César Ramal Asayag

Hospital Regional de Loreto · Loreto, Peru

Background Neurological opportunistic infections cause significant morbidity and mortality in people with human immunodeficiency virus (HIV) but are difficult to diagnose. Methods One hundred forty people with HIV with acute neurological symptoms from Iquitos, Peru, were evaluated for cerebral toxoplasmosis with quantitative polymerase chain react...

Background The study of the etiology of acute febrile illness (AFI) has historically been designed as a prevalence of pathogens detected from a case series. This strategy has an inherent unrealistic assumption that all pathogen detection allows for causal attribution, despite known asymptomatic carriage of the principal causes of acute febrile illn...

Background: The study of the etiology of acute febrile illness (AFI) has historically been designed as a prevalence of pathogens detected from a case series. This strategy has an inherent unrealistic assumption that all pathogen detection allows for causal attribution, despite known asymptomatic carriage of the principal causes of acute febrile ill...

Background There is a need to evaluate antibiotic use, duration of therapy and stewardship in low- and middle-income countries to guide the development of appropriate stewardship programs that are global in scope and effectively decrease unnecessary antibiotic use. Methods We prospectively collected information on illness occurrence and antibiotic...

Background Diagnosis of toxoplasmic encephalitis (TE) is challenging under the best clinical circumstances. The poor clinical sensitivity of quantitative polymerase chain reaction (qPCR) for Toxoplasma in blood and CSF and the limited availability of molecular diagnostics and imaging technology leaves clinicians in resource-limited settings with fe...

Background Diagnosis of toxoplasmic encephalitis (TE) is challenging under the best clinical circumstances. The poor sensitivity of quantitative polymerase chain reaction (qPCR) for Toxoplasma in blood and CSF and the limited availability of molecular diagnostics and imaging technology leaves clinicians in resource-limited settings with few options...

Se presentan dos casos de pacientes, naturales de Requena, ciudad a 160 Km al suroeste de Iquitos, departamento de Loreto, selva baja, con síntomas moderados de COVID-19, quienes fueron inyectados con ivermectina de uso veterinario por vía subcutánea en el hombro, como parte de un tratamiento que pudiera tener cierto efecto benéfico sobre la enferm...

Background: HIV-related incidence and mortality is increasing across Peru, with highest mortality rates recorded in the Amazonian region of Loreto. This epidemic is concentrated in men who have sex with men, a population with 14% HIV treatment adherence despite free national provision. This study investigates barriers and facilitators to following...

Background HIV-related incidence and mortality is increasing across Peru, with highest mortality rates recorded in Amazonian region of Loreto. This epidemic is concentrated in men who have sex with men, a population with 14% HIV treatment adherence despite free national provision. This study investigates barriers and facilitators to following healt...

Background HIV-related incidence and mortality is increasing across Peru, with highest mortality rates recorded in Amazonian Loreto. This epidemic is concentrated in MSM, a population with 14% HIV treatment adherence despite free national provision. This study investigates barriers and facilitators to following healthcare advice through experiences...

Background HIV-related incidence and mortality is increasing across Peru, with highest mortality rates recorded in Amazonian Loreto. This epidemic is concentrated in men who have sex with men, a population with 14% HIV treatment adherence despite free national provision. This study investigates barriers and facilitators to following healthcare advi...

Background Transmission of dengue virus (DENV) from humans to mosquitoes represents a critical component of dengue epidemiology. Examinations of this process have generally been hampered by a lack of methods that adequately represent natural acquisition of DENV by mosquitoes from humans. In this study, we assessed artificial and natural blood feedi...

Data summary of mosquito blood feeding experiments on 58 human participants. DoI = Day of illness; Viremia (log 10) expressed in FFU/ml, IR = infection rate (PCR+ bodies/total tested); DR = Dissemination rate (PCR+heads/PCR+bodies), SC = Disease Severity category (1 = mild, 4 = hospitalized, 2–3 = intermediate scores (see methods), and EXP = expose...

Description of final data cleanup for statistical analysis. Explains participants from S1 Table that were excluded from statistical analysis. (DOCX)

Here we report the first incidence of New Delhi metallo-β-lactamase (NDM-1)-producing Acinetobacter baumannii in Peru, identified via a strain-based nosocomial surveillance project carried out in Lima and Iquitos. The blaNDM-1 gene was detected by multiplex polymerase chain reaction (PCR) and confirmed by loci sequencing. Acinetobacter baumannii is...

Probiotics are increasingly used for diarrhea, but studies under FDA IND are few. We conducted a phase-one placebo-controlled study of Lactobacillus reuteri DSM 17938 under IND in 60 children 2-5 years of age (41 L. reuteri, 19 placebo) in a resource constrained community in Peru. No differences in objective data on adverse events were noted, altho...

Quantitative polymerase chain reaction (qPCR) for Toxoplasma gondii multicopy genes has emerged as a promising strategy for sensitive detection of parasite DNA. Quantitative polymerase chain reaction can be performed from blood samples, which are minimally invasive to collect. However, there is no consensus about what type of blood specimen yields...

Background: Delays in receiving adequate care for children suffering from pneumonia can be life threatening and have been described associated with parents' limited education and their difficulties in recognizing the severity of the illness. The "three delays" was a model originally proposed to describe the most common determinants of maternal mor...

Diffuse multibacillary leprosy of Lucio and Latapí is mainly reported in Mexico and Central America. We report a case in a 65-year-old man in Peru. He also had Lucio’s phenomenon, characterized by vascular thrombosis and invasion of blood vessel walls by leprosy bacilli, causing extensive skin ulcers. © 2017, Centers for Disease Control and Prevent...

Early childhood enteric infections have adverse impacts on child growth and can inhibit normal mucosal responses to oral vaccines, two critical components of environmental enteropathy. To evaluate the role of indoleamine 2,3-dioxygenase 1 (IDO1) activity and its relationship with these outcomes, we measured tryptophan and the kynurenine-tryptophan...

Mayaro virus (MAYV), an alphavirus similar to chikungunya virus (CHIKV), causes an acute debilitating disease which results in the development of long-term arthralgia in more than 50% of infected individuals. Currently, the immune response and its role in the development of MAYV-induced persistent arthralgia remain unknown. In this study, we evalua...

El dengue ha afectado a Iquitos desde 1990 causando varios brotes de gran impacto en la salud pública y por el que se desplegaron grandes esfuerzos para su control temporal. Actualmente, ante la expansión del virus chikungunya en las Américas y la amenaza de la emergencia del virus en Iquitos, reflexionamos a modo de lecciones aprendidas las activi...

Dengue has affected Iquitos since 1990 causing outbreaks of major impact on public health and for this reason great efforts have been made for its temporal control. Currently, with the expansion of the chikungunya virus in the Americas and the threat of the emergence of the virus in Iquitos, we reflect on lessons learned by way of the activities un...

The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort study communities in Peru are located in Loreto province, in a rural area 15 km from the city of Iquitos. This riverine population of approximately 5000 individuals is fairly representative of Lore...

Introduction Long-term disease surveillance data provide a basis for studying drivers of pathogen transmission dynamics. Dengue is a mosquito-borne disease caused by four distinct, but related, viruses (DENV-1-4) that potentially affect over half the world's population. Dengue incidence varies seasonally and on longer time scales, presumably driven...

During 2010-2013, we recruited 16 persons with confirmed Mayaro virus infection in the Peruvian Amazon to prospectively follow clinical symptoms and serologic response over a 12-month period. Mayaro virus infection caused long-term arthralgia in more than half, similar to reports of other arthritogenic alphaviruses.

Signs and symptoms in patients with Mayaro virus infection at the acute-phase visit and each follow-up visit, Amazon Basin region, Peru, 2010–2013.

Dengue fever is the world's most important arboviral disease, presenting a wide clinical spectrum. We report for the first time in Peru, a case caused by dengue virus serotype 4 with significant gastrointestinal involvement (acute acalculous cholecystitis and acute hepatitis). In addition we carried out a review of the literature atypical presentat...

El dengue es la arbovirosis más importante del mundo y causa un amplio espectro clínico. Presentamos el primer caso de dengue causado por el serotipo 4 (DENV-4) en Perú con compromiso gastrointestinal (colecistitis aguda alitiásica y hepatitis aguda moderada). Se presenta una revisión de la literatura médica sobre este tipo de presentación, enfatiz...

Dengue fever is the world's most important arboviral disease, presenting a wide clinical spectrum. We report for the first time in Peru, a case caused by dengue virus serotype 4 with significant gastrointestinal involvement (acute acalculous cholecystitis and acute hepatitis). In addition we carried out a review of the literature atypical presentat...

Long-lasting insecticidal net (LLIN) use is a proven malaria prevention method. Mass distribution has greatly expanded LLIN access in sub-Saharan Africa, but a gap remains between LLIN ownership and use. Furthermore, LLINs wear out more quickly than anticipated. This paper suggests a participatory research strategy-trials of improved practices (TIP...

Se describe el caso de un paciente varón, de 13 años de edad, procedente de la ciudad de Iquitos con cuadro clínico de Dengue y que cumplía con los criterios de dengue hemorrágico. La gravedad de este caso de dengue hemorrágico fue de grado II. El diagnóstico fue confirmado por serología. El serotipo encontrado fue el tres. Este es el primer caso d...

The study objective was to investigate an acute case of Chagas disease in the San Pedro de Shishita community, Pebas District, in the Peruvian Amazon basin, a non-endemic area. Both parents of the index case (acute case) were thoroughly interviewed, a seroepidemiological survey was carried out in the community, parasitological exams were carried ou...

Objectives. To explore the relationship between climatic variables with the transmission of malaria in Loreto, in a period of 13 years. Material and methods. Ecological study was conducted with data from the monthly average temperature (° C), relative humidity (%), precipitation (mm) and the level of the Amazon River (meters), with cases of malaria...

Objectives. To explore the relationship between climatic variables with the transmission of malaria in Loreto, in a period of 13 years. Material and methods. Ecological study was conducted with data from the monthly average temperature (º C), relative humidity (%), precipitation (mm) and the level of the Amazon River (meters), with cases of malaria...

An 8-year-old girl from the rural eastern Amazon depart- ment of Loreto presented to her local health post with a 1-week history of fever, headache, and poorly localized ab- dominal discomfort. At the health post, the child had a tem- perature of 39°C. A thick smear was obtained, and the patient was started on chloroquine after parasites were obser...

Introducción: la malaria es una enfermedad parasitemia endémica en el norte del Perú tanto a nivel de la costa como de la selva. El conocimiento sobre la incidencia de malaria en gestantes, de malaria congénita y algunas variables asociadas, es aún escaso.Objetivo: determinar la incidencia acumulada de malaria en gestantes en un periodo de 15 meses...

Introducción: la malaria es una enfermedad parasitaria causada por esporozoitos de Plasmodium. La Norma Técnica de Malaria y Malaria Grave en el Perú refiere que la búsqueda e identificación del febril es la actividad primordial, básica e inicial de la atención curativa ya que permite la identificación precoz del caso. Objetivo: evaluar la utilidad...

En: Rev Perú Med Exp Salud Pública 2005; 22 (1). El presente estudio busca evaluar la capacidad del Ministerio de Salud (MINSA) para el diagnóstico y tratamiento oportuno de la malaria en las comunidades periféricas de la ciudad de Iquitos. Para ello en el año 2001 se entrevistó a pacientes febriles atendidos por promotores de salud debido a la sos...

Epidemic malaria has rapidly emerged in Loreto Department, in the Peruvian Amazon region. Peru reports the second highest number of malaria cases in South America (after Brazil), most from Loreto. From 1992 to 1997, malaria increased 50-fold in Loreto but only fourfold in Peru. Plasmodium falciparum infection, which has increased at a faster rate t...

Epidemic malaria has rapidly emerged in Loreto Department, in the Peruvian Amazon region. Peru reports the second highest number of malaria cases in South America (after Brazil), most from Loreto. From 1992 to 1997, malaria increased 50-fold in Loreto but only fourfold in Peru. Plasmodium falciparum infection, which has increased at a faster rate t...

Introduction: In February 2000 an outbreak of malaria ocurred in Nuevo Pevas, a town with ten years of establishment situated in the district of Pevas, Loreto. Objective: To describe the characteristics of the outbreak of malaria in the village of Nuevo Pevas and the actions developped for its control. Methods: Once the outbreak was reported and ve...