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Open-access Revista do Instituto de Medicina Tropical de São Paulo

Publication of: Instituto de Medicina Tropical de São Paulo
Area: Biological Sciences, Health Sciences ISSN online version: 1678-9946

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Revista do Instituto de Medicina Tropical de São Paulo, Volume: 66, Published: 2024
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Revista do Instituto de Medicina Tropical de São Paulo, Volume: 66, Published: 2024

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ORIGINAL ARTICLE
Post-discharge all-cause mortality in COVID-19 recovered patients hospitalized in 2020: the impact of chronic kidney disease Lomba, Guilherme Schittine Bezerra Silva, Pedro Henrique Abreu da Rosário, Natalia Fonseca do Medeiros, Thalia Alves, Lilian Santos Silva, Andrea Alice Almeida, Jorge Reis Lugon, Jocemir Ronaldo

Abstract in English:

ABSTRACT In Brazil, the COVID-19 burden was substantial, and risk factors associated with higher in-hospital mortality rates have been extensively studied. However, information on short-term all-cause mortality and the factors associated with death in patients who survived the hospitalization period of acute SARS-CoV-2 infection is limited. We analyzed the six-month post-hospitalization mortality rate and possible risk factors of COVID-19 patients in a single center in Brazil. This is a retrospective cohort study focused on a six-month follow-up. The exclusion criteria were death during hospitalization, transference to another hospital, and age under 18. We collected data from the charts of all hospitalized patients from March 2020 to December 2020 with a positive RT-PCR test for SARS-CoV-2, resulting in a sample size of 106 patients. The main outcome was death after hospitalization, whereas comorbidities and demographics were evaluated as risk factors. The crude post-hospitalization death rate was 16%. The first 30 days of follow-up had the highest mortality rate. In a Cox regression model for post-hospitalization mortality, previous chronic kidney disease (HR, 4.06, 95%CI 1.46 – 11.30) and longer hospital stay (HR 1.01, 95%CI 1.00 – 1.02) were the only factors statistically associated with death. In conclusion, a high six-month all-cause mortality was observed. Within the six-month follow-up, a higher risk of death was observed for patients who had prior CKD and longer hospital stay. These findings highlight the importance of more intensive medical surveillance during this period.
ORIGINAL ARTICLE
Prevalence and antimicrobial resistance profile of pathogens isolated from patients with urine tract infections admitted to a university hospital in a medium-sized Brazilian city Negri, Mariana Lima, Bárbara Martins Woloszynek, Renata dos Santos Batista Reis Molina, Roberto Augusto Silva Germano, Carla Maria Ramos Melo, Débora Gusmão Souza, Leandro Cândido de Avó, Lucimar Retto da Silva de

Abstract in English:

ABSTRACT This study aimed to determine the antibiotic profile of microorganisms isolated from urine samples of patients with community urine tract infections (UTI) admitted to the University Hospital of the Federal University of Sao Carlos to support an appropriate local empirical treatment. A retrospective cross-sectional study was conducted from October 2018 to October 2020. Data from 1,528 positive urine cultures for bacterial pathogens and antibiograms were tabulated. Bacterial species prevalence and their resistance profile were analyzed and compared by sex and age. For Gram-negative fermenting bacteria, resistance rates were compared between patients with previous hospitalization and the total of infections caused by this group. For comparisons, the Chi-square test was performed, using Fisher’s exact test when necessary (BioEstat program, adopting p ≤ 0.05). A multivariate analysis was applied to assess the effect of the studied variables in predicting multidrug resistance. Infections were more prevalent in women and older adults. Gram-negative bacteria represented 90.44% of total cultures. In both sexes, E. coli prevalence was significantly higher in adults compared with older adults (p < 0.0001). For several antibiotics, resistance rates were higher in the older adults compared with other ages and in patients with Gram-negative fermenting infections and previous hospitalization compared with the total of infections by this group of bacteria. The closer to the hospitalization, the higher the number of antibiotics with superior resistance rates. Resistance rates for aminoglycosides, carbapenems, ceftazidime, nitrofurantoin, piperacillin+tazobactam, and fosfomycin were less than 20%, considered adequate for empirical treatment. Only hospitalization in the previous 90 days was statistically significant in predicting infections by multidrug-resistant bacteria.
ORIGINAL ARTICLE
The decline of measles antibody titers in previously vaccinated adults: a cross-sectional analysis Castiñeiras, Anna Carla Pinto Sales, Amanda Caroline Picone, Camila de Melo Diogo, Constância Lima Rossi, Átila Duque Galliez, Rafael Mello Ferreira Jr, Orlando da Costa Castiñeiras, Terezinha Marta Pereira Pinto Lopes, Marta Heloísa Sartori, Ana Marli Christovam

Abstract in English:

ABSTRACT The global reemergence of measles in 2018–2019 reinforces the relevance of high-coverage immunization to maintain the disease elimination. During an outbreak in the Sao Paulo State in 2019, several measles cases were reported in individuals who were adequately vaccinated according to the current immunization schedule recommends. This study aimed to assess measles IgG antibody seropositivity and titers in previously vaccinated adults. A cross-sectional study was conducted at CRIE-HC-FMUSP (Sao Paulo, Brazil) in 2019. It included healthy adults who had received two or more Measles-Mumps-Rubella vaccines (MMR) and excluded individuals with immunocompromising conditions. Measles IgG antibodies were measured and compared by ELISA (Euroimmun®) and chemiluminescence (LIASON®). The association of seropositivity and titers with variables of interest (age, sex, profession, previous measles, number of measles-containing vaccine doses, interval between MMR doses, and time elapsed since the last MMR dose) was analyzed. A total of 162 participants were evaluated, predominantly young (median age 30 years), women (69.8%) and healthcare professionals (61.7%). The median interval between MMR doses was 13.2 years, and the median time since the last dose was 10.4 years. The seropositivity rate was 32.7% by ELISA and 75.3% by CLIA, and a strong positive correlation was found between the tests. Multivariate analyses revealed that age and time since the last dose were independently associated with positivity. Despite being a single-center evaluation, our results suggest that measles seropositivity may be lower than expected in adequately immunized adults. Seropositivity was higher among older individuals and those with a shorter time since the last MMR vaccine dose.
ORIGINAL ARTICLE
In vitro susceptibility to fosfomycin in clinical and environmental extended-spectrum beta-lactamase producing and/or ciprofloxacin-non-susceptible Escherichia coli isolates Ribeiro, Victoria Stadler Tasca Bail, Larissa Ito, Carmen Antonia Sanches Andrade, Ana Paula de Arend, Lavinia Nery Villa Stangler Suss, Paula Hansen Nogueira, Keite da Silva Walflor, Haniel Siqueira Mortagua Faoro, Helisson Kuczera, Lia Carolina Soares de Medeiros Vicenzi, Fernando José Tuon, Felipe Francisco

Abstract in English:

ABSTRACT Extended-spectrum beta-lactamase producing and ciprofloxacin-non-susceptible Escherichia coli are clinical and environmental issues. We evaluated the susceptibility profile of fosfomycin in non-susceptible E. coli isolated from urine and the environment. We measured the activity of fosfomycin against 319 and 36 E. coli strains from urine and environmental isolates, respectively, collected from rivers. Fosfomycin resistance profiles were investigated using the minimal inhibitory concentration (MIC), according to the Clinical and Laboratory Standards Institute (CLSI) and the European Committee for Antimicrobial Susceptibility Testing (EUCAST) guidelines. Antibiotic susceptibility testing revealed that 5% and 6.6% of urine samples were non-susceptible to fosfomycin according to CLSI and EUCAST guidelines, respectively. The fosfomycin MIC50/90 was 0.5/4 mg/L. Of the 36 E. coli isolates from river water, 11.1% and 13,8% were non-susceptible to fosfomycin according to CLSI and EUCAST, respectively (range ≤0.25 ≥512 mg/L). All the isolates with MIC ≥512 mg/L for fosfomycin showed the fosA3 gene. Fosfomycin resistance was more frequent in the environment than in clinical samples.
ORIGINAL ARTICLE
Incomplete recovery of the CD4+/CD8+ ratio is associated with the late introduction of antiretroviral therapy among people living with HIV infection Prates, Gabriela da Silva Monteiro, Mariana Amelia Oliveira, Éricka Constantinov Nascimento, Najara Ataide de Lima Veiga, Ana Paula Rocha Ferreira, Mauricio Domingues Polis, Thales José Bueno Caetano, Gabriela Prandi Soares, Beatriz Rodrigues Pellegrina Magri, Marcello Mihailenko Chaves Pereira, Luisa Oliveira Fonseca, Luiz Augusto Marcondes Alves, Wagner Silva Duarte, Alberto José da Silva Casseb, Jorge Simão do Rosário

Abstract in English:

ABSTRACT Despite being subject to lower AIDS-related mortality rates and having a higher life expectancy, patients with HIV are more prone to develop non-AIDS events. A low CD4+/CD8+ ratio during antiretroviral therapy identifies people with heightened immune senescence and increased risk of mortality. In clinical practice, finding determinants of a low CD4+/CD8+ ratio may be useful for identifying patients who require close monitoring due to an increased risk of comorbidities and death. We performed a prospective study on the evolution of the CD4+/CD8+ ratio in 60 patients infected with HIV (80% males), who were subjected to two different antiretroviral regimens: early and deferred therapy. The initial CD4+/CD8+ ratio was ≤1 for 70% of the patients in both groups. Older age, CD4+ cell count at inclusion, Nadir CD8+T-cell count, and Initial CD4+/CD8+ ratio ≤ 1 were risk factors for lack of ratio recovery. In the multivariate analysis, a CD4+/CD8+ ratio > 1 at the start of the treatment was found to be a determinant factor in maintaining a CD4+/CD8+ ratio > 1. The nadir CD4+T-cell count was lower in the deferred therapy group (p=0.004), and the last CD4+/CD8+ ratio ≤1 was not associated with comorbidities. Ratio recovery was not associated with the duration of HIV infection, time without therapy, or absence of AIDS incidence. A greater improvement was observed in patients treated early (p=0.003). In contrast, the slope of increase was slower in patients who deferred treatment. In conclusion, the increase in the CD4+/CD8+ ratio occurred mostly for patients undergoing early strategy treatment and its extension did not seem to be related to previous HIV-related factors.
ORIGINAL ARTICLE
The influence of growth time on the identification of Bartonella henselae strains by MALDI-TOF mass spectrometry Lins, Karina de Almeida Piveta, Cristiane Santos Cruz Levy, Carlos Emilio Drummond, Marina Rovani Santos, Luciene Silva dos Sussulini, Alessandra Velho, Paulo Eduardo Neves Ferreira

Abstract in English:

ABSTRACT Bartonella spp. are bacteria responsible for neglected diseases worldwide. Bartonella henselae is the species most associated with human infections. It is associated with a large spectrum of clinical manifestations and is potentially fatal. The identification of Bartonella spp. is considered a challenge in clinical routine. These bacteria are fastidious, and the time required to isolate them varies from one to six weeks. MALDI-TOF mass spectrometry has emerged as an application for research on Bartonella spp. , and has still been little explored. We investigated whether three different B. henselae strains with different growth times—14 and 28 days—could be correctly identified by MALDI-TOF mass spectra fingerprint comparison and matching. We found that the spectra from strains with different growth times do not match each other, leading to misidentification. We suggest creating database entries with multiple spectra from strains with different growth times to increase the chances of accurate identification of Bartonella spp. by MALD-TOF MS.
ORIGINAL ARTICLE
Prevalence and clinical consequences of Hepatitis C virus infection in patients undergoing hematopoietic stem cell transplantation Diaz, Ana Claudia Marques Barbosa Witkin, Steven Sol Almeida Neto, Cesar de Mendrone Junior, Alfredo Rocha, Vanderson Costa, Silvia Figueiredo Ramos, Jessica Fernandes Mendes-Correa, Maria Cassia

Abstract in English:

ABSTRACT Hepatitis C virus (HCV) infection is a significant cause of morbidity and mortality among hematopoietic stem cell transplant (HCT) recipients. In Brazil, its occurrence in HCT recipients remains undetermined. We now report on HCV prevalence in HCT recipients and its clinical consequences. The medical records of all HCT recipients seen at Hospital das Clinicas, Sao Paulo University Medical School, from January 2010 to January 2020 were reviewed to determine HCV serostatus. A retrospective analysis of medical charts was undertaken on all seropositive cases to determine HCV genotype, presence of liver fibrosis, co-infections with other viruses, previous treatments, and clinical evolution of liver pathology after HCT. Of the 1,293 HCT recipients included in the study, seven (0.54%) were HCV antibody-positive and five (0.39%) were also viremic for HCV-RNA. Four of these individuals had moderate to severe liver fibrosis (METAVIR F2/F3) and one was cirrhotic. Two of the viremic patients developed acute liver dysfunction following transplantation. All patients had their acute episode of liver dysfunction resolved with no further complications. Four of the viremic patients were treated for HCV infection with direct acting agents (DAA). Information regarding HCV treatment was lacking for one of the viremic HCV patients due to loss of follow up. Sustained anti-virologic responses were observed in three cases after the use of DAA. The detection of HCV in hematological adults undergoing HCT and its successful treatment with DAA highlight the necessity of testing for HCV both prior to and following transplantation.
ORIGINAL ARTICLE
A spatial case-control study on symptomatic and inapparent primary dengue infections in an endemic city in Brazil Figueiredo, Gerusa Chiaravalloti, Francisco Campos, Sérgio Pellini, Alessandra Cristina Guedes Felix, Alvina Clara Luna, Expedito

Abstract in English:

ABSTRACT We conducted a spatial case-control study nested in a dengue incidence cohort to explore the role of the spatial and socioeconomic factors in the proportion of symptomatic (cases) and inapparent primary dengue virus infections (controls). Cohort participants were children and adolescents (2 to 16 years of age) at the beginning of the follow-up. Case definitions were, for symptomatic cases, fever plus a positive lab result for acute dengue (NS1, RT-PCR, ELISA IgM/IgG), and for inapparent infection a positive result for dengue IgG (ELISA) in subjects without symptoms and with a previously negative result at baseline. The covariates included sociodemographic factors, residential location, and socioeconomic context variables of the census tracts of residence of cases and controls. We used principal component analysis to reduce the contextual covariates, with the component values assigned to each one based on their residences. The data were modeled in a Bayesian context, considering the spatial dependence. The final sample consisted of 692 children, 274 cases and 418 controls, from the first year of follow-up (2014-2015). Being male, older age, higher educational level of the head of the family and having a larger number of rooms in the household were associated with a greater chance of presenting dengue symptomatic infection at the individual level. The contextual covariates were not associated with the outcome. Inapparent dengue infection has extensive epidemiological consequences. Relying solely on notifications of symptomatic dengue infections underestimates the number of cases, preserves a silent source of the disease, potentially spreading the virus to unaffected areas.
ORIGINAL ARTICLE
Associated factors, incidence, and management of gestational and congenital syphilis in a Brazilian state capital: a cross-sectional study Pires, Cássia de Paula Mareto, Lisany Krug Medeiros, Márcio José de Oliveira, Everton Falcão de

Abstract in English:

ABSTRACT Maternal and child health remains an enduring global challenge, having occupied a prominent position on international agendas since the dawn of the 21st century. During pregnancy, syphilis emerges as the second most prevalent cause of stillbirth on a global scale, potentially leading to a range of adverse outcomes. This study aimed to describe the clinical and epidemiological profile of cases of gestational and congenital syphilis and the hospital care provided for newborns in Campo Grande municipality, Mato Grosso do Sul State, Brazil, from 2013 to 2018. This is a cross-sectional study based on data from Brazilian Notifiable Diseases Surveillance System (SINAN) and hospital medical records. Chi-square or Fisher’s exact test and logistic regression analysis were used to assess the associations and relationships between the child’s clinical outcome at birth and the mother’s clinical-obstetric and epidemiological characteristics. Cumulative detection rate of gestational syphilis was 174.3 cases per 1,000 live births and cumulative incidence of congenital syphilis was 47.7 cases per 1,000 live births. Alcoholism, prenatal care, number of prenatal visits, maternal treatment regimen, and timing of maternal diagnosis were associated with child’s clinical outcome at birth and considered in the regression model. Prenatal visits showed a protective effect against the signs and symptoms of congenital syphilis (odds ratio = 0.37; 95% confidence interval = 0.17−0.77). Medical assistance was considered inadequate in 62.3% of cases. Prenatal consultations should be encouraged among pregnant women. There is a need for better education of health personnel on the treatment and diagnosis of syphilis.
ORIGINAL ARTICLE
Epidemiological and molecular surveillance of norovirus in the Brazilian Amazon: description of recombinant genotypes and improvement of evolutionary analysis Costa, Jonaia Novaes da Siqueira, Jones Anderson Monteiro Teixeira, Dielle Monteiro Lobo, Patrícia dos Santos Guerra, Sylvia de Fátima dos Santos Souza, Isadora Monteiro Cardoso, Bruna Trindade Moreira Farias, Luana Silva Soares Resque, Hugo Reis Gabbay, Yvone Benchimol Silva, Luciana Damascena da

Abstract in English:

ABSTRACT Noroviruses are highly infectious, genetically diverse viruses. Global outbreaks occur frequently, making molecular surveillance important for infection monitoring. This cross-sectional descriptive study aimed to monitor cases of norovirus gastroenteritis in the Brazilian Amazon. Fecal samples were tested by immunoenzymatic assay, RT-PCR and genetic sequencing for the ORF1/ORF2 and protease regions. Bayesian inference with a molecular clock was employed to construct the phylogeny. The norovirus prevalence was 25.8%, with a higher positivity rate among children aged 0-24 months. Genogroup GII accounted for 98.1% of the sequenced samples, while GI accounted for 1.9% of them. The GII.P16/GII.4 genotype was the most prevalent, with an evolution rate of 2.87x10−3 and TMRCA estimated in 2012. This study demonstrates that norovirus is a primary causative agent of gastroenteritis and provides data on viral genetic diversity that may facilitate infection surveillance and vaccine development.
ORIGINAL ARTICLE
Survival and mortality profile among people living with HIV in a cohort in the Northeastern region of Brazil Leite, Kaliene Maria Estevão Lima, Kledoaldo Oliveira Ximenes, Ricardo Arraes de Alencar Albuquerque, Maria de Fatima Militão de Miranda-Filho, Demócrito de Barros Godoi, Emmanuelle Tenório Albuquerque Madruga Montarroyos, Ulisses Ramos Lacerda, Heloísa Ramos

Abstract in English:

ABSTRACT Conditions related to the acquired immune deficiency syndrome (AIDS) are still a significant cause of morbidity and mortality among people living with HIV (PLHIV). Longer survival in this population were reported to increase the risk of developing noncommunicable chronic diseases (NCDs). This study aimed to estimate the survival and causes of death according to age group and sex among PLHIV monitored at two referral centers in the Northeastern Brazil. This is a prospective, retrospective cohort with death records from 2007 to 2018, based on a database that registers causes of death using the International Classification of Disease (ICD-10), which were subsequently coded following the Coding Causes of Death in HIV (CoDe). A total of 2,359 PLHIV participated in the study, with 63.2% being men, with a follow-up period of 13.9 years. Annual mortality rate was 1.46 deaths per 100 PLHIV (95% CI: 1.33 – 1.60) with a frequency of 20.9%. Risk of death for men increased by 49% when compared to women, and the risk of death in PLHIV increased by 51% among those aged 50 years and over at the time of diagnosis. It was observed that 73.5% accounted for AIDS-related deaths, 6.9% for non-AIDS defining cancer, 6.3% for external causes, and 3.2% for cardiovascular diseases. Among the youngest, 97.2% presented an AIDS-related cause of death. Highest frequency of deaths from neoplasms was among women and from external causes among men. There is a need for health services to implement strategies ensuring greater adherence to treatment, especially among men and young people. Moreover, screening for chronic diseases and cancer is essential, including the establishment of easily accessible multidisciplinary care centers that can identify and address habits such as illicit drug use and alcoholism, which are associated with violent deaths.
ORIGINAL ARTICLE
Immunogenicity of COVID-19 adsorbed inactivated vaccine (CoronaVac) and additional doses of mRNA BNT162b2 vaccine in immunocompromised adults compared with immunocompetent persons Ibrahim, Karim Yaqub Moreira, Raquel Megale Santos, Carolina Ferreira dos Strabelli, Tânia Mara Varejão Belizário, Juliana de Cássia Pinto, Maria Isabel de Moraes Marinho, Ana Karolina Barreto Berselli Pereira, Juliana Marquezi Mello, Liliane Saraiva de Ando, Mauricio Cesar Silva, Vitor Gabriel Lopes da Sato, Paula Keiko Lima, Marcos Alves de França, João Italo Dias Loch, Ana Paula Miyaji, Karina Takesaki Infante, Vanessa Precioso, Alexander Roberto Sartori, Ana Marli Christovam

Abstract in English:

ABSTRACT Inactivated COVID-19 vaccines data in immunocompromised individuals are scarce. This trial assessed the immunogenicity of two CoronaVac doses and additional BNT162b2 mRNA vaccine doses in immunocompromised (IC) and immunocompetent (H) individuals. Adults with solid organ transplant (SOT), hematopoietic stem cell transplant, cancer, inborn immunity errors or rheumatic diseases were included in the IC group. Immunocompetent adults were used as control group for comparison. Participants received two CoronaVac doses within a 28-day interval. IC received two additional BNT162b2 doses and H received a third BNT162b2 dose (booster). Blood samples were collected at baseline, 28 days after each dose, pre-booster and at the trial end. We used three serological tests to detect antibodies to SARS-CoV-2 nucleocapsid (N), trimeric spike (S), and receptor binding domain (RBD). Outcomes included seroconversion rates (SCR), geometric mean titers (GMT) and GMT ratio (GMTR). A total of 241 IC and 100 H adults participated in the study. After two CoronaVac doses, IC had lower SCR than H: anti-N, 33.3% vs 79%; anti-S, 33.8% vs 86%, and anti-RBD, 48.5% vs 85%, respectively. IC also showed lower GMT than H: anti-N, 2.3 vs 15.1; anti-S, 58.8 vs 213.2 BAU/mL; and anti-RBD, 22.4 vs 168.0 U/mL, respectively. After the 3rd and 4th BNT162b2 doses, IC had significant anti-S and anti-RBD seroconversion, but still lower than H after the 3rd dose. After boosting, GMT increased in IC, but remained lower than in the H group. CoronaVac two-dose schedule immunogenicity was lower in IC than in H. BNT162b2 heterologous booster enhanced immune response in both groups.
ORIGINAL ARTICLE
Malaria in a vulnerable population living in quilombo remnant communities in the Brazilian Amazon: a cross-sectional study from 2005-2020 Ribeiro, Beatriz Costa Garcia, Carla Gisele R Lima, Lilian Jéssica Passos Guerreiro, João F. Póvoa, Marinete Marins Cunha, Maristela G.

Abstract in English:

ABSTRACT Quilombo remnant communities are areas officially recognized by the Brazilian government as historical communities founded by formerly enslaved individuals. These communities are mostly located in the endemic areas of malaria in the Brazilian Amazon. We retrospectively described the prevalence of malaria among individuals living in 32 recognized quilombo remnant communities in the Baiao and Oriximina municipalities located in the Para State. The number of malaria cases and the Annual Parasitic Incidence (API) recorded by the Brazilian malaria surveillance system (SIVEP-Malaria) from January 2005 to December 2020 were analyzed. We found that all communities registered at least one case over the 16-year period, the most frequent parasitic species being Plasmodium vivax (76.1%). During this period, 0.44% (4,470/1,008,714) of the malaria cases registered in Para State were reported in these quilombo remnant communities, with frequencies of 10.9% (856/7,859) in Baiao municipality and 39.1% (3,614/9,238) in Oriximina municipality, showing that individuals living in these rural communities are exposed to malaria. These data indicate that effective surveillance requires improved measures to identify malaria transmission among vulnerable populations living in quilombo remnant communities in the Brazilian Amazon.
ORIGINAL ARTICLE
The association of fibrinogen–albumin ratio and neutrophil–lymphocyte ratio with the severity of respiratory syncytial virus infection in children Okay, Zeynep Uze Okay, Berker Hatipoglu, Halil Ugur Akkoc, Gulsen Sahin, Kamil

Abstract in English:

ABSTRACT Respiratory syncytial virus (RSV) is a common cause of respiratory infections. It is responsible for more than half of lower respiratory tract infections in infants requiring hospitalization. This study aimed to investigate the correlation between the fibrinogen–albumin ratio (FAR) and the severity of RSV infection and to compare its effectiveness with the neutrophil–lymphocyte ratio (NLR). This was a retrospective cohort study with patients aged from 29 days to two years who had been admitted to the pediatric clinic of our hospital. Patients were divided into four groups: group 1 (mild disease), group 2 (moderate disease), group 3 (severe disease), and group 4 (control). FAR and NLR were measured in all groups. FAR was significantly higher in group 3 than in the other groups, in group 2 than in groups 1 and 4, and in group 1 than in group 4 (p<0.001 for all). NLR was significantly higher in group 4 than in the other groups and in group 3 than in groups 1 and 2 (p<0.001 for all). FAR totaled 0.078 ± 0.013 in patients with bronchiolitis; 0.099 ± 0.028, in patients with bronchopneumonia; and 0.126 ± 0.036, in patients with lobar pneumonia, all with statistically significant differences (p<0.001). NLR showed no significant statistical differences. This study found a statistically significant increase in FAR in the group receiving invasive support when compared to that receiving non-invasive support (0.189 ± 0.046 vs. 0.112 ± 0.030; p=0.003). Mechanical ventilation groups showed no differences for NLR. FAR was used to identify severe RSV-positive patients, with a sensitivity of 84.4%, a specificity of 82.2%, and a cutoff value of >0.068. This study determined a cutoff value of ≤1.49 for NLR, with a sensitivity of 62.2% and a specificity of 62.2% to find severe RSV-positive patients. Also, statistically significant associations were found between FAR and hospitalization and treatment length and time up to clinical improvement (p<0.001 for all). NLR and hospitalization and treatment length showed a weak association (p<0.001). In children with RSV infection, FAR could serve to determine disease severity and prognosis and average lengths of hospitalization, treatment, and clinical improvement. Additionally, FAR predicted disease severity more efficiently than NLR.
ORIGINAL ARTICLE
Dynamic evaluation of liver fibrosis to assess hepatocellular carcinoma risk in patients with chronic hepatitis B receiving nucleoside analogs treatment Luo, Jia Yuan, Ming Li, Shan Chen, Lijuan Zhou, Mingsha Li, Hailan Bai, Xiuyuan Zhang, Zhiyu Zeng, Weiqi Sun, Xueyi Zhang, Qiongfang Chen, Yi Zhou, Li

Abstract in English:

ABSTRACT Despite good hepatitis B virus (HBV) inhibition by nucleoside analogs (NAs), cases of hepatocellular carcinoma (HCC) still occur. This study proposed a non-invasive predictive model to assess HCC risk in patients with chronic hepatitis B (CHB) receiving NAs treatment. Data were obtained from a hospital-based retrospective cohort registered on the Platform of Medical Data Science Academy of Chongqing Medical University, from 2013 to 2019. A total of 501 patients under NAs treatment had their FIB-4 index updated semiannually by recalculation based on laboratory values. Patients were divided into three groups based on FIB-4 index values: < 1.45, 1.45–3.25, and ≥ 3.25. Subsequently, HCC incidence was reassessed every six months using Kaplan-Meier curves based on the updated FIB-4 index. The median follow-up time of CHB patients after receiving NAs treatment was 2.5 years. HCC incidences with FIB-4 index < 1.45, 1.45–3.25, and ≥ 3.25 were 1.18%, 1.32%, and 9.09%, respectively. Dynamic assessment showed that the percentage of patients with FIB-4 index < 1.45 significantly increased semiannually (P < 0.001), and of patients with FIB-4 index ≥ 3.25 significantly decreased (P < 0.001). HCC incidence was the highest among patients with FIB-4 index ≥ 3.25. The FIB-4 index effectively predicted HCC incidence, and its dynamic assessment could be used for regular surveillance to implement early intervention and reduce HCC risk.
ORIGINAL ARTICLE
Accuracy of the Verbal Autopsy questionnaire in the diagnosis of COVID-19 deaths in a Brazilian capital Campos, Marcos Adriano Garcia Cutrim, Ézio Arthur Monteiro Cutrim, Érico Murilo Monteiro Oliveira, João Victor Pimentel de Oliveira, Eduardo José Silva Gomes de Pontes, Daniel de Brito Figueiredo Neto, José Albuquerque de Silva, Gyl Eanes Barros

Abstract in English:

ABSTRACT The Verbal Autopsy (VA) is a questionnaire about the circumstances surrounding a death. It was widely used in Brazil to assist in postmortem diagnoses and investigate excess mortality during the Coronavirus Disease 2019 (COVID-19) pandemic. This study aimed to determine the accuracy of investigating acute respiratory distress syndrome (ARDS) using VA. This is a cross-sectional study with prospective data collected from January 2020 to August 2021 at the Death Verification Service of Sao Luis city, Brazil. VA was performed for suspected COVID-19 deaths, and one day of the week was randomly chosen to collect samples from patients without suspected COVID-19. Two swabs were collected after death and subjected to reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 detection. Of the 250 cases included, the VA questionnaire identified COVID-19-related ARDS in 67.2% (52.98% were positive for COVID-19). The sensitivity of the VA questionnaire was 0.53 (0.45–0.61), the specificity was 0.75 (0.64–0.84), the positive predictive value was 0.81 (0.72–0.88), and the negative predictive value was 0.44 (0.36–0.53). The VA had a lower-than-expected accuracy for detecting COVID-19 deaths; however, because it is an easily accessible and cost-effective tool, it can be combined with more accurate methods to improve its performance.
Original Article
Genetic diversity in the partial sequence of the HIV-1 gag gene among people living with multidrug-resistant HIV-1 infection Alencar, Cecília Salete Sabino, Ester Cerdeira Diaz, Ricardo Sobhie Mendrone-Junior, Alfredo Nishiya, Anna Shoko

Abstract in English:

ABSTRACT The group-specific antigen (gag) plays a crucial role in the assembly, release, and maturation of HIV. This study aimed to analyze the partial sequence of the HIV gag gene to classify HIV subtypes, identify recombination sites, and detect protease inhibitor (PI) resistance-associated mutations (RAMs). The cohort included 100 people living with HIV (PLH) who had experienced antiretroviral treatment failure with reverse transcriptase/protease inhibitors. Proviral HIV-DNA was successfully sequenced in 96 out of 100 samples for gag regions, specifically matrix (p17) and capsid (p24). Moreover, from these 96 sequences, 82 (85.42%) were classified as subtype B, six (6.25%) as subtype F1, one (1.04%) as subtype C, and seven (7.29%) exhibited a mosaic pattern between subtypes B and F1 (B/F1), with breakpoints at p24 protein. Insertions and deletions of amino acid at p17 were observed in 51 samples (53.13%). The prevalence of PI RAM in the partial gag gene was observed in 78 out of 96 PLH (81.25%). Among these cases, the most common mutations were R76K (53.13%), Y79F (31.25%), and H219Q (14.58%) at non-cleavage sites, as well as V128I (10.42%) and Y132F (11.46%) at cleavage sites. While B/F1 recombination was identified in the p24, the p17 coding region showed higher diversity, where insertions, deletions, and PI RAM, were observed at high prevalence. In PLH with virological failure, the analysis of the partial gag gene could contribute to more accurate predictions in genotypic resistance to PIs. This can aid guide more effective HIV treatment strategies.
Original Article
Human papillomavirus in women infected with human immunodeficiency virus: association with viral load and lymphocyte count Morais, Ana Cléa Cutrim Diniz de Ferreira, Alice de Sá Barbosa, Carla Déa Trindade Lima, Maria Fernanda Bezerra Fook, Karina Donato Carvalho, Mônika Machado de Muniz, Alessandra Costa de Sales Araújo, Deborah Rocha de Monteiro, Pablo de Matos Araújo, Maria José Abigail Mendes Monteiro, Sally Cristina Moutinho Lopes, Fernanda Ferreira

Abstract in English:

ABSTRACT Women living with human immunodeficiency virus are at an increased risk of developing cancers related to human papillomavirus (HPV). Thus, it is important to combine clinical assessments, serological screening, and HPV data for planning prevention policies. This study aimed to identify HPV and its specific types in the cervical, anal, and oral mucosa of HIV-seropositive women, associating it with viral load and lymphocyte count. Sociodemographic characteristics, health data (CD4+ and CD8+ T cell counts and viral load), and biological samples (cervical, anal, and oral) were collected from 86 HIV-positive women undergoing antiretroviral therapy. Data were classified according to the presence or absence of HPV-DNA, HPV-DNA presence at one or more anatomic sites, and level of oncogenic risk, considering low- and high-risk oncogenic HPV-DNA groups. The presence of HPV in the cervicovaginal site was 65.9%, 63.8% in anal canal, and 4.2% in oral mucosa. A viral load ≥75 HIV copies/mL was associated with the presence of HPV-DNA. There was an association between viral load and the low-risk HPV or high-risk HPV groups. We found a high prevalence of HPV infection in HIV-seropositive women, particularly in the cervical and anal mucosa, with viral load ≥75 HIV copies/mL being associated with HPV-DNA presence.
Original Article
Impact of COVID-19 on tuberculosis notifications Pontes, Talita Antunes Antoniolli Fernandez-Llimos, Fernando Wiens, Astrid

Abstract in English:

ABSTRACT The COVID-19 pandemic has significantly impacted the control of diseases by overwhelming healthcare systems, and tuberculosis (TB) notifications may have been affected. This study aimed to analyze the impact of COVID-19 on TB notifications in the Sao Paulo State. This is a retrospective study examining TB notifications extracted from the TBweb database (Jan 2015 to Dec 2022). We conducted an interrupted time series (ITS) analysis of TB notifications using the declaration of the COVID-19 pandemic as the interrupting event (Bayesian causal impact analysis). A total of 177,103 notifications of TB incident cases were analyzed, revealing a significant decrease in 2020 (13%) and in 2021 (9%), which lost significance in 2022. However, changes were not associated with population density or the area of the regions. Future analyses of the effects of TB underdiagnosis might help describe the impact of underreporting on future TB incidence and mortality.
ORIGINAL ARTICLE
Unraveling clinical outcomes of long-term cART treatment in HIV-1 patients with or without the Brazilian GWGR motif in the V3 loop Folgosi, Victor Ângelo Komninakis, Shirley Vasconcelos Lopes, Luciano Monteiro, Mariana Amélia Assone, Tatiane Fonseca, Luiz Augusto Marcondes Domingues, Wilson Leite Junior, Pedro Domingos Victor, Jefferson Russo Casseb, Jorge

Abstract in English:

ABSTRACT The presence of genetic mutations in HIV poses a significant challenge, potentially leading to antiretroviral resistance and hampering therapeutic development. The Brazilian population has presented variations in the HIV envelope V3 loop gene, especially the GWGR motif. This motif has been linked to reduced transmission potential and slower CD4+ T cell decline. This study aimed to assess clinical outcomes in patients with HIV-1 infected with strains containing the GWGR motif compared with those without it during long-term cART. A cohort of 295 patients with HIV was examined for the GWGR motif presence in the V3 loop. A total of 58 samples showed the GWGR signature, while 237 had other signatures. Multifactorial analyses showed no significant differences in demographic characteristics, CD4+ cell count, AIDS progression, or mortality between GWGR carriers and others. However, the mean interval between the first positive HIV test and the initial AIDS-defining event was more than two times longer for women carrying the GWGR signature (p = 0.0231). We emphasize the positive impact of cART on HIV/AIDS treatment, including viral suppression, CD4+ cell preservation, and immune function maintenance. Although no significant differences were found during cART, residual outcomes reflecting adherence challenges were observed between diagnosis and the first AIDS-defining event. The previously described outcomes, highlighting statistically significant differences between individuals carrying the GPGR motif compared with those with the Brazilian GWGR motif, may be directly linked to the natural progression of infection before advancements in cART. Presently, these physicochemical aspects may no longer hold the same relevance.
ORIGINAL ARTICLE
Clinical and immunological features of laryngeal cryptococcosis Oliveira, Vítor Falcão de Taborda, Mariane Catarina, Mateus Bach Santa Kruschewsky, Wdson Luis Lima Rapozo, Marjorie Marini Rocha, Thais Queiroz da Pagliari, Carla Magri, Adriana Satie Gonçalves Kono Magri, Marcello Mihailenko Chaves Soto, Miriam Nacagami

Abstract in Portuguese:

ABSTRACT The literature holds few descriptions on immune response findings for laryngeal cryptococcosis. Immunology has been more extensively described in cases involving the central nervous system and the lungs, although many of these studies were conducted in animal models. We aimed to analyze the clinical and immunological characteristics of three patients with laryngeal cryptococcosis. We observed a weak participation of the innate immune response, whereas adaptive immunity showed the predominance of a Th2-type response over a Th1-type response. Most cases occur in male older adults with immunosuppressive conditions, of which HIV infection was absent. Hoarseness configured the main symptom. We found a disease that was restricted to the larynx and possibly the lungs by contiguity. Patients with hoarseness and lesions in nasal endoscopy should be investigated for cryptococcosis by a biopsy of the larynx, including with negative serum cryptococcal antigen. The immunological aspects of our findings of laryngeal involvement resembled those in the most commonly affected systems.
ORIGINAL ARTICLE
Antibacterial activity of Nocardia spp. and Streptomyces sp. on multidrug-resistant pathogens causing neonatal sepsis González-Nava, Janette Berenice Manzanares-Leal, Gauddy Lizeth Zapi-Colín, Luis Ángel Dávila-Ramos, Sonia Sandoval-Trujillo, Horacio Ramírez-Durán, Ninfa

Abstract in English:

ABSTRACT Neonatal sepsis leads to severe morbidity and occasionally death among neonates within the first week following birth, particularly in low- and middle-income countries. Empirical therapy includes antibiotics recommended by WHO. However, these have been ineffective against antimicrobial multidrug-resistant bacterial strains such as Klebsiella spp, Escherichia coli, and Staphylococcus aureus species. To counter this problem, new molecules and alternative sources of compounds with antibacterial activity are sought as options. Actinobacteria, particularly pathogenic strains, have revealed a biotechnological potential still underexplored. This study aimed to determine the presence of biosynthetic gene clusters and the antimicrobial activity of actinobacterial strains isolated from clinical cases against multidrug-resistant bacteria implicated in neonatal sepsis. In total, 15 strains isolated from clinical cases of actinomycetoma were used. PCR screening for the PKS-I, PKS-II, NRPS-I, and NRPS-II biosynthetic systems determined their secondary metabolite-producing potential. The strains were subsequently assayed for antimicrobial activity by the perpendicular cross streak method against Escherichia fergusonii Sec 23, Klebsiella pneumoniae subsp. pneumoniae H1064, Klebsiella variicola H776, Klebsiella oxytoca H793, and Klebsiella pneumoniae subsp. ozaenae H7595, previously classified as multidrug-resistant. Finally, the strains were identified by 16S rRNA gene sequence analysis. It was found that 100% of the actinobacteria had biosynthetic systems. The most frequent biosynthetic system was NRPS-I (100%), and the most frequent combination was NRPS-I and PKS-II (27%). All 15 strains showed antimicrobial activity. The strain with the highest antimicrobial activity was Streptomyces albus 94.1572, as it inhibited the growth of the five multidrug-resistant bacteria evaluated.
ORIGINAL ARTICLE
Evaluation of different cut-off points for IgG avidity and IgM in the diagnosis of acute toxoplasmosis in pregnant women participating in a congenital toxoplasmosis screening program Laguardia, Michelle Costa Carellos, Ericka Viana Machado Andrade, Glaucia Manzan Queiroz Carneiro, Mariângela Januário, José Nélio Vitor, Ricardo Wagner de Almeida

Abstract in English:

ABSTRACT The main social impact of toxoplasmosis stems from its ability to be vertically transmitted. Postnatally acquired infection is generally asymptomatic in approximately 70–90% of cases, making diagnosis often dependent on laboratory tests using serological methods to search for anti-T. gondii antibodies. This study aimed to investigate the ability of the VIDAS TOXO IgG avidity and VIDAS TOXO IgM assays to confirm recent toxoplasmosis. In total, 341 pregnant women with suspected acute toxoplasmosis were systematically monitored in the Program for Control of Congenital Toxoplasmosis in Minas Gerais State, Brazil. We conducted an observational analytical-descriptive cross-sectional study and grouped according to clinical and laboratory criteria as having acute or chronic toxoplasmosis. The VIDAS TOXO IgG avidity and VIDAS TOXO IgM assays were evaluated to investigate the capacity to identify acute infection. IgG avidity showed good performance in identifying acute toxoplasmosis when the IgG avidity index was lower than or equal to 0.1. Values greater than or equal to 3.16 according to the TOXO IgM kit were associated with a greater chance of acute infection. These results may contribute to a more adequate diagnosis of acute gestational toxoplasmosis and, consequently, the avoidance of inadequate or unnecessary treatments.
ORIGINAL ARTICLE
Stenotrophomonas maltophilia outbreak in a university hospital: epidemiological investigation and literature review of an emerging healthcare-associated infection Erinmez, Mehmet Aşkın, Feyza Nur Zer, Yasemin

Abstract in English:

ABSTRACT Stenotrophomonas maltophilia was considered to be a low-virulence organism. But it has emerged as a prominent opportunistic pathogen in patients with certain risk factors. This study aimed to describe an outbreak experienced in our hospital with all dynamics while evaluating previous S. maltophilia outbreak reports. S. maltophilia isolates were obtained from a university hospital in Türkiye in a seven-months period. Antimicrobial resistance, type of infections, predisposing factors of infected patients, antibiotic therapy, outcome of infections, and outbreak source were investigated. Also, S. maltophilia outbreaks in the literature were reviewed. In the 12 months prior to the outbreak, prevalence rate of clinical samples including S. maltophilia was 7/1,000 patient per day, opposed to 113/1,000 patient per day during the outbreak. Although a large number of cases were observed in a short seven-month period, a source of contamination could not be detected. Stable mortality rates (or remaining close to the average) during outbreaks can be attributed to the careful attention paid by laboratory and clinic physicians during procedures. S. maltophilia has potential to spread outbreaks and infect patients in operating rooms and intensive care units during invasive procedures.
ORIGINAL ARTICLE
Anemia and intestinal parasites in Mbya Guarani children, Misiones, Argentina Deschutter, Enrique-Jorge Marczuk, Rut-Karina Blanco, Nestor-Guillermo Ramos-Rincón, José-Manuel

Abstract in English:

ABSTRACT This study aimed to assess the prevalence of anemia in children of two Guarani communities in Misiones, Argentina, and to analyze its association with socioenvironmental and parasitic factors. This cross-sectional study took place in two villages, Koen Ju and Kaa Poty, and included Mbya Guarani children aged 6 months to 14 years. A multivariable analysis was performed to evaluate the association of anemia with the presence of intestinal parasites. Altogether, 162 children were included in the study: 53.1% were boys, 32.7% had low weight-for-age, and 22.2% low height-for-age. Nearly half (46.9%, n=76) had anemia, which was mainly mild (92.1%), with a few moderate cases (7.9%). Of the 109 children who underwent testing for intestinal parasites, 89 (81.7%) had at least one, and 53 (59.5%) had more than one. The main parasite was Blastocystis hominis (49.5%), followed by Entamoeba coli (47.7%), hookworms (36.7%), and Ascaris lumbricoides (31.5%). In the multivariable analysis, anemia was associated with intestinal parasitosis (adjusted odds ratio [OR] 4.24, 95% confidence interval [CI] 1.08–16.5; p=0.038) and male sex (adjusted OR 2.66; 95% CI 1.08–6.47; p= 0.01). Overall, we found that both anemia and intestinal parasites are common in the pediatric population of the Guarani ethnic group. Intestinal parasites and male sex were associated with the presence of anemia.
ORIGINAL ARTICLE
Intermediate and definitive hosts of wild Schistosoma mansoni: ecological niche modeling of hosts in low endemicity areas Santos, Elisiane Rodrigues dos Garcia, Juberlan Silva

Abstract in English:

ABSTRACT The relationship between the environment and animal life began to be seen as an important tool to help control zoonoses. Climate variations lead to changes in the environment, which can influence the spatial distribution of species and, consequently, the spread of diseases to humans. Considered the main non-human definitive host species of Schistosoma mansoni in Brazil, the wild rodent Nectomys squamipes plays an important role as a reservoir in maintaining the schistosomiasis cycle in the absence of humans. This study demonstrates the results of ecological niche modeling of intermediate and definitive wild hosts of S. mansoni in the Regional Health Superintendence of Barbacena (Minas Gerais State), which has registered 31 municipalities, 80% of which are classified as endemic for parasitosis. Environmental variables associated with the distribution of each species were used based on information from the scientific collections of Global Biodiversity Information Facility (GBIF) and Species Link to project the ecological niche model in the geographic space. Abiotic variables such as the mean annual temperature, isothermality, and precipitation seasonality were obtained from World Clim. Ecological niche modeling of the wild host, N. squamipes, revealed the occurrence of the species in geographic overlap with the Biomphalaria species. Knowing the influence of bioclimatic variables and identifying favorable conditions for the establishment, occurrence, and distribution of species are important information for developing strategic actions for the surveillance and control of this endemic species. The presence of the definitive wild host needs to be considered by control programs of schistosomiasis.
ORIGINAL ARTICLE
Prediction of promiscuous multiepitope-based peptide vaccine against RdRp of rotavirus using immunoinformatics studies Almohaimeed, Hailah M. Abdulfattah, Ahmed M. Alsulaimani, Fayez Alshammary, Aisha Almohaini, Mohammad Osama Almehiny, Khowlah Abdulrahman Hershan, Almonther Abdullah Alkhamiss, Abdullah Saleh Alghsham, Ruqaih S. Ghabban, Hanaa Soliman, Mona H. Alorabi, Jamal A. Abdulmonem, Waleed Al

Abstract in English:

ABSTRACT Rotavirus, a dsRNA virus in the Reoviridae family, shows a segmented genome. The VP1 gene encodes the RNA-dependent RNA polymerase (RdRp). This study aims to develop a multiepitope-based vaccine targeting RdRp using immunoinformatic approaches. In this study, 100 available nucleotide sequences of VP1-Rotavirus belonging to different strains across the world were retrieved from NCBI database. The selected sequences were aligned, and a global consensus sequence was developed by using CLC work bench. The study involved immunoinformatic approaches and molecular docking studies to reveal the promiscuous epitopes that can be eventually used as active vaccine candidates for Rotavirus. In total, 27 highly immunogenic, antigenic, and non-allergenic T-cell and B-cell epitopes were predicted for the Multiepitope vaccine (MEV) against rotavirus. It was also observed that MEV can prove to be effective worldwide due to its high population coverage, demonstrating the consistency of this vaccine. Moreover, there is a high docking interaction and immunological response with a binding score of −50.2 kcal/mol, suggesting the vaccine’s efficacy. Toll-like receptors (TLRs) also suggest that the vaccine is physiologically and immunologically effective. Collectively, our data point to an effective MEV against rotavirus that can effectively reduce viral infections and improve the health status worldwide.
ORIGINAL ARTICLE
Entomo-virological surveillance of Flavivirus in mosquitoes in Yucatan State, Mexico Argaez-Sierra, Diana Guadalupe Baak-Baak, Carlos Marcial Garcia-Rejon, Julian E. Cetina-Trejo, Rosa Carmina Tzuc-Dzul, Julio C. Acosta-Viana, Karla Y. Chan-Perez, José I. Cigarroa-Toledo, Nohemi

Abstract in English:

ABSTRACT The genus Flavivirus (Family: Flaviviridae) comprises arboviruses with the capacity to infect humans and animals. It also integrates insect-specific viruses. This study aimed to identify Flavivirus in mosquitoes captured in 17 municipalities in Yucatan State, Mexico. The mosquitoes were caught in households from November 2021 to May 2022. A total of 4,321 adult mosquitoes from five species were caught. The most abundant were Culex quinquefasciatus (n = 3,563) and Aedes aegypti (n = 734). For molecular investigations, 600 female mosquitoes were split into groups of 10, mostly for species and site location. Reverse transcriptase polymerase chain reaction (RT-PCR) amplified a region of the NS5 gene to find the Flavivirus ribonucleic acids (RNA). A total of 24 pools that were positive for Flavivirus were detected in Ae. aegypti specimens and subsequently subjected to sequencing using the Sanger method. A total of 12 sequences matched the established quality criteria and were subsequently employed for sequence homology analysis. We found that one sequence corresponded to the Zika virus (ZIKV), and 11 sequences had sequence similarity with Phlebotomus-associated flavivirus (PAFV), an insect-specific virus (ISF). In conclusion, we found ZIKV in the Merida municipality, Yucatan State, which suggests that the virus is silently circulating. Phlebotomus-associated flavivirus is distributed in five municipalities in Yucatan State, Mexico. Future studies could focus on isolating this virus and studying its biological role within Ae. aegypti.
ORIGINAL ARTICLE
Evaluation of d-dimer as outcome biomarker in COVID-19 acute respiratory distress patients Diniz, Simone Magalhães Mauad, Vitor Augusto Queiroz Fernandes, Caio Cesar Ferreira Bacci, Marcelo Rodrigues

Abstract in English:

ABSTRACT Acute respiratory distress syndrome is a significant complication in critical care patients. COVID-19 (C19)-associated severe respiratory failure is related to it, and d-dimer rise predicts a worse outcome. To investigate the association between d-dimer and the severity of this respiratory syndrome, we conducted a study in C19 intubated patients. A retrospective, single-center observational study was conducted with 64 C19 adult intubated patients. Strata of d-dimer results between patients was evaluated using survival analysis. Survival was higher in mild respiratory distress patients. D-dimer showed poor sensitivity and specificity in predicting respiratory failure severity. Risk assessment for death showed a higher prevalence of admission d-dimer results (HR 1.335; 95% CI 0.695–2.564). Our sample confidently represented the medical profile of C19 severe patients. Sepsis development in C19 is associated with the inflammatory storm in respiratory distress syndrome. As the receiver operating curves show, the increase in d-dimer results is consistent with inflammation rather than a prognostic biomarker. As expected, severe respiratory distress patients presented higher mortality. In summary, d-dimer results are not associated with the prognosis of C19 respiratory distress syndrome patients.
ORIGINAL ARTICLE
Mitigating adverse outcomes in tuberculosis treatment: analyzing a non-compliance risk assessment strategy in a case report Melo, Carolina Rossoni de Volpe-Chaves, Cláudia Elizabeth Silva, Kássia Raquel da Roso, João Gabriel Cibolli Bertucci, Alexandre Albuquerque Cunha, Eunice Atsuko Totumi Venturini, James Andrade, Ursulla Vilella Peruzzo, Michelle Mocellin Bezerra, Wanessa da Silva Peres Oliveira, Sandra Maria do Valle Leone de Paniago, Anamaria Mello Miranda

Abstract in English:

ABSTRACT Tuberculosis (TB) is a global public health concern and a leading cause of death. Its persistence occurs mainly because barriers in the care cascade are not being fully addressed. Healthcare professionals and scientists have been addressing treatment challenges such as abandonment and irregular drug intake via strategies such as directly observing treatment and singular therapeutic projects to improve adherence. However, while protocols and guidelines advocate these strategies, their implementation requires a broader approach from healthcare teams. This article examines the importance of such strategies in clinical TB management and analyzes an unfavorable outcome in an immunocompetent patient treated for pulmonary tuberculosis (PTB) from 2017 to 2022. After recurrence and treatment, the patient continued to have persistent acid-fast bacilli in the sputum, positive cultures for Mycobacterium tuberculosis, and progressive lung lesions, despite receiving the recommended treatment. Although categorized as having an intermediate risk of treatment abandonment, the patient faced challenges, such as the COVID-19 pandemic, pregnancy, and being diagnosed with COVID-19. After therapeutic failure and the loss of beneficial prospects, palliative care was initiated. This case illustrates the complexities of managing TB in patients with recurrent disease despite apparent adherence to treatment. After reassessing the risk of abandonment score, the patient was categorized as high-risk. This underscores the importance of singular therapeutic projects, such as psychological support for high-risk or intermediate patients, to prevent negative outcomes. This case reinforces the critical need for comprehensive patient-centered approaches to successfully treat and manage TB.
ORIGINAL ARTICLE
Evaluation of nitazoxanide in the treatment of experimental murine neurotoxoplasmosis Reis, Thaís Santos Anjo Siqueira, Victor da Silva Ferreira, Stéfanne Rodrigues Rezende Domann, Natália Rodrigues Júnior, Benílton Alves Fleury, Amanda Cristina Corrêa Souza, Isa Marianny Ferreira Nascimento Barbosa de Cardoso, Ludimila Paula Vaz Siqueira, Carla Silva Rezende, Hanstter Hallison Alves

Abstract in English:

ABSTRACT Toxoplasmosis is a widespread zoonotic disease that poses significant public health concern globally, with neurotoxoplasmosis being a severe complication associated with high mortality rates. The standard therapy for neurotoxoplasmosis involves a combination of sulfadiazine and pyrimethamine, which, despite its efficacy, is often limited by adverse effects leading to treatment discontinuation. This study aimed to evaluate the in vivo efficacy of nitazoxanide in treating neurotoxoplasmosis in mice infected with the Me49 strain. The study comprised two groups: Group I, including subgroups of uninfected, infected and treated with saline, and infected and untreated mice; and Group II, comprising infected mice treated with nitazoxanide at 100 mg/kg/day, nitazoxanide at 150 mg/kg/day, and pyrimethamine combined with sulfadiazine. After 14 days of treatment, the mice were euthanized for organ collection. Histopathological examination of the brains revealed that the highest dose of nitazoxanide reduced parasitic load and cerebral hemorrhages. Biochemical and histopathological analyses of liver and kidney tissues demonstrated toxicological profiles comparable to pyrimethamine and sulfadiazine. However, despite showing efficacy and similar toxicity levels, nitazoxanide treatment was less effective regimen in controlling neurotoxoplasmosis in this experimental model compared to the pyrimethamine and sulfadiazine. Thus, while nitazoxanide presents potential in neurotoxoplasmosis treatment, pyrimethamine combined with sulfadiazine remains the preferred therapeutic choice based on better efficacy observed in this study.
Original Article
Mutations in the voltage-gated sodium channel associated with pyrethroid resistance in Aedes albopictus in Yucatan, Mexico Chi-Chim, Wilbert Antonio Garcia-Rejon, Julian Everardo Tzuc-Dzul, Julio Cesar Talavera-Aguilar, Lourdes Cetina-Trejo, Rosa Cigarroa-Toledo, Nohemi Caamal-Villanueva, Viviana Argaez-Sierra, Diana Guadalupe Baak-Baak, Carlos Marcial

Abstract in English:

ABSTRACT Aedes albopictus (Skuse) is a competent vector of dengue and Zika viruses in Mexico. Monitoring the level of resistance of local population is essential due to its epidemiological significance. This study aimed to identify mutations in the voltage-gated sodium channel (VGSC) as one of the mechanisms responsible for pyrethroid insecticide resistance in Ae. albopictus. Immature samples were collected in a rural town in Yucatan, Mexico, from May to October 2021. The pyrethroid insecticide lambda-cyhalothrin was impregnated in CDC bottles and bioassays were conducted on Ae. albopictus populations 3–5 days after emergence. The mosquitoes were susceptible to the insecticide. Females were taken for total DNA extraction. Fragments of domains II, III, and IV of the voltage-gated sodium channel (VGSC) were amplified and sequenced. The presence of synonymous and non-synonymous mutations was found in positions 1532 and 1534 of domain III of the sodium channel gene (VGSC). No mutant alleles in domain IV were detected. A homozygous mutant (ACG) coding for the amino acid threonine (1008Thr) was identified in domain II. Domain III included three heterozygous alleles (P1528S, L1530S, and Ile1410Thr). This last heterozygous allele is reported for the first time in Mexico. Homozygous mutants encoding the amino acids serine/serine and serine/proline in domain III were observed. These have been reported in Aedes aegypti from Mexico, but not yet in Ae. albopictus. This represents new findings for the region, as Ae. albopictus has only been introduced there for approximately five years. In conclusion, non-synonymous mutations were found in Ae. albopictus in a rural area of Yucatan, emphasizing the importance of integrated vector control to prevent Asian tiger mosquitoes from spreading these resistant alleles.
Original Article
Trends in antimicrobial susceptibility patterns in Salmonella from human and nonhuman sources in Sao Paulo State, Brazil, 2016-2023 Tiba-Casas, Monique Ribeiro Almeida, Elisabete Aparecida Costa, Gisele Lozano Bertani, Amanda Maria de Jesus Vieira, Thais Camargo, Carlos Henrique

Abstract in English:

ABSTRACT Antimicrobial resistance constitutes a significant global challenge to public health and development, in which non-typhoidal Salmonella emerges as a critical concern. This study investigates the prevalence and antimicrobial resistance profiles of Salmonella isolates from both human and nonhuman sources. A total of 2,511 Salmonella isolates that had been collected from 2016 to 2023 were analyzed, of which 1,724 underwent antimicrobial susceptibility testing. The main focus lied on the 10 most prevalent serotypes, totaling 957 isolates. Serotyping showed the diverse distribution of serotypes, with Heidelberg, Typhimurium, Enteritidis, and the monophasic Salmonella Typhimurium occurring most often. Antimicrobial resistance was common since 512 strains resisted at least one drug and 319 several drugs. Notably, the Heidelberg and Mbandaka serotypes, predominantly occurring in nonhuman samples, showed multidrug resistance. Salmonella Typhi remained susceptible to antimicrobials. Resistance to nalidixic acid, tetracycline, sulfonamides, and ampicillin was prevalent, whereas all isolates remained susceptible to imipenem. A reduction in susceptibility rates for aminoglycosides was observed over the study period. Extended-spectrum β-lactamase production occurred in 4.4% of the isolates, of which Heidelberg configured the most prevalent extended-spectrum β-lactamase-positive serotype. These findings underscore the importance of surveillance and effective monitoring to control this pathogen, highlighting the necessity of prioritizing public health efforts.
Original Article
Clinical epidemiological and laboratory investigation in co-infection with COVID-19 and tuberculosis Belchior, Ana Carulina Guimarães Freitas Neto, Antônio Martins de Gusmao, Grassyelly Silva Santos, Evelin Jaqueline Lima dos Lemos, Everton Ferreira Pompilio, Mauricio Antonio Volpe-Chaves, Cláudia Elizabeth Brito, Eliana da Costa Alvarenga de Oliveira, Everton Falcão de Carreiro, Ana Caroline Blanco Paniago, Anamaria Mello Miranda

Abstract in English:

ABSTRACT Currently, COVID-19 and tuberculosis (TB) are the deadliest infectious diseases worldwide. Their synergy, form of presentation, morbidity, and mortality are data that have been scarcely explored. Thus, this study aimed to characterize the clinical, epidemiological, and laboratory factors of this co-infection and to analyze the factors associated with the active TB among COVID-19 cases. A case-control study was conducted with a retrospective survey of 21 laboratory-confirmed COVID-19/TB co-infected patients (case group) and 21 COVID-19 patients (control group). The study included participants from eight hospitals in Campo Grande city, capital of Mato Grosso do Sul State, Brazil, from March 2020 to March 2022. Association analysis and binomial logistic regression were employed with statistical significance set at p≤0.05. From the 21 identified cases of COVID-19/TB co-infection, we found a more frequent association with HIV infection than the control-group, without worsening the outcome. COVID-19/TB patients had less dyspnea and less need for mechanical ventilation compared to the cases with COVID-19 only. On the other hand, COVID-19/TB patients had higher levels of C-reactive protein and lower hemoglobin levels, the latter variable was independently associated with COVID-19/TB. Among the clinical differences presented among COVID-19/TB co-infected patients, despite the association with HIV and lower clinical repercussions, only lower hemoglobin levels were associated with COVID-19/TB.
ORIGINAL ARTICLE
Neutrophil/lymphocyte and platelet/lymphocyte ratio in seropositive women for human immunodeficiency virus (HIV) and human papillomavirus (HPV) coinfection Fook, Karina Donato Araújo, Maria José Abigail Mendes Muniz, Alessandra Costa de Sales Carvalho, Mônika Machado de Morais, Ana Cléa Cutrim Diniz de Araújo, Deborah Rocha de Guimarães, Sulayne Janayna Araújo Souza, Camila Penha Abreu Barbosa, Carla Déa Trindade Bertolaccini, Maria Fernanda Lima Belfort, Ilka Kassandra Pereira Lopes, Fernanda Ferreira Monteiro, Sally Cristina Moutinho

Abstract in English:

ABSTRACT This study aims to investigate the possible association between neutrophil/lymphocyte and platelet/lymphocyte ratio in women with HIV, undergoing antiretroviral treatment, with HPV coinfection. This is a cross-sectional study with HIV positive women; their biological samples were collected for laboratory tests (complete blood count) and oncotic cytology for detection of HPV DNA, by PCR-Nested (PGMY and GP primers). Viral load and CD4 and CD8 T-cells counts were obtained from medical records. The data were analyzed, comparing the two groups: those with coinfection and those without it. From 82 HIV seropositive women, 50% exhibited HPV coinfection and 12.2% of coinfected patients had cervical cell alterations. Quantification of viral load, CD4 and CD8 T-cells count, CD4 / CD8 ratio and neutrophil/lymphocyte (NLR) and platelet/lymphocyte (PLR) ratio presented significant differences between groups (p<0.05). The predicting power of NLR and PLR in differentiating HIV/HPV coinfection which demonstrated differences between groups (AUC of 0.882 and 0.776 for NLR and PLR, respectively). There is a relation between the neutrophil/lymphocyte and platelet/lymphocyte ratio with HIV/HPV coinfection in women undergoing antiretroviral treatment, suggesting a state of greater and persistent systemic inflammation, reflecting as a biomarker for screening and monitoring these patients.
ORIGINAL ARTICLE
Dynamics of communication on measles vaccination on digital platforms in the Brazilian context: challenges and perspectives Silva, Maria da Penha Soares Gattás, Vera Lúcia Luna, Expedito José de Albuquerque

Abstract in English:

ABSTRACT The infodemic and the spread of disinformation have fostered mistrust in vaccines, health institutions, and governments, contributing to a global decline in vaccination coverage and the resurgence of vaccine-preventable diseases like measles. In recent years, the use of digital platforms to access health information, including vaccines, has increased significantly. However, the rapid dissemination of disinformation on these under-regulated platforms can greatly influence vaccination behavior. This study aimed to identify and analyze the main arguments used on Facebook® regarding measles vaccination. Posts and comments in Brazilian Portuguese were extracted using keywords such as “Measles Vaccines,” “Triple Viral,” and “Tetra Viral” from general and anti-vaccine pages from January 2017 to December 31, 2020. A sample from both datasets was selected and analyzed using deductive content analysis. Of the posts, 213 (84.5%) were classified as pro-vaccine, primarily promoting vaccination campaigns, with limited discussions on vaccine risk-benefit and collective responsibility. Notably, anti-vaccine pages, though fewer in number and followers, were more active in posting than pro-vaccine pages. Of the anti-vaccine posts, 118 (59.3%) focused on undermining vaccine safety and efficacy, spreading disinformation to downplay disease risks. Although pro-vaccine messages showed the highest engagement on the platform, more effective communication strategies are needed to complement traditional health systems, as anti-vaccine posts appear to influence vaccination behavior, particularly among hesitant communities.
Original Article
Seroconversion and seroreversion rates of anti-Strongyloides IgG in rural areas of the Amazon: a population-based panel study Paula, Fabiana Martins de Gomes, Bruna Barroso Meisel, Dirce Mary Correia Lima Roldan, William Henry Nunes, Mônica da Silva Ferreira, Marcelo Urbano Gryschek, Ronaldo Cesar Borges

Abstract in English:

ABSTRACT Using a panel study design, we aimed to estimate the seroconversion and seroreversion rates of anti-Strongyloides IgG antibodies from surveys carried out 11 months apart in a rural community in the Amazon Basin in Brazil. We used enzyme immunoassays to measure anti-Strongyloides IgG antibodies in 325 baseline plasma samples and 224 others that were collected 11 months later from residents in the agricultural settlement of Granada, Acre State. We observed anti-Strongyloides IgG antibodies in 21.8% of the baseline samples (which showed that 3.4% of participants had larvae in their stool) and in 23.7% of the follow-up samples. The seroconversion rate estimated at 9.7 episodes/100 person-years at risk agrees with ongoing transmission. Specific antibodies were relatively short-lived and nine (25.0%) of 36 seropositive participants at baseline were seronegative when retested 11 months later. Fecal surveys can severely underestimate the prevalence of S. stercoralis infection in rural Amazonians. Serology provides a field-deployable diagnostic tool to find high-prevalence populations, identify associated risk factors, and monitor intervention programs.
Original Article
Seroprevalence of Strongyloides stercoralis, human T-lymphotropic virus, and Chagas disease in the Peruvian Amazon: a cross-sectional study Casapía-Morales, Martin Casanova-Rojas, Wilma-Selva Vázquez-Ascate, Jhosephi Carey-Angeles, Cristiam-Armando Alvarez-Antonio, Carlos Alava-Arévalo, Freddy-Franco Otero-Rodríguez, Silvia Ramos-Rincón, José-Manuel

Abstract in English:

ABSTRACT Strongyloides stercoralis infections, human T-lymphotropic virus (HTLV) infections, and Chagas diseases occur throughout many regions of Central and South America, including Peru. This study aimed to evaluate the seroprevalence of S. stercoralis, HTLV, and Chagas disease in Iquitos (Peruvian Amazon) and the associated epidemiological conditions for S. stercoralis seroprevalence in Iquitos. A population-based cross-sectional study was conducted from May 1 to June 15, 2020, to assess the seroprevalence of S. stercoralis [lysate antigen ELISA (enzyme linked immunosorbent assay)], HTLV (recombinant antigen ELISA), and Chagas disease (crude and recombinant antigen ELISAs). Of the 396 included individuals, 257 were seropositive for S. stercoralis (a 64.9% prevalence, 95% confidence interval [CI] 60.0% to 69.4%). In the multivariable analysis, seropositivity for S. stercoralis was higher in women (odds ratio [OR] 1.60, 95% CI 1.03 to 2.66) and residents of Punchana (OR 3.47, 95% CI 1.51 to 7.93), whereas residence in Iquitos was associated with lower positivity (OR 0.52, 95% CI 0.32 to 0.85). In total, four individuals were positive for HTLV (1.0% seroprevalence, 95% CI 0.3% to 2.7%), and none were positive for Chagas disease (0.0% seroprevalence, 95% CI 0.0% to 1.2%). The seroprevalence of S. stercoralis in Iquitos is high, particularly among women and residents of Punchana. The presence of HTLV infection indicates that the virus is circulating in Iquitos. This study found no cases of Chagas disease.
Original Article
Clinical characteristics of coronavirus disease 2019 patients with hepatitis B virus super-infection Yu, Shan Song, Cunzheng

Abstract in English:

ABSTRACT COVID-19 and hepatitis B disease are significant global pandemics, both of which can lead to liver damage. This study aims to report the clinical course of liver function and disease prognosis of COVID-19 patients with hepatitis B virus (HBV) super-infections. A total of 249 outpatients with COVID-19 were enrolled in this study from December 1, 2023 to February 28, 2024. Clinical characteristics, laboratory data, chest CT findings, and patients’ treatment and outcomes were collected and analyzed retrospectively. Of the 249 outpatients, 37 (14.9%) were super-infected with HBV, whereas 212 (85.1%) showed no such outcome. This study found no significant differences between the two groups regarding age, gender, symptoms, complications, or chest CT findings. However, COVID-19 patients super-infected with HBV showed lower white blood cell, neutrophil, and platelet counts (p < 0.05). Additionally, total bilirubin levels were significantly higher in the SARS-CoV-2/HBV super-infected group compared to the COVID-19-only group (p = 0.022). After the first week of similar treatment, both groups showed almost identical outcomes, including hospitalization, severity, and mortality rates. Thus, SARS-CoV-2/HBV super-infection slightly affected liver function but did not worsen COVID-19 outcomes. Routine HBV monitoring and liver function tests are recommended to manage COVID-19 patients with HBV super-infections. This study found no clear indications of the need to change the therapeutic prescription for COVID-19 in cases of HBV super-infections.
Original Article
Innate-immune cell distribution in pediatric HIV patients and uninfected controls Aquino, Cynthia Oliveira Pereira, Fernanda Mariz Frota, Ana Cristina Cisne Hofer, Cristina Barroso Milagres, Lucimar Gonçalves Manfro, Wânia Ferraz Pereira

Abstract in English:

ABSTRACT Innate immune cells are important players during an infection. The frequency of monocytes, myeloid-derived suppressor cells (MDSCs), natural killer (NK), and NKT cells were assessed in blood samples of children and adolescents living with HIV (CALHIV) and HIV-uninfected (HU) children. Blood samples from 10 CALHIV (treated or not) and six HU individuals were collected for approximately one year. Flow cytometry was employed to phenotypically characterize cell populations. We found a lower frequency of classical monocytes in CALHIV patients compared to the HU group (35.75% vs. 62.60%, respectively) but a higher frequency of CD56−CD16+ NK cells in CALHIV patients compared to the HU group (1.45% vs. 0.44%, respectively). At baseline, the frequency of monocytic-MDSCs inversely correlated with CD56dimCD16+ NK cells (r= −0.73, p=0.020), CD56−CD16+ NK cells (r= −0.78, p=0.010), and with intermediate monocytes (r= −0.71, p=0.027) in the CALHIV group. We also found a negative correlation between CD56++CD16+− and CD56dimCD16+ NK cells with CD4 T cells frequency at baseline. The results suggest an alteration in the innate compartment of the CALHIV cohort, which may contribute to their susceptibility to infections.
REVIEW
Multiple myeloma and Chagas disease: qPCR as a marker for preemptive antiparasitic therapy: a case reports series and review Carvalho, Noemia Barbosa Freitas, Vera Lúcia Teixeira de Seguro, Fernanda Salles Bezerra, Rita Cristina Fatobene, Giancarlo Nakanishi, Érika Yoshie Shimoda Visnadi, Helena Martinez, Gracia Batista, Marjorie Vieira Rocha, Vanderson Dulley, Frederico Luis Costa, Sílvia Figueiredo Shikanai-Yasuda, Maria Aparecida

Abstract in English:

ABSTRACT Multiple myeloma (MM) associated with Chagas disease is rarely described. This disease and its therapy suppress T cell and macrophage functions and increase regulatory T cell function, allowing the increase of parasitemia and the risk of Chagas Disease Reactivation (CDR). We aimed to analyze the role of conventional (cPCR) and quantitative Polymerase Chain Reaction (qPCR) for prospective monitoring of T. cruzi parasitemia, searching for markers of preemptive antiparasitic therapy in MM patients with Chagas disease. Moreover, we investigated the incidence and management of hematological diseases and CDR both inside and outside the transplant setting in the MEDLINE database. We found 293 studies and included 31 of them. Around 1.9–2.0% of patients with Chagas disease were reported in patients undergoing Stem Cell Transplantation. One case of CDR was described in eight cases of MM and Chagas disease. We monitored nine MM and Chagas disease patients, seven under Autologous Stem Cell Transplantation (ASCT), during 44.56±32.10 months (mean±SD) using parasitological methods, cPCR, and qPCR. From these patients, three had parasitemia. In the first, up to 256 par Eq/mL were detected, starting from 28 months after ASCT. The second patient dropped out and died soon after the detection of 161.0 par Eq/mL. The third patient had a positive blood culture. Benznidazole induced fast negativity in two cases; followed by notably lower levels in one of them. Increased T. cruzi parasitemia was related to the severity of the underlying disease. We recommend parasitemia monitoring by qPCR for early introduction of preemptive antiparasitic therapy to avoid CDR.
REVIEW
Interventions to prevent mother-to-child transmission in breastfeeding mothers with HIV: a systematic review and meta-analysis of randomized controlled trials Xu, Fangping Xiong, Ying Gu, Min Wan, Lingling Wang, Yun

Abstract in English:

ABSTRACT This study aimed to systematically review interventions to prevent mother-to-child transmission of HIV during breastfeeding. We conducted a systematic review and meta-analysis using specific criteria to identify randomized controlled trials that focused on pregnant and breastfeeding women living with HIV and their children from birth to 2 years of age. We extensively searched electronic databases, including Web of Science, Scopus, PubMed, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Google Scholar up to October 24, 2023. After screening 3,110 titles and abstracts, we reviewed 306 full texts. Of these, we assessed the quality and risk of bias of fifty-five articles, ultimately identifying seven studies. Four of these studies, which focused on antiretroviral therapy (ART), were included in the meta-analysis. There was little heterogeneity in study methodology and pooled estimates. The postnatal HIV transmission rate was found to be 0.01 (95%CI: 0.00 – 0.02). Therefore, the risk of mother-to-child transmission among breastfeeding mothers with HIV was significantly lower in the intervention groups than in the placebo groups. Analysis of funnel plots and Egger’s test (p = 0.589) showed no evidence of publication bias. In addition to the four articles, two studies compared different ART regimens and one study compared the administration of high-dose vitamin A to the mother or the child. The results suggest that the use of ART significantly reduces the risk of postnatal HIV transmission compared with placebo. However, the effectiveness of different ART regimens or other therapies, including high-dose vitamin A, is unclear.
REVIEW
Novel approaches for HTLV-1 therapy: innovative applications of CRISPR-Cas9 Domingues, Wilson Folgosi, Victor Ângelo Sanabani, Sabri Saeed Leite Junior, Pedro Domingos Assone, Tatiane Casseb, Jorge

Abstract in English:

ABSTRACT The human T-cell lymphotropic virus type 1 (HTLV-1) is a single-stranded positive-sense RNA virus that belongs to the Retroviridae family, genus Deltaretro, and infects approximately five to 10 million people worldwide. Although a significant number of individuals living with HTLV-1 remain asymptomatic throughout their lives, some develop one or more severe clinical conditions, such as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), a progressive and debilitating disease, and/or a subtype of non-Hodgkin’s lymphoma with a more threatening course known as adult T-cell leukemia/lymphoma (ATLL). Moreover, current therapeutic options are limited and focus primarily on treating symptoms and controlling viral latency. CRISPR-Cas9 gene editing is proposed as a promising tool to address the intricate links associated with HTLV-1. By targeting or silencing key genes during initial infection and dysregulating immune signaling pathways, CRISPR-Cas9 offers potential intervention opportunities. In this review, we address the therapeutic potential of CRISPR-Cas9 gene editing, as well as examine the primary mechanisms involved in editing potential target genes and discuss the existing evidence in the current scientific literature.
REVIEW
Haff disease: overview and clinical features Aguiar, Gabriel Rotsen Fortes Silva, Roberto Cesar de Moura Petruccelli, Karla Cristina Silva Oliveira, Michael Nascimento Brito, Gabriel Antônio Uchôa de Albuquerque, Polianna Lemos Moura Moreira Daher, Elizabeth De Francesco Silva Junior, Geraldo Bezerra da

Abstract in English:

ABSTRACT Haff disease was first described at the beginning of the twentieth century in Europe. Almost a century later, thousands of cases have now been reported in different countries. In Brazil, most cases are observed in the Amazon region, and its associated factors remain to be fully understood. This disease is an uncommon syndrome characterized by intense myalgia and rhabdomyolysis, which manifests within 24 h after consuming some types of freshwater or saltwater fish and crustaceans. A possible heat-stable toxin contained in seafood may be the cause of Haff disease, but this hypothesis is not yet completely proven. This review will describe the clinical and epidemiological aspects of Haff disease with updated literature.
REVIEW
Urinary tract infections and risk of preterm birth: a systematic review and meta-analysis Wang, Erping Tang, Peng Chen, Chen

Abstract in English:

ABSTRACT This systematic review and meta-analysis assessed the association between urinary tract infections (UTIs) during pregnancy and the risk of preterm birth (PTB). We searched multiple databases for relevant observational studies, categorizing them as UTI-based (comparing PTB incidence in women with and without UTIs) or PTB-based (comparing UTI prevalence in women with and without PTB). Using a random-effects model in Stata software version 17.0, we estimated pooled and adjusted odds ratios (ORs) with 95% confidence intervals (CIs), and performed subgroup, sensitivity, and cumulative analyses to explore heterogeneity. In total, 30 studies comprising 32 datasets were included, involving a total of 249,810 cases and 2,626,985 healthy controls. The meta-analysis revealed a significant positive association between UTIs during pregnancy and PTB occurrence (OR, 1.92; 95% CI, 1.62–2.27). A sub-group analysis based on studies, the participants showed significant association in both PTB-based (OR, 2.01; 95% CI, 1.58–2.56) and UTI-based studies (OR, 1.79; 95% CI, 1.42–2.26). However, Egger’s test indicated the presence of publication bias (p=0.020), and substantial heterogeneity was observed across the included studies (I2=96.6; p< 0.001). These findings emphasize the critical importance of early detection and effective management of UTIs in pregnant women to reduce the risk of PTB and its associated adverse outcomes. While the results highlight a robust link between UTIs during pregnancy and PTB risk, the potential influence of publication bias and substantial heterogeneity should be considered to interpret these findings. Further research is needed to better understand the underlying mechanisms and to develop targeted interventions for high-risk pregnant women.
REVIEW
Zika virus infection and acute transverse myelitis: a comprehensive systematic review Colognese, Bianca Aparecida Argollo, Nayara

Abstract in English:

ABSTRACT The Zika virus (ZIKV) has been associated with several complications, including acute transverse myelitis (ATM), an acute inflammation of the spinal cord, with rapid development of motor, sensory and dysautonomic symptoms. It is a rare disease, and its clinical features, as well as differences in relation to idiopathic ATMs, are still not completely known. The objective of this paper is to review the literature in search of clinical features and complementary exams of ATM post-ZIKV infection, alone or in association with other neurological conditions (mixed diseases), as well as its treatments and prognoses. The search was made on 5 databases, using the PRISMA methodology (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Nine articles were selected (total of 20 subjects), which were divided between isolated ATM and mixed neurological syndromes with ATM. The study found a predominance of individuals aged 20 to 30. Among the six subjects in the mixed group, three were over 50 years old. The median prodromal period was 2 days for the mixed diseases group and 7 days for the isolated ATM group. Some individuals in the isolated ATM group exhibited signs of dysautonomia, such as syncope, postural lability, and arrhythmia. The mixed group had a higher incidence of coinfections, with 4 cases compared to 1 case in the isolated ATM group. Over 50% of the individuals had moderate to moderately severe disability. These findings suggest that severe conditions may progress to significant sequelae, highlighting the need for prompt diagnosis and treatment, particularly during endemic periods.
CASE REPORT
Severe esophagitis induced by antituberculosis drugs: a case report Mamani, Roxana Flores Silva, Franciele Moreira Lima-Júnior, Marcos Vidal de Lima, Juliana Paitach de Oliveira Vianna, Vitor Montez Azevedo, Rivelino Trindade de McBenedict, Billy Martins, Ezequias Batista

Abstract in English:

ABSTRACT Tuberculosis stands as one of humanity’s oldest afflictions, intrinsically intertwined with social disparities. This formidable disease spares no age group and remains the prevailing cause of infection-induced mortality worldwide, particularly in developing nations. We present a case of a 56-year-old woman with diabetes who was diagnosed with Pulmonary Tuberculosis. After receiving antituberculosis drugs as part of her treatment, she experienced a range of systemic manifestations and suffered from severe ulcerative esophagitis. This adverse reaction led to uncontrollable gastrointestinal intolerance, tragically resulting in her untimely demise. The incident underscores the potential seriousness of adverse reactions that can arise from tuberculosis treatment medications.
CASE REPORT
Secondary oral syphilis presenting as a tumor-like lesion on the lower lip Sugaya, Norberto Migliari, Dante

Abstract in English:

ABSTRACT This study presents a case of atypical manifestation of secondary syphilis. Diagnosis was initiated prompted by the patient’s complaint of a lower lip lesion, present for three months, resembling a malignant neoplasm. The lesion, a 3 cm (diameter) ulcerated nodule, arising from conjunctive tissue, raised concern. However, further physical examination revealed additional clinical features, including cervical micropolyadenopathy and erythematous skin lesions, prompting a reevaluation of the diagnosis, most likely secondary syphilis. These findings led to a serological investigation, which, ultimately, confirmed the diagnosis of syphilis. The case underscores the importance of recognizing syphilis as a formidable imitator, posing challenges in establishing differential diagnoses of mucocutaneous diseases.
CASE REPORT
Calcified cerebral toxoplasmosis associated with recurrent perilesional edema causing neurological manifestations in an HIV-infected individual: case report with a decade-long follow-up Bonato, Flávia Carolina Soares Rivero, René Leandro Magalhães Garcia, Hector Hugo Vidal, José Ernesto

Abstract in English:

ABSTRACT Four cases of people living with HIV/AIDS (PLWHA) with calcified cerebral toxoplasmosis associated with perilesional edema causing a single episode of neurological manifestations have recently been reported. Here, we describe the first detailed description of perilesional edema associated with calcified cerebral toxoplasmosis causing three episodes of neurological manifestations in a PLWHA, including seizures in two of them. These recurrences occurred over approximately a decade. Throughout this period, the patient showed immunological and virological control of the HIV infection, while using antiretroviral therapy regularly. This case broadens the spectrum of an emerging presentation of calcified cerebral toxoplasmosis, mimicking a well-described finding of neurocysticercosis in immunocompetent hosts.
CASE REPORT
Neurological manifestation of Brazilian spotted fever in childhood Mendes, Bruna Fernanda Deicke Moreira, Marina Melo Jimenez, Ana Luisa Lodi Silva, Lívia Barbosa da Thiersch, Laura Maria Silva Rodrigues, Carolina Malaquias Torres, Bruna Ribeiro Costa, Juliana Goulart Dias da Diniz, Lilian Martins Oliveira

Abstract in English:

ABSTRACT Rocky Mountain Spotted Fever is a rickettsial disease caused by the bacteria Rickettsia rickettsii. In Brazil, the disease is known as Brazilian spotted fever (BSF), being the most significant tick-borne disease in the country. Among the affected patients, only 5% of cases occur in children aged one to nine years. Typical symptoms of the disease are fever, rash, headache and digestive symptoms. Neurological manifestations such as seizures, aphasia and hemiparesis have been described in few patients. This study aimed to describe the case of an infant diagnosed with BSF who presented severe signs of neurological manifestation.
CASE REPORT
Myelotoxicity and kidney dysfunction related to the use of trimethoprim-sulfamethoxazole for the treatment of Pneumocystis jirovecii pneumonia: a case report of severe adverse events with a common drug Mendes, Isabel Cristina Melo Mamani, Roxana Flores Coelho, David Richer Araujo Pimentel, Clarisse

Abstract in English:

ABSTRACT Trimethoprim-sulfamethoxazole (TMP-SMX) is the primary therapeutic option for Pneumocystis jirovecii pneumonia (PCP). Gastrointestinal symptoms and cutaneous rash are common side effects, with hyperkalemia being uncommon in patients without kidney dysfunction, and myelotoxicity being even rarer. We present the case of a male patient with hypertension and a recent diagnosis of non-Hodgkin lymphoma, undergoing rituximab treatment for two months. He was admitted to the intensive care unit due to dyspnea, tachypnea, and pleuritic pain, requiring mechanical ventilation. Chest computed tomography showed bilateral and multilobed ground-glass opacities, compromising more than 80% of the lung parenchyma. Pulmonary tuberculosis and COVID-19 were ruled out. An angiotomography and Doppler ultrasound revealed an extensive pulmonary thrombus and deep venous thrombosis. Empiric treatment with TMP-SMX for PCP was initiated, but within four days, the patient experienced metabolic acidosis and severe hyperkalemia, necessitating hemodialysis. He also presented with progressive pancytopenia and critical levels of leukopenia and thrombocytopenia. The hypothesis of TMP-SMX-induced myelotoxicity was suspected. Considering the unavailability of an alternative treatment, it was opted to continue TMP-SMX and initiate a granulocyte-colony-stimulating factor. However, the patient maintained medullary deterioration, becoming refractory to the transfusion of blood derivates. On the 17th day of treatment, a clinical decision was made to suspend TMP-SMX, leading to improvements within 48 hours in marrow and kidney functions, metabolic acidosis, and hyperkalemia. Despite all efforts, the patient died after 35 days of hospitalization due to hospital-acquired infections. This case highlights the importance of clinicians recognizing potential myelotoxicity with TMP-SMX and promptly discontinuing the drug if necessary.
CASE REPORT
First occurrence of feline sporotrichosis in a metropolitan area of Central-West Brazil Ferreira, Mariana Almeida Castilho, Allana de Paula Vargas, Gabrielle Silveira Patini, Bruna Elisa Moreira, André Luís Elias Santos, Jandra Pacheco dos Xavier, Roseli Santos de Freitas Del Negro, Gilda Maria Barbaro Taborda, Carlos Pelleschi Gremião, Isabella Dib Ferreira Júnior, Álvaro

Abstract in English:

ABSTRACT Sporotrichosis is a neglected mycosis that affects human and animal hosts, including domestic cats. In Brazil, its most frequently diagnosed etiological agent is Sporothrix brasiliensis. Zoonotic transmission of S. brasiliensis occurs via direct contact between an infected cat and a susceptible human host. Notification of confirmed cases of feline sporotrichosis is not mandatory in Brazil. The metropolitan area of Goiania city can be considered a silent area for the occurrence of feline sporotrichosis. In this context, voluntary reporting of feline sporotrichosis cases is recommended for all healthcare professionals. This study aimed to report the first occurrence of S. brasiliensis in a cat from the metropolitan area of Goiania city. Cytopathology, mycology, thermal dimorphism and calmodulin gene amplification tests were performed. The mycological and molecular biological diagnoses corresponded to S. brasiliensis. The etiological agent of zoonotic sporotrichosis was detected in the metropolitan area of Goiania city, and therefore there is a risk of the emergence of new cases of cats infected with S. brasiliensis and the occurrence of zoonotic transmission of this fungus.
CASE REPORT
SARS-CoV-2 shedding, infectivity, and evolution in an immunocompromised adult patient Mendes-Correa, Maria Cassia Ghilardi, Fábio de Rose Salomão, Matias Chiarastelli Villas-Boas, Lucy Santos Paula, Anderson Vicente de Paiao, Heuder Gustavo Oliveira Costa, Antonio Charlys da Tozetto-Mendoza, Tânia Regina Freire, Wilton Sales, Flavia Cristina Silva Claro, Ingra Morales Sabino, Ester Cerdeira Faria, Nuno Rodrigues Witkin, Steven Sol

Abstract in English:

ABSTRACT This study aimed to provide further insight into the evolutionary dynamics of SARS-CoV-2 by analyzing the case of a 40-year-old man who had previously undergone autologous hematopoietic stem cell transplantation due to a diffuse large B-cell lymphoma. He developed a persistent SARS-CoV-2 infection lasting at least 218 days and did not manifest a humoral immune response to the virus during this follow-up period. Whole-genome sequencing and viral cultures confirmed a persistent infection with a replication-positive virus that had undergone genetic variation for at least 196 days after symptom onset.
CASE REPORT
Challenging diagnosis of Plasmodium ovale malaria in a Colombian traveler: the importance of including P. ovale wallikeri in molecular screening Nieto-Clavijo, Carlos Morales, Liliana Vega, Angela Patricia Guerra Cortés, Liliana Jazmín Cortés Chaparro-Olaya, Jacqueline

Abstract in English:

ABSTRACT This study reports a challenging diagnosis of Plasmodium ovale malaria in a Colombian citizen returning from Cameroon. Initial microscopy screenings conducted at two private hospitals yielded conflicting results, with the first showing negative smears and the second diagnosing P. vivax. Subsequent microscopy examinations at two government laboratories identified P. ovale, although the routine species-specific PCR strategy was negative. PCR confirmation was finally obtained when P. ovale wallikeri primers were used. Although P. ovale is not frequently found in Colombia, there is a clear need to include both P. ovale curtisi and P. ovale wallikeri in the molecular diagnostic strategy. Such need stems primarily from their extended latency period, which affects travelers, the increasing number of African migrants, and the importance of accurately mapping the distribution of Plasmodium species in Colombia.
CASE REPORT
Tinea corporis intrafamilial infection in pets due to Microsporum canis Sierra-Maeda, Karla Yaeko Martínez-Hernández, Fernando Arenas, Roberto Boeta-Ángeles, Leticia Martínez-Chavarría, Luary Carolina Rodríguez-Colín, Sonia Fabiola Xicohtencatl-Cortes, Juan Hernández-Castro, Rigoberto

Abstract in English:

ABSTRACT Microsporum canis, one of the most widespread dermatophytes worldwide, is a zoonotic microorganism that transmits infection from reservoirs such as cats and dogs to humans. This microorganism is associated with Tinea corporis and other clinical manifestations; however, few studies have used genetic surveillance to determine and characterize the process of zoonotic transmission. In this study, we show a clear example of zoonotic transmission from a cat to an intrafamilial environment, where it caused Tinea corporis by infection with M. canis. Molecular characterization using the b-tubulin gene and Random Amplified Polymorphic DNA analysis made it possible to determine that the six isolates of M. canis obtained in this study belonged to the same genetic variant or clone responsible for reservoir-reservoir or reservoir-human transmission.
Case Report
Misleading subcutaneous mycosis: a case report of subsequent clinical mycetoma-like and histological chromoblastomycosis-like lesions Brufatto, João Paulo Turri Pontes, Laís Schreiber, Angélica Zaninelli Cintra, Maria Leticia Souza, Cintia Avila Gomide, Luciana Vilela Guerra, Helena Maciel Mendonça Tolentino Stelini, Rafael Fantelli Brum, Isabela Vilela França, Andrea Fernandes Eloy da Costa Magalhães, Renata Ferreira Velho, Paulo Eduardo Neves Ferreira

Abstract in English:

ABSTRACT Hyalohyphomycosis and phaeohyphomycosis are groups of mycoses caused by several agents and show different clinical manifestations. We report a case of an immunocompromised patient who presented rare manifestations of opportunistic mycoses: mycetoma-like hyalohyphomycosis on his right foot caused by Colletotrichum gloeosporioides, followed by cutaneous phaeohyphomycosis on his right forearm caused by Exophiala oligosperma. Further to the rarity of this case, the patient's lesion on the foot shows that the clinical aspects of mycetomas could falsely appear in other fungal infections similar to hyalohyphomycosis. We also show that the muriform cells that were seen in the direct and anatomopathological examination of the skin are not pathognomonic of chromoblastomycosis, as observed in the lesion of the patient's forearm.
CASE REPORT
Histoplasmosis in a fingolimod-treated patient: case report and scoping review Oliveira, Vítor Falcão de Silva, Guilherme Diogo da Silva, Larissa Teixeira Gonçalves, Victor Lucas Rivas, Paula Emilia Marques, Alexandre Coelho Taborda, Mariane Magri, Adriana Satie Gonçalves Kono Apóstolos-Pereira, Samira Luisa Callegaro, Dagoberto Magri, Marcello Mihailenko Chaves

Abstract in English:

ABSTRACT Fingolimod is a sphingosine-1-phosphate receptor modulator used to treat multiple sclerosis. While fingolimod has been associated with an increased risk of cryptococcal meningitis, its correlation with other deep mycoses remains unclear. In this study, we conducted a scoping review of fingolimod associated with histoplasmosis, based on a case report, a literature review, and data from the FDA Adverse Events Reporting System (FAERS) as of January 24th, 2023. A 30-year-old Brazilian woman diagnosed with relapsing-remitting multiple sclerosis, receiving a daily dose of 0.5 mg of fingolimod, presented with a two-month history of fever and unintended weight loss, accompanied by lymphadenopathy, splenomegaly, and lung involvement was investigated. Biopsy of a lung nodule revealed fungal structures suggestive of Histoplasma sp. Additionally, serological testing yielded positive for Histoplasma capsulatum. Disseminated histoplasmosis should be considered in the differential diagnosis of febrile syndromes in patients undergoing fingolimod therapy for multiple sclerosis, particularly in the Americas, where this mycosis is endemic. Treatment with itraconazole and modification of immunotherapy can achieve excellent clinical outcomes.
CASE REPORT
Rhinocerebral mucormycosis and Trichosporon asahii fungemia in a pediatric patient with acute lymphoblastic leukemia: a rare coinfection Hu, Liuyang Liu, Guiliang Chen, Xingchun

Abstract in English:

ABSTRACT Mucormycosis is a rare life-threatening opportunistic infection, with rhinocerebral mucormycosis (ROCM) being the most common presentation. Trichosporon asahii is an emerging pathogen that often causes fatal infections in patients with underlying hematologic malignancies due to its high drug resistance. We report a rare case of concomitant rhinocerebral mucormycosis and T. asahii fungemia secondary to Pseudomonas aeruginosa sepsis in a patient with neutropenia and acute lymphoblastic leukemia. A boy aged one year and two months was diagnosed with B-cell acute lymphoblastic leukemia on January 10 and underwent three courses of regular chemotherapy. He experienced neutropenia for 154 days and was hospitalized for vomiting, diarrhea and fever for 3 days. The day after hospitalization, Pseudomonas aeruginosa was isolated by blood culture and ceftazidime/avibactam was administered. Extracorporeal Membrane Oxygenation (ECMO) was used to provide continuous extracorporeal respiration and circulation for the patient. On day 8, the patient developed T. asahii fungemia. On day 10, he presented with necrotizing skin caused by Rhizopus delemar. He was treated with liposomal amphotericin B for Rhizopus delemar and voriconazole for T. asahii infection. Unfortunately, his health deteriorated and he died on day 11 due to the rapid progression of the infection and multiple organ failure. The management and treatment of such a complex infection requires a multidisciplinary approach and close monitoring of the patient’s condition. Therefore, it is imperative to continue to research and report rare cases such as this to further understand the complexities of mucormycosis and trichosporidiosis coinfection and improve patient outcomes.
CASE REPORT
Fatal viscerotropic and neurotropic disease after yellow fever vaccine: a rare manifestation leading to diagnosis of severe combined immunodeficiency in an infant Vieira, Lara Jhullian Tolentino Goebel, Gabriela Assunção Barcelos, Yuri Cunha, Luciana Oliveira Santos, Luisa Teles Melo Romanelli, Roberta Maia de Castro Minafra, Fernanda Gontijo Carvalho, Andrea Lucchesi de Carvalho, Luiz Fernando Andrade de Diniz, Lilian Martins Oliveira

Abstract in English:

ABSTRACT Yellow fever vaccine (YFV) is a live attenuated vaccine that can cause a mild infection in immunocompetent patients. However, it may not be self-limiting in patients with inborn errors of immunity (IEI) and may be the first and most severe presentation in these patients. A 10-month-old female infant sought emergency care presenting fever for three days and diffuse exanthema. She was a previous healthy child of consanguineous parents. The child had received YFV 28 days before the onset of symptoms. Upon hospital admission, petechial rash on the limbs and hepatosplenomegaly were noted on physical exam. Laboratory tests showed thrombocytopenia, increased serum aminotransferases and elevated gamma-glutamyl transferase (GGT) and alkaline phosphatase levels. During hospitalization she developed hypoactivity, drowsiness, and hypotonia. The possibility of viscerotropic and neurotropic vaccine associated disease was suspected and a possible primary immunodeficiency disease considered. The patient was tested for antibodies against the yellow fever virus (MAC ELISA) on serum and cerebrospinal fluid (CSF) samples, showing positive IgM results. Immunophenotyping showed low levels of lymphocytes and absence of T-cell receptor excision circles (TREC), leading to diagnose of severe combined immunodeficiency disease (SCID). Despite treatment, after 35 days of hospitalization, she evolved to cardiorespiratory arrest and death. Serious adverse events after administration of the YFV are rare and associated with neurological or visceral involvement in most cases. The unfavorable outcome highlights the importance of neonatal screening for SCID and the clinical suspicion of primary immunodeficiencies in infants who have serious adverse events to live virus vaccines.
CASE REPORT
First case of urban leishmaniasis in the Campeche State, Mexico Blum-Domínguez, Selene Sánchez-Montes, Daniel Sokani Becker, Ingeborg García-Martínez, Rolando Tamay-Segovia, Paulino

Abstract in English:

ABSTRACT Cutaneous leishmaniasis represents 99% of all reported leishmaniasis cases in Mexico and typically occurs in agricultural or sylvatic areas. Campeche State is endemic for leishmaniasis; however, there are no previous records of urban Leishmania transmission. This report presents a case of cutaneous leishmaniasis in a 75-year-old man residing in an urban area. The patient presented with a three-month-old lesion on the right ear following an initial misdiagnosis of a bacterial infection. Given the suspicion of leishmaniasis, a tissue imprint was collected, revealing the presence of Leishmania amastigotes. Subsequently, amplification and sequencing of the Alanine aminotransferase and Internal transcribed spacer subunit 1 genes confirmed the presence of Leishmania mexicana. The patient was then treated with intralesional meglumine antimoniate. This case is significant as it marks the first confirmed human transmission of L. mexicana in an urban environment in Campeche State, demonstrating the importance of considering this pathology in patients with skin lesions originating from non-endemic areas in Mexico.
Case Report
Paracoccidioidomycosis presenting as a cecal lesion mimicking cholangiocarcinoma: a case report of unusual intestinal manifestation Giesteira, Eduarda Raunheitti Santore, Giovanna França Teixeira, Julia de Abreu Martins, Ezequias Batista Villar, Bianca Balzano de la Fuente McBenedict, Billy Ronchini, Karla Regina Oliveira de Moura Silva, Natalia Chilinque Zambão da Leça Junior, Nilo Fernandes Pinheiro, Patrícia Yvonne Maciel Vilte, Remberto Maurício de La Cruz Vargas Vieira, Thais de Oliveira Ferreira, Laura da Cunha

Abstract in English:

ABSTRACT Paracoccidioidomycosis, the most important systemic mycosis in Latin America, is closely linked to rural activities. In Brazil, it is an endemic disease, with an estimated 4,000 to 6,000 annual cases, accounting for over 80% of the global diagnoses. We present an intriguing case of this disease with an intestinal manifestation in a 71-year-old woman. The involvement of the cecal appendix led to a complication of cholangitis that mimicked cholangiocarcinoma.
Case Report
Long-term chronic infection of a young immunocompromised patient by the SARS-CoV-2 P.2 VOI Romano, Camila Malta Silva, Vitor Gabriel Lopes da Silva, Luciane Sussuchi da Aranda, Carolina Sanchez Oliveira, Cristina Mendes de Siqueira, Marilda Mendonça Teixeira Pereira, Elisa Cavalcante Resende, Paola Cristina Bellei, Nancy Cristina Junqueira Levi, José Eduardo Moraes-Pinto, Maria Isabel de

Abstract in English:

ABSTRACT An immunocompromised patient was infected by the SARS-CoV-2 variant of interest named Zeta (P.2) in February 2021. More than one year later, he suffered from symptomatic COVID-19 and sequencing revealed the same variant, which accumulated 23 substitutions. This case illustrates intra-host evolution of a particular SARS-CoV-2 variant, highlighting the importance of genomic surveillance of immunocompromised patients.
Case Report
Scrotal abscess caused by Candida glabrata in a patient with uncontrolled diabetes mellitus and chronic renal failure Tüz, Mehmet Ali Ecer, Derya Tuna Atik, Tuğba Kula Yapıcı, Oktay

Abstract in English:

ABSTRACT Candida glabrata is a yeast which incidence has increased in recent years and usually causes urogenital and bloodstream infections. Its resistance to fluconazole hinders C. glabrata infections treatment. This case report presents a case of candidemia and scrotal abscess caused by C. glabrata, which was successfully treated with liposomal amphotericin B. The primary treatment options for C. glabrata candidemia are echinocandins and amphotericin B formulations. However, echinocandins and lipid-based amphotericin B formulations do not properly pass through the urinary system. Amphotericin B deoxycholate has a high risk of side effects and is difficult to obtain. The treatment option for candidemia caused by fluconazole-resistant C. glabrata secondary to urinary tract infection is unclear and there are no sufficient studies. For treatment, liposomal amphotericin B may be considered, especially for scrotal and prostatic fluconazole-resistant fungal abscesses. More studies comparing the penetration of antifungals into scrotal and prostatic tissue and the success of antifungal treatment in these tissue infections are needed.
BRIEF COMMUNICATION
Identification of SARS-CoV-2 in urban rodents from Southern Mexico City at the beginning of the COVID-19 pandemic Martínez-Hernández, Fernando Gonzalez-Arenas, Nelly Raquel Cervantes, José Antonio Ocampo Villalobos, Guiehdani Olivo-Diaz, Angelica Rendon-Franco, Emilio Maravilla, Pablo Valdovinos, Mirza Romero Muñoz-Garcia, Claudia Irais

Abstract in English:

ABSTRACT Currently, there are some concerns about the situation and, in particular, about the future of the COVID-19 pandemic and the new emerging variants of SARS-CoV-2. Rodents are an example of synanthropic animals in urban environments that harbor important zoonoses. Although the molecular identification of SARS-CoV-2 in Rattus norvegicus from New York City had been reported, in other studies, urban wild rodents infected with this virus have not been found. This study aimed to molecularly identify the presence of SARS-CoV-2 in urban wild rodents from Mexico City, trapped along a water channel of a public park as part of a pest control program, at the beginning of the COVID-19 pandemic, during the fall and winter of 2020. Up to 33 Mus musculus and 52 R. norvegicus were captured and euthanized, large intestine samples with feces from the animals were obtained. RNAs were obtained and subjected to qRT-PCR for SARS-CoV-2 identification and threshold cycle (Ct) values were obtained. Four mice (12.1%) and three rats (5.8%) were positive, three rodents exhibited Ct<30. Our results on the frequency of SARS-CoV-2 in urban rats are in line with other previous reports. Thus, similar to other authors, we suggest that surveillance for the detection of SARS-CoV-2 in urban wild rodents, as sentinel animals, should be maintained.
BRIEF COMMUNICATION
Viable Leishmania parasites in the absence of an in vitro IFN-γ response in asymptomatic carriers Loría-Cervera, Elsy Nalleli Sosa-Bibiano, Erika Ivett López-Ávila, Karina Beatriz Oca-Aguilar, Ana Celia Montes de Moreno-Nava, Marisol Sarahí Torres-Castro, Jimmy Raymundo

Abstract in English:

ABSTRACT Asymptomatic infection (the absence or inapparent signs and symptoms) has been observed in many endemic areas of leishmaniasis, however, little is known about the parasitological and immunological factors associated with this type of infection. This study aimed to identify the in vitro expression of IFN-γ in asymptomatic carriers of viable Leishmania parasites. Asymptomatic infection was identified using the Montenegro skin test in an at-risk population from Yucatan, Mexico. Parasite viability was evinced in the blood by 7SL RNA transcripts amplification. The expression of mRNA IFN-γ was analyzed in peripheral blood mononuclear cells stimulated with soluble Leishmania antigen, using RT-qPCR. Parasite viability was observed in 33.3 % (5/15) of asymptomatic subjects. No differences were found in the expression of IFN-γ between asymptomatic and healthy subjects, and no correlation was found between the presence of viable parasites and the expression of IFN-γ. This study demonstrates the persistence of Leishmania parasites in the absence of an in vitro IFN-γ response in asymptomatic carriers from Mexico.
BRIEF COMMUNICATION
Cardiorespiratory optimal point in post-COVID-19 patients: a cross-sectional study Santos, Karinne Simões da Cruz Brito, Gabriela Menezes Gonçalves de Melo, Enaldo Vieira de Sousa, Antônio Carlos Sobral Martins-Filho, Paulo Ricardo Campos, Milena dos Santos Barros

Abstract in English:

ABSTRACT The varied clinical presentations of SARS-CoV-2 infection have raised concerns about long-term consequences, especially “long-COVID” or “post-COVID-19 syndrome.” In this context, the cardiorespiratory optimal point (COP) within the Cardiopulmonary Exercise Test (CPET) emerges as a crucial metric for evaluating functional capacities and detecting cardiovascular and pulmonary anomalies post-COVID-19. This study aimed to assess COP values among post-COVID-19 patients and categorized them based on the initial severity of their disease. In this cross-sectional study conducted in the Northeast Brazil, 80 patients (26 females and 54 males) previously infected with SARS-CoV-2 underwent CPET. We clinically stratified patients into mild, moderate, or severe COVID-19 categories and assessed COP values and other cardiorespiratory metrics. We found differences in the predicted COP between patients with mild and severe COVID-19 (p=0.042). Additionally, patients with moderate and severe COVID-19 record had an average COP value exceeding 22. Other parameters, including respiratory exchange ratio, heart rate, and oxygen uptake efficiency slope, did not differ across the groups. Patients with a history of severe COVID-19 showed altered COP values, suggesting potential discrepancies in cardiovascular and respiratory system integration. The outcomes emphasize the importance of continuous monitoring and assessment of the cardiorespiratory domain for post-COVID-19 patients. Further research is needed to understand the relationship between elevated COP in post-severe COVID-19 and its long-term prognostic implications.
BRIEF COMMUNICATION
COVID-19 in hematopoietic stem cell transplant recipients during three years of the pandemic: a multicenter study in Brazil Randi, Bruno Azevedo Higashino, Hermes Ryoiti Silva, Vinícius Ponzio da Salomão, Matias Chiarastelli Pignatari, Antonio Carlos Campos Abdala, Edson Vasques, Fabiana Silva, Celso Arrais Rodrigues da Silva, Roberto Luiz da Lazari, Carolina dos Santos Levi, José Eduardo Xavier, Erick Menezes Côrtes, Marina Farrel Luna-Muschi, Alessandra Rocha, Vanderson Costa, Silvia Figueiredo

Abstract in English:

ABSTRACT Hematopoietic stem cell transplant (HSCT) recipients are at -increased risk for severe COVID-19. The aim of this study was to evaluate the burden of COVID-19 in a cohort of HSCT recipients. This retrospective study evaluated a cohort of adult hospitalized HSCT recipients diagnosed with COVID-19 in two large hospitals in São Paulo, Brazil post-HSCT, from January 2020 to June 2022. The primary outcome was all-cause mortality. Of 49 cases, 63.2% were male with a median age of 47 years. Allogeneic-HSCT (51.2%) and autologous-HSCT (48.9%) patients were included. The median time from HSCT to COVID-19 diagnosis was 398 days (IQR: 1211-134), with 22 (44.8%) cases occurring within 12 months of transplantation. Most cases occurred during the first year of the pandemic, in non-vaccinated patients (n=35; 71.4%). Most patients developed severe (24.4%) or critical (40.8%) disease; 67.3% received some medication for COVID-19, primarily corticosteroids (53.0%). The probable invasive aspergillosis prevalence was 10.2%. All-cause mortality was 40.8%, 51.4% in non-vaccinated patients and 14.2% in patients who received at least one dose of the vaccine. In the multiple regression analyses, the variables mechanical ventilation (OR: 101.01; 95% CI: 8.205 – 1,242.93; p = 0.003) and chest CT involvement at diagnosis ≥50% (OR: 26.61; 95% CI: 1.06 – 664.26; p = 0.04) remained associated with all-cause mortality. Thus, HSCT recipients with COVID-19 experienced high mortality, highlighting the need for full vaccination and infection prevention measures.
BRIEF COMMUNICATION
Demographic and clinical characteristics of people diagnosed with active sexually transmitted infections among monkeypox cases in Brazil: the 2022 outbreak Souza, Isabella Nepomuceno de Pascom, Ana Roberta Pati Spinelli, Matheus Funke Dias, Guilherme Borges Barreira, Draurio Miranda, Angélica Espinosa

Abstract in English:

ABSTRACT The worldwide monkeypox (mpox) outbreak in 2022 showed a high frequency of sexually transmitted infections (STI). A cross-sectional study was carried out using secondary data from the Brazilian official mpox surveillance systems. A total of 10,169 mpox cases were identified, with a median age of 32 years. Among them, 92.3% were male at birth and 57.5% were men who have sex with other men (MSM). Approximately 11% were diagnosed with STI, including 5.8% with syphilis and 2.5% with genital herpes. Individuals aged from 25 to 34 years, MSM, individuals with HIV-positive status, and those manifesting skin eruptions or penile edema were associated with STI. Laboratory investigation for mpox must be implemented as a priority in STI clinics (especially for MSM) to mitigate neglected cases, ensure appropriate treatments, and prevent misdiagnoses.
BRIEF COMMUNICATION
Can habits and behaviors predict colonization by community-associated MRSA in patients admitted to a Brazilian hospital? Pinheiro, Marcos Vinicius de Barros Cavalcante, Fernanda Sampaio Ferreira, Dennis de Carvalho Guimarães, Ana Carolina Fonseca Ferreira, Adriana Lúcia Pires Costa, Claudia Regina da Santos, Kátia Regina Netto dos Nouér, Simone Aranha , Rangel, Ana Pereira Castiñeiras, Anna Carla Gonzalez, Christiany Moçali Freire, Joana Guimarães, Luiz Felipe Batista, Raquel

Abstract in English:

ABSTRACT This study aimed to identify factors associated with colonization by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in adult patients admitted to a Brazilian hospital. This is a cross-sectional study, in which patients underwent a nasal swab and were asked about hygiene behavior, habits, and clinical history. Among the 702 patients, 180 (25.6%) had S. aureus and 21 (2.9%) MRSA. The factors associated with MRSA colonization were attending a gym (OR 4.71; 95% CI; 1.42 – 15.06), smoking habit in the last year (OR 2.37; 95% CI; 0.88 – 6.38), previous hospitalization (OR 2.18; CI 95%; 0.89 – 5.25), and shared personal hygiene items (OR 1.99; 95% CI; 0.71 – 5.55). At the time of admission, colonization by CA-MRSA isolates was higher than that found in the general population. This can be an important public health problem, already endemic in hospitals, whose factors such as those associated with habits (smoking cigarettes) and behaviors (team sports practice and activities in gyms) have been strongly highlighted. These findings may help developing infection control policies, allowing targeting patients on higher-risk populations for MRSA colonization.
BRIEF COMMUNICATION
Chronotropic incompetence is associated with reduced aerobic conditioning and sedentary behavior in patients with post-acute COVID-19 syndrome Campos, Milena dos Santos Barros Brito, Gabriela Menezes Gonçalves de Santos, Karinne Simões da Cruz Santos, Marcos Antonio Almeida Martins-Filho, Paulo Ricardo Sousa, Antônio Carlos Sobral

Abstract in English:

ABSTRACT Post-acute COVID-19 syndrome, or long COVID, presents with persistent symptoms, including cough, dyspnea, and fatigue, extending beyond one month after SARS-CoV-2 infection. Cardiac complications such as chest pain and arrhythmias have raised concerns, with chronotropic incompetence (CI), an inadequate heart rate increase during exercise, emerging as a significant condition contributing to diminished exercise tolerance and quality of life. This study estimated the prevalence of CI and explored its association with aerobic capacity and physical activity levels in long COVID patients. A cross-sectional study was conducted at a private hospital in Sergipe, Brazil, involving 93 patients over 18 years old with persistent post-COVID-19 symptoms after confirmed SARS-CoV-2 infections. Exclusion criteria included beta-blocker use, inadequate respiratory exchange ratio, and inability to complete cardiopulmonary exercise testing (CPET). Clinical histories, CPET results, and chronotropic index calculation were used to identify CI, with logistic regression analyzing associated factors. Of the participants (mean age 45 years; average duration since COVID-19 diagnosis 120 days), 20.4% were diagnosed with CI. Logistic regression identified a strong association between CI and sedentary behavior (OR 11.80; 95% CI 2.54 to 54.78; p=0.001). Patients with CI showed lower predicted peak heart rates and maximal oxygen uptake. The prevalence of CI among long COVID patients in this study was approximately 20%, associated with decreased aerobic capacity and increased sedentary behavior. These findings highlight the need for timely diagnosis and therapeutic interventions, including cardiopulmonary rehabilitation, to enhance the quality of life in post-COVID patients with CI. The study’s cross-sectional design and its specific context have limited causality inference and generalizability, underscoring the importance of further research in diverse settings.
BRIEF COMMUNICATION
Hepatic endotheliitis in Golden Syrian hamsters (Mesocricetus auratus) experimentally infected with SARS-CoV-2 Souza, Alex Junior Souza de Souza Filho, Antônio Francisco de Zimpel, Cristina Kraemer Ayupe, Marina Caçador Araújo, Marcelo Valdemir de Machado, Rafael Rahal Guaragna Salles, Erika Salgado, Caio Loureiro Tavares, Mariana Silva Silva-Pereira, Taiana Tainá Souza, Paula Carolina de Durigon, Edison Luiz Heinemann, Marcos Bryan Brandão, Paulo Eduardo Fonseca, Denise Morais da Guimarães, Ana Marcia de Sá Sá, Lilian Rose Marques de

Abstract in English:

ABSTRACT Hepatic injuries in COVID-19 are not yet fully understood and indirect pathways (without viral replication in the liver) have been associated with the activation of vascular mechanisms of liver injury in humans infected with SARS-CoV-2. Golden Syrian hamsters are an effective model for experimental reproduction of moderate and self-limiting lung disease during SARS-CoV-2 infection. As observed in humans, this experimental model reproduces lesions of bronchointerstitial pneumonia and pulmonary vascular lesions, including endotheliitis (attachment of lymphoid cells to the luminal surface of endothelium). Extrapulmonary vascular lesions are well documented in COVID-19, but such extrapulmonary vascular lesions have not yet been described in the Golden Syrian hamster model of SARS-CoV-2 infection. The study aimed to evaluate microscopic liver lesions in Golden Syrian hamsters experimentally infected with SARS-CoV-2. In total, 38 conventional Golden Syrian hamsters, divided into infected group (n=24) and mock-infected group (n=14), were euthanized at 2-, 3-, 4-, 5-, 7-, 14-, and 15-days post infection with SARS-CoV-2. Liver fragments were evaluated by histopathology and immunohistochemical detection of SARS-CoV-2 Spike S2 antigens. The frequencies of portal vein endotheliitis, lobular activity, hepatocellular degeneration, and lobular vascular changes were higher among SARS-CoV-2-infected animals. Spike S2 antigen was not detected in liver. The main results indicate that SARS-CoV-2 infection exacerbated vascular and inflammatory lesions in the liver of hamsters with pre-existing hepatitis of unknown origin. A potential application of this animal model in studies of the pathogenesis and evolution of liver lesions associated with SARS-CoV-2 infection still needs further evaluation.
BRIEF COMMUNICATION
Unveiling microbial worlds: exploring viral metagenomics among waste pickers at Latin America’s largest dumpsite Cruvinel, Vanessa Resende Nogueira Carvalho, Eneas de Alves, Daiani Cristina Cilião Marques, Carla Pintas Bezerra, Rafael dos Santos Giovanetti, Marta Sampaio, Sandra Coccuzzo Elias, Maria Carolina Araújo, Wildo Navegantes de Haddad, Rodrigo Slavov, Svetoslav Nanev

Abstract in English:

ABSTRACT Waste pickers constitute a marginalized demographic engaged in the collection of refuse, facing considerable occupational hazards that heighten their susceptibility to contract infectious diseases. Moreover, waste pickers contend with societal stigmatization and encounter barriers to accessing healthcare services. To explore the viral profile of waste pickers potentially linked to their occupational environment, we conducted a metagenomic analysis on 120 plasma specimens sampled from individuals employed at the Cidade Estrutural dumpsite in Brasilia city, Brazil. In total, 60 blood donors served as a comparative control group. Specimens were pooled and subjected to Illumina NextSeq 2000 sequencing. Viral abundance among waste pickers revealed the presence of significant pathogens, including HIV, HCV, and Chikungunya, which were not detected in the control group. Additionally, elevated levels of anelloviruses and Human pegivirus-1 were noted, with a comparable incidence in the control group. These findings underscore the utility of metagenomics in identifying clinically relevant viral agents within underserved populations. The implications of this study extend to informing public health policies aimed at surveilling infectious diseases among individuals facing socioeconomic disparities and limited access to healthcare resources.
BRIEF COMMUNICATION
Streptococcus equi subspecies zooepidemicus: an emergent cause of meningoencephalitis in Northeastern Brazil Farias, Luis Arthur Brasil Gadelha Sousa, Marcos Maciel Cavalcante, Karene Ferreira Jucá, Marina Pinheiro Catunda Castro, Aldenise de Olinda Mello, Liana Perdigão Mesquita, Rafael Ferreira Bandeira, Silviane Praciano Marchi, Ana Paula Coelho, Tânia Mara Silva Lima Neto, Antônio Silva Arruda, Érico Antonio Gomes de Costa, Silvia Figueiredo Oliveira, Maura Salaroli de Perdigão Neto, Lauro Vieira

Abstract in English:

ABSTRACT This study describes an outbreak of Streptococcus equi subspecies zooepidemicus infections that caused meningoencephalitis and bacteremia related to unpasteurized milk consumption in northeastern Brazil. Epidemiological investigations and a brief literature review were conducted. Strains with possible neurotropism had not been identified in Brazil before these cases; however, in 2023, another case of meningoencephalitis caused by Streptococcus equi sp. zooepidemicus was described, revealing the need to maintain surveillance and highlighting that these neurotropic strains continue to circulate in the environment.
BRIEF COMMUNICATION
First report of white piedra caused by Cutaneotrichosporon debeurmannianum Almeida Jr, Hiram Larangeira de Faria, Eduardo Camargo Assis, Thales Moura de Leite, Ingrid Gonçalves Costa Gimenes, Viviane Mazo Fávero

Abstract in English:

ABSTRACT Piedras are small nodules found on the hair shafts. White piedra was initially described as caused by Trichosporon beigelii, which was later reclassified in several species. We describe the first case of white piedra caused by Cutaneotrichosporon debeurmannianum. Affected hairs were examined in natura with scanning electron microscopy, after gold metallization. The typical whitish cerebriform creamy colony was obtained in Sabouraud medium. Fungal genomic DNA extracted from cultures and locus was amplified with the NL1/NL4 primer pair from the D1/D2 region of the large ribosomal subunit (LSU) of 28S rRNA. With scanning electron microscopy, nodules are easily identified surrounding the hair shaft; with high magnifications, rounded structures adhered to each other were identified. Comparison of the nucleotide sequences of IMT-1703 Cutaneotrichosporon debeurmannianum revealed 99.6% similarity with the 28S large ribosomal unit rDNA sequence. This case of white piedra was caused by Cutaneotrichosporon debeurmannianum.
Brief Communication
Evaluation of the public health laboratory network for tegumentary leishmaniasis in an endemic area of Brazil Medeiros, Fernanda Alvarenga Cardoso Souza Filho, Job Alves Pimentel, Maria Inês Fernandes Reis, Ilka Afonso Menezes-Souza, Daniel Silva, Aline Fagundes da Marcelino, Andreza Pain

Abstract in English:

ABSTRACT Diagnostic networks ensure efficiency in disease diagnosis. A descriptive study evaluated the network of public health laboratories (NPHL) in Minas Gerais State, Brazil, using diagnostic results for tegumentary leishmaniasis (TL) from the laboratory management system in 2017–2020. Out of 1,369 individuals analyzed, 704 (51.4%) cases of TL were confirmed, with 610 (86.7%) by direct parasitological examination (DPE) and 94 (13.4%) by polymerase chain reaction (PCR). Notably, 25.3% of cases with DPE-negative results were PCR-positive. Consecutive diagnostic tests enhanced diagnosis of TL. NPHL-MG is a promising model for expanding similar networks and improving disease control.
ERRATUM
Evaluation of larval surface antigens from infective larvae of Strongyloides venezuelensis for the serodiagnosis of human strongyloidiasis
ERRATUM
Can COVID-19 impact the natural history of paracoccidioidomycosis? Insights from an atypical chronic form of the mycosis
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