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Revista do Instituto de Medicina Tropical de São Paulo, Volume: 64, Published: 2022
  • Biodiversity assessment of Phlebotomine (Diptera: Psychodidae) in an environmental impacted area in Rio de Janeiro State, Brazil Original Article

    Vieira, Vanessa Rendeiro; Aguiar, Gustavo Marins de; Azevedo, Alfredo Carlos Rodrigues de; Rangel, Elizabeth Ferreira; Guimarães, Anthony Érico

    Abstract in English:

    ABSTRACT From October 1994 to September 1996, in the municipality of Mangaratiba, Rio de Janeiro State, phlebotomines were captured on the walls of the houses by means of a manual suction tube and light traps, in the household, the peridomicile and in the forest. As it is an area undergoing a real expansion and an increment in the local tourism, with the purpose of assessing changes in the phlebotomine fauna caused by environmental changes in the region, new captures were made in the same location from October 2015 to September 2016, this time using only light traps. In the two phases of the study, a total of 6,681 phlebotomines were captured. The results indicated that Ny. intermedia and Mg. migonei are fully adapted to this anthropic environment, while Pi. fischeri was more abundant and eclectic, and was probably attracted to exercise hematophagy. Nyssomyia intermedia can be suggested as the main vector of the etiological agent of the American Tegumentary Leishmaniasis in the studied areas. Pintomyia fischeri can also transmit Leishmania braziliensis, both in the environment altered by human action, and in the wild environment. Phlebotomines were captured in greater numbers between 6 and 8 pm in the peridomicile and between 9 and 11 pm in the household. The highest densities of phlebotomines were recorded in December, January and February. Despite almost 20 years between the two studies in the municipality of Mangaratiba, there was no change in the profile of the phlebotomine fauna in general; however, there was a greater density of species of medical importance in areas that suffered environmental impacts.
  • Spurious infection by Calodium hepaticum (Bancroft, 1983) Moravec, 1982 and intestinal parasites in forest reserve dwellers in Western Brazilian Amazon Original Article

    Oliveira, Fernanda Bittencourt de; Correia, Tuan Pedro Dias; Neves, Leandro Batista das; Teixeira, Paulo Eduardo Ferlini; Moreira, Junior da Costa; Souza, Leandro Siqueira de; Neves, Renata Heisler; Almeida, Fernanda Barbosa de; Bóia, Márcio Neves; Silva, Rosângela Rodrigues e; Silva, José Roberto Machado e

    Abstract in English:

    ABSTRACT Subsistence hunting is the main source of protein for forest reserve dwellers, contributing to the development of spurious infections by Calodium hepaticum, frequently associated with the consumption of the liver from wild mammals. The prevalence of infections by soil-transmitted helminths (STHs) and intestinal protozoa is considered an indicator of the social vulnerability of a country, besides providing information on habits, customs and quality of life of a given population. Intestinal parasites mostly affect poor rural communities with limited access to clean water and adequate sanitation. This study reports the results of a parasitological survey carried out in 2017 and 2019, in two municipalities (Xapuri and Sena Madureira) in Acre State. Stool samples were collected from 276 inhabitants. Upon receipt, each sample was divided into two aliquots. Fresh samples without preservative were processed and examined by the Kato-Katz technique. Samples fixed in 10% formalin were processed by the spontaneous sedimentation and the centrifugal sedimentation techniques. Calodium hepaticum eggs were found in three stool samples. The overall STH prevalence was 44.9%. The hookworm prevalence (19.2%) was higher than that of Ascaris lumbricoides (2.5%) and Trichuris trichiura (0.7%), an unexpected finding for municipalities belonging to the Western Brazilian Amazon. When considering parasites transmitted via the fecal-oral route, Endolimax nana and Entamoeba coli showed the highest positivity rates, of 13% and 10.9%, respectively. This study is the first report of spurious infection by C. hepaticum among forest reserve dwellers that consume undercooked liver of lowland pacas. Additionally, this is the first report of Blastocystis sp. in Acre State.
  • Mapping the morbidity and mortality of Chagas disease in an endemic area in Brazil Original Article

    Medeiros, Carolina de Araújo; Silva, Maria Beatriz de Araújo; Oliveira, André Luiz Sá de; Alves, Sílvia Marinho Martins; Barros, Maria das Neves Dantas da Silveira; Cavalcanti, Maria da Glória Aureliano de Melo; Oliveira, Gênova Maria de Azevedo; Carrazzone, Cristina de Fátima Velloso; Oliveira Jr, Wilson Alves de; Medeiros, Zulma Maria de

    Abstract in English:

    ABSTRACT Chagas disease is among the 21 neglected diseases according to the World Health Organization. This study aimed to investigate the morbidity and mortality distribution of Chagas disease for identifying areas with greater prevalences and deaths of the disease in Northeast Brazil. A population-based ecological study was performed from 2016 to 2018 using data on acute Chagas disease patients from the Disease Notification Information System, chronic cases from the Chagas Disease and the referral Heart Failure Outpatient Clinic in Pernambuco, and Chagas disease-related mortality from the Mortality Information System. The unit of analysis were Pernambuco State mesoregions. The indicators were spatialized into thematic maps on the occurrence and mortality of the disease per 100,000 inhabitants. No cases of acute disease were reported in the period analyzed. Data on 801 chronic Chagas disease patients were analyzed. The population showed an average age of 62 years, with female predominance. The most prevalent comorbidity was systemic arterial hypertension and cardiologic involvement without ventricular dysfunction. The average chronic disease occurrence rate was 3.2/ 100,000 people/ year. As for deaths in the mortality system; in total, 350 deaths were recorded, showing male predominance, age ≥ 60 years, and chronic disease with cardiac involvement as the main mortality cause. The annual average mortality proportion was 1.6/100,000 people. The chronic case distribution showed spatial heterogeneity, with the highest rates of chronic disease and deaths observed in two mesoregions, with the main cause of death being heart-related. This highlights the need for more specialized services in areas with higher burden of the disease to avoid delay in the patients’ care.
  • Secondary infections in a cohort of patients with COVID-19 admitted to an intensive care unit: impact of gram-negative bacterial resistance Original Article

    Costa, Rafael Lessa da; Lamas, Cristiane da Cruz; Simvoulidis, Luiz Fernando Nogueira; Espanha, Claudia Adelino; Moreira, Lorena Pinto Monteiro; Bonancim, Renan Alexandre Baptista; Weber, João Victor Lehmkuhl Azeredo; Ramos, Max Rogerio Freitas; Silva, Eduardo Costa de Freitas; Oliveira, Liszt Palmeira de

    Abstract in English:

    ABSTRACT Some studies have shown that secondary infections during the COVID-19 pandemic may have contributed to the high mortality. Our objective was to identify the frequency, types and etiology of bacterial infections in patients with COVID-19 admitted to an intensive care unit (ICU) and to evaluate the results of ICU stay, duration of mechanical ventilation (MV) and in-hospital mortality. It was a single-center study with a retrospective cohort of patients admitted consecutively to the ICU for more than 48 h between March and May 2020. Comparisons of groups with and without ICU- acquired infection were performed. A total of 191 patients with laboratory-confirmed COVID-19 were included and 57 patients had 97 secondary infectious events. The most frequent agents were Acinetobacter baumannii (28.9%), Pseudomonas aeruginosa (22.7%) and Klebsiella pneumoniae (14.4%); multi-drug resistance was present in 96% of A. baumannii and in 57% of K. pneumoniae. The most prevalent infection was ventilator-associated pneumonia in 57.9% of patients with bacterial infections, or 17.3% of all COVID-19 patients admitted to the ICU, followed by tracheobronchitis (26.3%). Patients with secondary infections had a longer ICU stay (40.0 vs. 17 days; p < 0.001), as well as a longer duration of MV (24.0 vs 9.0 days; p= 0.003). There were 68 (35.6%) deaths overall, of which 27 (39.7%) patients had bacterial infections. Among the 123 survivors, 30 (24.4%) had a secondary infections (OR 2.041; 95% CI 1.080 - 3.859). A high incidence of secondary infections, mainly caused by gram-negative bacteria has been observed. Secondary infections were associated with longer ICU stay, MV use and higher mortality.
  • Toxocara canis 30-35 kDa excretory-secretory antigen is an important marker in mice challenged by inocula containing different parasite load levels Original Article

    Fonseca, Gabriela Rodrigues e; Corral, Marcelo Andreetta; Paula, Fabiana Martins de; Meisel, Dirce Mary Correia Lima; Gryschek, Ronaldo Cesar Borges; Lescano, Susana Angélica Zevallos

    Abstract in English:

    ABSTRACT The Western-blotting technique was applied to identify antigenic fractions of excretory-secretory Toxocara canis antigen recognized by IgG antibodies throughout an experimental infection in mice challenged by different inocula. Mice were inoculated with 5, 50 and 500 embryonated eggs and serum samples were collected 15, 30, 60, 90 and 120 days post-infection. Serum samples were analyzed using an excretory-secretory Toxocara antigen. Antibodies recognized antigenic fractions from 30 to 90 kDa. The protein fraction of 30-35 kDa was the most frequently recognized regardless of the size of inoculum and the stage of infection represented by the different collection times, but the antigenic recognition was more evident in groups infected with 50 and 500 eggs. This study presents an antigenic panel of the excretory-secretory antigen of T. canis and suggests that the 30-35 kDa antigenic fraction is a promising marker of the infection and should be further explored in future studies on experimental toxocariasis.
  • Coxsackievirus A6 strains causing an outbreak of hand-foot-and-mouth disease in Northeastern Brazil in 2018 Original Article

    Luchs, Adriana; Azevedo, Lais Sampaio de; Souza, Ellen Viana de; Medeiros, Roberta Salzone; Souza, Yasmin França Viana Pires de; Teixeira, Dalane Loudal Florentino; Carneiro, Thiago Franco de Oliveira; Alencar, Gabriela Maria Fernandes de; Morais, Fernanda Lúcia de Sousa Leite; Pinto, Diana de Fátima Alves; Okay, Thelma Suely; Yamamoto, Lidia; Morais, Vanessa dos Santos; Araújo, Emerson Luiz Lima; Leal, Elcio; Costa, Antonio Charlys da

    Abstract in English:

    ABSTRACT Hand-foot-and-mouth disease (HFMD) is a highly contagious viral disease commonly associated to Enteroviruses (EV). During 2018, Brazil faced massive HFMD outbreaks spread across the country. This study aimed to characterize the EV responsible for the HFMD outbreak that occurred in Paraiba State, Brazilian Northeastern region, in 2018, followed by a phylogenetic analysis to detail information on its genetic diversity. A total of 49 serum samples (one from each patient) collected from children ≤ 15 years old, clinically diagnosed with HFMD were tested for EV using conventional RT-PCR and RT-qPCR. EV infection was confirmed in 71.4% (35/49) of samples. The mean and median ages were 1.83 years and one year old, respectively. Twenty-two EV-positive samples were successfully sequenced and classified as EV-A species; 13 samples were also identified with the CV-A6 genotype. The phylogenetic analysis (VP1 region) of three samples revealed that the detected CV-A6 strains belonged to sub-lineage D3. The CV-A6 strains detected here clustered with strains from South America, Europe and West Asia strains that were also involved in HFMD cases during the 2017-2018 seasons, in addition to the previously detected Brazilian CV-A6 strains from 2012 to 2017, suggesting a global co-circulation of a set of different CV-A6 strains introduced in the country at different times. The growing circulation of the emerging CV-A6 associated with HFMD, together with the detection of more severe cases worldwide, suggests the need for a more intense surveillance system of HFMD in Brazil. In addition, this investigation was performed exclusively on serum samples, and the analysis of whole blood samples should be considered and could have shown advantages when employed in the diagnosis of enteroviral HFMD outbreaks.
  • An algorithm based on molecular protocols to improve the detection of Plasmodium in autochthonous malarial areas in the Atlantic Forest biome Original Article

    Farinas, Maria de Lourdes Rego Neves; Aschar, Mariana; Costa-Nascimento, Maria de Jesus; Di Santi, Silvia Maria

    Abstract in English:

    ABSTRACT Malaria is the most important vector-borne disease in the world and a challenge for control programs. In Brazil, 99% of cases occur in the Amazon region. In the extra-Amazonian region, a non-endemic area, epidemiological surveillance focuses on imported malaria and on autochthonous outbreaks, including cases with mild symptoms and low parasitemia acquired in the Atlantic Forest biome. In this scenario, cases are likely to be underreported, since submicroscopic parasitemias are not detected by thick blood smear, considered the reference test. Molecular tests are more sensitive, detecting asymptomatic individuals and mixed infections. The aim of this study was to propose a more efficient alternative to detect asymptomatic individuals living in areas of low malaria endemicity, as they are reservoirs of Plasmodium that maintain transmission locally. In total, 955 blood samples from residents of 16 municipalities with autochthonous malaria outbreaks in the Sao Paulo State were analyzed; 371 samples were collected in EDTA tubes and 584 in filter paper. All samples were initially screened by a genus-specific qPCR targeting ssrRNA genes (limit of detection of 1 parasite/µL). Then, positive samples were subjected to a nested PCR targeting ssrRNA and dihydrofolate reductase-thymidylate synthase genes (limit of detection of 10 parasites/µL) to determine Plasmodium species. The results showed a statistically significant difference (K = 0.049; p < 0.0001) between microscopy positivity (6.9%) and qPCR (22.9%) for EDTA-blood samples. Conversely, for samples collected in filter paper, no statistical difference was observed, with 2.6% positivity by thick blood smear and 3.1% for qPCR (K = 0.036; p = 0.7). Samples positive by qPCR were assayed by a species-specific nested PCR that was in turn positive in 26% of samples (16 P. vivax and 4 P. malariae ). The results showed that molecular protocols applied to blood samples from residents in areas with autochthonous transmission of malaria were useful to detect asymptomatic patients who act as a source of transmission. The results showed that the genus-specific qPCR was useful for screening positives, with the subsequent identification of species by nested PCR. Additional improvements, such as standardization of blood plotting on filter paper and a more sensitive protocol for species determination, are essential. The qPCR-based algorithm for screening positives followed by nested PCR will contribute to more efficient control of malaria transmission, offering faster and more sensitive tools to detect asymptomatic Plasmodium reservoirs.
  • Generation of neutralizing antibodies against Omicron, Gamma and Delta SARS-CoV-2 variants following CoronaVac vaccination Original Article

    Silva Jr, Almir Ribeiro da; Villas-Boas, Lucy Santos; Tozetto-Mendoza, Tania Regina; Honorato, Layla; Paula, Anderson de; Witkin, Steven S.; Mendes-Correa, Maria Cassia

    Abstract in English:

    ABSTRACT Vaccination is a fundamental tool to prevent SARS-CoV-2 infection and to limit the COVID-19 pandemic. The emergence of SARS-CoV-2 variants with multiple mutations has raised serious concerns about the ability of neutralizing antibody responses elicited by prior vaccination to effectively combat these variants. The neutralizing capacity against the Gamma, Delta and Omicron variants of sera from individuals immunized with the CoronaVac vaccine remains incompletely determined. The present study evaluated 41 health care workers at the Faculdade de Medicina of the Universidade de Sao Paulo, in Sao Paulo, Brazil, naive to previous SARS- CoV-2 infection, who were vaccinated with two doses of the CoronaVac SARS-CoV-2 vaccine 28 days apart. Neutralizing antibody levels against the Gamma, Delta, and Omicron variants were measured at 32 and 186 days after the second vaccination. We also measured neutralizing antibodies against Omicron in 34 of these individuals following a subsequent booster immunization with the Pfizer vaccine. Quantification of neutralizing antibodies was performed using the Cytopathic Effect-based Virus Neutralization test. Neutralization antibody activity against the Gamma, Delta and Omicron variants was observed in 78.0%, 65.9% and 58.5% of serum samples, respectively, obtained at a mean of 32 days after the second immunization. This decreased to 17.1%, 24.4% and 2.4% of sera having activity against Delta, Gamma and Omicron, respectively, at 186 days post-vaccination. The median neutralizing antibody titers at 32 days were 1:40, 1:20 and 1:20 against Gamma, Delta and Omicron, respectively, and decreased to an undetectable median level against all variants at the later time. A booster immunization with the Pfizer vaccine elicited neutralizing antibodies against Omicron in 85% of subjects tested 60 days after vaccination. We conclude that two doses of the CoronaVac vaccine results in limited protection of short duration against the Gamma, Delta and Omicron SARS-CoV-2 variants. A booster dose with the Pfizer vaccine induced antibody neutralizing activity against Omicron in most patients which was measurable 60 days after the booster.
  • Adult patients admitted to a tertiary hospital for COVID-19 and risk factors associated with severity: a retrospective cohort study Original Article

    Santos, Veridiana Baldon dos; Stein, Airton Tetelbom; Barilli, Sofia Louise Santin; Garbini, Andresa Fontoura; Almeida, Rafaela Charão de; Carazai, Daniela dos Reis; Santos, Fernanda Costa dos; Lutkmeier, Raquel; Greve, Isadora Helena; Klafke, André; Mussart, Ketlen Monteiro; Wittke, Estefania Inez

    Abstract in English:

    ABSTRACT COVID-19 is a disease whose knowledge is still under construction, high transmissibility, with no consensual treatment available to everyone. Therefore, the identification of patients at higher risk of evolving to the critical form of the disease is fundamental. The study aimed to determine risk factors associated with the severity of COVID-19 in adults patients. This is an observational, retrospective study from a cohort of adult patients with COVID-19 admitted to a public hospital from March to August 2020, whose medical records were evaluated. For the association of possible severity predictors, a Poisson regression was used. The primary outcome was the critical form of the disease (need for admission to the Intensive Care Unit and/or invasive mechanical ventilation). We included 565 patients: mostly men; 55.5% of those who progressed to the critical form of the disease were over sixty years old. Hypertension, diabetes mellitus and obesity were the most frequent comorbidities. There were 39.8% of patients who progressed to the critical form of the disease. The hospital mortality rate was 22.1%, and that of critical patients was 46.7%. The independent factors associated with the severity of the disease were obesity [RR = 1.33 (95% CI 1.07 to 1.66; p = 0.011)], SpO2/FiO2 ratio ≤ 315 [RR = 2.20 (95% CI 1.79 to 2.71; p = 0.000)], C-reactive protein > 100 mg/L [RR = 1.65 (95% CI 1.33 to 2.06; p = 0.000)], and lymphocytes < 1,000/µL [RR = 1.44 (95% CI 1.18 to 1.75; p = 0.000)]. Advanced age and comorbidities were dependent factors strongly associated with the critical form of the disease.
  • A new focus of spotted fever caused by Rickettsia parkeri in Brazil Original Article

    Martiniano, Nicole Oliveira de Moura; Sato, Tayra Pereira; Vizzoni, Vinicius Figueiredo; Ventura, Sheila de Figueiredo; Oliveira, Stefan Vilges de; Amorim, Marinete; Gazêta, Gilberto Salles

    Abstract in English:

    ABSTRACT Spotted fever (SF) is a tick-borne zoonosis caused by bacteria of the genus Rickettsia . The disease varies in severity from mild clinical forms to severe cases. In Brazil, Rickettsia rickettsii SF is the most serious rickettsiosis and can result in death if not diagnosed and treated at the onset of symptoms. The SF mild form is caused by Rickettsia parkeri strain Atlantic Rainforest, and this etiological agent has been reported in the South, Southeast and Northeast regions of the country, in areas of preserved or little antropized Atlantic Rainforest. Amblyomma ovale is the proven vector and dogs are the hosts associated with the bioagent cycle. During a SF case investigation in Paraty municipality, Rio de Janeiro State, an Atlantic Rainforest biome area in Southeastern Brazil, the human pathogen R. parkeri strain Atlantic Rainforest was detected by PCR in a sample of human skin inoculation eschar and in a female A. ovale tick collected from a dog. These results expand the known area of occurrence of this mild form rickettsiosis in Brazil. In addition, the results of the present study indicate the importance of implementing programs to control canine ectoparasites and to raise awareness of the risks of infection, signs and symptoms of SF caused by R. parkeri strain Atlantic Rainforest.
  • Molecular dynamics of the COVID-19 pandemic in Espirito Santo (Brazil) and border States Original Article

    Torezani, Renata; Vargas, Aura Marcela Corredor; Ardisson, Juliana Santa; Pirovani, Milenna Machado; Santos, Pedro Henrique Dias dos; Paneto, Greiciane Gaburro; Bastos-Filho, Teodiano Freire

    Abstract in English:

    ABSTRACT This study represents the first overview of the epidemiological dynamics of SARS-CoV-2 in Espirito Santo (ES) State, Brazil, filling in knowledge on this topic, observing data collected in the State, and aiming at understanding the epidemiological dynamics of the virus in ES, as well as its possible routes of transmission and dissemination. . Our results highlight that, so far, nine lineages have been identified with ES State. The B.1.1.33 lineage was the first with the highest occurrence in ES, remaining predominant until September 2020. The second predominant lineage was Gamma, representing 45% of the samples. The Delta lineage appears on the State scene, proving to be the next dominant lineage. This research allowed us to understand how the lineages advanced and were distributed in the State, which is important for future work, also making it possible to guide sanitary control measures. Data analyses were made through the GISAID database for ES State showed that the pandemic in the State has been evolving dynamically with lineage replacements over the months since the first notification.
  • Silent circulation of Chikungunya virus among pregnant women and newborns in the Western Brazilian Amazon before the first outbreak of chikungunya fever Original Article

    Kanunfre, Kelly Aparecida; Rocha, Mussya Cisotto; Malta, Maíra Barreto; Souza, Rodrigo Medeiros de; Castro, Marcia Caldas; Boscardin, Silvia Beatriz; Souza, Higo Fernando Santos; Witkin, Steven S.; Cardoso, Marly Augusto; Okay, Thelma Suely

    Abstract in English:

    ABSTRACT The prevalence of immunity to Chikungunya virus (CHIKV) in pregnant women and newborns in the Western Brazilian Amazon was assessed at a time when previous studies did not report chikungunya fever in the area. In 435 asymptomatic pregnant women and 642 healthy unrelated newborns, the presence of IgM and IgG antibodies to CHIKV were determined by a commercial ELISA. All participants were negative to IgM anti-CHIKV. Anti-CHIKV IgG was identified in 41 (9.4%) pregnant women and 66 (10.3%) newborns. The presence of anti-CHIKV IgG was positively associated with the lowest socioeconomic status in pregnant women (OR 2.54, 95% CI 1.15-5.62, p=0.021) and in the newborns’ mothers (OR 5.10, 95% CI 2.15-12.09, p< 0.001). Anti-CHIKV IgG was also associated with maternal age in both, the pregnant women (OR 1.06, 95% CI 1.00-1.11, p=0.037) and the newborns’mothers (OR 1.08, 95% CI 1.03-1.12, p=0.001). Pregnancy outcomes in which the mother or the newborn was anti-CHIKV IgG positive proceeded normally. Negative CHIKV serology was associated with being positive for DENV antibodies and having had malaria during pregnancy. These findings showed that there was already a silent circulation of CHIKV in this Amazon region before the first outbreak of chikungunya fever. Furthermore, seropositivity for CHIKV was surprisingly frequent (10%) in both, pregnant women and newborns, affecting mainly low-income women.
  • String test: a potentially useful tool in the diagnosis of pulmonary tuberculosis in Brazilian children and adolescents Original Article

    Cardoso, Claudete Aparecida Araújo; Rossoni, Andrea Maciel de Oliveira; Rezende, Joana Moraes de; Aurilio, Rafaela Baroni; Santos, Roberta Jaime Ferreira Lima dos; Ferrarini, Maria Aparecida Gadiani; Kritski, Afranio Lineu; Martin, Anandi; Sant’Anna, Clemax Couto

    Abstract in English:

    ABSTRACT This study investigated the potential use of the String Test (ST) for the diagnosis of pulmonary tuberculosis (PTB) in children and adolescents. This is a case series of patients aged 4-15 years presenting with clinically presumed PTB and submitted to ST in three pediatric TB referral centers in Brazil, between November 2017 and July 2020. The ST was performed in the morning, after 4-12 h of fasting, followed by ingestion of the capsule by the patient, which was attached to the patient’s malar region. The material was collected for simultaneous smear microscopy (acid-fast bacilli - AFB), culture and the molecular investigation by the GeneXpert MTB/RIF®. Thirty-three patients with presumed PTB were included and ST was performed in 26 (78.8%) of them and 7 (21.2%) patients could not swallow the cord. The diagnosis of PTB was established in 11 (42.3%) of the 26 patients who underwent the ST. The diagnosis of PTB was confirmed (by culture or GeneXpert MTB/RIF®) in 5 patients, 4 of whom were also positive by the ST. Two of them showed positivity by the GeneXpert MTB/RIF® only in the ST sample. Two other patients had a positive ST following the induced sputum test (AFB, GeneXpert MTB/RIF®, and positive culture in both specimens). Thus, ST was positive in 36.4% of the patients in whom PTB was diagnosed. ST could be a useful test for diagnosing PTB in children and adolescents.
  • Usefulness of laboratory parameters and chest CT in the early diagnosis of COVID-19 Original Article

    Colak, Ayfer; Oncel, Dilek; Altın, Zeynep; Turken, Melda; Arslan, Fatma Demet; Iyilikci, Veli; Yilmaz, Nisel; Oncel, Guray; Kose, Sukran

    Abstract in English:

    ABSTRACT In the present study, the importance of laboratory parameters and CT findings in the early diagnosis of COVID-19 was investigated. To this end, 245 patients admitted between April 1st, and May 30th, 2020 with suspected COVID-19 were enrolled. The patients were divided into three groups according to chest CT findings and RT-PCR results. The non-COVID-19 group consisted of 71 patients with negative RT-PCR results and no chest CT findings. Ninety-five patients with positive RT-PCR results and negativechest CT findings were included in the COVID-19 group; 79 patients with positive RT-PCR results and chest CT findings consistent with COVID-19 manifestations were included in COVID-19 pneumonia group. Chest CT findings were positive in 45% of all COVID-19 patients. Patients with positive chest CT findings had mild (n=30), moderate (n=21) andor severe (n=28) lung involvement. In the COVID-19 group, CRP levels and the percentage of monocytes increased significantly. As disease progressed from mild to severe, CRP, LDH and ferritin levels gradually increased. In the ROC analysis, the area under the curve corresponding to the percentage value of monocytes (AUC=0.887) had a very good accuracy in predicting COVID-19 cases. The multinomial logistic regression analysis showed that CRP, LYM and % MONO were independent factors for COVID-19. Furthermore, the chest CT evaluation is a relevant tool in patients with clinical suspicion of COVID-19 pneumonia and negative RT-PCR results. In addition to decreased lymphocyte count, the increased percentage of monocytes may also guide the diagnosis.
  • Malaria at international borders: challenges for elimination on the remote Brazil-Peru border Original Article

    Palma-Cuero, Monica; Machado, Myrna Barata; Graça, Jucelia Taiz Bruno; Anjos, Ney Batista dos; Pereira, Rafael Santos; Suárez-Mutis, Martha Cecilia

    Abstract in English:

    ABSTRACT Understanding local epidemiology is essential to reduce the burden of malaria in complex contexts, such as Brazilian municipalities that share borders with endemic countries. A descriptive study of malaria in the period 2003 to 2020 was conducted using data from the Malaria Epidemiological Surveillance Information System related to a remote municipality with an extensive border with Peru to understand the disease transmission, focusing on the obstacles to its elimination. The transmission increases at the end of the rainy season. During the period of 18 years, 53,575 malaria cases were reported (Mean of API 224.7 cases/1,000), of which 11% were imported from Peru. Thirteen outbreaks of malaria were observed during the studied period, the last one in 2018. The highest burden of cases was caused by P. vivax (73.2%), but P. falciparum was also prevalent at the beginning of the study period (50% in 2006). Several changes in the epidemiological risk were observed: (1) the proportion of international imported cases of malaria changed from 30.7% in 2003 to 3.5% in 2020 (p<0.05); (2) indigenous people affected increased from 24.3% in 2003 to 89.5% in 2020 (p<0.0001); (3) infected children and adolescents < 15 years old increased from 50.2% in 2003 to 67.4% in 2020 (p<0.01); (4) the proportion of men decreased from 56.7% in 2003 to 50.4% in 2020 (p<0.01); (5) the likelihood of P. falciparum malaria has significantly declined (p<0.01). The number of cases and the incidence of malaria in 2019 and 2020 were the lowest in the period of 18 years. The burden of malaria in indigenous areas and its determinants, seasonality, geographical access and the long international border are obstacles for the elimination of malaria that must be overcome.
  • Spatio-temporal dynamics of dengue-related deaths and associated factors Original Article

    Santana, Lidia Maria Reis; Baquero, Oswaldo Santos; Maeda, Adriana Yurika; Nogueira, Juliana Silva; Chiaravalloti Neto, Francisco

    Abstract in English:

    ABSTRACT Since the reintroduction of dengue viruses in 1987, Sao Paulo State (SP), Brazil, has experienced recurrent epidemics in a growing number of municipalities, each time with more cases and deaths. In the present study, we investigated the spatio-temporal dynamics of dengue-related deaths and associated factors in SP. This was an ecological study with spatial and temporal components, based on notified dengue-related deaths in the municipalities of SP between 2007 and 2017. A latent Gaussian Bayesian model with Poisson probability distribution was used to estimate the standardized mortality ratios (SMR) for dengue and relative risks (RR) for the socioeconomic, demographic, healthcare-related, and epidemiological factors considered. Epidemiological factors included the annual information on the number of circulating serotypes. A total of 1,019 dengue-related deaths (0.22 per 100,000 inhabitant-years) between 2007 and 2017 were confirmed in SP by laboratory testing. Mortality increased with age, peaking at 70 years or older (1.41 deaths per 100,000 inhabitant-years). Mortality was highest in 2015, and the highest SMR values were found in the North, Northwest, West, and coastal regions of SP. An increase of one circulating serotype, one standard deviation in the number of years with cases, and one standard deviation in the degree of urbanization were associated with increases of 75, 35, and 45% in the risk of death from dengue, respectively. The risk of death from dengue increased with age, and the distribution of deaths was heterogeneous in space and time. The positive relationship found between the number of dengue serotypes circulating and years with cases at the municipality/micro-region level indicates that this information can be used to identify risk areas, intensify surveillance and control measures, and organize healthcare to better respond to this disease.
  • Follow-up of patients with COVID-19 by the Delta variant after hospital discharge in Guangzhou, Guandong, China Original Article

    Wu, Qilin; Wang, Chang; Jing, Qinlong; Lu, Jianyun; Liang, Boheng; Liu, Lan; Wu, Jinyi; Yu, Qing; Deng, Xilong; Zhang, Zhoubin

    Abstract in English:

    ABSTRACT The B.1.617.2 (Delta) variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has contributed to a new increment in cases across the globe. We conducted a prospective follow-up of COVID-19 cases to explore the recurrence and potential propagation risk of the Delta variant and discuss potential explanations for the infection recurrence. A prospective, non-interventional follow-up of discharged patients who had SARS-CoV-2 infections by the Delta variant in Guangdong, China, from May 2021 to June 2021 was conducted. The subjects were asked to complete a physical health examination and undergo nucleic acid testing and antibody detection for the laboratory diagnosis of COVID-19. In total, 20.33% (25/123) of patients exhibited recurrent positive results after discharge. All patients with infection recurrence were asymptomatic and showed no abnormalities in the pulmonary computed tomography. The time from discharge to the recurrent positive testing was usually between 1-33 days, with a mean time of 9.36 days. The cycle threshold from the real-time polymerase chain reaction assay that detected the recurrence of positivity ranged from 27.48 to 39.00, with an average of 35.30. The proportion of vaccination in the non-recurrent group was higher than that in the recurrently positive group (26% vs. 4%; χ2 = 7.902; P < 0.05). Two months after discharge, the most common symptom was hair loss and 59.6% of patients had no long-term symptoms at all. It is possible for the Delta variant SARS-CoV-2 patients after discharge to show recurrent positive results of nucleic acid detection; however, there is a low risk of continuous community transmission. Both, the physical and mental quality of life of discharged patients were significantly affected. Our results suggest that it makes sense to implement mass vaccination against the Delta variant of SARS-CoV-2.
  • Predominance of Leishmania (Leishmania) amazonensis DNA in Lutzomyia longipalpis sand flies (Diptera: Psychodidae) from an endemic area for leishmaniasis in Northeastern Brazil Original Article

    Carvalho-Silva, Reyllane; Ribeiro-da-Silva, Rosa Cristina; Cruz, Léo Nava Piorsky Dominici; Oliveira, Maxcilene da Silva de; Amoedo, Pedro Marinho; Rebêlo, José Manuel Macário; Guimarães-e-Silva, Antonia Suely; Pinheiro, Valéria Cristina Soares

    Abstract in English:

    ABSTRACT Leishmaniasis is a serious public health concern in the Northeastern region of Brazil, where the sand fly fauna is well studied, although few species have been identified as competent vectors. The detection of Leishmania spp. parasites in wild-caught sand flies could help sanitary authorities draw strategies to avoid the transmission of the parasites and, therefore, the incidence of leishmaniases. We detected Leishmania DNA in wild-caught sand flies and correlated that data with aspects of sand fly ecology in the Caxias municipality, Maranhao State, Brazil. The sand flies were sampled in the peridomicile (open areas in the vicinity of human residences) and intradomicile (inside the residences) from July/2019 to March/2020. Leishmania DNA was detected in females, targeting a fragment of the Internal Transcribed Spacer (ITS1) from ribosomal DNA. Among the fourteen species of sand flies identified, five (Lutzomyia longipalpis, Nyssomyia whitmani, Evandromyia evandroi, Micropygomyia trinidadensis, and Micropygomyia quinquefer) harbored DNA of Leishmania (Leishmania) amazonensis. The most abundant species in rural (Ny. whitmani: 35.2% and Ev. evandroi: 32.4%) and urban areas (Lu. longipalpis: 89.8%) are the permissive vectors of L. (L.) amazonensis, especially Ny. whitmani, a known vector of causative agents of cutaneous leishmaniasis. Although Lu. longipalpis is the vector of L. (L.) infantum, which was not detected in this study, its permissiveness for the transmission of L. (L.) amazonensis has been reported. We suspect that visceral leishmaniasis and cutaneous leishmaniasis are caused by L. (L.) amazonensis, and the transmission may be occurring through Lu. longipalpis, at least in the urban area.
  • Report of autochthonous cases of localized cutaneous leishmaniasis caused by Leishmania (Leishmania) mexicana in vulnerable, susceptible areas of Southeastern Mexico Original Article

    Canché-Pool, Elsy Beatriz; Canto-Hau, Dulce María; Vargas-Meléndez, Mirna Alexandra; Tello-Martín, Raúl; Reyes-Novelo, Enrique; Escobedo-Ortegón, Francisco Javier; Ruiz-Piña, Hugo Antonio; Cambranes-Puc, Luis Humberto; Torres-Castro, Jimmy Raymundo; Palacio-Vargas, Jorge Alfredo; Durán-Caamal, Celmy; Cerón-Espinosa, José; Carpio-Pedroza, Juan Carlos; Rivera-Hernández, Octavio César

    Abstract in English:

    ABSTRACT Localized cutaneous leishmaniasis (LCL) is an endemic disease in several Mexican States with the main endemic areas located in the South-Southeast region of the country, where 90% of Leishmania (Leishmania) mexicana cases are registered. The Southeast region is located in the Yucatan Peninsula, including Campeche, Quintana Roo and Yucatan States. Campeche and Quintana Roo register more than 60% of the cases in the country each year, while in Yucatan the reports are of imported cases due to residents traveling to endemic areas. However, since 2015, autochthonous cases have been diagnosed by health authorities in municipalities with no previous transmission records. We aimed to identify Leishmania parasite species involved in autochthonous cases by means of the PCR technique. The present study included 13 autochthonous cases of LCL with clinical and parasitological diagnoses during 2018 and 2019 by health authorities, without specific identification of the causal agent. Tissue samples were taken by scraping the margins of active lesions and then they were spotted onto an FTATM Elute Microcard. Next, DNA was eluted and used for PCR amplification of specific Leishmania genus and L. (L.) mexicana species-specific fragments. Molecular analysis showed evidence that L. (L.) mexicana was the causal agent of LCL in 12 of the 13 patients; in one patient, PCR was not performed due to the patient’s refusal to participate in the study. Identifying Leishmania species that cause LCL is necessary to define efficient treatment schemes and control strategies for the disease in vulnerable and susceptible areas of the Yucatan State’s municipalities.
  • Are the clinical features of leprosy and American tegumentary leishmaniasis worse in patients with both diseases? Original Article

    Carvalho, Amanda Gabriela de; Luz, João Gabriel Guimarães; Steinmann, Peter; Ignotti, Eliane

    Abstract in English:

    ABSTRACT This cross-sectional population-based study compared clinical features of leprosy and American tegumentary leishmaniasis (ATL) in patients diagnosed with both diseases (n=414) and in those diagnosed with only leprosy (n=27,790) or only ATL (n=24,357) in Mato Grosso State, which is a hyperendemic area for both diseases in Midwest Brazil. All new cases of leprosy and ATL reported in the area from 2008 to 2017 were included. Patients diagnosed with both diseases were identified by a probabilistic linkage procedure applied to leprosy and ATL databases of the national reporting system. The distribution of the frequency of clinical features between groups was compared by the chi-square test, followed by a multivariate logistic regression. Patients diagnosed with both leprosy and ATL presented higher odds of having nerve damage (OR: 1.34; 95% CI: 1.09–1.66) and leprosy reactions (OR: 1.35; 95% CI: 1.04–1.76) compared to patients diagnosed only with leprosy. Mucocutaneous leishmaniasis (OR: 2.29; 95% CI: 1.74–3.00) was more frequent among patients with both diagnoses when compared to patients who only had ATL. In conclusion, patients diagnosed with both leprosy and ATL present more severe clinical features of such diseases. Our data can be useful for designing health policies aimed at timely and integrated management of leprosy and ATL in co-endemic areas.
  • Epidemiological characterization of notified human brucellosis cases in Southern Brazil Original Article

    Bernardi, Fabricio; Possa, Marina Gabriela; Rossi, Camila Elizandra; Benevenuto, Luíz Guilherme Dercore; Nascif Junior, Iucif Abrão; Jesus, Jacqueline de; Oliveira, Barbara Cardoso de; Zanelatto, Carla; Sena, Joice Gama; Fonseca-Alves, Carlos Eduardo; Elias, Fabiana

    Abstract in English:

    ABSTRACT Brucellosis is one of the most important and widespread bacterial zoonotic diseases worldwide, and it is transmitted to humans from various sources, including direct contact with infected animals and the ingestion of contaminated products, including unpasteurized milk. There are only a few epidemiological studies on said disease in humans in Western Santa Catarina, a region instantiated by agriculture. Thus, the objective of this study was to characterize the epidemiological aspects of human brucellosis reported in Western Santa Catarina from 2013 to 2018. The data were provided by the Epidemiological Surveillance Board (Diretoria de Vigilancia Epidemiologica). The frequency of the disease in humans and the epidemiological profile of confirmed human cases were evaluated. Cases that were screened positive and those that were confirmed and submitted to the therapeutic protocol were analyzed. During the study period, 3,671 people were tested, of which 12.34% were screened positive (453/ 3,671) and 3.40% were confirmed (125/3,671). The year with the highest number of people testing positive was 2015 (123 cases), and 2018 was the year with the highest number of confirmed cases (39 cases). Confirmed cases predominated in males (48.8%), self-declared white (22.4%), aged 20-59 years old (60%), with incomplete primary education (22.4%), of rural origin (59.2%), with occupational contact with cattle (64.8%), engaged in professions directly linked to agricultural and livestock activities (55.5%), and who reported consumption of unpasteurized dairy products (59.2%). No seasonal variation was observed in case numbers. The results demonstrated that brucellosis is an endemic disease in Western Santa Catarina.
  • SARS-CoV-2 in saliva, viremia and seroprevalence for COVID-19 surveillance at a single hematopoietic stem cell transplantation center: a prospective cohort study Original Article

    Mobile, Rafael Zancan; Warnawin, Stephanie von Stein Cubas; Kojo, Teresinha Keiko; Rodrigues, Jéssica Alline Pereira; Cavilha, Adriana Mendes de Quadros; Zerbinati, Rodrigo Melim; Adamoski, Douglas; Oliveira, Jaqueline Carvalho de; Conzentino, Marcelo Santos; Huergo, Luciano Fernandes; Gradia, Daniela Fiori; Braz-Silva, Paulo Henrique; Schussel, Juliana Lucena

    Abstract in English:

    ABSTRACT This prospective cohort study aims to analyze the surveillance of COVID-19 at a single hematopoietic stem cell transplantation (HSCT) center in Brazil, in 29 patients undergoing allogeneic HSCT and 57 healthcare workers (nurses and dentists), through viral shedding of SARS-CoV-2 in saliva and plasma and seroprevalence of anti-SARS-CoV-2 IgG. In addition, we report two cases with prolonged persistent detection of SARS-CoV-2 without seroconversion. The sample collection was performed seven times for patients and five times for healthcare workers. Only two patients tested positive for SARS-CoV-2 in their saliva and plasma samples (6.9%) without seroconversion. All healthcare workers were asymptomatic and none tested positive. Two patients (6.9%) and four nurses (8%) had positive serology. No dentists had positive viral detection or positive serology. Our results reflect a low prevalence of positive RT-PCR and seroprevalence of SARS-CoV-2 in patients and healthcare workers at a single HSCT center. Results have also corroborated how the rigorous protocols adopted in transplant centers were even more strengthened in this pandemic scenario.
  • Identification of α-L-fucosidase (ALFuc) of Blastocystis sp. subtypes ST1, ST2 and ST3 Original Article

    Martínez-Ocaña, Joel; Martínez-Flores, Williams Arony; Olivo-Díaz, Angélica; Romero-Valdovinos, Mirza; Martínez-Hernández, Fernando; Aguilar-Osorio, Guillermo; Flisser, Ana; Maravilla, Pablo

    Abstract in English:

    ABSTRACT Blastocystis sp. is a common intestinal microorganism. The α-L-fucosidase (ALFuc) is an enzyme long associated with the colonization of the gut microbiota. However, this enzyme has not been experimentally identified in Blastocystis cultures. The objective of the present study was to identify ALFuc in supernatants of axenic cultures of Blastocystis subtype (ST)1 ATCC-50177 and ATCC-50610 and to compare predicted ALFuc proteins of alfuc genes in sequenced STs1–3 isolates in human Blastocystis carriers. Excretion/secretion (Es/p) and cell lysate proteins were obtained by processing Blastocystis ATCC cultures and submitting them to SDS–PAGE and immunoblotting. In addition, 18 fecal samples from symptomatic Blastocystis human carriers were analyzed by sequencing of amplification products for subtyping. A complete identification of the alfuc gene and phylogenetic analysis were performed. Immunoblotting showed that the amplified band corresponding to ALFuc (~51 kDa) was recognized only in the ES/p. Furthermore, prediction analysis of ALFuc 3D structures revealed that the domain α-L-fucosidase and the GH29 family's catalytic sites were conserved; interestingly, the galactose-binding domain was recognized only in ST1 and ST2. The phylogenetic inferences of ALFuc showed that STs1–3 were clearly identifiable and grouped into specific clusters. Our results show, for the first time through experimental data that ALFuc is a secretion product of Blastocystis sp., which could have a relevant role during intestinal colonization; however, further studies are required to clarify this condition. Furthermore, the alfuc gene is a promising candidate for a phylogenetic marker, as it shows a conserved classification with the SSU-rDNA gene.
  • Prevalence of intestinal parasitic infections versus knowledge, attitudes and practices of male residents in Brazilian urban slums: a cross-sectional study Original Article

    Bordignon, Julio Cesar Pegado; Paulino, Érica Tex; Silva, Milena Enderson Chagas da; Alencar, Maria de Fatima Leal; Gomes, Keyla Nunes Farias; Sotero-Martins, Adriana; Santos, José Augusto Albuquerque dos; Boia, Marcio Neves; Moraes Neto, Antonio Henrique Almeida de

    Abstract in English:

    ABSTRACT Intestinal parasitic infections (IPIs) are neglected diseases caused by helminths and protozoa, with the relationships between parasite, host and environment having the potential to produce high morbidity and incapacity to work and mortality in vulnerable areas. This study assessed the prevalence of IPIs concerning socio-environmental conditions and analyzed the knowledge, attitudes and practices related to these diseases among men living in the slums of Rio de Janeiro city, Rio de Janeiro State, Brazil. A cross-sectional study was conducted in an agglomeration of urban slums between 2018 and 2019, with men aged between 20 and 59 years. A socioeconomic status questionnaire and an IPIs knowledge, attitudes and practices questionnaire (KAPQ) were applied. Coproparasitological diagnoses (n=454) were performed using four methods and samples of water for household consumption (n=392) were subjected to microbiological and physicochemical analysis. A total of 624 participants were enrolled. About 40% of the households had “water unsuitable for consumption”. Only one Major Area, MA 3 was not statistically significant for IPIs (AOR=0.75; 95% CI: 0.30-1.88; p=0.55). The overall prevalence of IPIs was 23.8%. Endolimax nana (n=65, 14.3%) and hookworm (n=8, 1.7%) were the most frequently identified parasites. The analysis of the frequency of responses to the KAPQ has shown that men reported to seeking medical care if they were suspicious of IPIs, and around 35% would self-medicate. The results have shown the need to adopt integrated health education practices targeting male residents in urban slums to qualify the care with water for human consumption and promote self-care about IPIs. The household can be considered strategic for Primary Health Care activities for men.
  • Shotgun metagenomic sequencing of the first case of monkeypox virus in Brazil, 2022 Original Article

    Claro, Ingra Morales; Romano, Camila Malta; Candido, Darlan da Silva; Lima, Evelyn Lepka de; Lindoso, José Angelo Lauletta; Ramundo, Mariana Severo; Moreira, Filipe Romero Rebello; Barra, Luiz Alberto Costa; Borges, Luciana Marques Sansão; Medeiros, Lucas Alberto; Tomishige, Marcia Y. S.; Moutinho, Tomas; Silva, Anderson José Dias da; Rodrigues, Camila Cristina Martini; Azevedo, Luiz Cesar Fernandes de; Villas-Boas, Lucy Santos; Silva, Camila Alves Maia da; Coletti, Thaís Moura; Manuli, Erika R.; O’Toole, Aine; Quick, Joshua; Loman, Nicholas; Rambaut, Andrew; Faria, Nuno R.; Figueiredo-Mello, Claudia; Sabino, Ester Cerdeira

    Abstract in English:

    ABSTRACT Monkeypox virus (MPXV), a zoonotic virus endemic to the African continent, has been reported in 33 non-endemic countries since May 2022. We report an almost complete genome of the first confirmed case of MPXV in Brazil. Shotgun metagenomic sequencing was completed in 18 hours, from DNA extraction to consensus sequence generation.
  • Microcephaly caused by or associated with congenital infections in the last 20 years in Brazil: a systematic review Review

    Quintans, Maria Dolores Salgado; Bueno, Arnaldo Costa; Cardoso, Claudete Aparecida Araújo

    Abstract in English:

    ABSTRACT This systematic review aimed to identify the pathogens causing or associated with congenital microcephaly in Brazil in the last 20 years due to the lack of official information by the Health Authorities and, as a consequence the uncertainty on the real infectious etiology of congenital microcephaly. A review protocol was prepared according to the PRISMA recommendation, using the PubMed, SciELO and LILACS databases to search for references presenting original data on microcephaly caused by or associated with congenital infectious in Brazil, using the descriptors “MICROCEPHALY AND INFECTION”. The search ended on 30/Jun/2020. All selected titles were read in full and analyzed independently by the three reviewers. After searching the databases, 2,389 articles were selected for title review. Of these, 109 were excluded due to duplicates and 2,236 according to the criteria defined in the review. Only 44 met the eligibility criteria and were therefore read in full. Data extraction was performed on 10 articles, all published after 2015. Seven studies were literature reviews or case series, only two were case-control, and one was a cross-sectional study. As the studies focused on the period of the ZIKV epidemic in Brazil, the cases of congenital microcephaly between 2015 and 2017 were attributed to maternal infection by this virus when it was not possible to prove the presence of other etiological agents. Among the TORCH agents, a predominance of syphilis was observed. The analyzed studies did not add consistent information about the infectious causes or association of microcephaly in Brazil outside the period of ZIKV epidemic, revealing the need for more studies on the subject.
  • Plasmodium falciparum merozoite surface protein 3 as a vaccine candidate: a brief review Review

    Alves, Késsia Caroline Souza; Guimarães, Jander Matos; Almeida, Maria Edilene Martins de; Mariúba, Luís André Morais

    Abstract in English:

    ABSTRACT Despite the many efforts of researchers around the world, there is currently no effective vaccine for malaria. Numerous studies have been developed to find vaccine antigens that are immunogenic and safe. Among antigen candidates, Plasmodium falciparum merozoite surface protein 3 (MSP3) has stood out in a number of these studies for its ability to induce a consistent and protective immune response, also being safe for use in humans. This review presents the main studies that explored MSP3 as a vaccine candidate over the last few decades. MSP3 formulations were tested in animals and humans and the most advanced candidate formulations are MSP3-LSP, a combination of MSP3 and LSP1, and GMZ2 (a vaccine based on the recombinant protein fusion GLURP and MSP3) which is currently being tested in phase II clinical studies. This brief review highlights the history and the main formulations of MSP3-based vaccines approaches against P. falciparum .
  • Galectin-3 and fibrosis intensity in Chronic Chagas Cardiomyopathy: a systematic review Review

    Chaves, Ana Thereza; Oliveira, Ana Laura Grossi de; Guimarães, Nathalia Sernizon; Magalhães, Isabela Cristina; Menezes, Cristiane Alves da Silva; Rocha, Manoel Otávio da Costa

    Abstract in English:

    ABSTRACT Chronic Chagas Cardiomyopathy (CCC) is the most prevalent type of myocarditis and the main clinical form of the Chagas disease, which has peculiarities such as focal inflammation, structural derangement, hypertrophy, dilation, and intense reparative fibrosis. Many cellular compounds contribute to CCC development. Galectin-3 is a partaker in inflammation and contributes to myocardial fibrosis formation. Some studies showed the connection between Galectin-3 and fibrosis in Chagas disease but are still inconclusive on the guidance for the early implementation of pharmacological therapy. This systematic review evaluated Galectin-3 as a biomarker for fibrosis intensity in CCC. Two independent reviewers have searched five databases (PubMed, EMBASE, Cochrane Library, Scopus, and Lilacs), using the following search terms: galectin-3, biomarkers, fibrosis, Chagas cardiomyopathy, and Chagas disease. Overall, seven studies met the inclusion criteria and made up this review. There were four trials conducted through animal model experiments and three trials with humans. Experimental data in mice indicate an association between Galectin-3 expression and fibrosis in CCC (75% of studies). Data from human studies showed no direct connection between myocardial fibrosis and Galectin-3 expression (80% of studies). Thus, human findings do not provide significant evidence indicating that Galectin-3 is related to fibrosis formation in Chagas disease. Based on the analyzed studies, it is suggested that Galectin-3 might not be a good fibrosis marker in CCC.
  • Tenofovir-induced renal and bone toxicity: report of two cases and literature review Case Report

    Fioroti, Carlos Eduardo Andrade; Distenhreft, Jesiree Iglésias Quadros; Paulino, Bruna Bastos; Lacchine, Kamilla; Ramos, Danilo Rodrigues; Seguro, Antonio Carlos; Luchi, Weverton Machado

    Abstract in English:

    ABSTRACT Tenofovir Disoproxil Fumarate (TDF) is one of the drugs in the initial first-line antiretroviral regimen for the treatment of hepatitis B and HIV infections. Despite its effectiveness and few adverse effects, it is related to renal and bone toxicity. We described two cases of HIV-positive middle-aged women who had been using TDF for two and four years (cases 1 and 2, respectively) and were admitted to the emergency room. Case 1 presented with metabolic ileum and diffuse bone pain while case 2 presented with bilateral coxo-femoral pain after a fall from standing height. Both cases had similar laboratory tests: hyperchloremic metabolic acidosis, hypophosphatemia, hypokalemia, hypouricemia and elevated plasma creatinine. In urinary exams, there was evidence of renal loss of electrolytes, justifying the serum alterations, in addition to glucosuria and proteinuria. The bone pain investigation identified bone fractures and reduced bone mineral density, together with increased levels of parathyroid hormone, alkaline phosphatase and vitamin D deficiency. These two cases illustrate the spectrum of adverse renal and bone effects associated with TDF use. TDF was discontinued and treatment was focused on correcting the electrolyte disturbances and acidosis, in addition to controlling the bone disease through vitamin D and calcium supplementation. The renal changes found in both cases characterized the Fanconi’s syndrome, and occurred due to TDF toxicity to proximal tubule cells mitochondria. Bone toxicity occurred due to direct interference of TDF in bone homeostasis, in addition to vitamin D deficiency and phosphaturia resulting from tubulopathy. During the follow-up, both cases evolved with chronic kidney disease and in one of them, the Fanconi’s syndrome did not revert. We emphasize the need to monitor markers of bone metabolism and glomerular and tubular functions in patients using TDF.
  • Short- and long-term effects of antiretroviral therapy on peripheral regulatory CD4+/CD25hi/CD127low T lymphocytes in people living with HIV/AIDS Case Report

    Hu, Ronghua; Chen, Tielong; Yan, Yajun; Zhou, Yingying; Yang, Rongrong; Xiong, Yong

    Abstract in English:

    ABSTRACT The effect of antiretroviral therapy (ART) on CD4+/CD25hi/CD127low T lymphocyte changes in people living with HIV/AIDS (PLWHA) is still a matter of debate. From October 2015 to December 2019, peripheral blood from 70 cases of PLWHA were collected for the detection of CD4+/CD25hi/CD127low T lymphocytes by flow cytometry. Statistical analysis was performed to detect changes of CD4+/CD25hi/CD127low T lymphocytes in patients with different duration of ART and different treatment effects. We found that the number of CD4+/CD25hi/CD127low T lymphocytes in ART-naive PLWHA were lower than those in healthy volunteers (10.3±٦.٠ cells/uL vs 31.7±8.0 cells/uL, P < 0.05). CD4+/CD25hi/CD127low T lymphocyte counts increased to 17.8±٤.٠ cells/uL 6 months post-ART and 25.0±١١.٩ cells/uL 9 months post-ART, respectively (P < 0.05). There was no significant difference in CD4+/CD25hi/CD127low T lymphocyte counts between PLWHA who reached a complete immune reconstruction after ART and healthy volunteers. The growth of CD4+/CD25hi/CD127low T lymphocyte counts in patients who had baseline CD4 > 200 cells/uL was greater than those who had baseline CD4 ≤ 200 cells/uL (12.6±٤.٦ cells/uL vs 5.6±٥.٠ cells/uL, P = 0.027). CD4+/CD25hi/CD127low T lymphocyte counts were positively correlated with CD4+ T lymphocyte counts (r = 0.923, P < 0.001) and CD4+/CD8+ ratio (r = 0.741, P < 0.001), but were negatively correlated with HIV-VL (r = −0.648, P = 0.000). In conclusion, the results of the present study showed that changes in CD4+/CD25hi/CD127low T lymphocyte counts can be used to assess the effect of ART in PLWHA.
  • Pulmonary hemorrhage in dengue: differential diagnosis with acute viral respiratory syndromes including COVID-19 Case Report

    Aguiar, Leonardo Antonio; Oliveira-Scussel, Ana Carolina de Morais; Menezes, Jerônimo Coelho de; Idaló, Priscila Barbosa; Freitas, Lara Élida Guazzeli de; Zago, Luzia Beatriz Ribeiro; Oliveira, Cristina da Cunha Hueb Barata de; Tavares, Naiara Clemente; Oliveira, Edward José de; Silva, Marcos Vinícius da; Teixeira, Luciana de Almeida Silva

    Abstract in English:

    ABSTRACT Clinical similarities among viral diseases become even more relevant considering the current scenario, especially in Brazil, where there is a high incidence of these diseases and overlapping seasonality. We report the case of a patient with acute clinical manifestations composed of predominant respiratory symptoms and alveolar hemorrhage in which three etiologies (dengue, influenza and COVID-19) were investigated concomitantly. Only the diagnosis of dengue was confirmed. Then, the patient’s immunological profile in response to stimulation of mononuclear cells with dengue virus antigen was analyzed in an attempt to identify specific characteristics that could be associated with the clinical manifestation.
  • COVID-19-associated meningoencephalitis in a Brazilian patient: case report and literature review Case Report

    Silva, Francisco José Cândido da; Farias, Luís Arthur Brasil Gadelha; Holanda, Pablo Eliack Linhares de; Nunes, Fernanda Remígio; Miyajima, Fábio; Damasceno, Lisandra Serra

    Abstract in English:

    ABSTRACT The global pandemic of COVID-19 is caused by the novel coronavirus SARS-CoV-2, which often causes flu-like symptoms and can progress to severe respiratory illness. Thus, as the disease spreads, COVID-19 cases have multiplied across the world, and manifestations involving multiple systems have been described. We report a case of COVID-19-associated meningoencephalitis in a Brazilian male patient who presented with seizures and altered mental status. To the best of our knowledge, this is the first reported case of COVID-19-associated meningoencephalitis in Brazil. COVID-19-associated meningoencephalitis is a rare manifestation of this viral infection and clinicians should be aware of this possible complication.
  • Two-year history of lymphadenopathy and fever caused by Bartonella henselae in a child Case Report

    Maria, Helga Kaiser Sanches de; Gazzoli, Emily; Drummond, Marina Rovani; Almeida, Amanda Roberta de; Santos, Luciene Silva dos; Pereira, Ricardo Mendes; Tresoldi, Antonia Terezinha; Velho, Paulo Eduardo Neves Ferreira

    Abstract in English:

    ABSTRACT We report the case of a 6-year-old boy that presented with enlarged lymph nodes on his neck. He complained of tiredness and discouragement, which worsened during feverish periods. There were no relevant laboratory test abnormalities and serological tests were not reactive. Bartonella henselae DNA was detected by species-specific nested polymerase chain reaction. After treatment, the patient progressed with no fever or lymphadenopathy. Bartonellosis is a group of infectious diseases caused by bacteria of the genus Bartonella. This case report is a useful reminder to clinicians that long-term fever of unknown origin can be related to B. henselae infection, even if the specific serology is not reactive.
  • Chronic type 2 reaction possibly triggered by an asymptomatic Bartonella henselae infection in a leprosy patient Case Report

    Santos, Luciene Silva dos; Drummond, Marina Rovani; França, Andrea Fernandes Eloy da Costa; Pavan, Maria Helena Postal; Stelini, Rafael Fantelli; Cintra, Maria Letícia; Souza, Elemir Macedo de; Velho, Paulo Eduardo Neves Ferreira

    Abstract in English:

    ABSTRACT As leprosy and leprosy reactions are the most prevalent infectious cause of physical disability, it is important to commit efforts to better understand these chronic reactions. Infections, even when asymptomatic, can trigger leprosy reactions and Bartonella spp. in turn, can cause chronic infections. We presented a case of a 51-year-old man who was admitted presenting with chronic type 2 leprosy reactions. He had a lepromatous form of leprosy that was histologically diagnosed six months after the onset of signs and symptoms compatible with a chronic type 2 reaction. He reported a history of a previous hepatitis B diagnosis. During a 24-month multidrug therapy (MDT), chronic reactions were partially controlled with prednisone and thalidomide. Thirty-three months following the leprosy treatment, he still experienced chronic reactions, and whole bacilli as well as globi were found on a new skin biopsy. Since coinfections can trigger type 2 reactions and the patient had close contact with animals and ticks, we investigated the presence of a Bartonella sp. infection. Bartonella henselae DNA was detected in a skin fragment obtained before the beginning of the leprosy retreatment. However, even after six months of a second leprosy MDT, he continued to experience type 2 chronic reactions. He was admitted to the hospital to undergo an intravenous antibiotic therapy for 14 days and then complete the treatment per os for ten more weeks. Leprosy reactions improved following the treatment for B. henselae. After completing the MDT treatment, he has been accompanied for sixty months with no signs of leprosy or leprosy reactions. The asymptomatic infection by B. henselaein this patient was considered the putative trigger of chronic leprosy reactions and leprosy relapse.
  • Severe visceral leishmaniasis and COVID-19 coinfection in an immunosuppressed patient Case Report

    Martins, Luciamáre Perinetti Alves; Fukasawa, Josianne Thomazini; Messias, Mirella Beni Balbino Ferreira; Castanho, Roberto Esteves Pires; Andrade, Leticia Abrantes; Sperança, Márcia Aparecida; Suzuki, Rodrigo Buzinaro

    Abstract in English:

    ABSTRACT Visceral leishmaniasis (VL) is an opportunistic disease in immunosuppressed individuals, who may present severe clinical conditions, such as the ones described in this patient. She lived in an endemic region for VL, and was possibly infected with L. (L.) infantum chagasi through the bite of a contaminated sand fly. This initial infection has triggered a pemphigus vulgaris condition by immunogenic proteins present in the mosquito's saliva. The immunosuppression caused by the use of high doses of corticosteroids to control the disease promoted a severe VL condition, with hepatosplenomegaly, thrombocytopenia and hemorrhages, requiring hospitalization and the onset of a subsequent SARS-CoV-2 infection. Due to the intensity of clinical manifestations related to VL, aggravated by COVID-19, she died two days after admission to the Clinical Hospital of Marilia Medical School (HC–Famema).
  • Management and treatment of decompensated hepatic fibrosis and severe refractory Schistosoma mansoni ascites with transjugular intrahepatic portosystemic shunt Case Report

    Santo, Maria Cristina Carvalho do Espírito; Gryschek, Ronaldo Cesar Borges; Farias, Alberto Queiroz; Andraus, Wellington; Carvalho, Noêmia Barbosa; Leite, Olavo Henrique Munhoz; Castro, Felipe Corrêa; Cerri, Giovanni Guido; Hypólitti, Gustavo Henrique; Carnevale, Francisco César; Assis, André Moreira de

    Abstract in English:

    ABSTRACT This study aimed to report the first case of a patient with hepatosplenic schistosomiasis mansoni, refractory ascites and portal vein thrombosis treated with a transjugular intrahepatic portosystemic shunt (TIPS), at the Instituto de Radiologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil. After the procedure, the patient recovered favorably and progressed with portal pressure reduction and no deterioration of the liver function. Endovascular shunt modification is a conservative medical approach that often helps in reducing symptoms significantly, making it a less invasive and a safer alternative to liver transplantation for the treatment of schistosomiasis with portal hypertension.
  • Meningitis caused by Capnocytophaga canimorsus in a COVID-19 patient: a rare complication of dog bites Case Report

    Farias, Luís Arthur Brasil Gadelha; Stolp, Ângela Maria Veras; Bandeira, Silviane Praciano; Mesquita, Rafael Ferreira; Bessa, Pedro Pinheiro de Negreiros; Holanda, Pablo Eliack Linhares de; Costa, Silvia Figueiredo; Takeda, Christianne Fernandes Valente; Perdigão Neto, Lauro Vieira

    Abstract in English:

    ABSTRACT Capnocytophaga canimorsus is a gram-negative rod that is part of the commensal microbiota of dogs’ and cats’ mouths. In this case, we report an 85-year-old man with COVID-19 who had his right arm bitten by a dog. His symptoms were impaired consciousness, agitation and aggressive behavior. Physical examination revealed neck stiffness and Brudzinski’s sign. The cerebrospinal fluid culture was compatible with Capnocytophaga canimorsus. He required intensive care and received a 14-day prescription of meropenem. After 40 days of hospitalization, the patient was fully recovered and was discharged. This case highlights the importance of physician and microbiologist be awareness of this disease, mainly in patients with neurological symptoms after a dog or cat bite.
  • Diabetic foot infection caused by bacteria of the Burkholderia cepacia complex: report of an unusual case and a scoping literature review Case Report

    Paes Leme, Rodrigo Cuiabano; Chaves, Jéssica Reis Esteves; Gonçalves, Luiz Carlos Soares; Alvim, Leonardo César; Almeida, João Roberto Chaves de; Renó, Leonardo da Cruz

    Abstract in English:

    ABSTRACT Burkholderia cepacia complex (BCC) is group of widespread gram-negative bacillus organized in over 20 phylogenetically distinct bacterial species. According to previous studies, BCC species pathogens are widely reported in patients with cystic fibrosis (CF), but not in individuals with diabetes mellitus (DM). In this case report, a 42-year-old male patient with DM and a foot infection caused by BCC is presented. The patient was hospitalized after antibiotic treatment failure and improved after two surgical debridement procedures and a high-dose extended infusion (EI) of meropenem. The team of vascular surgeons and the infectious disease specialists worked fervently to solve the case. Finally, a scoping review was conducted to map BCC infections in patients with DM.
  • SARS-CoV-2 testing among patients and healthcare professionals in an HIV outpatient clinic in Brazil Brief Communication

    Matsuda, Elaine Monteiro; Oliveira, Isabela Penteriche de; Campos, Ivana Barros de; Ahagon, Cintia Mayumi; Castejon, Marcia Jorge; Silva, Valeria Oliveira; Manzoni, Fernanda Matsuda; López-Lopes, Giselle Ibette; Brígido, Luís Fernando de Macedo

    Abstract in English:

    ABSTRACT The COVID-19 pandemic in Brazil has been marked by high infection and death rates. The immune response generated by current vaccination might be influenced by previous natural infection, and baseline estimates may help in the evaluation of vaccine-induced serological response. We evaluated previous SARS-CoV-2 testing (RT-PCR), and performed rapid diagnostic tests (RDT) and high throughput electrochemiluminescence immunoassay (ECLIA) before vaccination among people living with HIV (PLWH), users of antiretroviral prophylaxis (PrEP/PEP), and healthcare professionals in an HIV outpatient clinic (HCP-HC). RDT was positive in 25.7% (95% CI: 19-33%) overall, 31.3% (95% CI : 18-45%) among PLWH, 23.7% (95% CI : 14-34%) in PrEP/PEP users and 21.4% (95% CI : 05-28%) in HCP-HC (p=0.548). Diagnostic RT-PCR testing was very limited, even for symptomatic individuals, and whereas all HCP-HC had one test perfomed, only 35% of the patients (PREP/PEP/PLWH) were tested (p<0.0001). Adequate monitoring of post-vaccination humoral response and breakthrough infections including those in asymptomatic cases are warranted, especially in immunologically compromised individuals.
  • Population pharmacokinetic modeling of benznidazole in Brazilian patients with chronic Chagas disease Brief Communication

    Frade, Virgínia Paula; Moreira, Carlos Henrique Valente; Sabino, Ester Cerdeira; Bedor, Danilo César Galindo; Ghilard, Fábio de Rose; Oliveira, Cláudia Di Lorenzo; Sanches, Cristina

    Abstract in English:

    ABSTRACT The present study aimed to establish a population pharmacokinetic (PopPK) modeling of benznidazole (BZD) in Brazilian patients with chronic Chagas disease. This was part of a Brazilian prospective cohort study with eight patients diagnosed with Chagas disease during the beginning of BZD treatment up to the 60th day. On the 15th day of treatment, a blood sampling was collected and analyzed. A one-compartment PK model was developed using Pmetrics. Patients with an average age of 50.3 (SD: 6.2) years old, 6 female patients and 2 males, 70.2 kg (14.2), receiving a 5 mg/Kg/day dose were included. PK parameters estimated for CL, V and Ka were 6.27 L/h, 38.97 L and 1.66 h-1, respectively. This is the first study to establish a population pharmacokinetic modeling of BZD in Brazilian patients with chronic Chagas disease. Therefore, further studies are needed to obtain the complete characterization of BZD pharmacokinetics.
  • Impact of COVID-19 on liver transplant recipients during the first pandemic wave, in a tertiary hospital, in Northeastern Brazil Brief Communication

    Neves, Marina Seixas Studart e; Paiva, José Hícaro Hellano Gonçalves Lima; Ferreira, Natália Stefani de Assunção; Queiroz, Francisca Patrícia Almeida; Limeira, Camilla Bezerra Bastos; Veras, Camila Monteiro; Carvalho, Themístocles Mesquita Teles de; Freitas, Taina Veras de Sandes; Esmeraldo, Ronaldo de Matos; Brasil, Ivelise Regina Canito

    Abstract in English:

    ABSTRACT Worldwide, transplant programs have suffered a setback during the coronavirus disease 2019 (COVID-19) pandemic and most have temporarily suspended their transplant activities. . We identified 36 liver transplant patients who tested positive for COVID-19. The cases were confirmed by the nucleic acid test (RT-PCR). Epidemiological, demographic, clinical, laboratory, management and outcome data were obtained from the patients’ medical records. Fourteen patients (38.9%) required admission to the Intensive Care Unit and/or invasive ventilatory support (severe cases). The mean age of these severe cases was 63.8 years. Regarding the time since the transplant, 71.4% (10/14 patients) had undergone the procedure less than one year before. The immunosuppressive therapy was reduced in patients who required Intensive Care Unit. A total of 12 cases (12/14, 85.7%) required invasive ventilatory support. Eight cases (8/14, 57.1%) required renal replacement therapy. In this group of patients, nine died (64.3 %). In turn, 22 patients had mild to moderate symptoms of COVID-19, not requiring invasive ventilatory support or admission to the Intensive Care Unit. The mean age in these patients was 56.5 years and comorbidities were present in 15 (68.2%) of the cases. In this group, only five patients (5/22, 22.7%) required hospitalization due to complications and there were no deaths This report describes the results of COVID-19 infection in a very specific population, suggesting that liver transplant patients have a significant higher risk of progressing to severeCOVID-19 , with a mortality rate among critically-ill patients above that of the general population.
  • Gene-Xpert Ultra for the diagnosis of extrapulmonary tuberculosis in children and adolescents Brief Communication

    Aurilio, Rafaela Baroni; Ferreira, Sidnei; Parente, Ana Alice Amaral Ibiapina; Sant’Anna, Maria de Fátima Pombo; Pereira, Cláudia Stella; Malaquias, Thiago da Silva Santos; Kritski, Afrânio Lineu; Sant’Anna, Clemax Couto

    Abstract in English:

    ABSTRACT This prospective study describes the use of Gene-Xpert Ultra for the diagnosis of extrapulmonary tuberculosis (EPTB) in children and adolescents, in Rio de Janeiro, Brazil. Eighteen patients were studied; the final diagnosis of EPTB was established in 13 (72%). Gene-Xpert Ultra results showed detection in 10/13 (77%) of EPTB cases (7 of these 10 with trace-positive results). Gene-Xpert Ultra proved to be a promising method for the diagnosis of childhood EPTB.
  • SARS-CoV-2 and rhinovirus infections: are there differences in clinical presentation, laboratory abnormalities, and outcomes in the pediatric population? Brief Communication

    Pereira, Maria Fernanda Bádue; Suguita, Priscila; Litvinov, Nadia; Farhat, Sylvia Costa Lima; Paula, Camila Sanson Yoshino de; Lázari, Carolina dos Santos; Bedê, Pedro Vale; Framil, Juliana Valeria de Souza; Bueno, Catarina; Branas, Priscila Cristina Abduch Adas; Guimarães, Irina Monteiro da Costa; Leite, Marcia Marques; Navega, Ana Carolina Barsaglini; Nanbu, Danilo Yamamoto; Schvartsman, Claudio; Pinho, João Renato Rebello; Silva, Clovis Artur Almeida; Marques, Heloisa Helena de Sousa; ,

    Abstract in English:

    ABSTRACT This study aims to assess COVID-19 and other respiratory viruses in pediatric patients. Between April 17 and September 30, 2020, we collected 1,566 respiratory samples from 1,044 symptomatic patients who were younger than 18 years old to assess SARS-CoV-2 infection. Of these, 919 were analyzed for other respiratory pathogens (ORP). Patients with laboratory-confirmed COVID-19 or ORP were included. We evaluated 76 pediatric COVID-19 infections and 157 other respiratory virus infections. Rhinovirus occurred in 132/157 (84%). COVID-19 patients who were significantly older, had more fevers, headaches and pneumonia than those with ORP. The median white blood cell count was lower in patients with SARS-CoV-2 than in those with ORP (6,470 versus 8,170; p=0.02). COVID-19 patients had significantly worse symptoms than those with ORP.
  • High incidence of acute Q fever among incarcerated people in Cayenne, French Guiana Brief Communication

    Bonifay, Timothée; Beillard, Emmanuel; Daniel, Marie; Schiemsky, Vanessa; Vierendeels, Evelyn; Demar, Magalie; Pastre, Agathe; Hamiche, Karim; Nacher, Mathieu; Epelboin, Loic

    Abstract in English:

    ABSTRACT Q fever is a major public health problem in French Guiana. In recent years, a considerable number of cases has been reported in French Guiana’s penitentiary center. The main objective of this study was to describe the epidemiology of these cases. A retrospective study was conducted at the prison to identify cases of acute Q fever in people incarcerated between 2010 and 2021. During the study period, 16 patients were diagnosed with acute Q fever. The positivity rate varied between 13 and 57%. The annual incidence rate in 2019, 2020 and 2021 was 269 (95% CI: 0-640) 1,120 (95% CI: 290-1950) and 1,931 (95% CI: 60-3810) per 100,000 person-years, respectively. While several vertebrate species have already been shown to play an important role in the transmission of Coxiella burnetii, the full epidemiology picture in the tropics is far from clear, and the prison context, with its controlled environment, could help provide answers.
  • Low frequency of SARS-CoV2 infection in daycare centers during the reopening of school activities in the Southeast’s poor area of Brazil Brief Communication

    Soares, Graciela dos Santos; Morais, Lucas Vinicius; Silva, Kevin Cézar Nascimento; Ferreira, Elaine Moura; Shio, Marina Tiemi; Romano, Camila Malta; Conde, Carla Regiani; Sabino, Ester Cerdeira; França, Carolina Nunes; Nali, Luiz Henrique

    Abstract in English:

    ABSTRACT SARS-Cov2 has already infected over 482 million people and caused more than 6.1 million deaths. The beginning of the pandemic has led the health authorities of several countries to adopt non-pharmacological preventive measures such as daycare closures. The reopening took place when the country had the highest rates of infection and mortality (mainly due to the gamma variant (P.1) outbreak) and the beginning of the vaccination program. Therefore, we aimed to investigate the prevalence of SARS-CoV2 in daycare after educational activities resumed. The study was conducted in seven childcare facilities. Swab samples from the nasopharynx were collected from children and staff members. The viral RNA was obtained through PureLink RNA extraction kit purification and SARS-CoV2 presence was detected using the All plex SARS-CoV2 kit. The study population included 201 participants, including daycare workers and children. The average age of the workers and children is 40 and 3 years old, respectively. Among the children, 47.5% are female and among the workers, 91.4%. One (0.5%) test came out positive for the presence of SARS-CoV-2, which was from a sample of an asymptomatic childcare worker, and no secondary infections were detected. Considering that the return to daycare activities occurred during a period with a high number of deaths and a lack of vaccines throughout the country, the small number of cases indicates the effectiveness of the several preventive measures used by daycare centers in preventing SARS-CoV2 transmission.
  • Neutralizing antibodies against the SARS-CoV-2 Omicron variant following two CoronaVac vaccinations and a Pfizer/BioNTech mRNA vaccine booster Letter To The Editor

    Silva Jr, Almir Ribeiro da; Villas-Boas, Lucy Santos; Paula, Anderson Vicente de; Tozetto-Mendoza, Tania Regina; Honorato, Layla; Witkin, Steven S.; Mendes-Correa, Maria Cassia
  • Dengue in the cooling off period of the COVID-19 epidemic in Brazil: from the shadows to the spotlight Letter To The Editor

    Souza, Caio Santos de; Romano, Camila Malta
Instituto de Medicina Tropical de São Paulo Av. Dr. Enéas de Carvalho Aguiar, 470, 05403-000 - São Paulo - SP - Brazil, Tel. +55 11 3061-7005 - São Paulo - SP - Brazil
E-mail: revimtsp@usp.br