Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 5 uppsatser.

Thesis (Ph.D.)--University of Alabama at Birmingham, 2008. / Title from PDF title page (viewed on July 12, 2010). Includes bibliographical references (p. 131-148).

“Cartas al editor” / Revisión por pares

Orientador: Maria de Lourdes Ribeiro de Souza da Cunha / Resumo: Diante da importância de S. aureus resistente à meticilina (Methicillin-resistant Staphylococcus aureus - MRSA) em feridas, este estudo objetivou estudar a prevalência, fatores de risco e epidemiologia molecular de S. aureus coletados de feridas e narinas de pacientes atendidos nas 17 Unidades Básicas de Saúde do município de Botucatu-SP, Brasil. Após a identificação dos isolados de S. aureus, foram realizados: teste de susceptibilidade à 13 drogas antimicrobianas, identificação do gene de resistência (mecA) e dos genes codificadores da Leucocidina PantonValentine- PVL (pvl), enterotoxinas A-E (sea, seb, sec, sed, e see), hemolisinas α, β e δ (hla, hlb e hld), esfoliatinas A, B e D (eta, etb e etd), biofilme (icaAD) e Toxina-1 da Sindrome do choque tóxico - TSST-1 (tst); tipagem molecular por Pulsed-Field Gel Eletroforese (PFGE), Multilocus sequence typing (MLST) e spa typing. Foram incluídos 171 pacientes, dos quais foram isolados 119 S. aureus. Amostras nasais foram coletadas apenas em 74 pacientes do total estudado. A prevalência de S. aureus e MRSA foi de 51,5% e 8,7%, respectivamente. No geral foram isolados 101 MSSA de 73 pacientes, destes 98 foram isolados de feridas e 21 de narinas; e 18 MRSA de 15 pacientes, sendo 4 isolados de narinas e 14 de feridas, com 6 MRSA com SCCmec tipo II e 12 com SCCmec tipo IV. Os isolados mostraram alto nível de resistencia a penicilina (85%), seguido pela eritromicina (27%), gentamicina (12%), clindamicina (11%), e levofloxacina (6%). N... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Given the importance of methicillin resistant S. aureus (Methicillin-resistant Staphylococcus aureus - MRSA) and wounds, this study aimed to study the prevalence, risk factors and molecular epidemiology related to the presence of S. aureus sensitive and resistant to methicillin in wounds of patients who attended BHUs in a city in Sao Paulo state, Brazil. After the identification of S. aureus isolates was performed: susceptibility testing to 13 antimicrobial drugs, identification of the resistance gene (mecA) and the genes encoding Panton-Valentine Leukocidin - PVL (pvl), enterotoxins AE (sea, seb, sec, sed and see) hemolysins α, β and δ (hla, hlb and hld), esfoliatinas A, B and D (eta, etb and etd), biofilm (icaAD) and Toxin-1 syndrome of toxic shock - TSST-1 (tst); Molecular typing by Pulsed-Field gel electrophoresis (PFGE), multilocus sequence typing (MLST) and spa typing. 171 patients were included and 119 S. aureus isolates. Nasal samples were collected only in 74 patients of the total sample. The prevalence of S. aureus and MRSA was 51.5% and 8.7%, respectively. Overall 101 MSSA were isolated from 73 patients, 98 of these were isolated from wounds and 21 nostrils; MRSA and 18 of 15 patients, 4 isolates from nostrils and 14 wounds, with six MRSA with SCCmec type II and 12 SCCmec type IV. The strains showed high-level resistance to penicillin (85%) followed by erythromycin (27%), gentamicin (12%), clindamycin (11%) and levofloxacin (6%). There was no resistance to sulfame... (Complete abstract click electronic access below) / Doutor

Background The burden of non-communicable diseases (NCDs) is rapidly increasing globally, and particularly in Africa, where the health focus, until recently, has been on infectious diseases. The response to this growing burden of NCDs in Africa has been affected owing to a poor understanding of the burden of NCDs, and the relative lack of data and low level of research on NCDs in the continent. Recent estimates on the burden of NCDs in Africa have been mostly derived from modelling based on data from other countries imputed into African countries, and not usually based on data originating from Africa itself. In instances where few data were available, estimates have been characterized by extrapolation and over-modelling of the scarce data. It is therefore believed that underestimation of NCDs burden in many parts of Africa cannot be unexpected. With a gradual increase in average life expectancy across Africa, the region now experiencing the fastest rate of urbanization globally, and an increase adoption of unhealthy lifestyles, the burden of NCDs is expected to rise. This thesis will, therefore, be focussing on understanding the prevalence, and/or where there are available data, the incidence, of four major NCDs in Africa, which have contributed highly to the burden of NCDs, not only in Africa, but also globally. Methods I conducted a systematic search of the literature on three main databases (Medline, EMBASE and Global Health) for epidemiological studies on NCDs conducted in Africa. I retained and extracted data from original population-based (cohort or cross sectional), and/or health service records (hospital or registry-based studies) on prevalence and/or incidence rates of four major NCDs in Africa. These include: cardiovascular diseases (hypertension and stroke), diabetes, major cancer types (cervical, breast, prostate, ovary, oesophagus, bladder, Kaposi, liver, stomach, colorectal, lung and non-Hodgkin lymphoma), and chronic respiratory diseases (chronic obstructive pulmonary disease (COPD) and asthma). From extracted crude prevalence and incidence rates, a random effect meta-analysis was conducted and reported for each NCD. An epidemiological model was applied on all extracted data points. The fitted curve explaining the largest proportion of variance (best fit) from the model was further applied. The equation generated from the fitted curve was used to determine the prevalence and cases of the specific NCD in Africa at midpoints of the United Nations (UN) population 5-year age-group population estimates for Africa. Results From the literature search, studies on hypertension had the highest publication output at 7680, 92 of which were selected, spreading across 31 African countries. Cancer had 9762 publications and 39 were selected across 20 countries; diabetes had 3701 publications and 48 were selected across 28 countries; stroke had 1227 publications and 19 were selected across 10 countries; asthma had 790 publications and 45 were selected across 24 countries; and COPD had the lowest output with 243 publications and 13 were selected across 8 countries. From studies reporting prevalence rates, hypertension, with a total sample size of 197734, accounted for 130.2 million cases and a prevalence of 25.9% (23.5, 34.0) in Africa in 2010. This is followed by asthma, with a sample size of 187904, accounting for 58.2 million cases and a prevalence of 6.6% (2.4, 7.9); COPD, with a sample size of 24747, accounting for 26.3 million cases and a prevalence of 13.4% (9.4, 22.1); diabetes, with a sample size of 102517, accounting for 24.5 million cases and a prevalence of 4.0% (2.7, 6.4); and stroke, with a sample size of about 6.3 million, accounting for 1.94 million cases and a prevalence of 317.3 per 100000 population (314.0, 748.2). From studies reporting incidence rates, stroke accounted for 496 thousand new cases in Africa in 2010, with a prevalence of 81.3 per 100000 person years (13.2, 94.9). For the 12 cancer types reviewed, a total of 775 thousand new cases were estimated in Africa in 2010 from registry-based data covering a total population of about 33 million. Among women, cervical cancer and breast cancer had 129 thousand and 81 thousand new cases, with incidence rates of 28.2 (22.1, 34.3) and 17.7 (13.0, 22.4) per 100000 person years, respectively. Among men, prostate cancer and Kaposi sarcoma closely follows with 75 thousand and 74 thousand new cases, with incidence rates of 14.5 (10.9, 18.0) and 14.3 (11.9, 16.7) per 100000 person years, respectively. Conclusion This study suggests the prevalence rates of the four major NCDs reviewed (cardiovascular diseases (hypertension and stroke), diabetes, major cancer types, and chronic respiratory diseases (COPD and asthma) in Africa are high relative to global estimates. Due to the lack of data on many NCDs across the continent, there are still doubts on the true prevalence of these diseases relative to the current African population. There is need for improvement in health information system and overall data management, especially at country level in Africa. Governments of African nations, international organizations, experts and other stakeholders need to invest more on NCDs research, particularly mortality, risk factors, and health determinants to have evidenced-based facts on the drivers of this epidemic in the continent, and prompt better, effective and overall public health response to NCDs in Africa.

Made available in DSpace on 2016-08-15T20:31:26Z (GMT). No. of bitstreams: 1 Ana Carla Diogenes Suassuna Bezerra.pdf: 4743309 bytes, checksum: 21a42c884d2564a7d3ec54fe73b2d368 (MD5) Previous issue date: 2007-05-02 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / significant loss in the productive of the flock. Have been examined 15 establishments of reform agrarian in the period between august 2005 at november 2006, with objective of identify ectoparasites the of goat and sheep. After the animal s exam, was proceeded the scraped, exam direct of fur and collect of pavilion headphone. Of the 494 goat inspect, 89.87% had positive, while 76.72% sheep. The arthropods identified in goat was: Damalinia caprae (89.87%), Rhipicephalus microplus (1.01%), furthermore, the larvae of Cochliomyia hominivorax (0.4%), Psoroptes cuniculi (0.4%), and Ctenocephalides felis (3.23%), Amblyomma parvum (1.01%) and Linognathus stenopsis (0.2%), that for the first time examine this specie within of the Nordeste s brasilian. And several multiparasitism of the D. caprae with R. microplus (0.46%) and P. cuniculi with D. caprae (0.23%). In sheep D. caprae with R. microplus (0.46%)p was found D. ovis (74.5%), R. microplus (0.86%), larvae of C. hominivorax (0.43%) and A. parvum (0.43%) was resisted in fist time, into species, within of the region Nordeste s Brazil being added, the association of D. ovis with R. microplus (0.56%). In relation to the sex and old animals, haven t association (p>0.05). In roll to the period year, have difference (p<0.05), with epoch drought to demonstrating big prevalence (82.15%). To return important the development of studies to evaluate your important as factor limit for production animals / Os caprinos e ovinos apresentam uma diversidade de ectoparasitos que podem resultar perdas consideráveis na produtividade desses animais. Foram visitados 15 assentamentos de reforma agrária, de agosto de 2005 a novembro de 2006, com o objetivo de identificar ectoparasitas de caprinos e ovinos, onde procedeu-se realização de raspados, exames diretos e coletas de exsudato do pavilhão auricular. Dos 494 caprinos examinados, 89,87% apresentaram ectoparasitos, e 76,72% dos ovinos. Os artrópodes identificados em caprinos foram: Damalinia caprae (80,76%), Rhipicephalus microplus (1,01%), larvas de Cochliomyia hominivorax (0,6%), Psoroptes cuniculi (0,4%), além de Ctenocephalides felis (3,23%), Amblyomma parvum (1,01%) e Linognathus stenopsis (0,2%), que pela primeira vez foram descritos no Nordeste brasileiro. E parasitismo misto de D. caprae com R. microplus (0,46%) P. cuniculi com D. caprae (0,23%). Em ovinos foram D. ovis (74,5%), R. microplus (0,86%), larvas de C. hominivorax (0,43%) e A. parvum (0,43%), que foi registrado pela primeira vez, nessa espécie, no Nordeste do Brasil. Além, da associação de D. ovis com R. microplus (0,56%). No que concerne ao sexo e a idade, não houve associação (p>0,05). Em relação ao período do ano, houve diferença (p<0,05), com a época seca demonstrando maior prevalência (82,15%). Torna-se importante o desenvolvimento de estudos para avaliar a sua importância como fator limitante à produção animal

Master of Public Health / Department of Diagnostic Medicine and Pathobiology / Robert Larson / Among animal products consumed by humans, ground beef has been reported as one of the most common vehicles for STEC outbreaks in humans. In the United States, cull dairy cattle contribute as one of the primary sources for ground beef. The objective of this study was to determine the prevalence and concentration of 7 Shiga toxin-producing Escherichia coli serogroups (STEC-7; O26, O103, O111, O121, O45, O145, and O157) and associated virulence genes (Shiga toxin 1 and 2 (stx1, stx2), intimin (eae), and enterohomolysin (ehxA)) in the feces of cull dairy cattle processed in commercial slaughter plants during summer months. Fecal swab samples (n=183) were collected from three processing plants, one in California and two in Pennsylvania. At each plant at least 60 to 65 cattle were selected, and the samples were obtained by swabbing the mucosal surface of the recto-anal junction using a sterile cotton-tipped applicator. To determine prevalence, all samples were subjected to culture-based detection methods that included enrichment, serogroup-specific immunomagnetic separation and plating on selective media, followed by polymerase chain reaction for serogroup confirmation and virulence gene detection. Pre-enriched fecal samples were subjected to spiral plating to determine the concentration of STEC-7. A sample was considered STEC positive if a recovered isolate harbored one of the 7 target O genes, stx1, and/or stx2. Of the 183 fecal swab samples collected, 23 (12.6%) harbored at least one O157, O26, O103, or O111 serogroup, with their associated virulence genes. However, none of the fecal samples from this cattle population carried STEC at high-levels (>10⁴ CFU/g). This study has provided important information on STEC-7 prevalence from dairy cattle that enter the ground beef processing system. However, there is still a need to determine prevalence and concentration of STEC in cull dairy cattle during winter months as well as in other sources of ground beef production (e.g., imported lean beef, cull beef).

maria.cristina.rc2690@gmail.com / Article / Introduction: There is limited and controversial information regarding the potential impact of depression on glycemic control. This study aims to evaluate the association between depression and poor glycemic control. In addition, the prevalence of depression and rates of poor glycemic control were determined. Methods: Cross-sectional study performed in the endocrinology unit of two hospitals of ESSALUD in Peru. The outcome of interest was poor glycemic control, evaluated by glycated hemoglobin (HbA1c: < 7% versus ≥ 7%), whereas the exposure of interest was depression defined as 15 or more points in the Patient Health Questionnaire-9 tool. The association of interest was evaluated using Poisson regression models with robust standard errors reporting prevalence ratios (PR) and 95% confidence intervals (95% CI) adjusting for potential confounders. Results: A total of 277 participants, 184 (66.4%) males, mean age 59.0 (SD: 4.8), and 7.1 (SD: 6.8) years of disease were analyzed. Only 31 participants (11.2%; 95% CI: 7.5%–14.9%) had moderately severe or severe depression, whereas 70 (25.3%; 95% CI 20.3%–30.8%) had good glycemic control. Depression increased the probability of having poor glycemic control (PR = 1.32; 95% CI 1.15–1.51) after adjusting for several potential confounders. Conclusions: There is an association between depression and poor glycemic control among type 2 diabetes patients. Our results suggest that early detection of depression might be important to facilitate appropriate glycemic control and avoid further metabolic complications. / We would like to thank Dr Viviana Ulloa who helped us to access data and T2D patients, and Dr Percy Mayta- Tristan for revising initial versions of the manuscript. AB-O is supported by Wellcome Trust Research Training Fellowship in Public Health and Tropical Medicine (Grant number 103994/Z/14/Z). / Revisión por pares

Introdução: A síndrome hepatopulmonar (SHP) é definida pela tríade clínica composta de doença hepática, dilatações vasculares intrapulmonares (DVIP) e alterações de gases arteriais, caracterizados por diferença alvéolo-arterial de oxigênio (PA-aO2)≥ 15mmHg (≥20 mmHg,se idade > 64 anos) ou PaO2<80mmHg. Essa síndrome é considerada uma complicação freqüente da cirrose, independente de sua etiologia. Objetivos: Caracterizar a prevalência da doença e o perfil dos portadores de SHP candidatos a transplante hepático na Santa Casa de Porto Alegre; avaliar a presença de fatores de risco como idade, sexo, etiologia da cirrose, gravidade da doença hepática, bem como analisar as variações gasométricas e da função pulmonar em pacientes portadores da síndrome. Métodos: Foram avaliados pacientes listados para transplante hepático no Complexo Hospitalar Santa Casa de Porto Alegre, que apresentaram ecocardiograma e gasometria arterial para avaliar a presença SHP de acordo com as diretrizes vigentes. Foi realizada a pesquisa no prontuário e os analisados exames laboratoriais, ecocardiograma e testes de função pulmonar. Foi realizada a análise univariada através do programa do software R (R Development Core Team, 2012), com cálculo do odds ratio e utilizado o Teste Exato de Fisher para testar a significância estatística das características clínicas, demográficas e das etiologias mais comuns.Foi determinado o intervalo de confiança de 95%. Para análise estatística das variáveis quantitativas, foi empregado o teste t de Student para comparação entre os grupos com presença e ausência da SHP. Resultados: Estudaram-se 133 pacientes e a prevalência da SHP em nossa série foi de 36,84%, utilizando como ponto de corte de gradiente alvéolo-arterial (PA-aO2)≥ 15mmHg (≥20 mm Hg, se idade > 64 anos), conforme determinado pela Diretriz de Doenças Vasculares Hepatopulmonares (PHD) publicado em 2004.. A presença de idade superior a 50 anos, bem como a cirrose causada exclusivamente por vírus C ficaram definidas como fatores de risco estatisticamente significativos. A cirrose causada exclusivamente por vírus C, etiologia mais prevalente, envolvendo 68,66% dos pacientes. Dos pacientes com MELD maior que 15, a SHP esteve presente em 44,9%. Dentro da amostra estudada, 100 pacientes possuíam espirometria com medida da difusão de monóxido de carbono (DLCO), 22,37% dos pacientes apresentaram DLCO menor que 60% do previsto. Desses apenas 41,18% tinham diagnóstico de SHP. A mediana de DLCO, nos pacientes com ou sem SHP, mostrou-se semelhante entre os grupos, de modo que esse parâmetro de função pulmonar, apesar de ser o único alterado, em alguns pacientes, não se apresentou como critério fidedigno de avaliação. A PaCO2 e PaO2 100% não apresentaram diferença entre os grupos com ou sem SHP. No entanto, a PaO2 mostrou-se diferente, estatisticamente, reforçando o conceito de critério diagnóstico e forte indicador da presença de shunt. Conclusões: Principais conclusões do estudo: a prevalência em nossa amostra foi consideravelmente maior que a maioria das publicações, onde a ocorrência da doença ficou em torno de 13 a 18%, possivelmente, devido à adequação do ponto de corte do gradiente alvéolo-arterial, conforme determinado pela Diretriz de Doenças Vasculares Hepatopulmonares (PHD) publicado em 2004. A redução da DLCO (<60% do previsto) pode ser vista em um terço dos pacientes com cirrose hepática, com ou sem SHP, possivelmente relacionados à ascite ou à anemia. No entanto, conforme já descrito em estudos anteriores, a mediana de DLCO em pacientes com critérios diagnósticos para SHP foi menor, podendo sugerir que esse marcador funcional possa ser o único útil na avaliação complementar, mesmo sabendo que a DLCO é um parâmetro que não se altera após o transplante hepático. A PaO2 é dado imprescindível a ser avaliado nos pacientes cirróticos, já que é definido como critério diagnóstico de SHP, além de retornar aos níveis normais após transplante hepático. A análise bioquímica para cálculo do MELD ganhou destaque desde que passou a ser o principal critério de inclusão em lista de transplante. Na série estudada, a maioria dos pacientes apresentou MELD menor que 15, o que define doença menos avançada. Este fato esclarece que os pacientes incluídos na amostra, em sua maioria, foram listados antes de 2006, quando o critério era cronológico e não gravidade. Normalmente, a evolução da hepatopatia até cirrose hepática é mais frequente em pacientes portadores de hepatite por vírus C. Dessa maneira, a relação encontrada, nesse estudo, com a presença de cirrose por vírus C e SHP foi, possivelmente, casual e devido à alta prevalência de hepatopatia por vírus C seguida de cirrose. / Introduction: The hepatopulmonary syndrome (HPS) is defined by the clinical triad consists of liver disease, pulmonary vascular dilatation (IPVD) and changes in arterial blood gases, characterized by alveolar-arterial oxygen gradient (PA-aO2) ≥ 15mmHg (≥ 20 mm Hg, if age> 64 years) or PaO2 <80mmHg. This syndrome is considered a frequent complication of cirrhosis, regardless of etiology. Objectives: To describe the prevalence of the disease and the profile of patients with SHP liver transplant candidates at the hospital Santa Casa de Porto Alegre; evaluate the presence of risk factors such as age, sex, etiology of cirrhosis, severity of liver disease, well as to analyze the variations of gas exchange and pulmonary function in patients with the syndrome. Methods: We evaluated patients listed for liver transplantation in a Hospital Santa Casa de Porto Alegre, who had echocardiography and arterial blood gas analysis to assess the presence SHP according to current guidelines. A survey was conducted in the medical records and analyzed laboratory tests, echocardiography and pulmonary function tests. Univariate analysis was performed using the software program R (R Development Core Team, 2012), with calculation of odds ratios and used the Fisher Exact Test to test the statistical significance of demographic, clinical and the most common etiologies. It was determined the confidence interval of 95%. For statistical analysis of quantitative variables, we used the Student t test for comparison between groups with and without HPS. Results: We studied 133 patients and the prevalence of HPS in our series was 36.84%, using a cutoff of alveolar-arterial gradient (PA-aO2) ≥ 15mmHg (≥ 20 mm Hg, if age> 64 years), as determined by Guideline Hepatopulmonares Vascular Diseases (PHD) published in 2004. The presence of older than 50 years, as well as cirrhosis caused by hepatitis C virus were exclusively defined as statistically significant risk factors. Cirrhosis caused solely by virus C, more prevalent etiology involving 68.66% of patients. Of the patients with MELD scores greater than 15, the SHP was present in 44.9%. Within the study sample, 100 patients had spirometry with measurement of diffusion of carbon monoxide (DLCO), 22.37% of patients had DLCO less than 60% predicted. These only 41.18% had a diagnosis of HPS. The median DLCO in patients, with or without SHP, was similar between the groups, so that this parameter of lung function, despite being the only altered, in some patients, it is not presented as an evaluation criterion reliable assessment. The PaCO2 and PaO2 100% showed no difference between groups with or without SHP. However, PaO2 proved statistically different, reinforcing the concept of diagnostic criteria and a strong indicator of the presence of shunts. Conclusions: Main conclusions of the study: the prevalence in our sample was considerably higher than most publications, where the occurrence of the disease was around 13 to 18%, possibly, due to the cutoff adequacy of alveolar-arterial gradient as determined by the Guideline Hepatopulmonares Vascular Diseases (PHD) published in 2004. The decrease in DLCO (<60% predicted) can be seen in one third of patients with liver cirrhosis, with or without HPS, possibly related to ascites or anemia. However, as already described in previous studies, the median DLCO in patients with diagnostic criteria for HPS was lower, may suggest that this functional marker may be the only useful in further evaluation, even though the DLCO is a parameter that does not change after liver transplantation. The PaO2 is essential given to be evaluated in cirrhotic patients, since it is defined as diagnostic criteria of HPS, and return to normal levels after liver transplantation. Biochemical analysis for calculating the MELD gained prominence since it became the main criterion for inclusion on the transplant list. In the series studied, most patients had MELD less than 15, which defines less advanced disease. This fact explains that the patients included in the sample, most were listed before 2006, when the criterion was chronological and not gravity. Typically, the development of liver cirrhosis is even more frequent in patients with viral hepatitis C. Thus, the relationship found in this study with the presence of cirrhosis and HPS C virus was possibly due to casual and high prevalence of C virus liver cirrhosis followed.

This thesis consists of three sections, all of which are linked to the ecology of infectious disease and the decline of amphibians caused by chytridiomycosis. This thesis represents a detailed analysis of factors that allow the amphibian chytrid fungus, Batrachochytrium dendrobatidis (Bd), to persist in the Peruvian Andes. Collectively, these three sections elaborate on the current knowledge of the disease, how it persists in an area, as well as recommendations for future disease mitigation. Chapter one is a review of environmental and biological factors that contribute to the persistence of Bd. Here we address the use of biotic and abiotic reservoirs by the pathogen that allow Bd to persist. Biological reservoirs include both amphibian and non-amphibian hosts, thus allowing Bd to persist and proliferate when susceptible host densities recover. More than 40% of all amphibian populations are in decline and more than a third are at risk of extinction making it important to develop conservation measures for endangered and diminishing biodiversity. By understanding disease dynamics between reservoirs and other susceptible hosts, mitigation strategies can be developed to save amphibian populations from loss of genetic diversity or extinction. Chapter two addresses the current distribution and disease status of Bd in the Kosñipata Valley in southeastern Peru. We investigated the post-epizootic distribution and prevalence of Bd by examining trends in Bd prevalence across multiple sample periods. We modeled infection prevalence using logistic regression as a function of species, sample period, reproductive mode, life stage, and elevation and their two-way interactions. The most parsimonious model of prevalence contained two-way interactions between sample period and elevation, and reproductive mode and life stage. Overall we observed that prevalence varied over time; prevalence was higher in 2012-2015 than it was in 2008-2009. The interaction between elevation and sample period revealed that while prevalence decreased with elevation during the wet season, it generally increased with elevation during the dry season. We concluded that the prevalence of Bd in the Kosñipata Valley appears to have stabilized over time, indicating enzootic Bd. Long-term monitoring of infection in hosts is important because temporal patterns in prevalence and infection intensity are associated with changes in population abundance which could lead to future changes in the disease state. Chapter three examines Hypsiboas gladiator as a proposed reservoir species for Bd. We conducted field surveys to determined prevalence and calculated Bd loads across life stages, and calculated zoospore shedding rates of H. gladiator and sympatric species. Results showed that H. gladiator had the highest prevalence and Bd load, followed by Pristimantis toftae and then P. platydactylus. We tried to determine if prevalence and Bd load varied with distance from streams but found no direct evidence to support our claims. We also conducted susceptibility trials of H. gladiator to Bd. Results from our susceptibility trials are inconclusive. Shedding rates were higher in 2014 than 2013 for all species and varied by year. At this time we cannot determine if H. gladiator is a reservoir species for Bd.