An uncontrolled clinical trial carried out in Panama City, Panama.
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Global diversity and evolution of Salmonella enterica serovar Panama: a genomic epidemiology study.
BACKGROUND: Non-typhoidal Salmonella is a globally important bacterial pathogen, typically associated with foodborne gastrointestinal infection. Some non-typhoidal Salmonella serovars can also colonise typically sterile sites in people to cause invasive non-typhoidal Salmonella disease. Salmonella enterica serovar Panama is responsible for a substantial number of cases of human bloodstream infection, but despite its global dissemination, numerous outbreaks, and a reported association with invasive non-typhoidal Salmonella disease, S enterica serovar Panama (S Panama) is understudied. We aimed to describe the genomic epidemiology and evolutionary history of S Panama to provide a vital baseline of understanding for this globally important serovar. METHODS: In this genomic epidemiology study, we analysed S Panama genomes derived from historical collections, national surveillance datasets, and publicly available epidemiological and whole-genome sequencing data which span the years 1931-2019. Maximum likelihood and Bayesian phylodynamic approaches were used to investigate population structure and evolutionary history and to infer geotemporal dissemination. A combination of different bioinformatic approaches with short-read and long-read data were used to characterise geographical and clade-specific trends in antimicrobial resistance (AMR) and genetic markers for invasiveness. FINDINGS: We analysed 836 S Panama genomes, of which 559 (67%) were sequenced as part of this study. The collection represents all inhabited continents and includes isolates collected between 1931 and 2019. We identified the presence of four geographically linked S Panama clades (C1 [ie, the Latin America and the Caribbean clade; n=338], C2 [ie, the European clade; n=124], C3 [ie, the Martinique clade; n=131], and C4 [ie, the Asia and Oceania clade; n=104]) and regional trends in AMR profiles. Most isolates (715 [86%] of 836) were pan-susceptible to antibiotics and belonged to clades circulating in Latin America and the Caribbean (64%, n=458). Most antibiotic-resistant isolates in our collection (113 [93%] of 121) fell within clades C4 (ie, the Asia and Oceania clade) and C2 (ie, the European clade), the latter of which had the highest invasiveness index values based on the conservation of 196 extraintestinal predictor genes. INTERPRETATION: This first large-scale phylogenetic analysis of S Panama has revealed important information about the population structure, AMR, global ecology, and genetic markers of invasiveness of the identified genomic subtypes. Our findings provide an important baseline for understanding S Panama infection. The presence of multidrug-resistant clades with elevated invasiveness index values should be monitored through ongoing surveillance, as such clades could pose an increased public health risk. FUNDING: UK Research and Innovation Global Challenges Research Fund and Biotechnology and Biological Sciences Research Council, UK Medical Research Council, Wellcome Trust, John Lennon Memorial Scholarship, Institut Pasteur, Santé publique France, Fondation Le Roch-Les Mousquetaires, Investissement d'Avenir Programme, and Australian National Health and Medical Research Council.
Humans↗
Drug utilization in Panama.
The availability and use of therapeutic agents in Panama is critically reviewed. Of the 3800 drug products on the market, 50% are vitamins, tonics and fixed ratio combination products. Many drugs are of unproven efficacy and safety, not marketed in more developed countries. Hospital and outpatient studies have documented inappropriate prescribing habits. To improve drug utilization, regulatory and educational strategies have been implemented in the Panama Social Security Institute. Drugs of doubtful or no value and unnecessary duplications have been withdrawn from its therapeutic formulatory. Outreach services provided by the Panama Social Security Institute include the distribution of a drug bulletin, workshops, seminars and person to person drug information (counterdetailing) to health personnel. Drug information to patients is also included in the overall strategy to promote the rational use of drugs. Nevertheless, much work is still needed to formulate and implement an essential drugs and health policy in Panama.
Drug Utilization↗
[Phage-typing and tetracycline resistance in Salmonella panama strains of animal origin in the Federal Republic of Germany (1969-1975) (author's transl)].
505 out of 1369 S. panama strains isolated mainly from animals, foods, and feedstuffs from 1969 to 1975 were phage-typed. 41% (= 207) of the S. panama isolates examined originated from swine, 26% from cattle and calves, 15% from dogs, and 13% were from other animal species and materials. 465 strains (=92%) showed typical reactions. 23% were specified as phage-type A, 24% as phage-type B and 36% as phage-type G. Phage-types D, E, and F did not occur. In swine, being the most frequent carriers of S. panama, phage-types A, B, and G had nearly the same shares. In dogs, phage-type G predominated to which nearly one half of the examined S. panama isolates from this species belonged. 205 (=41%) out of 505 strains examined for their resistance to antibiotics proved to be tetracycline-resistant. All 123 strains of phage-type B were tetracycline-resistant, all 35 strains of phage-type C were tetracycline-sensitive. 5 strains of phage-type A exhibited transferable tetracycline-resistance determinants.
Animals↗
Palm trees and Chagas' disease in Panama.
An ecological survey of triatomines in the sylvan ecosystem of the Canal Zone and selected sites in Panama disclosed for the first time a close association of Rhodnius pullescens and Triatoma dimidiata, the two most important vector species of Chagas' disease in Panama, with a single species of a widely distributed palm tree, Scheelea zonensis. This association may explain why Chagas' disease is prevalent in certain rural communities in Central Panama and rare in others. An immense focus of zoonotic Trypanosoma cruzi infection exists in the forests of the Canal Zone with presence of large populations of triatomines, associated with scheelea zonensis and other yet undescribed microhabitats, and high (50--60%) trypanosome infections in all of the major triatomine species. Common opossums, anteaters, and spiny rats seem to be the principal animal reservoirs of T. cruzi in this complex and relatively undisturbed ecosystem.
Animals↗
Human T-lymphotropic virus type II among Guaymi Indians--Panama.
Human T-lymphotropic virus type 2 (HTLV-II) is one of four retroviruses (i.e., HTLV-I, human immunodeficiency virus type 1 [HIV-1], and HIV-2) that are known to infect humans. During 1988, investigators from the Gorgas Memorial Laboratory (GML) and the National Institutes of Health (NIH) tested serum specimens collected during 1978-1987 throughout Panama to determine the prevalence of HTLV-I infection (1), which is endemic in southern Japan and the Caribbean basin (2). HTLV seropositivity rates were low in all areas of Panama except among the Guaymi Indians in Changuinola (9%),* a city in western Panama (Figure 1). During 1989-1991, additional testing of 36 seropositive specimens from Guaymi Indians detected that the infections were due to HTLV-II (3,4). This report summarizes risk factor data for HTLV-II infection among Guaymi Indians.
Adolescent↗
[The cholera epidemic in Panama 1991].
The authors studied the epidemiology of the outbreak of cholera (due to Vibrio cholerae 01, Inabe serotype) which occurred in Panama in 1991, during which 1179 probable cases were reported, with 292 hospitalizations, 29 deaths and 51 confirmed cases. There was an average of 24.7% hospitalizations and a 2.5% mortality. The epidemic involved 21 of 24 "corregimientos' in Darién, 2 of 4 in San Blas, 5 of 15 in Panama East, 3 of 40 in Colón and one of 19 in the metropolitan area of Panama City. The incidence of infected patients was seen in infants less than 1 year old and in children 1 to 4 years of age. Taking into account the population in each 'corregimiento', it can be said that less than 1% of the population was infected, but that in San Blas, where few communities have aqueduct and latrines, 10% of the population was infected.
Age Factors↗
[Instability of group FII plasmids in "Salmonella panama" (author's transl)].
Almost all Salmonella panama isolated in France only harbour R plasmids of incompatibility groups I1 (K Col Ib) and N (T). Reference R plasmids belonging to 11 incompatibility groups have been introduced into S. panama. All are stable after 50 generations except those of group FII. FII instability cannot be explained either by the presence of a group FII cryptic plasmid or by restriction enzymes in S. panama.
Conjugation, Genetic↗
Human T-cell lymphotropic virus type I and neurologic disease in Panama, 1985 and 1986.
Human T-cell lymphotropic virus type I (HTLV-I) causes adult T-cell leukemia and has recently been associated with HTLV-associated myelopathy/tropical spastic paraparesis. The HTLV-I is endemic throughout the Caribbean basin and parts of South America, and HTLV-associated myelopathy/tropical spastic paraparesis also seems to be common in this area. This 2-year study, 1985 and 1986, was designed to evaluate the occurrence of HTLV-I infection in all newly diagnosed cases of selected neurologic diseases in Panama City, Panama. Six (8%) of 71 patients had antibody to HTLV-I detected by immunofluorescence, enzyme-linked immunosorbent assay, radioimmunoassay, and Western blot assays; 5 patients' conditions were diagnosed as spastic paraparesis, and all 5 were seropositive and also had HTLV-I antibody in cerebrospinal fluid. The remaining seropositive patient had multiple sclerosis, and no antibody was detected in her cerebrospinal fluid. Clinical and electrophysiologic studies indicated that HTLV-I-associated spastic paraparesis is a multifocal, primarily demyelinating disease that principally involves the spinal cord.
Adult↗
Epidemiological patterns of cutaneous leishmaniasis in Panama. II. Incidental occurrence of cases in non-endemic settlements.
Epidemiological studies on cutaneous leishmaniasis were carried out in a settlement in the Bayano region, Republic of Panama, during 1971-72. This settlement was established about 12 years earlier for the purpose of cattle raising by small groups of settlers. The primary forest was cut and cleared and the area planted with grass. The presence of active cases of cutaneous leishmaniasis among humans and animals, both domestic and ferals, was investigated. In addition, phlebotomine sandflies were collected to determine their species composition. In 1971, nine of the 161 persons interviewed had active lesions; all but one of the patients were males and of these seven were adults. Five (9%) of 55 dogs and one (3%) of 33 feral mammals examined also were found infected. Strains of the parasite infecting both humans and animals were characterized as Leishmania braziliensis. About 60% of the sandflies collected belong to four man-biting species previously incriminated as vectors of human cutaneous leishmaniasis in Panama. The extensive pasture, together with periodic applications of insecticides in the houses by the antimalarial agency in this country, provided an effective barrier against transmission within the settlement itself. However, both humans and dogs acquired the disease during excursions into the surrounding forest. No new cases were found in 1972.
Animals↗
Epidemiology of epilepsy in Guaymi Indians from Bocas del Toro Province, Republic of Panama.
This cross-sectional study was conducted to describe the epidemiology of epilepsy in Guaymi Indians residing in Changuinola, a small town on Panama's Caribbean coast near Costa Rica. We randomly selected households and attempted to enroll all residents aged less than or equal to 1 year; 337 eligible subjects agreed to participate (93% response rate). We administered a standard neurologic disease screening examination to all subjects and, if any abnormality was found, we administered a standard neurologic evaluation. We detected 19 cases of active epilepsy; the mean age at onset was 12 years, and generalized tonic-clonic seizures were the most common diagnosis (10 of 19, 53%). The prevalence of active epilepsy among Caribbean coastal Guaymi (57/1000) is considerably greater than that in lower class Panama City populations (22/1000) or in other parts of the world. To identify risk factors for epilepsy, we collected epidemiologic data and serum (for Cysticercus antibody) from subjects with active epilepsy and from 44 age/sex-matched controls. Significantly more cases (47%) than controls (6%) had other family members with epilepsy (relative risk, RR = 14); 44% of cases and 13% of controls reported a history of febrile seizures during childhood (RR = 6).
Adolescent↗
Epidemiological patterns of cutaneous leishmaniasis in Panama. III. Endemic persistence of the disease.
Endemic persistence of cutaneous leishmaniasis is described in El Aguacate, a community established in the forest of central Panama about 75 years ago. Physiographic pecularities partially isolate El Aguacate from other villages in the region. Some of the original forest environment has been preserved and man-biting species of phlebotomine sandflies were abundant as was the two-toed sloth, Choloepus hoffmanni, the principal reservoir host of Leishmania braziliensis in Panama. The inhabitants, as well as their dogs, were examined for natural leishmaniasis in 1969 and 1973. Mammals and phlebotomine sandflies were collected from 1968 to 1973 in a search for reservoir hosts and potential vectors of the disease. Similar studies were undertaken in two nearby villages during 1968 and 1969. L. braziliensis has persisted for many years in El Aguacate, and infection is acquired during childhood. Dogs also were found naturally infected, and the two-toed sloth showed yearly infection rates up to 47.8%. Parasites were demonstrated from a night monkey, Aotus trivirgatus.
Adolescent↗
Natural cutaneous leishmaniasis among dogs in Panama.
A search for cutaneous leishmaniasis among dogs was conducted in several forest settlements of central Panama from 1968 to 1973. A total of 11 (3.3%) of 333 animals examined was found infected and, in 9 of these, parasites were isolated in culture and characterized as Leishmania braziliensis. Infected dogs occurred in three settlements, one of which was free of human leishmaniasis. In the latter case, infections were acquired in the nearby forest during hunting excursions. Ulcerated skin lesions primarily on the lower aspect of ears, or depigmentation and inflammation of the nostrils were manifested, with persistence as long as 45 months. The parasites did not disseminate from the lesion to viscera or other areas of the skin. The dog may serve as an incidental reservoir host of human leishmaniasis and/or a liaison of the infection between the jungle and forest settlements in the Republic of Panama.
Animals↗
Ecological associations of vesicular stomatitis virus in rural Central America and Panama.
The principal objective of this study was to determine ecological associations of vesicular stomatitis virus (VSV)- New Jersey and VSV-Indiana in rural Central America and Panama. Two types of information were linked: the results of neutralizing antibody tests performed on sera from 3,232 lifetime residents of 189 rural study communitities of Central America and Panama, and ecological characteristics of the study communities as determined from natural resource atlases. The major finding was that neutralizing antibody acquistion to VSV-New Jersey was greatest for persons living at elevations between 350 and 649 meters, with relatively open, dry vegetation and distinct seasonal alternation of dry and moist (not wet) ground conditions. Similar ecological associations were found for VSV-Indiana, except that the risk of infection was also high in moist environments with dense tree cover. The results suggest that VSV-New Jersey and VSV-Indiana have similar but not identical maintenance and transmission cycles and that basic maintenance cycles for both viruses may exist in dry, open habitats rather than in tropicla rain forest habitats as was previously assumed for VSV-Indiana.
Adolescent↗
Results of spraying with ultra-low-volume malathion at ground level in Panama City.
Several ultra-low-volume (ULV) sprayings of technical malathion (95 per cent) were carried out in Panama City. Their purpose was to find out how useful this ULV technique could be in helping to combat mosquitoes, especially Aedes aegypti. Two residential areas were selected as sites for the trials. One of these was San Francisco, a district near the shoreline of the Bay of Panama with many individual houses and a few tall buildings. The other was El Cangrejo, a district further inland containing numerous multi-story apartment buildings and several luxury hotels. Two trials were conducted in San Francisco, both involving a single application of insecticide. One of these tested the effect of street spraying on mosquitoes and larvae left inside and outside of one and two story dwellings, while the other involved similar testing of the effects on ten floors of a high-rise apartment building. There was only one trial in El Cangrejo, but this employed three applications of insecticide at two-day intervals. Like the second San Francisco trial, it tested the effect of the spray on mosquitoes and larvae left in a high-rise apartment building. All the mosquitoes used were obtained from the insectarium of the National Malaria Eradication Service. A. aegypti adults and larvae and Anopheles albimanus larvae were used in the first San Francisco trial. Thereafter, because available supplies of A. aegypti were exhausted, An. albimanus adults and larvae were used alone. The results of these trials were very satisfactory. All adult mosquitoes were killed in most cases, the only exceptions being mosquitoes exposed to a single application that was made under adverse conditions. Fairly high rates of larval mortality were also obtained. Overall, the results strongly indicate that thrice-weekly ground-level ULV spraying with malathion can serve as a highly effective mosquito control measure.
Aedes↗
[Hepatic polycystic hydatidosis. Clinical and histopathologic report of the second native case of echinococcosis in the Republic of Panama].
The second autochthonous case of hepatic hydatidosos by Echinococcus vogelli is reported for the Republic of Panama. The patient was a 8 year old female living in the Province of Colon (Maria Chiquita). She claimed never to have traveled outside panamanian territory. The multichambered cysts with fertile, numerous protoscolices were identified from biopsied material obtained after exploratory laparotomy at Manuel Amador Hospital in Colon (Republic of Panama). The cyst appeared multiloculated mostly affecting the left lobe of the liver, beside a cystic lesion on the right lobe. The large rostellar hooks, in a count of 100 protoscolices, had a total length of handles and blades which average 41 microns in diameter, which coincide with those of E. vogeli, the most prevalent hydatid disease in man in South and Central America.
Echinococcosis, Hepatic↗
A survey of intestinal parasitism in a community on the Pan American Highway route in eastern Panama.
A survey of intestinal parasitism was conducted at Yaviza, a town in eastern Panama's Province of Darien. Single stool specimens from 202 persons, representing 11 percent of the town's total population, were examined. In all, 181 (90 per cent) of the specimens examined were found positive for one or more potentially pathogenic parasites. The most common parasite found was Trichuris trichiura, which was observed in 80 per cent of the samples. Others were Ascaris lumbricoides, in 62 per cent of the samples; hookworm, in 41 per cent; Entamoeba histolytica, in 16 per cent; Stronhyloides stercoralis, in 7 per cent; Giardia lamblia, in 5 per cent; and Hymenolepis diminuta, in 0.5 per cent. The aim of the survey was to gather baseline data on parasite prevalence before the Pan American Highway passes through this area. Construction of the highway is producing marked environmental change. in eastern Panama, and it is anticipated that the date from the survey will prove useful in later efforts to assess the health impact of that change.
Adolescent↗
[Neurologic diseases associated with the HTLV-1 virus in Panama].
Studies of the prevalence of the human T-cell lymphotropic virus (HTLV-1) in 1984 to 1986 in the Republic of Panama revealed a national seroprevalence of 1 to 2%. Since 1985 clinical epidemiological studies of neurological diseases associated to HTLV-1 are being done. Two hundred and fitly six clinical cases of thirty eight different neurological diseases of unknown etiology studied in the Neurology Services of the Santo Tomas Hospital and the Social Security Metropolitan Hospital Complex have been associated in some way to the HTLV-1. Twelve cases of progressive spastic paraparesis were identified and related to HLTV-1 as an etiologic agent. The ratio of men to women was maintained at 1:1 with the average age at onset at 44 years and without racial preference. There are important doubts about the association of this virus to multiple sclerosis. The seroprevalence of the HTLV-1 virus in Panama is found to be similar to that reported in neighboring countries and the association of tropical spastic paraparesis to THLV-1 infection is identified.
Adult↗