviruses and serological studies can lead to improved understanding of virus circulation dynamics and host susceptibility. From July–August 2010, we conducted serological and molecular surveys in free–ranging black howlers (Alouatta caraya) captured in northeastern Argentina. We used 90% plaque-reduction neutralization tests (PRNT90) to analyze 108 serum samples for antibodies to WNV, SLEV, YFV, DENV (serotypes 1and 3), ILHV, and BSQV. Virus genome detection was performed using generic reverse transcription (RT)-nested PCR to identify flaviviruses in 51 antibody-negative animals. Seventy animals had antibodies for one or more flaviviruses for a total antibody prevalence of 64.8% (70/108). Monotypic (13/70, 19%) and heterotypic (27/70, 39%) patterns were differentiated. Specific neutralizing antibodies against WNV, SLEV, DENV-1, DENV-3, ILHV, and BSQV were found. Unexpectedly, the highest flavivirus antibody prevalence detected was to WNV with 9 (8.33%) monotypic responses. All samples tested by (RT)-nested PCR were negative for viral genome. This is the first detection of WNV-specific antibodies in black howlers from Argentina and the first report in free-ranging non-human primates from Latin-American countries. Given that no animals had specific neutralizing antibodies to YFV, our results suggest that the study population remains susceptible to YFV. Monitoring of these agents should be strengthened to detect the establishment of sylvatic cycles of flaviviruses in America and evaluate risks to wildlife and human health.Fil: Morales, Maria Alejandra. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbran". Instituto Nacional de Enfermedades Virales Humanas; ArgentinaFil: Fabbri, Cintia M.. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbran". Instituto Nacional de Enfermedades Virales Humanas; ArgentinaFil: Zunino, Gabriel Eduardo. Universidad Nacional de General Sarmiento. Instituto del Conurbano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Kowalewski, Miguel Martin. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia". Estación Biológica de Usos Múltiples (Sede Corrientes); ArgentinaFil: Luppo, Victoria C.. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbran". Instituto Nacional de Enfermedades Virales Humanas; ArgentinaFil: Enría, Delia A.. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbran". Instituto Nacional de Enfermedades Virales Humanas; ArgentinaFil: Levis, Silvana C.. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbran". Instituto Nacional de Enfermedades Virales Humanas; ArgentinaFil: Calderón, Gladys Ethel. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbran". Instituto Nacional de Enfermedades Virales Humanas; Argentin

Assistenza territoriale extraospedaliera dei pazienti COVID-19: quali sono state le scelte farmacologiche adottate dai medici di medicina generale della provincia di Modena nel corso della prima ondata della pandemia e di quelle successive

Introduzione La fase iniziale della pandemia SARS-CoV-2 è stata caratterizzata da una forte incertezza e mancanza di linee guida ufficiali, soprattutto riguardo la gestione farmacologica extraospedaliera dei pazienti COVID-19. L’obiettivo di questo studio è descrivere le strategie terapeutiche dei medici di medicina generale (MMG) e le loro variazioni nel corso delle diverse ondate o in base alla gravità della patologia. Materiali e metodi È stato condotto uno studio retrospettivo che ha valutato una coorte di adulti positivi a SARS-CoV-2 (diagnosticato tramite tampone molecolare) gestiti in ambito territoriale dai MMG della provincia di Modena, da marzo 2020 ad aprile 2021. Hanno aderito allo studio, su base volontaria, 46 MMG (10% dei MMG della provincia di Modena). I dati clinici e quelli relativi alla prescrizione farmaceutica sono stati estratti dalle cartelle cliniche informatizzate. Risultati Sono stati analizzati un totale di 5340 pazienti affetti da SARS-CoV-2: 3883 (73%) asintomatici o con sintomi lievi e 1457 (27%) colpiti dalle forme più severe della patologia. 1413 pazienti (27%) non hanno ricevuto trattamenti farmacologici (94% di questi asintomatici/paucisintomatici). Paracetamolo è stato complessivamente il farmaco più prescritto (47%), seguito da FANS (29%), antibiotici (28%), eparina (16%), steroidi (13%), ossigeno (4%) e idrossiclorochina (0,9%). Tra la prima ondata e quelle successive è emerso un aumento della prescrizione di FANS (22% vs 30%, p < 0,01) e una riduzione della prescrizione di paracetamolo (60% vs 46%, p < 0,001) di idrossiclorochina (11% vs 0,2%, p<0,001) e antibiotici (41% vs 27%, p < 0,001). Specificatamente tra le ondate si è ridotta la prescrizione di macrolidi (25% vs 15%, p < 0,001) e fluorochinoloni (4% vs 2%, p < 0,001) ed è aumentato l’utilizzo di betalattamici (1% vs 15%, p < 0,05). Stratificando le prescrizioni in base alla gravità dei sintomi emerge che antibiotici, cortisone, eparina e ossigeno vengono prescritti più frequentemente nei pazienti con forme severe e il loro utilizzo in questi pazienti aumenta significativamente dalla prima ondata a quelle successive. Conclusioni Le scelte farmacologiche compiute dai MMG della provincia di Modena sono cambiate in modo significativo tra la prima ondata e quelle successive anche in seguito alla diffusione delle prime linee guida ufficiali sulla corretta gestione territoriale dell’infezione da SARS-CoV-2. Questo evidenzia come la medicina territoriale sia recettiva e capace di adattare rapidamente le proprie risposte alla pandemia in modo corretto e coerente con le evidenze man mano disponibili e sottolinea l’importanza di interventi di supporto da parte della direzione delle Cure Primarie da svolgere sempre più in collaborazione con i MMG

COVID-19 pneumonia in the outpatient setting in Italy: a population-based observational study'

Background: While around 80% of symptomatic SARS-CoV-2 infections are characterised by mild to moderate respiratory symptoms, two out of ten patients develop severe disease, with pneumonia being the most common clinical outcome. Little is known about the prevalence and the patient management of SARS-CoV-2 related pneumonia in Italian general practices. Research questions: To describe the clinical features of outpatients with SARS-CoV-2 related pneumonia and the management strategies of Italian general practitioners (GPs) in the province of Modena (Italy). Method: Retrospective study of SARS-CoV-2 infected adult outpatients managed by their GPs from March to May 2020 to April 2021. Data on GPs’ monitoring and treatment strategies, patients’ clinical and sociodemographic characteristics, hospitalisation and death were extracted from the GP’s electronic medical records and were analysed using descriptive and bivariate statistics. Results: 5340 patients from 46 GP practices were included in the analyses and among these 1457 (27%) developed pneumoniae with (12%) or without (15%) respiratory failure. Among these, 940 (66 %) were managed entirely in the outpatient setting by GPs. 59% of patients received paracetamol, 33 % NSAID, 59% antibiotics, 37% corticosteroids, 47% LMWH, 14% oxygen and 3% hydroxychloroquine; significant differences were observed in prescription patterns between the first and subsequent waves. 921 (63%) patients with pneumonia received active monitoring while 611 (42%) were visited at home; this percentage remained stable despite the exponential increase in the overall number of cases and the resulting GPs’ workload. 114 (8%) patients with pneumonia died, mostly (96%) with critical disease and 27 (24%) of deaths occurred in the outpatient setting. Conclusions: The study quantifies the important contribution of Primary Care to the management of COVID-19 outpatients with pneumonia in Italy and describes the variation of therapeutic and management strategies between the first and subsequent waves