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Leptospirosis una enfermedad zoonótica, breve revisión de la situació= ;n en el Ecuador

 

Leptospirosis a zoonotic disease, a brief review of the situation in Ecuador

 


= 1

Pedro Chuva Castillo

https://orcid.org/= 0000-0002-3025-6758

 

Universidad Católica de Cuenca (UCC), Cuenca, Azuay, Ecuador.

pedro.chuva.07@est.ucacue.edu.ec  

= 2

Edy Castillo Hidalgo

 

https://orcid.org/= 0000-0001-5311-5002

 

Universidad Católica de Cuenca (UCC), Cuenca, Azuay, Ecuador.

 

 

 

 

 

 <= /u>

 

Artículo de Investigación Científica y Tecnológica

Enviado: 06/06/2022

Revisado: 08/07/2022

Aceptado: 24/08/2022

Publicado:07/09/2022

        DOI: https://doi.o= rg/10.33262/anatomiadigital.v5i3.2305   

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C&iacu= te;tese:

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Chuva Castillo, P., & Castillo Hidalgo, E. (2022). Leptospirosis una enferm= edad zoonótica, breve revisión de la situación en el Ecua= dor. Anatomía Digital, 5(3), 292-305. https://doi.o= rg/10.33262/anatomiadigital.v5i3.2305

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3Deditorial1.png<= span style=3D'font-family:"Times New Roman",serif;mso-fareast-font-family:"Tim= es New Roman"; mso-fareast-language:ES'>

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ANATOMÍA DIGITAL, es una Revista Electónica, Trimestral, que se publicará en soporte electrónico tiene como misión contribuir a la   formación de  profesionales competentes con visión humanística y crítica que sean capaces de  exponer&nbs= p; sus resultados  investigativos y científicos en la misma medi= da que se promueva mediante su intervención cambios positivos en = ; la sociedad. https://anatomiadigital.org  

La revista es editada por la Editorial Ciencia Digital (Editorial de prestigio registrada en la Cámara Ecuatorian= a de Libro con No de Afiliación 663) www.celibro.org.= ec

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Esta revista está protegida bajo una licencia Creative Commons AttributionNonCommercialNoDerivatives 4.0 International. Copia de la licencia: http://creativec= ommons.org/licenses/by-nc-nd/4.0/

 

Palabras claves: leptospirosis, MAT, zoonosis, seroprevalencia, Ecuador

 

Resumen

Intr= oducción: La leptospirosis como una enfermedad de carácter zoonótico en los últimos años ha  sido de gran preocupación= en el mundo siendo una enfermedad de declaración ante la OMS a me= dida del pasar de los años en ciertas zonas preferentemente las ligadas= a climas tropicales y subtropicales se ha&= nbsp; establecido que   tiene un aumento su presencia especialmente en estaciones lluviosa= s, esta bacteria causa enfermedad en varios pacientes sea animales o humanos= , y por esa causa en importante conocer su distribución y propagación. Objetivos: El objetivo principal de la presente investigación es tener un documento actualizado sobre la leptospir= osis su potencial zoonosis y el estado actual en el país Ecuador. Determinar la leptospirosis como una enfermedad zoonótica de importancia epidemiológica a nivel nacional. Conocer la distribución de la leptospirosis en cuánto a sus investigaciones a nivel nacional. Metodología: Bibliogr&aac= ute;fica para leptospirosis como enfermedad de importancia zoonótica para elaborar un documento con una actualización de esta importante, se encontraron 23 publicaciones, pero se tomaron en cuenta 13 esto con la finalidad de conocer la situación actual y real de la leptospirosi= s en el Ecuador. Resultados: Esta investigación se apreció que los casos positivos para leptospirosis utilizando cualquier técnica diagnostica se obtuvieron diversos resultados los cuales en promedio fue de 58.04% de prevalencia siendo la región costa la que presenta la mayoría de los casos. Conclusiones: La leptospirosis es una enfermedad que afecta a varias especies incluido al humano a nivel mundial, pero en nuestro país es sub considerada, se puede concluir que en todas las investigaciones que se reportan existe una alta prevalencia y la región más estudiada es la costa.

 

 

<= span style=3D'font-size:12.0pt;line-height:115%;font-family:"Times New Roman",= serif; mso-fareast-font-family:"Times New Roman";mso-fareast-language:ES'>Keywor= ds: Leptospira, MAT, cepas, seroprevalence, Ecuador.

 

 

 

Abstract

Introduction: Leptospirosis as= a zoonotic disease in recent years has been of great concern in the world b= eing a disease of declaration to the WHO as the years go by in certain areas preferably those linked to tropical and subtropical climates it has been established that its presence has an increase especially in rainy seasons,  this bacterium cau= ses disease in several patients, whether animal or human, and for that reason= it is important to know its distribution and spread.  Objectives: The main objecti= ve of this research is to have an updated document on leptospirosis, its potential zoonoses and the current state in the country Ecuador. To deter= mine leptospirosis as a zoonotic disease of epidemiological importance at the national level. To know the distribution of leptospirosis in terms of the= ir research at the national level. Methodology: Bibliographic for leptospirosis as a disease of zoonotic importance to elaborate a document with an update of this important, 23 publications were found, but 13 were considered to know the current and real situation of leptospirosis in Ecuador. Results: This investigation showed that the positive cases for leptospirosis using any diagnostic technique obtained various results which on average was de 58.04% of prevalence being the coastal region the= one that presents most of the cases. Conclusions: Leptospirosis i= s a disease that affects several species including humans worldwide, but in o= ur country, it is under consideration, it can be concluded that in all the investigations that are reported there is a high prevalence, and the most studied region is the coast.

 

 

 

 

Introducci&oac= ute;n

La leptospirosis es una enfermedad zoonótica de investigación a nivel mundial causa un importante número de casos cada  año con alta incidencia  en regiones tropicales y subtropic= ales alrededor del mundo (1), en ciertas z= onas se ha  establecido que   tiene un aumento a fines de = verano y otoño en estaciones lluviosas, con presencia de infecciones en los lugares que están expuestos a aguas estancadas o condiciones climáticas referentes a climas tropicales y subtropicales ADDIN CSL_CITAT= ION {"citationItems":[{"id":"ITEM-1","itemDa= ta":{"DOI":"10.1371/journal.pone.0227055","IS= BN":"1111111111","ISSN":"19326203","= ;PMID":"31986154","abstract":"Background Leptospirosis, caused by pathogenic Leptospira, is a zoonosis of global distribution. This infectious disease is mainly transmitted by indirect exposure to urine of asymptomatic animals via the environment. As human cas= es generally occur after heavy rain, an emerging hypothesis suggests that rain= fall re-suspend leptospires together with soil particles. Bacteria are then carr= ied to surface water, where humans get exposed. It is currently assumed that pathogenic leptospires can survive in the environment but do not multiply. However, little is known on their capacity to survive in a soil and freshwa= ter environment. Methods We conducted a systematic review on Leptospira and leptospirosis in the environment in order to collect current knowledge on t= he lifestyle of Leptospira in soil and water. In total, 86 scientific articles retrieved from online databases or institutional libraries were included in this study. Principals findings/significance This work identified evidence = of survival of Leptospira in the environment but major gaps remain about the survival of virulent species associated with human and animal diseases. Stu= dies providing quantitative data on Leptospira in soil and water are a very rece= nt trend, but must be interpreted with caution because of the uncertainty in t= he species identification. Several studies mentioned the presence of Leptospir= a in soils more frequently than in waters, supporting the hypothesis of the soil habitat and dispersion of Leptospira with resuspended soil particles during heavy rain. In a near future, the growing use of high throughput sequencing will offer new opportunities to improve our understanding of the habitat of Leptospira in the environment. This better insight into the risk of leptospirosis will allow implementing efficient control measures and preven= tion for the human and animal populations exposed.","author":[{"dropping-particle":"&qu= ot;,"family":"Bierque","given":"Emilie&q= uot;,"non-dropping-particle":"","parse-names"= :false,"suffix":""},{"dropping-particle":&quo= t;","family":"Thibeaux","given":"Ro= man","non-dropping-particle":"","parse-names&= quot;:false,"suffix":""},{"dropping-particle"= :"","family":"Girault","given":&quo= t;Dominique","non-dropping-particle":"","pars= e-names":false,"suffix":""},{"dropping-partic= le":"","family":"Soupé-Gilbert",&= quot;given":"Marie Estelle","non-dropping-particle":"","parse-na= mes":false,"suffix":""},{"dropping-particle&q= uot;:"","family":"Goarant","given":= "Cyrille","non-dropping-particle":"","pa= rse-names":false,"suffix":""}],"container-tit= le":"PLoS ONE","id":"ITEM-1","issue":"1"= ,"issued":{"date-parts":[["2020"]]},"pag= e":"1-22","title":"A systematic review of Leptospira in water and soil environments","type":"article-journal","volum= e":"15"},"uris":["http://www.mendeley.com/doc= uments/?uuid=3D73416f0e-fe22-4a70-9024-37d5d2525d37"]}],"mendeley= ":{"formattedCitation":"(2)"},"properties&quo= t;:{"noteIndex":0},"schema":"https://github.com/ci= tation-style-language/schema/raw/master/csl-citation.json"}(2). Existen tres grupos epidemiológicos de leptospirosis, el primer grupo ocurre en climas templados asociados con ganadería, el segundo grupo acontece = en áreas húmedas tropicales, donde un mayor número de serovares infecta a animales y humanos (3), debido a la existencia de reser= vorios, como roedores, caninos, bovinos y porcinos; el tercer grupo comprende la tr= ansmisión por roedores (4,5). Las genoespecies de Leptospiras se clasifican por homología del ADN, y dentro de cada especie, se emplean reacciones serológicas que identifican antígenos de superficie, para asi= gnar aislamientos a serogrupos. En la actualidad más de 250 serotipos (6)= , y se enfrentan a un crecimiento exponencial debido a su variedad genóm= ica esto ha hecho comprender la relación entre especies  y huéspedes intermediarios = y su relación con la distribución geográfica o ambiental (7). El gé= nero Leptospira ha sido previamente conocido como dos especies interrogans y bif= lexa (8), esta como sepa saprofítica con una característica de espirales que van desde 1 um hasta 20 μm. Para ser visualizadas requie= ren un campo oscuro o contrate de fases (9).

Las leptospiras crecen bajo condiciones aeróbicas de 28 a 30 °C., en medio sólido, también conocido como Ellinghausen-McCullough-J= ohnson-Harris (EMJH) (10). Pocos son los factores de virulencia que han sido descritos pa= ra Leptospira, y entre ellos están: las lipoproteínas y Heme oxigenasa 7 (HemO), La proteína del interruptor del motor flagelar (= FliY), Las proteínas involucradas en la biosíntesis de lipopolisac&a= acute;ridos (LPS), la proteína relacionada con la motilidad (FlaA2), las proteínas LigA, LigB, Lig32 y las hemolisinas, que promueven la lisi= s de eritrocitos (11).  Se ha estab= leció que las leptopirosis se distribuyen a través de la orina de los anim= ales infectaos y están en contacto con otros animales e incluso el humano= (12), por otro lad= o  la orina que  se encuentre contaminada con leptospirosis, es infecciosa para los humanos, como también para los animales (13), por lo tanto, los cuidadores, tenedores y personal que manej= e  mascotas deben tener sumo cuidado al manejar perros sospechosos de leptospirosis, utilizando siempre  como también la utilizaci&oa= cute;n de detergentes y de desinfectantes a base de yodo; las inundaciones estacionales son reconocidas como factores de riesgo para la leptospirosis humana (14).     

Huéspedes y reservorios 

Leptospira interrogan= s serovar Bratislava, tiene como huéspedes a perros, cerdos y caballos= , Leptospira interrogans serovar Can= icola y Leptospira interrogans serovar Grippotyphosa, también tienen a los perros como huéspedes (15= ). Los roedores, ganado y pequeños mamíferos como mapaches, zarigüeyas y zorrillos, a menudo están implicados como importan= tes reservorios para la leptospirosis (16), se sabe que las ratas son los que portan varias especies y serovares de Leptospira y pueden infectar tanto animales como humanos siendo la especie más común la rata sal= vaje (rattus spp) y otras especies como la rata noruega y la rata o marró= n (17).

Transmisión 

La enfermedad de Leptospira se puede transmitir de dos maneras; la transmisión directa es cuando existe un contacto directo  con orina infectada, transferencia venérea y placentaria, heridas por mordedura o ingestión de tejidos infectados, la transmisión indirecta  se da mediante un contacto  con fuentes de agua contaminada, su= elo y comida (18), con factores= que favorecen su crecimiento como pH de  suelo con pH 5.0 a 5.5, y las temperaturas ambientales entre 0 = 0C y 25 0C., favorecen la supervivencia de las leptospiras, mientras que la congelación, deshidratación y la exposición a la radiación ultravioleta disminuyen notablemente la supervivencia (19)= .  

Diagnóstico de laboratorio 

En el diagnóstico se establecen varias metodologías siendo las m= ás utilizadas para la detección de Leptospiras técnicas, como: anticuerpos fluorescentes, técnicas de impregnación de plata; Reacción cadena polimerasa (PCR) cuantitativo en tiempo real, pruebas serológicas como la prueba de microaglutinación (6).  En determinados países, están utilizando una serie de ensayos por inmunoabsorción lig= ado a enzimas (ELISA) (20), basadas en serotipos que predominan en la región, en la cual van a utilizar la indicada prueba, en la actualid= ad el método gold estándar es la prueba de MAT esto se debe tomar d= os muestras seriadas con un intervalo de 10 días y comparar la titulaci= ón observando un incremento de hasta 4 veces en sus anticuerpos (21).

Tratamiento para leptospirosis canina 

En general el tratamiento para leptospirosis está basado en antibióticos los más utilizados son penicilinas de benzilo po= r 7 días en dosis de 15mg a 25 mg, puede mejorar la sintomatología en cambio = para esta contraindicado el uso de tetracaínas en enfermedad renal (22),  El tratamiento para leptospirosis c= anina es en base de 20 mg de ampicilina, por kilogramo de peso vía intravenosa, cada 6 horas, y con reducción de dosis para los perros azotémicos (23), la ampicilina no puede ser administrada por v&iacut= e;a oral, porque no es absorbido confiablemente por el tracto gastrointestinal; también puede ser utilizada la penicilina G, en dosis de 25000 - 400= 00 U/kg IV, cada 12 horas (24), los perros deben recibir doxiciclina durante 2 semanas, después que los signos gastrointestinales disminuyan, con el fin de eliminar los microorganismos de los túbulos renales (25).   

Medidas de prevención y control para leptospirosis canina<= /i>

Dentro de las medidas de prevención la vacunación generalmente previ= ene la enfermedad (26). Dentro de es= to las vacunas comerciales que proporcionan protección contra leptospirosis= han sido utilizadas cuando se ha identificado las principales variantes (27); l= as vacunas con procedimientos recombinantes han mostrado resultados eficientes= (19). El control de la leptospirosis canina dependerá de la higiene del entorno, mediante la eliminación de los roedores, control de reservorios, como también manteniendo un control sanitario en las mascotas (28). El uso de sistemas de georeferencia (SIG) y el anális= is estadístico espacial, son métodos que  en el campo de la salud permiten establecer y asociar  ambiente= s y reproducción de la leptospirosis(29), ya que  está íntimamente relacionado las características ecológicas de la leptospirosis con  el  medio ambiente, dando un aná= ;lisis completo y estableciendo las zonas de mayor incidencia de la enfermedad permitiendo la participación de los distintos profesionales en el ámbito de salud humana y animal para así tomar medidas de prevención (29).

Metodolog&iacu= te;a

Bibliográfica para leptospirosis como enfermedad de importancia zoonótica para elaborar un documento con una actualización de esta importante enfermedad  tomando en cuenta = los hallazgo clínicos, de laboratorio, sus factores de riegos, su tratamiento como control y conocer la realidad en el Ecuador, para el efect= o se obtuvieron publicaciones de revistas electrónicas como Pudmed, Sciel= o, Google académico y revistas de libre acceso principalmente de los últimos años, se encontraron 23 publicaciones pero se tomaron= en cuenta 13 esto con la finalidad de conocer la situación  actual y real de la leptospirosis = en el Ecuador.

Resultados y D= iscusión

Para la presente investigación se tomó en cuenta artículos = de revista de acceso gratuito principalmente encontraron 23 publicaciones pero= se tomaron en cuenta 13 artículos los cuales fueron los que tení= an datos de prevalencia o seroprevalencia,&nb= sp; Esta investigación se apreció que los casos positivos = para leptospirosis utilizando cualquier técnica diagnostica se obtuvieron diversos resultados los cuales en  promedio fue de 58.04%  de prevalencia siendo la región costa la que presenta la mayoría= de casos, esto debido a que es la zona con mayor número de investigacio= nes 10 en total de las 13 que se tomaron en cuenta , las cepas con mayor presen= cia son la L. pomona y L. icterohaemorrhagiae  que se presentan mayormente  en bovinos, la L. canicola, L h= ardjo en perros, la L. icterohaemorrhagiae en ratas, y la L. wolffi= en fauna exótica, tambien  se describen L. Gripptyphosa, L. = borgpeterseniiL kirschneriiL santarosaiLint= errogansL noguchiiL. clado wolffii que se describen en las investigaciones consult= adas pero con menor presencia de titulación.  

La leptospirosis siendo una zoonosis de importancia a nivel mundial y su prese= ncia merece una atención epidemiológica (30),  en el Ecuador esta enfermedad ha es= tado investigada en cuanto a su prevalencia teniendo como resultados que las principales ciudades donde se ha  establecido  la mayoría de las publicaci= ones son de la región costa (31), en donde se establece una alta seroprevalencia, así en un estudio de seroprevalencia de leptospiros= is realizado por Pérez y Equihua en el 2020 en un centro de rescate de la ciudad = de Guayaquil-Ecuador donde se encontraban varios animales de distintas especie= s  se sometieron al estudio  mediante la técnica de MAT en donde se evaluó la seroprevalencia  estableciendo que todos los animale= s eran positivos a uno o varios serovares con niveles de titulación superio= res a 1/200 hasta 1/3200, y que los principales serovares encontrados fueron L.= canícola 24/29 (82.8%), L. Hardjo 21/29 (72.4%) e Icterohaemorrhagiae 19/29 (65.5%), mientras que en animales salvajes o fauna silvestre el serovar presente es = L.  Wolfii 4/6  (66.7%) (32). En un estudio realizado en las parroquias de Tarqui, Cumbe y Victoria del Portete del cantón Cuenca en Bovinos de los autores Chicaiza & Crespo, 1988 identificaron solo en la parroquia Tarqui de 127 animales se identific&oacu= te; una prevalencia del 27%, siendo la de mayor presencia L. Sejroe , L, Hardjo= , L, Wolfi (33), mientras que Chuva y Yunga (2019) mencionan que en un estudio realizado en la parroquia Tarqui del cantón Cuenca,  en 249 perros estudiados se encontró un 61,8 % de casos positivos, siendo Tutupali Chico la comunidad con mayor presencia de la enfermedad (77,6%), Centro Parroquial (63,2%) y Gullanzhapa (45,5%).siendo el serovar L. Canicola el de mayor presencia y de mayor titulación 1/600, se estableció que 154 sueros eran  positivos con 1 o varios  serovares (34). Mientr= as que Calero Y Monti en una investigación donde evalúan al sistema = de monitoreo que establece el Ecuador para la vigilancia de leptospirosis dond= e se establece que la región con un alto índice es la región Costa con una mediana de 0,85% (IC 95% 0,41–0,99), mientras que la región oriental con una mediana de 0,54% (IC 95% 0,18– 0,99) y= la región sierra con una mediana 0.29 % (IC 95% 0,02-0,89). También establece = que la “Asistencia o probabilidad de acudir a un centro de salud” y “Probabilidad de tener síntomas”, fueron los criterios p= rincipalmente que influyeron (35).  En tanto Barragan et al. en el 2016= (36), determinaron en dos comunidades rurales de la región costa de Ecuado= r donde identificaron Leptospira ssp en pacientes humanos que presentaban fiebre   utilizando PCR en tiempo real y secuenciación de amplicones (14.7% de presencia) en donde pudieron d= eterminar las especies (L.&nb= sp;borgpeterseniiL kirschneriiL santarosaiLint= errogansL noguchiiL. clado wolffii).

En cuanto al nivel de conocimiento por parte de las personas vinculadas a la cadena de producción animal se evaluó mediante un estudio realizado en Manabí provincia del Ecuador en el año del 2019 = por Burgos et al. (37), indican que el 63,02 % tiene conocimiento de la enferme= dad mientras que el 36,02 % no la conoce esto vinculado principalmente a nivel = de educación (nivel superior 67%), sexo (hombre 63%.), y profesió= ;n (médicos veterinarios 2.04 mayor conocimiento que un ganadero).

 En un estudio sobre los puntos críticos de leptospirosis  en los Estados Unidos de América, en el cual  se obtuvieron  de 14 años de datos de leptospirosis en 3109 condados, y se  analizaron las condiciones medioambientales, como también los aspectos socio-económico, y luego, los correlacionaron con las tasas= de infección, con el fin de elaborar un mapa con los puntos de mayor ri= esgo de leptospirosis canina, encontraron que, la infección está principalmente influenciada por el medio ambiente y el uso de la tierra (38= ).

Conclusiones  = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;  

·= ;      =    La leptospirosis es una enfermedad que afecta a varias especies incluido al humano a nivel  mundial, pero en nuestro paí= s es sub considerada, se puede concluir que en todas las investigaciones que se reportan existe una alta prevalencia y la región más estudiad= a es la costa, y en otras regiones se investiga pero de manera más reserv= ada para  sin embargo la estrategi= a de control por parte del organismo de vigilancia epidemiologia  se enfoca al diagnóstico y tratamiento mas no a la erradicación y control principalmente, es de= cir que en el Ecuador no existe conciencia sobre la potencial zoonosis de esta enfermedad por lo que es importante que la comunidad científica, profesionales y personas vinculadas con el manejo de animales y desechos conozcan más esta enfermedad   que en cuanto a la Leptospira es una enfermedad de importancia tanto para cuidadore tenedores y profesionales (3= 9),  que tiene un contacto directo con animales que3 pueden estar infectados,  Se ha establecido que no es necesar= io que un animal presente síntomas o enferme para presentar la enfermedad (= 40), por lo que se debe tener todas las medidas de protección inocuidad y bioseguridad al momento de manejar animales especialmente sus desechos (41)= .

Recomendacione= s

·= ;      =    En países desarrollados la lept= ospirosis ha sido un problema epidemiológico en donde se ha tomado acció= ;n por parte de entidades competentes estableciendo datos a través de diversos estudios espaciales y estadísticos, En este aspecto es importante conocer la realidad local y nacional y establecer medidas de con= trol enfocadas a la salud pública.

·= ;      =    En cuanto a la vacunación se de= be establecer las cepas de leptospirosis que existen en el medio y así poder estab= lecer un control y no introducir nuevas variedades de cepas.

·= ;      =    Existe vacunación en cuanto a mascotas específicamente perros que son los principales portadores y= que pueden transmitir a personas debió a su potencial zoonótico p= ero esto se ha visto limitado ya sea por el desconocimiento de los propietarios= por los costos que representa llevar a una macota al veterinario presentes en c= ada región. Las cepas que están en el mercado nacinla son la L, canicola, L Interrogans, L Gryptopitosa, L Pomona.

 

Referencias Bibliográficas

=

1.&n= bsp;      Lau, C. L., Mayfield, H. J., Lowry, J. H., Watson, C. H., Kama, M., Nilles, E. J= ., & Smith, C. S.; Unravelling infectious disease eco-epidemiology using Bayesian networks and scenario analysis: A case study of leptospirosis in F= iji. Environmental Modelling and Software, 97, 271–286. (2017= ). https://doi.or= g/10.1016/j.envsoft.2017.08.004

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El artículo que se publica es de exclusi= va responsabilidad de los autores y no necesariamente reflejan el pensamiento = de la Revista Anatomía Digital= .

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El artículo queda en propiedad de la revista y, por tanto, su publicación parcial y/o total en otro medio tiene que ser autorizado= por el director de la Revista Anatomía Digital.=

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        =             &nb= sp;            =      Evolución        =                    P&aac= ute;gina1 ------=_NextPart_01D8C2FA.97E13140--