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Revista da Sociedade Brasileira de Medicina Tropical, Volume: 55, Published: 2022
  • The health-related quality of life in patients with Chagas disease: the state of the art Review Article

    Almeida, Igor Lucas Geraldo Izalino de; Oliveira, Luciano Fonseca Lemos de; Figueiredo, Pedro Henrique Scheidt; Oliveira, Rafael Dias de Brito; Damasceno, Thayrine Rosa; Silva, Whesley Tanor; Oliveira, Lucas Frois Fernandes de; Ávila, Matheus Ribeiro; Lima, Vanessa Pereira; Lages, Ana Thereza Chaves; Mediano, Mauro Felippe Felix; Rocha, Manoel Otávio Costa; Costa, Henrique Silveira

    Abstract in English:

    ABSTRACT Chagas disease (CD) is a neglected tropical disease associated with poverty in which patients are surrounded by stigma. These factors can contribute to reducing health-related quality of life (HRQoL). Therefore, a broad discussion of HRQoL in the CD population is required. This study aimed to discuss the main findings of HRQoL in patients with CD, focusing on the association between sociodemographic and lifestyle factors, echocardiographic and functional determinants, and the effect of non-invasive interventions on HRQoL. A literature search of the MEDLINE, Web of Science, CINAHL, Scopus, and LILACS databases was performed with no data or language restrictions. Twenty-two articles were included in this meta-analysis. In general, HRQoL is worse in patients with CD than in healthy individuals, particularly in the presence of cardiovascular and/or gastrointestinal symptoms. Sex, age, functional class, level of physical activity, healthy habits, and medications received could affect HRQoL. Among the echocardiographic and functional determinants, decreased systolic function seems to negatively affect HRQoL. No association with the peak oxygen uptake was observed in the maximal tests. By contrast, well-tolerated field tests with submaximal intensities were associated with HRQoL. Both pharmaceutical care and exercise training have a positive effect on the HRQoL of patients with Chagas cardiomyopathy, and the mental component can be a prognostic marker in this population. In conclusion, assessment of HRQoL can provide important information about the health status of patients with CD, and its use in clinical practice is warranted.
  • The health-related quality of life in patients with post-COVID-19 after hospitalization: a systematic review Review Article

    Figueiredo, Eduardo Augusto Barbosa; Silva, Whesley Tanor; Tsopanoglou, Sabrina Pinheiro; Vitorino, Débora Fernandes de Melo; Oliveira, Luciano Fonseca Lemos de; Silva, Keity Lamary Souza; Luz, Hiago Daniel Herédia; Ávila, Matheus Ribeiro; Oliveira, Lucas Fróis Fernandes de; Lacerda, Ana Cristina Rodrigues; Mendonça, Vanessa Amaral; Lima, Vanessa Pereira; Mediano, Mauro Felippe Felix; Figueiredo, Pedro Henrique Scheidt; Rocha, Manoel Otávio Costa; Costa, Henrique Silveira

    Abstract in English:

    ABSTRACT Symptoms in post-COVID-19 patients who require hospitalization can persist for months, significantly affecting their health-related quality of life (HRQoL). Thus, the present study aimed to discuss the main findings regarding HRQoL in post-COVID-19 patients who required hospitalization. An electronic search was performed in the MEDLINE, EMBASE, CINAHL, Web of Science, LILACS, and Scopus databases, without date and language restrictions, until July 2021. Twenty-four articles were included in the analysis. It seems that HRQoL partially improved soon after hospital discharge, although the negative impact on HRQoL may persist for months. The physical and mental aspects are affected because patients report pain, discomfort, anxiety, and depression. The HRQoL of COVID-19 infected patients was worse than that of uninfected patients. Additionally, HRQoL seemed worse in patients admitted to the intensive care unit than in those who remained in the ward. Improvements in HRQoL after hospital discharge are independent of imaging improvement, and there seems to be no association between HRQoL after hospital discharge and disease severity on hospital admission. Many factors have been identified as determinants of HRQoL, with women and advanced age being the most related to worse HRQOL, followed by the duration of invasive mechanical ventilation and the need for intensive care. Other factors included the presence and number of comorbidities, lower forced vital capacity, high body mass index, smoking history, undergraduate education, and unemployment. In conclusion, these findings may aid in clinical management and should be considered in the aftercare of patients.
  • Spatial and spatiotemporal patterns of human visceral leishmaniasis in an endemic southeastern area in countryside Brazil Review Article

    Cruz, Cleya da Silva Santana; Cardoso, Diogo Tavares; Ferreira Júnior, Claudio Luiz; Barbosa, David Soeiro; Carneiro, Mariângela

    Abstract in English:

    ABSTRACT Visceral leishmaniasis (VL) has shown endemic pattern and epidemic episodes in urban and rural areas, however, there are still gaps in knowledge with regards to disease transmission. This study aimed to analyze the spatiotemporal dispersion of VL cases in the municipality of Araçuaí, Minas Gerais. A study of confirmed VL cases was conducted considering the endemic and epidemic periods between 2012 and 2017. The incidence rate was calculated, and for spatial analysis, the kernel map, directional distribution ellipse, and space-time scanning techniques were used. The correlations between VL cases and exposure variables (precipitation, humidity, and temperature) were calculated. The mean incidence of VL in the endemic period was 18.5 (95% confidence interval (CI) 5.9-32.5) and 44.4 in the epidemic period (95%CI, 12.0-28.6) by 100,000 inhabitants. The relative risk for the epidemic period was 2.4 (95% CI 1.4-4.1) when compared to the endemic period. A higher incidence of the disease was observed in rural areas of the municipality. Kernel mapping analysis revealed hotspots in the urban area of the municipality. The directional distribution ellipse encompasses the urban perimeter and part of the rural area of the municipality, expanding eastward during the epidemic period. Spatial analysis revealed a high-risk cluster for VL in rural areas. A positive correlation was observed between VL cases and temperature during the endemic period. Spatial analysis allowed us to outline the epidemiological scenario of human VL cases. These findings may be useful in case surveillance and in the work of health professionals and managers in Brazil.
  • Anti-vaccination movements in the world and in Brazil Review Article

    Oliveira, Isadora Sousa de; Cardoso, Larissa Soares; Ferreira, Isabela Gobbo; Alexandre-Silva, Gabriel Melo; Jacob, Beatriz de Cássia da Silva; Cerni, Felipe Augusto; Monteiro, Wuelton Marcelo; Zottich, Umberto; Pucca, Manuela Berto

    Abstract in English:

    ABSTRACT Over the years, vaccinations have provided significant advances in public health, because they substantially reduce the morbimortality of vaccine-preventable diseases. Nevertheless, many people are still hesitant to be vaccinated. Brazil is a region of many anti-vaccine movements, and several outbreaks of vaccine-preventable diseases, such as yellow fever and measles, have occurred in the country during the last few years. To avoid new outbreaks, immunization coverage must be high; however, this is a great challenge to achieve due to the countless anti-vaccine movements. The World Health Organization has suggested new actions for the next decade via the Immunization Agenda 2030 to control, reduce, or eradicate vaccine-preventable diseases. Nonetheless, the vaccination coverage has decreased recently. To resolve the anti-vaccine issue, it is necessary to propose a long-term approach that involves innovative education programs on immunization and critical thinking, using different communication channels, including social media. Cooperation among biology and health scientists, ethicists, human scientists, policymakers, journalists, and civil society is essential for an in-depth understanding of the social action of vaccine refusal and planning effective education measures to increase the vaccine coverage.
  • Clustered Regularly Interspaced Short Palindromic Repeats/ CRISPR associated protein 9-mediated editing of Schistosoma mansoni genes: Identifying genes for immunologically potent drug and vaccine development Review Article

    Naidoo, Pragalathan; Mkhize-Kwitshana, Zilungile Lynette

    Abstract in English:

    ABSTRACT Schistosomiasis is a neglected acute and chronic tropical disease caused by intestinal (Schistosoma mansoni and Schistosoma japonicum) and urogenital (Schistosoma haematobium) helminth parasites (blood flukes or digenetic trematodes). It afflicts over 250 million people worldwide, the majority of whom reside in impoverished tropical and subtropical regions in sub-Saharan Africa. Schistosomiasis is the second most common devastating parasitic disease in the world after malaria and causes over 200,000 deaths annually. Currently, there is no effective and approved vaccine available for human use, and treatment strongly relies on praziquantel drug therapy, which is ineffective in killing immature larval schistosomula stages and eggs already lodged in the tissues. The Clustered Regularly Interspaced Short Palindromic Repeats/CRISPR associated protein 9 (CRISPR/Cas9)-mediated gene editing tool is used to deactivate a gene of interest to scrutinize its role in health and disease, and to identify genes for vaccine and drug targeting. The present review aims to summarize the major findings from the current literature reporting the usage of CRISPR/Cas9-mediated gene editing to inactivate genes in S. mansoni (acetylcholinesterase (AChE), T2 ribonuclease omega-1 (ω1), sulfotransferase oxamniquine resistance protein (SULT-OR), and α-N-acetylgalactosaminidase (SmNAGAL)), and freshwater gastropod snails, Biomphalaria glabrata (allograft inflammatory factor (BgAIF)), an obligatory component of the life cycle of S. mansoni, to identify their roles in the pathogenesis of schistosomiasis, and to highlight the importance of such studies in identifying and developing drugs and vaccines with high therapeutic efficacy.
  • An overview of Zika virus genotypes and their infectivity Review Article

    Bernardo-Menezes, Lucas Coêlho; Agrelli, Almerinda; Oliveira, Ana Sofia Lima Estevão de; Moura, Ronald Rodrigues de; Crovella, Sergio; Brandão, Lucas André Cavalcanti

    Abstract in English:

    ABSTRACT Zika virus (ZIKV) is an enveloped, single-stranded RNA arbovirus belonging to the genus Flavivirus. It was first isolated from a sentinel monkey in Uganda in 1947. More recently, ZIKV has undergone rapid geographic expansion and has been responsible for outbreaks in Southeast Asia, the Pacific Islands, and America. In this review, we have highlighted the influence of viral genetic variants on ZIKV pathogenesis. Two major ZIKV genotypes (African and Asian) have been identified. The Asian genotype is subdivided into Southwest Asia, Pacific Island, and American strains, and is responsible for most outbreaks. Non-synonymous mutations in ZIKV proteins C, prM, E, NS1, NS2A, NS2B, NS3, and NS4B were found to have a higher prevalence and association with virulent strains of the Asian genotype. Consequently, the Asian genotype appears to have acquired higher cellular permissiveness, tissue persistence, and viral tropism in human neural cells. Therefore, mutations in specific coding regions of the Asian genotype may enhance ZIKV infectivity. Considering that mutations in the genomes of emerging viruses may lead to new virulent variants in humans, there is a potential for the re-emergence of new ZIKV cases in the future.
  • Epidemiology and control strategies for tuberculosis in countries with the largest prison populations Review Article

    Busatto, Caroline; Bierhals, Dienefer Venske; Vianna, Julia Silveira; Silva, Pedro Eduardo Almeida da; Possuelo, Lia Gonçalves; Ramis, Ivy Bastos

    Abstract in English:

    ABSTRACT Tuberculosis (TB) is a serious infectious disease, and its control is considered a challenge, especially among vulnerable populations such as prisoners. The occurrence of TB in prisons is an alarming public health problem in many countries. This integrative review aims to describe the epidemiology of TB and control strategies for this disease in countries with the largest prison populations. Studies have shown that it is essential to know the prevalence of TB in prisons of each country. This is because it can serve as an indication of the need for action in prisons to reduce TB rates, including improving the structure of prison environments, rapidly and accurately diagnosing new cases, identifying drug-resistant strains, and implementing effective and directly observed treatment for TB.
  • Antineoplastic properties and pharmacological applications of Crotalus durissus terrificus snake venom Review Article

    Alves, Brunna Fernanda Arraez; Ferreira Jr, Rui Seabra

    Abstract in English:

    ABSTRACT Snake toxins are widely studied owing to their importance in snakebite accidents, a serious public health issue in tropical countries, and their broad therapeutic potential. Isolated fractions from venom produced by snakes of the genus Crotalus sp. present a wide variety of pharmacological uses such as antifungal, antiviral, antibacterial, and antitumor properties, among other therapeutic potentialities. Given the direct effect of this venom on tumor cells, isolation of its compounds is important for the characterization of its anticarcinogenic actions. Crotalus durissus terrificus venom and its toxins have been widely evaluated as potential candidates for the development of new antineoplastic therapies that are efficient against different tumor lines and cellular targets. This review highlights the venom toxins of this species, with a focus on their antineoplastic properties.
  • Lesions caused by human and domestic and wild animal bites Review Article

    Haddad Junior, Vidal

    Abstract in English:

    ABSTRACT Animal bites are a common problem in the emergency room. There are many reports of isolated cases (mainly of domestic mammals); however, texts with more comprehensive and general guidance on these kinds of bite injuries are necessary, including those caused by wild mammals, reptiles, and even fish. This review aims to update knowledge on this problem, which includes human and domestic and wild animal bites. Health teams in emergency care centers should be aware of the initial and late measures required to control this problem.
  • Health-Related Quality of Life Reported by Patients With Chagas Disease: A Systematic Review of Qualitative Evidence With GRADE Recommendations Review Article

    Silva, Whesley Tanor; Oliveira, Lucas Frois Fernandes; Xavier, Diego Mendes; Figueiredo, Pedro Henrique Scheidt; Lacerda, Ana Cristina Rodrigues; Mendonça, Vanessa Amaral; Ávila, Matheus Ribeiro; Ferreira Júnior, Cláudio Luiz; Lima, Márcia Maria Oliveira; Mediano, Mauro Felippe Felix; Rocha, Manoel Otávio da Costa; Costa, Henrique Silveira

    Abstract in English:

    ABSTRACT Patients with Chagas disease have reduced health-related quality of life (HRQoL). Hence, we aimed to identify the factors that mostly affected their HRQoL. This was a systematic review of qualitative studies. The Latin American and Caribbean Health Sciences Literature, Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Web of Science, and SciVerse Scopus databases were searched for relevant studies without language or date restrictions. The search and data analysis were performed by independent reviewers; all qualitative studies that reported the factors that had an impact on the HRQoL of patients with Chagas disease were included. The risk of bias was assessed using the Critical Appraisal Skills Program Qualitative Study Checklist; confidence in the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative approach. Five studies were included in this review: four in Brazil and one in California, United States, with immigrants from Central and South America. The sample consisted of 207 patients with chronic Chagas disease. Stigma, physical limitations, work absenteeism, emotional or mental aspects, fear of treatment, and fear of the future had the strongest impact on the HRQoL. All items showed moderate confidence except for fear of treatment (low confidence). The physical, emotional, mental, and cultural aspects affected the HRQoL of patients with chronic Chagas disease. Identification of these factors is important in the development of strategies aimed at improving the HRQoL of this population.
  • Overview of polymyxin resistance in Enterobacteriaceae Mini Review

    Silva, Kesia Esther da; Rossato, Luana; Leite, Andressa Ferraz; Simionatto, Simone

    Abstract in English:

    ABSTRACT Polymyxin antibiotics are disfavored owing to their potential clinical toxicity, especially nephrotoxicity. However, the dry antibiotic development pipeline, together with the increasing global prevalence of infections caused by multidrug-resistant (MDR) gram-negative bacteria, have renewed clinical interest in these polypeptide antibiotics. This review highlights the current information regarding the mechanisms of resistance to polymyxins and their molecular epidemiology. Knowledge of the resistance mechanisms and epidemiology of these pathogens is critical for the development of novel antibacterial agents and rapid treatment choices.
  • Neurobrucellosis: the great mimicker Mini Review

    Soares, Cristiane Nascimento; Angelim, Abraão Iuri Medeiros; Brandão, Carlos Otavio; Santos, Roberto Queiroz; Mehta, Ravi; Silva, Marcus Tulius Teixeira da

    Abstract in English:

    ABSTRACT Neurobrucellosis is caused by bacteria of the genus Brucella and is responsible for several clinical manifestations, making diagnosis challenging. The most common route of infection is through the consumption of unpasteurized or raw dairy products such as fresh milk, butter, and cheese. As neurological complications can develop chronically, they are frequently misdiagnosed as other infections, such as tuberculosis. This report reviews the clinical manifestations, diagnostic approach, treatment, and prognosis of neurobrucellosis, illustrating a case of chronic intracranial hypertension and meningoencephalitis secondary to brucellosis. The clinical presentation of brucellosis can mimic several systemic diseases, resulting in diagnostic delays and clinical complications. A high degree of suspicion is required, and neurobrucellosis should always be considered in the differential diagnosis of chronic meningitis.
  • Stroke in Chagas disease: from pathophysiology to clinical practice Mini Review

    Lage, Thaís Aparecida Reis; Tupinambás, Julia Teixeira; Pádua, Lucas Bretas de; Ferreira, Matheus de Oliveira; Ferreira, Amanda Cambraia; Teixeira, Antonio Lucio; Nunes, Maria Carmo Pereira

    Abstract in English:

    ABSTRACT Despite substantial progress toward its control, Chagas disease continues to be a major public health problem in Latin America and has become a global health concern. The disease affects approximately 6 million people, of whom 20-40% will develop cardiomyopathy over the years after the initial Trypanosoma cruzi infection. Chagas cardiomyopathy is the most serious and frequent manifestation of Chagas disease. Clinical manifestations vary widely according to the severity of myocardial dysfunction, ranging from asymptomatic to severe forms, including dilated cardiomyopathy with heart failure, arrhythmias, thromboembolism events, and sudden death. Chagas disease is a risk factor for stroke regardless of the severity of cardiomyopathy, which is a leading cause of chronic disability. Classically, stroke etiology in patients with Chagas disease is thought to be cardioembolic and related to apical aneurysm, mural thrombus, and atrial arrhythmias. Although most strokes are thromboembolic, other etiologies have been observed. Small vessel disease, atherosclerosis, and cryptogenic diseases have been reported in patients with Chagas disease and stroke. The potential mechanisms involved in non-embolic strokes include the presence of associated risk factors, pro-inflammatory and prothrombotic disease states, and endothelial dysfunction. However, the contribution of each mechanism to stroke in Chagas disease remains unclear. The review aims to provide an overview of stroke in Chagas disease, highlighting the main pathophysiological mechanisms, clinical presentation, approaches for prevention, and unanswered questions regarding treatment strategies.
  • COVID-19 epidemic curve in Brazil: a sum of multiple epidemics, whose inequality and population density in the states are correlated with growth rate and daily acceleration. An ecological study Major Article

    Pinto, Airandes de Sousa; Rodrigues, Carlos Alberto; Nascimento Sobrinho, Carlito Lopes; Cruz, Lívia Almeida da; Santos Junior, Edval Gomes dos; Nunes, Paulo Cesar; Costa, Matheus Gomes Reis; Rocha, Manoel Otávio da Costa

    Abstract in English:

    ABSTRACT Background: The epidemic curve has been obtained based on the 7-day moving average of the events. Although it facilitates the visualization of discrete variables, it does not allow the calculation of the absolute variation rate. Recently, we demonstrated that the polynomial interpolation method can be used to accurately calculate the daily acceleration of cases and deaths due to COVID-19. This study aimed to measure the diversity of epidemic curves and understand the importance of socioeconomic variables in the acceleration, peak cases, and deaths due to COVID-19 in Brazilian states. Methods: Epidemiological data for COVID-19 from federative units in Brazil were obtained from the Ministry of Health’s website from February 25 to July 11, 2020. Socioeconomic data were obtained from the Instituto Brasileiro de Geografia e Estatística ( Using the polynomial interpolation methods, daily cases, deaths and acceleration were calculated. Moreover, the correlation coefficient between the epidemic curve data and socioeconomic data was determined. Results: The combination of daily data and case acceleration determined that Brazilian states were in different stages of the epidemic. Maximum case acceleration, peak of cases, maximum death acceleration, and peak of deaths were associated with the Gini index of the gross domestic product of Brazilian states and population density but did not correlate with the per capita gross domestic product of Brazilian states. Conclusions: Brazilian states showed heterogeneous data curves. Population density and socioeconomic inequality were correlated with a more rapid exponential growth in new cases and deaths.
  • Clinical Impact of the Line Probe Assay and Xpert® MTB/RIF Assay in the Presumptive Diagnosis of Drug-Resistant Tuberculosis in Brazil: A Pragmatic Clinical Trial Major Article

    Kritski, Afranio; Oliveira, Maria Martha; Almeida, Isabela Neves de; Ramalho, Daniela; Andrade, Monica Kramer de Noronha; Carvalho, Monica; Miranda, Pryscila Fernandes Campino; Dalcolmo, Margareth Pretti; Braga, Jose Ueleres; Brígido, Tania; Mesquita, Eliene; Dias, Claudia; Gambirasio, Aglae; Souza Filho, Joao Baptista; Detjen, Anne; Phillips, Patrick Peter John; Langley, Ivor; Fujiwara, Paula; Squire, Stephen Bertel

    Abstract in English:

    ABSTRACT Background: Rapid molecular methods such as the line probe assay (LPA) and Xpert® MTB/RIF assay (Xpert) have been recommended by the World Health Organization for drug-resistant tuberculosis (DR-TB) diagnosis. We conducted an interventional trial in DR-TB reference centers in Brazil to evaluate the impact of the use of LPA and Xpert. Methods: Patients with DR-TB were eligible if their drug susceptibility testing results were available to the treating physician at the time of consultation. The standard reference MGITTM 960 was compared with Xpert (arm 1) and LPA (arm 2). Effectiveness was considered as the start of the appropriate TB regimen that matched drug susceptibility testing (DST) and the proportions of culture conversion and favorable treatment outcomes after 6 months. Results: A higher rate of empirical treatment was observed with MGIT alone than with the Xpert assay (97.0% vs. 45.0%) and LPA (98.2% vs. 67.5%). Patients started appropriate TB treatment more quickly than those in the MGIT group (median 15.0 vs. 40.5 days; p<0.01) in arm 1. Compared to the MGIT group, culture conversion after 6 months was higher for Xpert in arm 1 (90.9% vs. 79.3%, p=0.39) and LPA in arm 2 (80.0% vs. 83.0%, p=0.81). Conclusions: In the Xpert arm, there was a significant reduction in days to the start of appropriate anti-TB treatment and a trend towards greater culture conversion in the sixth month.
  • Malaria in Haiti: A descriptive study on spatial and temporal profile from 2009 to 2018 Major Article

    Jules, Jean Ricardo; Alencar, Jeronimo; Suárez-Mutis, Martha Cecília; Baptiste, Ernst Jn; Albuquerque, Hermano de; Rosa-Freitas, Maria Goreti; Raccurt, Christian; Oliveira, Ricardo Lourenço de; Silva-do-Nascimento, Teresa Fernandes

    Abstract in English:

    ABSTRACT Background: Haiti is one of the Caribbean countries where malaria persists. More than 99% of malaria cases are caused by Plasmodium falciparum, the main vector being the mosquito Anopheles albimanus. In this paper, we describe the epidemiological profile of malaria in Haiti between 2009 and 2018. Methods We analyzed information on cases reported by the Ministry of Health of Haiti and the World Health Organization (WHO). Results: Between 2009 and 2018, 232,479 malaria cases were reported by the Ministry of Public Health and Population (MSPP); an increase in the incidence of malaria in the country in 2010, followed by a decrease in 2011, was primarily observed. Due to recent efforts to reduce malaria by 2020, its incidence declined from 60,130 cases in 2010 to 8,978 cases in 2018. Controversially, in terms of the number of reported cases, the MSPP and WHO report conflicting data. However, the results from both datasets present the same trend in Haiti from 2009 to 2018. The results also illustrate the endemicity of the disease throughout Haiti, both in rural and urban areas, especially along the coast. Conclusions: This study emphasizes the need to promote official data collection and analyses, as well as the application of epidemiological surveillance of malaria at the municipal level, for a better understanding of the real impact of malaria on the Haitian population and to create more appropriate interventions.
  • Reliability of point-of-care circulating cathodic antigen assay for diagnosing schistosomiasis mansoni in urine samples from an endemic area of Brazil after one year of storage at -20 degrees Celsius Major Article

    Favre, Tereza Cristina; Beck, Lilian Christina Nóbrega Holsback; Bezerra, Fernando Schemelzer Moraes; Graeff-Teixeira, Carlos; Coelho, Paulo Marcos Zech; Enk, Martin Johannes; Katz, Naftale; Oliveira, Ricardo Riccio; Reis, Mitermayer Galvão dos; Pieri, Otávio Sarmento

    Abstract in English:

    ABSTRACT Background The World Health Organization recommends reliable point-of-care (POC) diagnostic testing to eliminate schistosomiasis. Lateral flow immunoassay that detects schistosome circulating cathodic antigen (CCA) in urine to establish prevalence thresholds for intervention in endemic areas is recommended. Stored urine may be useful if surveying at-risk populations is delayed or interrupted by unforeseen circumstances, such as the current COVID-19 pandemic. This study evaluated the manufacturer’s claim that Schistosoma mansoni infection can be reliably diagnosed in urine samples stored at -20°C for one year. Methods Two-hundred-forty-two subjects from an endemic site in Brazil provided one urine sample each for testing with URINE CCA (SCHISTO) ECO TESTE® (POC-ECO) and one stool sample each for testing with Kato-Katz (KK) and Helmintex® (HTX) as a robust reference standard for infection status. At least 2 ml of urine from each participant was stored at -20°C; after one year, 76 samples were randomly selected for POC-ECO retesting. Results: The POC-ECO agreement between freshly collected and stored urine was inadequate considering trace results as positive (Cohen’s kappa coefficient κ = 0.08) and negative (κ = 0.36). POC-ECO accuracy was not significantly greater than that of routine KK (54%; 95% confidence interval: 42.1%-65.5%). Conclusions The precision and accuracy of POC-ECO have to be optimized in both freshly collected and stored urine before it can be recommended for use in control programs in Brazil.
  • Temporal evolution of dermonecrosis in loxoscelism assessed by photodocumentation Major Article

    Borrasca-Fernandes, Carla Fernanda; Prado, Camila Carbone; Capitani, Eduardo Mello De; Hyslop, Stephen; Bucaretchi, Fábio

    Abstract in English:

    ABSTRACT Background: Although loxoscelism (bites by brown spiders of the genus Loxosceles) frequently results in dermonecrosis, no previous clinical reports have provided detailed temporal photodocumentation of the evolution of dermonecrotic lesions in a case series. Methods This was a retrospective cohort study involving a case series of loxoscelism. Only cases of dermonecrosis with photodocumentation of lesion evolution (from admission until complete or almost complete healing) were included. Results: Eight patients (six men, two women; median age, 38 years) fulfilled the inclusion criteria. The bite sites included the thigh (n = 4), forearm (n = 2), abdomen (n = 1), and trunk (n = 1). Time interval between the bite and first contact with our service ranged from 15 to 216 h (median = 29 h). The main clinical manifestations included local erythematous and ischemic violaceous lesions overlying a base of indurated edema (livedoid plaque, 8), local pain (8), exanthema (6), serohemorrhagic vesicles/blisters (5), fever (5), and jaundice (1). Based on a previously established classification, the cases were classified as probable cutaneous-necrotic loxoscelism (CNL, n = 4), presumptive CNL (n = 3), and presumptive cutaneous-hemolytic loxoscelism (n = 1). Seven patients were treated with anti-arachnidic antivenom (AV; median time post-bite = 46 h). Complete lesion healing ranged from 34 to 98 days post-bite (median, 68 days; six patients). None of the patients required reconstructive plastic surgery. Conclusions The sequential photographic documentation showed considerable variation in the process of wound healing, with complete epithelialization requiring up to 3 months after the bite.
  • Monitoring Rhodnius neglectus (Lent, 1954) populations’ susceptibility to insecticide used in controlling actions in urban areas northwest of São Paulo state Major Article

    Silva, Rubens Antonio da; Maldonado, Lis Adriana; Pessoa, Grasielle Caldas D’Ávila; Diotaiuti, Liléia

    Abstract in English:

    ABSTRACT Background: Chagas disease (CD) is caused by the flagellate protozoan Trypanosoma cruzi and can be carried by different species of triatomines, including Rhodnius neglectus, which is wild, well distributed in Brazil, and has formed colonies in palm trees located in urban areas of municipalities in the state of São Paulo. Chemical control has been routinely used to reduce population density, but each year, there has been an increase in species dispersion and density. This study aimed to evaluate the susceptibility of insects to insecticides used in control. Methods: The reference population was collected from Araçatuba municipality, Nilce Maia. Dilutions of deltamethrin were prepared and applied to the back of the first-stage nymphs, which were biologically synchronized. The control group received pure acetone only. Mortality was assessed after 72 h. Results: The mortality rate with respect to diagnostic dose was 100%. The susceptibility profile observed for this population showed RR50 ranging from 1.76 to 3.632. Conclusions: The populations were susceptible to the insecticides tested. It is possible that the insecticide residual effect on this ecotope has decreased the lifespan, and controlling failures may be the cause of recolonization in this environment.
  • Association between vitamin D serum levels and clinical, laboratory, and parasitological parameters in patients with malaria from an endemic area of the Amazon Major Article

    Setto, Janaina Maria; Libonati, Rosana Maria Feio; Ventura, Ana Maria Revoredo da Silva; Chaves, Tânia do Socorro Souza; Sequeira, Carina Guilhon; Martins Filho, Arnaldo Jorge; Machado, Ricardo Luiz Dantas; Franceschin, Sylvia do Carmo Castro; Barreto, Jéssica Thuanny Teixeira

    Abstract in English:

    ABSTRACT Background: Some studies have suggested the importance of vitamin D [25(OH)D] in malaria clinical practice. The prevalence of 25(OH)D deficiency in the Amazon population is not well known, and there are few studies in patients with malaria. This study aimed to evaluate 25(OH)D serum levels in patients with malaria and determine their relationships with epidemiological, clinical, laboratory, and parasitemia data. Methods: An analytical cross-sectional study of 123 patients with malaria and 122 individuals without malaria was performed in Itaituba, Pará, Brazil, from January 2018 to October 2019, by evaluating sociodemographic, clinical-epidemiological, parasitological, and laboratory data and adopting a 5% significance level. Parametric tests (Student's t-test), non-parametric tests (Mann-Whitney U), and Spearman’s correlation ([rs], for non-parametric variables) were used according to the nature of the distribution of the variables. For the qualitative variables, Pearson's chi-square test, Fisher's exact test, and the G test were used. Spearman's correlation was used to compare the results of the 25(OH)D levels and blood counts performed among patients and the control group. Results: Malaria patients residing in a mining area had 25(OH)D serum levels that were significantly lower than those in the control group residing in the mining area, though both were within normal levels. Red blood cell counts had an inverse correlation with parasitemia (Plasmodium falciparum), and platelet levels had an inverse correlation with parasitemia (Plasmodium vivax). 25(OH)D deficiency was evidenced in Itaituba, in the state of Pará, which is an endemic area of malaria in the Amazon region.
  • Low eligibility for hepatitis B treatment in the Brazilian public health system Major Article

    Scarponi, Cristiane Faria Oliveira; Pedrosa, Marco Antônio Ferreira; Mol, Marcos Paulo Gomes; Hardman, Michael John Mascarenhas; Greco, Dirceu Bartolomeu

    Abstract in English:

    ABSTRACT Background: Chronic hepatitis B (CHB) affects 257 million people worldwide. However, the proportion of patients eligible for treatment in the public health system has not been established. This study describes the clinical and laboratory profiles of untreated CHB patients and estimates the eligibility rate for antiviral therapy in accordance with the Brazilian Clinical Protocol and Therapeutic Guidelines. Methods: Records of 670 CHB patients were collected from May 2012 to September 2013 in Minas Gerais. Data from each patient were analyzed by hepatitis B virus (HBV) management. Results: 461 CHB patients were treatment-naive. Of these, 23 were HBeAg-positive, 352 were HBeAg-negative, and 14 were clinically diagnosed with cirrhosis. Periodic monitoring was performed in only three patients. However, 9.3% of untreated patients met the eligibility criteria for HBV treatment. Conclusions: Few CHB patients were active carriers and eligible candidates for antiviral therapy. This study revealed inadequate pre-treatment conduct in the Brazilian public health system, emphasizing the need for regular laboratory follow-up for patients initially not eligible for treatment. Such information may indirectly subsidize the planning and improvement of actions and services related to optimal HBV management in the public sphere.
  • Frequency of exposure to arboviruses and characterization of Guillain Barré syndrome in a clinical cohort of patients treated at a tertiary referral center in Brasília, Federal District Major Article

    Matos, Luíza Morais de; Borges, Ariely Teotonio; Palmeira, Aline Barbosa; Lima, Vinicius Moreira; Maciel, Ernane Pires; Fernandez, Rubens Nelson Morato; Mendes, João Pedro Lima; Romero, Gustavo Adolfo Sierra

    Abstract in English:

    ABSTRACT Background: Guillian Barré syndrome (GBS) is an acute autoimmune polyradiculoneuropathy often associated with previous exposure to infectious agents. Methods: A clinical cohort of 41 patients with GBS admitted to the Base Hospital Institute of the Federal District between May 2017 and April 2019 was followed up for 1 year. Serological tests for arbovirus detection and amplification of nucleic acids using polymerase chain reaction for zika virus (ZIKV), dengue virus (DENV), and chikungunya virus (CHIKV) were performed. Results: The cohort consisted of 61% men with a median age of 40 years, and 83% had GBS-triggering events. A total of 54% had Grade 4 disability, 17% had Grade 3, 12% had Grade 2, 10% had Grade 5, and 7% had Grade 1. The classic form occurred in 83% of patients. Nerve conduction evaluations revealed acute demyelinating inflammatory polyneuropathy (51%), acute motor axonal neuropathy (17%), acute sensory-motor neuropathy (15%), and indeterminate forms (17%). Four patients were seropositive for DENV. There was no laboratory detection of ZIKV or CHIKV infection. Ninety percent of patients received human immunoglobulin. Intensive care unit admission occurred in 17.1% of the patients, and mechanical ventilation was used in 14.6%. One patient died of Bickerstaff’s encephalitis. Most patients showed an improvement in disability at 10 weeks of follow-up. Conclusions: GBS in the Federal District showed a variable clinical spectrum, and it was possible to detect recent exposure to DENV.
  • COVID-19's intra-urban inequalities and social vulnerability in a medium-sized city Major Article

    Nogueira, Mário Círio; Leite, Isabel Cristina Gonçalves; Teixeira, Maria Teresa Bustamante; Vieira, Marcel de Toledo; Colugnati, Fernando Antonio Basile

    Abstract in English:

    ABSTRACT Background: Social conditions are related to the impact of epidemics on human populations. This study aimed to investigate the spatial distribution of cases, hospitalizations, and deaths from COVID-19 and its association with social vulnerability. Methods: An ecological study was conducted in 81 urban regions (UR) of Juiz de Fora from March to November 2020. Exposure was measured using the Health Vulnerability Index (HVI), a synthetic indicator that combines socioeconomic and environmental variables from the Demographic Census 2010. Regression models were estimated for counting data with overdispersion (negative binomial generalized linear model) using Bayesian methods, with observed frequencies as the outcome, expected frequencies as the offset variable, and HVI as the explanatory variable. Unstructured random-effects (to capture the effect of unmeasured factors) and spatially structured effects (to capture the spatial correlation between observations) were included in the models. The models were estimated for the entire period and quarter. Results: There were 30,071 suspected cases, 8,063 confirmed cases, 1,186 hospitalizations, and 376 COVID-19 deaths. In the second quarter of the epidemic, compared to the low vulnerability URs, the high vulnerability URs had a lower risk of confirmed cases (RR=0.61; CI95% 0.49-0.76) and a higher risk of hospitalizations (RR=1.65; CI95% 1.23-2.22) and deaths (RR=1.73; CI95% 1.08-2.75). Conclusions: The lower risk of confirmed cases in the most vulnerable UR probably reflected lower access to confirmatory tests, while the higher risk of hospitalizations and deaths must have been related to the greater severity of the epidemic in the city’s poorest regions.
  • In vitro and in vivo Anti-leishmanial Potential of [Ag (PTA) 4 ]BF 4 and [Ag(HBPz 3 )(PPh 3 )] Silver Complexes Major Article

    Soldera, Pauline de Faria; Chagas, Ana Flavia da Silva; Brasil, Anny Maisa Vargas; Comandolli-Wyrepkowski, Claudia Dantas; Porchia, Marina; Pereira, Antonia Maria Ramos Franco

    Abstract in English:

    ABSTRACT Background: American tegumentary leishmaniasis is a parasitic disease known for being difficult to treat; therefore, the search for more effective therapeutic methods is necessary. The objective of this study was to evaluate the in vitro and in vivo antileishmanial activity of silver complexes [Ag(PTA)4]BF4 (Ag1) and [Ag(HBPz3)(PPh3)] (Ag2) against Leishmania (Leishmania) amazonensis [L. (L.) amazonensis] and Leishmania (Viannia) guyanensis. Methods: In vitro bioassays were performed to evaluate the activity of the complexes against promastigote and amastigote forms and evaluate their cytotoxicity. In vivo experiments were performed with hamsters (Mesocricetus auratus) infected and treated topically with two gels containing each metallic complex. Results: Both complexes reduced the number of viable parasites against the promastigote forms of L. (L.) amazonensis. Ag2 was mainly effective against the amastigote forms. The Ag2 complex did not present cellular cytotoxicity, and regarding the selectivity index, both complexes were considered acceptable, with Ag2 having the best selectivity index in murine peritoneal macrophages in relation to L. (L.) amazonensis. Ag2 showed better results in the topical treatment against infections caused by L. (L.) amazonensis, with a small reduction in the lesion volume after the 14th day of treatment and less parasitic load at the lesion site. Conclusions: Ag2 was more effective than Ag1 against L. (L.) amazonensis.
  • Molecular characterization of Cryptosporidium spp. obtained from fecal samples of immunosuppressed patients from Brazil Major Article

    Cunha, Flávia de Souza; Jann, Higor Wilson; Lugon, Jocemir Ronaldo; Peralta, José Mauro; Peralta, Regina Helena Saramago

    Abstract in English:

    Abstract Background: Cryptosporidium spp. are pathogenic protozoans that play an important role in developing diseases in the elderly, children, and immunosuppressed individuals. Methods: The objective of this study was to detect and genetically characterize Cryptosporidium spp. in kidney transplanted patients (n = 97 samples; group 1) and immunosuppressed individuals from an outpatient clinic suspected of having Cryptosporidium infection (n = 53 samples; group 2). All fecal samples were analyzed by parasitological stool examination, immunochromatographic test, and real-time polymerase chain reaction (real-time PCR). Cryptosporidium-positive samples were tested using nested PCR for the gp60 gene, followed by sequencing for subtype determination. Results: Parasitological examination was negative in all Group 1, and positive in four Group 2 samples. Real-time PCR revealed Cryptosporidium in 13 samples: four in Group 1 (three C. hominis and one C. parvum) and nine in Group 2 (seven C. hominis, one C. parvum, and one mixed C. hominis/C. parvum). The immunochromatographic test was reactive in 11 samples (four in Group 1 and seven in Group 2). All 11 C. hominis isolates were identified as subtype IbA10G2 and one C. parvum as subtype IIbA15G2R1. All C. hominis belonged to subtype IbA10G2, which is recognized as the most prevalent and pathogenic subtype. Conclusions: This study showed, for the first time, that the presence of Cryptosporidium subtypes is considered more virulent in Brazilian transplanted kidney patients.
  • Oxidative stress induction by crude extract of Xylaria sp. triggers lethality in the larvae of Aedes aegypti (Diptera: Culicidae) Major Article

    Costa, Maria Beatriz Silva; Simões, Rejane de Castro; Silva, Márcia de Jesus Amazonas da; Oliveira, André Correa de; Acho, Leonard Domingo Rosales; Lima, Emerson Silva; Tadei, Wanderli Pedro; Teles, Helder Lopes; Oliveira, Camila Martins de

    Abstract in English:

    ABSTRACT Background: Aedes aegypti is currently controlled with synthetic larvicides; however, mosquitoes have become highly resistant to these larvicides and difficult to eradicate. Studies have shown that insecticides derived from fungal extracts have various mechanisms of action that reduce the risk of resistance in these mosquitoes. One possible mechanism is uncontrolled production of reactive oxygen species (ROS) in the larvae, which can cause changes at the cellular level. Thus, the crude extract of Xylaria sp. was evaluated to investigate the oxidative effect of this extract in A. aegypti larvae by quantifying the oxidative damage to proteins and lipids. Methods: The larvicidal potential of the crude extract of Xylaria sp. Was evaluated, and the extract was subsequently tested in human lung fibroblasts for cytotoxicity and ROS production. ROS level was quantified in the larvae that were killed following exposure to the extract in the larvicide test. Results: The crude extract of Xylaria sp. Caused cytotoxicity and induced ROS production in human lung fibroblasts and A. aegypti larvae, respectively. In the larvicide trial, the extract showed an LC50 of 264.456 ppm and an LC90 of 364.307 ppm, and was thus considered active. The extract showed greater oxidative damage to lipids and proteins, with LC90 values of 24.7 µmol MDA/L and 14.6278 ×10-3 nmol carbonyl/ mg protein, respectively. Conclusions: Crude extracts of Xylaria sp. induced oxidative stress that may have caused the mortality of A. aegypti larvae.
  • Seroprevalence of Chagas disease in urban and rural indigenous populations of the south of Gran Chaco Major Article

    Colussi, Carlina; Stafuza, Mariana; Nepote, Marcelo; Mendicino, Diego

    Abstract in English:

    ABSTRACT Background: In Latin America, Chagas disease is endemic, with a high prevalence in rural indigenous communities and an increasing prevalence in urban areas owing to migration from rural areas with active vector transmission. This study aimed to assess differences in the prevalence of Chagas disease in urban and rural moqoit communities, one of the main ethnic indigenous groups in the south of Gran Chaco. Methods: A seroprevalence study was conducted in six moqoit populations in the Santa Fe province, Argentina. The variables studied were serology results for Chagas disease, residents of urban or rural areas, age, and sex. Results: The results showed that 9.26% of the 702 volunteers evaluated and 18.32% of the 131women of childbearing potential were seropositive. According to the calculated prevalence ratio, the prevalence of Chagas disease in urban communities was6.41 (95% confidence inverval: 3.73-11.02) times higher than that in rural communities: 21.59% in urban communities vs. 3.37%in rural communities. Conclusions: The seroprevalence found in the moqoit community was higher than the estimated level for the general population of the same region, with a greater impact in urban areas than in rural areas. The urbanization of groups of people with poor socio-sanitary conditions in the second half of the 20th century could have caused this higher seroprevalence of Chagas disease.
  • Seroprevalence and factors associated with SARS-CoV-2 infection among education workers after the first wave: the first cross-sectional study in Brazil Major Article

    França, Pâmela de Castro; Silva, Paulo Goberlânio Barros; Rocha, Jose Lima de Carvalho; Perdigão, Anne Carolinne Bezerra; Oliveira, Nayara Santos de; Araújo, Fernanda Montenegro de Carvalho; Fonseca, Marcela Helena Gambim; Lima, Giovanna Rolim Pinheiro; Almeida, Magda Moura de; Alencar, Carlos Henrique; Oliveira, Wanderson Kleber de; Cavalcanti, Luciano Pamplona de Góes

    Abstract in English:

    ABSTRACT Background: The school community was heavily impacted by the Covid-19 pandemic, especially with the long time of school closures. This study aimed to analyze the seroprevalence of SARS-CoV-2 antibodies and possible factors associated with seropositivity for COVID-19 in teachers and other school staff, and to estimate the fraction of asymptomatic individuals by sex and age group. Methods: We conducted a serological survey of SARS-CoV-2 infections. An analytical cross-sectional study was conducted in Fortaleza, Brazil. Teachers and other staff members from pre-schools to universities of higher education to were investigated. Results: A total of 1,901 professionals participated in the study, of which 1,021 were staff and 880 were teachers. The seroprevalence of SARS-CoV-2 was 8.0% (152/1901). In the seropositive group, 48.3% were asymptomatic. There was a predominance of women (68.4%); and, 47.1% of the participants were between 31 and 45 years old. There was an increase in prevalence with increasing age. An inverse relationship was found for education level: more professionals with less education tested positive for COVID-19. The presence of an infected person living in the same household was significantly associated with positive results for COVID-19 among the professionals. Conclusions: This is the first study to report the seroprevalence of IgG against SARS-CoV-2 in Brazilian educational staff after the first wave of the disease. In this study, the seroprevalence was much lower than that in the general population. During school reopening, a small fraction of school workers showed serologically detectable signs of SARS-CoV-2 exposure.
  • Epidemiological Aspects and High Magnitude of Human Visceral Leishmaniasis in Ceará, Northeast of Brazil, 2007-2021 Major Article

    Cavalcante, Kellyn Kessiene de Sousa; Borges, Kelvia Maria Oliveira; Cavalcante, Francisco Roger Aguiar; Correia, Francisco Gustavo Silveira; Florêncio, Caroline Mary Gurgel Dias; Alencar, Carlos Henrique

    Abstract in English:

    ABSTRACT Background: Human visceral leishmaniasis HVL is endemic to 75 countries. The state of Ceará, the Northeast region of Brazil, is of great sanitary importance for the transmission of HVL, and it stands out as an area of interest for epidemiological aspects and control strategies. This study aimed to characterize HVL in relation to epidemiological aspects, composite incidence, and mortality rates in the state of Ceará, Brazil, from 2007 to 2021. Methods: This ecological study used temporal and spatial cuts of HVL data from the notifiable diseases information system. Epidemiological indicators such as incidence, mortality, and composite indices of incidence and mortality were calculated according to the Ministry of Health standardization. Results: There were 6,775 confirmed cases, with high incidence coefficients in 2009 6.96 cases/100,000 inhabitants and 2011 9.83 cases/100,000 inhabitants, and the highest mortality rate in 2011 6.96 deaths/100,000 inhabitants. The composite index of incidence and mortality identified municipalities in the Northern, Northwestern, and Southern regions of Ceará as having the highest risk of HVL. Conclusions: HVL remained endemic throughout the study period, with epidemiological indicators and risk of transmission expressing high magnitude, mainly in the Northeast, Northwest, and South regions of Ceará.
  • High schistosomiasis-related mortality in Northeast Brazil: trends and spatial patterns Major Article

    Silva, Bárbara Morgana da; Ferreira, Anderson Fuentes; Silva, José Alexandre Menezes da; Amorim, Rebeca Gomes de; Domingues, Ana Lúcia Coutinho; Pinheiro, Marta Cristhiany Cunha; Bezerra, Fernando Schemelzer de Moares; Heukelbach, Jorg; Ramos Jr, Alberto Novaes

    Abstract in English:

    ABSTRACT Background: We analyzed the trends and spatial patterns of schistosomiasis-related mortality in Northeast Brazil in 2000-2019. Methods: A mixed population-based ecological study was conducted, using information on the underlying or associated causes of death. We used Joinpoint regression analysis to calculate the trends. The spatial analysis included rates, spatial moving averages, and standardized mortality rates. The spatial dependence analysis was based on Getis-Ord's G and Gi* indices (Gi star) and local Moran’s index to check for autocorrelation. Results: A total of 5,814,268 deaths were recorded, of which 9,276 (0.16%) were schistosomiasis-related; 51.0% (n=4,732, adjusted rate 0.90/100,000 inhabitants [95% confidence interval (CI) 0.88-0.93]) were males; 40.0% (n=3,715, adjusted rate 7.40/100.000 inhabitants [95%CI: 7.16-7.64]) were ≥70 years old; 54.8% (n=5,087, crude rate 0.80/100,000 inhabitants) were of mixed/Pardo-Brazilian ethnicity; and 77.9% (n=7,229, adjusted rate 0.86/100,000 inhabitants [95%CI: 0.84-0.88]) lived outside state capitals. The highest proportion of deaths was in the state of Pernambuco (53.9%, n=4,996, adjusted rate 2.72/100,000 inhabitants [95%CI: 2.64-2.79]). Increasing mortality rate was verified in the state of Sergipe. On the coast of the state of Rio Grande do Norte and Bahia, there was spatial dependence of spatio-temporal risk patterns with clusters. Throughout the study period, we found positive spatial autocorrelation and cluster formation. Conclusions: In Northeast Brazil, schistosomiasis persists with a high mortality rate, especially in the coastal region, with heterogeneous spatial and temporal patterns. To eliminate schistosomiasis by 2030, it is necessary to strengthen the financing and management of the unified health system (SUS).
  • Impacts of El Niño Southern Oscillation on the dengue transmission dynamics in the Metropolitan Region of Recife, Brazil Major Article

    Ferreira, Henrique dos Santos; Nóbrega, Ranyére Silva; Brito, Pedro Vinícius da Silva; Farias, Jéssica Pires; Amorim, Jaime Henrique; Moreira, Elvis Bergue Mariz; Mendez, Érick Carvalho; Luiz, Wilson Barros

    Abstract in English:

    ABSTRACT Background: This research addresses two questions: (1) how El Niño Southern Oscillation (ENSO) affects climate variability and how it influences dengue transmission in the Metropolitan Region of Recife (MRR), and (2) whether the epidemic in MRR municipalities has any connection and synchronicity. Methods: Wavelet analysis and cross-correlation were applied to characterize seasonality, multiyear cycles, and relative delays between the series. This study was developed into two distinct periods. Initially, we performed periodic dengue incidence and intercity epidemic synchronism analyses from 2001 to 2017. We then defined the period from 2001 to 2016 to analyze the periodicity of climatic variables and their coherence with dengue incidence. Results: Our results showed systematic cycles of 3-4 years with a recent shortening trend of 2-3 years. Climatic variability, such as positive anomalous temperatures and reduced rainfall due to changes in sea surface temperature (SST), is partially linked to the changing epidemiology of the disease, as this condition provides suitable environments for the Aedes aegypti lifecycle. Conclusion: ENSO may have influenced the dengue temporal patterns in the MRR, transiently reducing its main way of multiyear variability (3-4 years) to 2-3 years. Furthermore, when the epidemic coincided with El Niño years, it spread regionally and was highly synchronized.
  • Burden of syphilis in Brazil and federated units, 1990-2016: estimates from the Global Burden of Disease Study 2019 Major Article

    Bezerra, Juliana Maria Trindade; Castro, Pedro Alves Soares Vaz de; Machado, Carla Jorge; Carneiro, Mariângela

    Abstract in English:

    ABSTRACT Background: Syphilis is a chronic infectious disease that has created challenging situations for humanity for centuries. Transmission can occur sexually or vertically, with great repercussions on populations, particularly among women and children. The present study presents information on the main burden imposed by syphilis generated by the Global Burden of Disease (GBD) Study 2019 for Brazil and its 27 federated units. Methods: We described the metrics of incidence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), standardized by age and per 100,000 inhabitants, from 1990 to 2019, and we compared the disease burden between the years 1990 and 2019. Results: In Brazil, the disease burden increased between 2005 and 2019 for all metrics. Although a higher incidence of syphilis was found among women in 2019, DALYs [YLLs (males: 15.9%; females: 21.8%), YLDs (males: 25.0%; females: 50.0%), and DALYs (males: 16.2%; females: 22.4%)] were higher among men. In 2019, the highest DALY rate per 100,000 inhabitants was observed in individuals aged above 50 years. The State of Maranhão presented the highest values of DALYs {1990: 165.2 [95% uncertainty interval (UI) 96.2-264.4]; 2005: 43.8 [95% UI 30.3-62.4]; 2019: 29.1 [95% UI 19.8-41.1]} per 100,000 inhabitants in the three years analyzed. Conclusions: The burden of syphilis has increased in recent years. Men presented higher DALYs, although the incidence of the disease was higher in women. Syphilis affects a large number of people across all age groups, causing different degrees of disability and premature death (DALYs).
  • Laboratory-based study of drug resistance and genotypic profile of multidrug-resistant tuberculosis isolates in Salvador, Bahia, Brazil Major Article

    Sousa, Erivelton de Oliveira; Carneiro, Rita Terezinha de Oliveira; Montes, Fátima Cristina Onofre Fandinho; Conceição, Emilyn Costa; Bartholomay, Patricia; Marinho, Jamocyr Moura; Lima, Karla Valéria Batista; Natividade, Marcio Santos da; Araújo, Wildo Navegantes de; Matos, Eliana Dias; Barbosa, Theolis

    Abstract in English:

    Abstract Background: Surveillance of multidrug resistant/extensively drug-resistant tuberculosis (MDR/XDR-TB) is essential to guide disease dissemination control measures. Brazil contributes to a significant fraction of tuberculosis (TB) cases worldwide, but only few reports addressed MDR/XDR-TB in the country. Methods: This cross-sectional, laboratory-based study describes the phenotypic resistance profiles of isolates obtained between January 2008 and December 2011 in Bahia, Brazil, and sociodemographic, epidemiological, and clinical characteristics (obtained from mandatory national registries) of the corresponding 204 MDR/XDR-TB patients. We analyzed the mycobacterial spoligotyping and variable number of tandem repeats of mycobacterial interspersed repetitive units in 12-loci profiles obtained from Salvador. Results: MDR/XDR-TB patients were predominantly male, had a median age of 43 years, belonged to black ethnicity, and failed treatment before MDR-TB diagnosis. Nearly one-third of the isolates had phenotypic resistance (evaluated by mycobacteria growth indicator tube assay) to second-line anti-TB drugs (64/204, 31%), of which 22% cases (14/64) were diagnosed as XDR-TB. Death was a frequent outcome among these individuals and was associated with resistance to second-line anti-TB drugs. Most isolates successfully genotyped belonged to the Latin-American Mediterranean (LAM) Family, with an unprecedented high proportion of LAM10-Cameroon subfamily bacilli. More than half of these isolates were assigned to a unique cluster by the genotyping methods performed. Large clusters of identical genotypes were also observed among LAM SIT42 and SIT376 strains. Conclusions: We highlight the need for strengthening local and national efforts to perform early detection of TB drug resistance and to prevent treatment discontinuation to limit the emergence of drug-resistant strains.
  • Snakebites caused by the genera Bothrops and Lachesis in the Brazilian Amazon: a study of factors associated with severe cases and death Major Article

    Magalhães, Samara Freire Valente; Peixoto, Henry Maia; Freitas, Lúcia Rolim Santana de; Monteiro, Wuelton Marcelo; Oliveira, Maria Regina Fernandes de

    Abstract in English:

    ABSTRACT Background: Snakebites are a major problem in developing countries owing to their high morbidity rates, severity, and sequelae. In Brazil, most cases of envenomation are caused by Bothrops and Lachesis snakes. The present study aimed to evaluate variables associated with death, systemic complications, and amputations in victims of envenomation due to Bothrops or Lachesis snake. Methods: An analytical epidemiological study was performed with data from the Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação [SINAN]) relating to the Brazilian Amazon for the period 2010-2015. A hierarchical Poisson regression analysis was performed with three aspects, namely, individual characteristics, sociodemographic characteristics, and clinical conditions. Results: The following associations were observed: i) advanced age (>65 years), sepsis, renal failure, and hemorrhagic manifestations were related to two outcomes - death due to snakebite and death from all causes; ii) more advanced age (≥46 years), time to health care longer than 6 hours, renal and hemorrhagic manifestations, and region of occurrence being rural areas were associated with systemic complications; and iii) children (up to 12 years old) were associated with amputations. Conclusions: Knowledge of the characteristics associated with severe outcomes in snakebites may help identify patients who will require more intensive care or longer follow-up and may provide the physician with counseling rationale for their possible prognosis.
  • Role of transforming growth factor-beta 1 and connective tissue growth factor levels in coronavirus disease-2019-related lung Injury: a prospective, observational, cohort study Major Article

    Laloglu, Esra; Alay, Handan

    Abstract in English:

    ABSTRACT Background: Coronavirus disease-2019 (COVID-19) results in acute lung injury. This study examined the usefulness of serum transforming growth factor-beta 1 (TGF-β1) and connective tissue growth factor (CTGF) levels in predicting disease severity in COVID-19 patients with pulmonary involvement. Methods: Fifty patients with confirmed COVID-19 and pulmonary involvement between September 2020, and February 2021 (Group 1) and 45 healthy controls (Group 2) were classified into three subgroups based on clinical severity: moderate, severe, and critical pneumonia. Serum TGF-β1 and CTGF concentrations were measured on days 1 and 7 of admission in Group 1 using an enzyme-linked immunosorbent assay. These concentrations were also measured in control cases. The mean serum TGF-β1 and CTGF levels were then compared among COVID-19 patients, based on clinical severity. Results: Significantly higher mean serum TGF-β1 and CTGF levels were observed on both days in Group 1 than in the control group. The mean serum TGF-β1 and CTGF levels on day 7 were also significantly higher than those on day 1 in Group 1. The critical patient group had the highest serum TGF-β1 and CTGF levels on both days, and the difference between this group and the moderate and severe pneumonia groups was significant. Cutoff values of 5.36 ng/mL for TGF-β1 and 626.2 pg/mL for CTGF emerged as predictors of COVID-19 with pulmonary involvement in receiver-operating characteristic curve analysis. Conclusions: TGF-β1 and CTGF are potential markers that can distinguish COVID-19 patients with pulmonary involvement and indicate disease severity. These findings may be useful for initiating treatment for early-stage COVID-19.
  • Triatomine fauna in the state of Bahia, Brazil: What changed after 40 years of the vector-control program? Major Article

    Ribeiro-Jr, Gilmar; Araújo, Renato Freitas de; Carvalho, Cristiane Medeiros Moraes de; Cunha, Gabriel Muricy; Lanza, Fernanda Cardoso; Miranda, Diego Lopes Paim; Sousa, Orlando Marcos Farias de; Santos, Carlos Gustavo Silva dos; Fonseca, Eduardo Oyama Lins; Santos, Roberto Fonseca dos; Reis, Renato Barbosa; Gurgel-Gonçalves, Rodrigo; Reis, Mitermayer Galvão

    Abstract in English:

    ABSTRACT Background: Neglected tropical diseases are a growing threat to global health, and endemic Chagas disease has emerged as one of the most important health problems in America. The main strategy to prevent Trypanosoma cruzi transmission is chemical control of vectors. This study presents a descriptive analysis of synanthropic triatomines before and after the implementation of a vector-control program in Bahia, Brazil. Methods: Descriptive analysis and geospatial statistics were performed on triatomine data, (1) the relative abundance and (2) proportional spatial distribution, from Bahia during two periods: (A) 1957 to 1971 and (B) 2006 to 2019. Results: We observed a decrease in the relative abundance of Panstrongylus megistus (A: n=22.032, 61.9%; B: n=1.842, 1.0%) and Triatoma infestans (A: n=1.310, 3.7%; B: n=763, 0.43%), as well as an increase in the relative abundance of T. sordida (A: n=8.314, 23.4%, B: n=146.901, 81.6%) and T. pseudomaculata (A: n=894, 2.5%, B: n=16.717, 9.3%). Conclusions: Our results indicate a clear reduction in the occurrence of P. megistus and T. infestans (last record in 2015) and an increase in the relative abundance and geographical distribution of T. sordida and T. pseudomaculata after 40 years of the vector-control program. The high frequency of other triatomine species in the municipalities of the state of Bahia and their abundance in recent years highlight the need to reinforce permanent entomological surveillance actions to prevent Chagas disease.
  • Work ability and associated factors in people living with human T-cell leukemia virus type 1 Major Article

    Costa, Dayana Alves; Carvalho, Fernando Martins; Vieira, Nicolle Melo; Falcão, Gleicy Gabriela Spínola Carneiro; Sarmento, Viviane Almeida; Brites, Carlos; Lins-Kusterer, Liliane

    Abstract in English:

    ABSTRACT Background: Infection with the human T-lymphotropic virus type 1 (HTLV-1) affects an estimated 10-15 million people worldwide. However, knowledge of the impact of HTLV-1 infection on work ability is lacking. This study aimed to measure the frequency and identify factors associated with poor work ability in patients living with HTLV-1. Methods: This cross-sectional study included 207 individuals infected with HTLV-1 who attended the University Hospital in Salvador, Bahia, Brazil. HTLV-1 antibodies were detected in the participants’ blood by enzyme-linked immunosorbent assay (ELISA) and confirmed by western blotting. Participants answered a questionnaire on sociodemographic data, personal habits, clinical data, health-related quality of life, and work ability, evaluated using the work ability index questionnaire. A Poisson regression model with a robust variance estimate was used to identify the factors associated with the prevalence of poor work ability. Results: Patients mean age was 55.2, ranging from 19 to 84 years, 73.0% were females, 100% had monthly family income less than US$ 394, and 33.8% presented HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP). No individual was classified as having excellent work ability. Poor work ability prevalence was strongly associated (prevalence ratio; 95% confidence interval [CI]) with sedentarism (1.30; 1.03-1.65), neurological symptoms (1.25; 1.02-1.52), and low physical (0.95; 0.94-0.96) and mental (0.98; 0.97-0.99) component summaries of health-related quality of life. Conclusions: Poor work ability among people living with HTLV-1 is associated with sedentarism, neurologic symptoms, and low health-related quality of life.
  • Prediction of malaria using deep learning models: A case study on city clusters in the state of Amazonas, Brazil, from 2003 to 2018 Major Article

    Barboza, Matheus Félix Xavier; Monteiro, Kayo Henrique de Carvalho; Rodrigues, Iago Richard; Santos, Guto Leoni; Monteiro, Wuelton Marcelo; Figueira, Elder Augusto Guimaraes; Sampaio, Vanderson de Souza; Lynn, Theo; Endo, Patricia Takako

    Abstract in English:

    ABSTRACT Background: Malaria is curable. Nonetheless, over 229 million cases of malaria were recorded in 2019, along with 409,000 deaths. Although over 42 million Brazilians are at risk of contracting malaria, 99% percent of all malaria cases in Brazil are located in or around the Amazon rainforest. Despite declining cases and deaths, malaria remains a major public health issue in Brazil. Accurate spatiotemporal prediction of malaria propagation may enable improved resource allocation to support efforts to eradicate the disease. Methods: In response to calls for novel research on malaria elimination strategies that suit local conditions, in this study, we propose machine learning (ML) and deep learning (DL) models to predict the probability of malaria cases in the state of Amazonas. Using a dataset of approximately 6 million records (January 2003 to December 2018), we applied k-means clustering to group cities based on their similarity of malaria incidence. We evaluated random forest, long-short term memory (LSTM) and dated recurrent unit (GRU) models and compared their performance. Results: The LSTM architecture achieved better performance in clusters with less variability in the number of cases, whereas the GRU presents better results in clusters with high variability. Although Diebold-Mariano testing suggested that both the LSTM and GRU performed comparably, GRU can be trained significantly faster, which could prove advantageous in practice. Conclusions: All models showed satisfactory accuracy and strong performance in predicting new cases of malaria, and each could serve as a supplemental tool to support regional policies and strategies.
  • Serological and Molecular Study of the Duffy Blood Group among Malarial Endemic Region Residents in Brazil Major Article

    Langhi Júnior, Dante; Albuquerque, Sérgio; Serafim, Rui; Duarte, Gustavo de Carvalho; Covas, Dimas Tadeu; Bordin, José O.

    Abstract in English:

    ABSTRACT Background: The atypical chemokine receptor 1 (ACKR1) gene encodes the Duffy blood group antigens in two allelic forms: FY*A (FY*01) and FY*B (FY*02), which define the Fy(a+b-), Fy(a-b+), and Fy(a+b+) phenotypes. FY*BES (FY*02N.01) is a single T to C substitution at nucleotide -67 that prevents the FY*B from being expressed in red blood cells (RBCs). Methods: We evaluated 250 residents from a Brazilian malarial endemic region (RsMR). All individuals were phenotyped for Fya and Fyb antigens and genotyped for FY*A, FY*B, FY*B SE , and FY*B weak alleles. Results: Among the 250 individuals, 209 (83.6%) reported previous malaria infection, and 41 (16.4%) did not. The Fy(a+b+) phenotype was present in 97/250 (38.8%), while the Fy(a-b-) was present in 7/250 (2.8%). The FY*A/FY*B was found in 130/250 (52%) and the FY*A/FY*A in 45/250 (18%). The c.1-67>TC was present, in homozygosity, in 11/250 (4.4%). Among 34 individuals with the Fy(a+b-) and FYA*/FYB* mutations, 4/34 (11.8%) had homozygosity for the c.1-67T>C. One individual presented the Fy(a+b-), FY*A/FY*B, and c.1-67T>C in homozygosis, whereas the other presented the Fy(a+b-), FY*A/FY*A, and c.1-67T>C in heterozygosis. Conclusions: We reported a low prevalence of the Fy(a-b-) in persons who had previously been infected with Plasmodium vivax (67.5%). We observed that 102/141 (72.3%) individuals expressing the Fyb antigen had a P. vivax infection, indicating the importance of the Fyb antigen, silenced by a c.1-67T>C mutation in homozygosis, in preventing the P. vivax infection. We showed that the c.1-67T>C mutation in the FY*A did not silence the FY*A expression on RBCs.
  • Utilizing prospective space-time scan statistics to discover the dynamics of coronavirus disease 2019 clusters in the State of São Paulo, Brazil Major Article

    Ferreira, Ricardo Vicente; Martines, Marcos Roberto; Toppa, Rogério Hartung; Assunção, Luiza Maria de; Desjardins, Michael Richard; Delmelle, Eric

    Abstract in English:

    ABSTRACT Background: The number of deaths and people infected with coronavirus disease 2019 (COVID-19) in Brazil has steadily increased in the first few months of the pandemic. Despite the underreporting of coronavirus cases by government agencies across the country, São Paulo has the highest rate among all Brazilian states. Methods: To identify the highest-risk municipalities during the initial outbreak, we utilized daily confirmed case data from official reports between February 25 and May 5, 2020, which were aggregated to the municipality level. A prospective space-time scan statistic was conducted to detect active clusters in three different time periods. Results: Our findings suggest that approximately 4.6 times more municipalities belong to a significant space-time cluster with a relative risk (RR) > 1 on May 5, 2020. Conclusions: Our study demonstrated the applicability of the space-time scan statistic for the detection of emerging clusters of COVID-19. In particular, we identified the clusters and RR of municipalities in the initial months of the pandemic, explaining the spatiotemporal patterns of COVID-19 transmission in the state of São Paulo. These results can be used to improve disease monitoring and facilitate targeted interventions.
  • Molecular characterization of nontuberculous Mycobacteria in a tuberculosis and HIV reference unit in the State of Amazonas, Brazil Major Article

    Lima, Ana Carolina de Oliveira de; Schmid, Karen Barros; Melo, Hilda Ferreira de; Athayde, Rafaella Christine; Monte, Rossiclea Lins; Almeida, Isabela Neves de; Miranda, Silvana Spíndola de; Kritski, Afrânio; Rossetti, Maria Lucia; Cordeiros-Santos, Marcelo

    Abstract in English:

    ABSTRACT Background: In recent years, the prevalence of nontuberculous mycobacterial (NTM) infections has increased in different regions of the world. The American Thoracic Society (ATS) recommends standardized identification criteria, reinforcing the need for faster and less complicated clinical and laboratory techniques. Methods: In this retrospective study, NTM species isolated from pulmonary, extrapulmonary, and disseminated samples from patients treated at a TB/HIV reference unit in the State of Amazonas from 2011 to 2014 were identified through a combination of molecular techniques. Results: To identify the molecular technique, 50 cryopreserved NTM cultures were recovered and subcultivated in culture medium. The potentially pathogenic NTM species identified were M. avium, M. intracellulare, M. kansasii, M. chelonae, M. abscessus, M. fortuitum, and M. peregrinum. Results of GenoType® showed moderate agreement with those of genomic sequencing (kappa = 0.60), whereas the results obtained by the PRA-hsp65 technique disagreed with the results obtained by sequencing (kappa = 0.49). Conclusions: Our findings highlight that GenoType CM is a good method for the identification of NTM, as well as the need for the application of standardized criteria, such as those set forth by the ATS.
  • Thesis and dissertations examining tuberculosis in Brazil between 2013 and 2019: an overview Major Article

    Reis, Ana Júlia; Pizzol, Juliana Lemos Dal; Gattelli, Rúbia; Groll, Andrea von; Ramos, Daniela Fernandes; Ramis, Ivy Bastos; Kritski, Afrânio; Silva, José Roberto Lapa e; Silva, Pedro Eduardo Almeida da

    Abstract in English:

    ABSTRACT Background: Tuberculosis (TB) remains a serious public health problem, with approximately 10 million new cases reported annually. Knowledge about the quantitative evolution of theses and dissertations (T&Ds) examining human TB in Brazil can contribute to generating strategic planning for training professionals in this field and disease control. Therefore, this study highlights the role of T&Ds on TB in national scientific disclosures. Methods: An integrative review related to TB was performed, including T&Ds produced in Brazil and completed between 2013 and 2019. Results: A total of 559,457 T&Ds were produced, of which 1,342 were associated with TB, accounting for 0.24% of the total number of T&Ds in Brazil. This was evidenced by a predominance of themes such as attention/health care, epidemiology, and TB treatment, and 80.2% of the T&Ds on TB were related to the large areas of health and biological sciences. Only 19.7% of T&Ds were associated with groups of patients considered at risk for TB, and 50.9% were produced in southeastern Brazil. The 1,342 T&Ds on TB were developed in 416 postgraduate programs linked to 121 higher education institutions (HEIs). We highlight that 72.7% of T&Ds on TB were produced in federal HEIs, 27.4% in state HEIs, and 8.5% in private HEIs. Conclusions: Strategic themes, such as TB control, require public policies that aim to increase the number of doctors and masters with expertise in TB, with geographic uniformity, and in line with the priorities for disease control.
  • Leishmania V. braziliensis infection in asymptomatic domestic animals within an endemic region in the Northeast of Brazil Major Article

    Silva, Claudio Júlio da; Lima, Karina Patricia Baracho; Monteiro, Juliana Figueirêdo da Costa Lima Suassuna; Silva, Andréa Karla Sales Ferreira da; Silva, Fernando José da; Pereira, Allana Maria de Souza; Hernandes, Valéria Pereira; Silva, Elis Dionísio da; Silva, Cláudia Sofia de Assunção Gonçalves e; Brandão Filho, Sinval Pinto; Brito, Maria Edileuza Felinto de

    Abstract in English:

    ABSTRACT Background: American cutaneous leishmaniasis is a commonly neglected, vector-borne tropical parasitic disease that is a major public health concern in Brazil. Leishmania (Viannia) braziliensis is the main species associated with the disease. Accurate diagnosis is based on epidemiological surveillance, clinical assessment, and laboratory testing. Leishmania (V.) braziliensis has been detected in several wild and synanthropic mammals. Their epidemiological role has not been entirely elucidated. This study aimed to assess potential L. braziliensis infections in asymptomatic domestic animals, by molecular and serological testing in endemic areas, in the metropolitan region of Recife. Methods: Blood samples and conjunctival fluids were collected from 232 animals (canids, felids, equines, and caprines) for the detection of L. braziliensis using molecular tests (conventional and real-time polymerase chain reaction [PCR and qPCR]). For immunological detection, blood samples from 115 dogs were assessed using enzyme-linked immunosorbent assay. Results: Real-time quantitative PCR showed positive results for blood and conjunctival samples in all investigated species. The results of the blood and conjunctival samples were 68.2% and 26.9% in Canis familiaris, 100% and 41.7% in Felis catus, 77.3% and 30.8% in Equus caballus/Equus asinus, and 50% and 33.3% in Capra hircus samples, respectively. Conclusions: Results from this study adds valuable information to our understanding of the role of asymptomatic domestic animals, L. braziliensis life cycle, and American cutaneous leishmaniasis in Northeast Brazil.
  • Entomological surveillance of Chagas disease in the East of Minas Gerais region, Brazil. Major Article

    Rezende, Mariana de Almeida Rosa; Lana, Marta de; Diotaiuti, Liléia; Machado-de-Assis, Girley Francisco

    Abstract in English:

    ABSTRACT Background: After decentralizing the actions of the Chagas Disease Control Program (CDCP) in Brazil, municipalities were now responsible for control measures against this endemic, supervised by the Regional Health Superintendencies (RHS). We aimed to evaluate the recent entomological surveillance of Chagas disease in the Regional Health Superintendence of Governador Valadares (RHS/GV) from 2014 to 2019. Methods: Triatomines captured by residents during entomological surveillance were sent to the reference laboratory, where the species and evolutionary stages were identified, place of capture, and presence of Trypanosoma cruzi. A database was created, and the following were calculated: the rate of infection by T. cruzi (overall rate and rate by species), monthly seasonality, spatial distribution of species, number of captures, and infected triatomines/health microregions. Results: We identified 1,708 insects; 1,506 (88.2%) were triatomines, most were adult instars (n=1,469), and few were nymphs (n=37). The identified species were Triatoma vitticeps, Panstrongylus megistus, Panstrongylus diasi, Rhodnius neglectus, and Panstrongylus geniculatus. The first three were most frequently captured and distributed throughout the study area. Most bugs were captured intradomicile (72.5%), mainly in the second semester, between September and November, with an average infection rate of 41.5% (predominantly T. vitticeps, 49.2%). All municipalities sent triatomines, especially in the microregions of Governador Valadares. Conclusions: These data reinforce the need and importance of improving Chagas disease control measures in the region to establish active and participatory entomological surveillance.
  • Factors associated with deaths from dengue in a city in a metropolitan region in Southeastern Brazil: a case-control study Major Article

    Sousa, Selma Costa de; Silva, Thais Almeida Marques da; Soares, Aleida Nazareth; Carneiro, Mariângela; Barbosa, David Soeiro; Bezerra, Juliana Maria Trindade

    Abstract in English:

    ABSTRACT Background: Dengue is a public health problem in Brazil. Therefore, this study aimed to analyze factors associated with deaths from dengue in residents of the municipality of Contagem, Metropolitan Region of Belo Horizonte, state of Minas Gerais, Brazil, during the 2016 epidemic. Methods: To determine the factors associated with deaths due to dengue, we used a logistic regression model (univariate and multivariable) in which the response variable (outcome) was death due to dengue. Independent variables analyzed included demographic variables and those related to symptoms, treatment, hospitalization, testing, comorbidities, and case history. Results: The factors associated with dengue deaths in the final multivariable model [p < 0.05; 95% confidence interval (CI)] were age (OR = 1.07; 95%CI 1.03-1.11) and presence of bleeding (OR = 8.55; 95%CI 1.21-59.92). Conclusions: The results showed that age and the presence of bleeding factors increased the risk of dengue death. These findings indicate that warning signs of dengue should be routinely monitored, and patients should be instructed to seek medical attention when they occur. It is also emphasized that the parameters and epidemiological conditions of dengue patients need to be continuously investigated to avoid a fatal outcome.
  • Clinical characteristics and laboratory parameters associated with the risk of severe COVID-19 in patients from two hospitals in Northeast Brazil Major Article

    Araújo, Sara Larissa de Melo; Feitosa, Thiala Alves; Pereira, Vanessa Cardoso; Andrade, Clara Caldeira de; Silva, Ana Tércia Paulo; Andrade, Lorena Viana de; Lopes, Kamila Erika Ribeiro; Sá, Mirela Vanessa de Souza; Souza, Carlos Dornels Freire de; Armstrong, Anderson da Costa; Carmo, Rodrigo Feliciano do

    Abstract in English:

    ABSTRACT Background: Although most coronavirus disease 2019 (COVID-19) infections are mild, some patients have severe clinical conditions requiring hospitalization. Data on the severity of COVID-19 in Brazil are scarce and are limited to public databases. This study aimed to investigate the clinical and laboratory factors associated with the severity of COVID-19 in a cohort of hospitalized adults from two hospitals in Northeast Brazil. Methods: Patients over 18 years of age who were hospitalized between August 2020 and July 2021 with a confirmed diagnosis of COVID-19 were included. The patients were classified into two groups: moderate and severe. Clinical, laboratory and imaging parameters were collected and compared between the groups. A multivariate logistic regression model was used to determine the predictors of COVID-19 severity. Results: This study included 495 patients (253 moderate and 242 severe). A total of 372 patients (75.2%) were between 18 and 65 years of age, and the majority were male (60.6%; n = 300). Patients with severe disease had higher levels of leukocytes, neutrophils, platelets, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, blood glucose, C-reactive protein, ferritin, D-dimer, aspartate aminotransferase, creatinine, and urea (p < 0.05). In multivariate logistic regression, the following variables were significant predictors of COVID-19 severity: leukocytes (odds ratio [OR] 3.27; 95% confidence interval [CI] 2.12-5.06), international normalized ratio (INR) (OR 0.22, 95% CI 0.14-0.33), and urea (OR 4.03; 95% CI 2.21-7.35). Conclusions: The present study identified the clinical and laboratory factors associated with the severity of COVID-19 in hospitalized Brazilian individuals.
  • In vitro and in silico assessment of new beta amino ketones with antiplasmodial activity Major Article

    Krombauer, Gabriela Camila; Guedes, Karla de Sena; Banfi, Felipe Fingir; Nunes, Renata Rachide; Fonseca, Amanda Luisa da; Siqueira, Ezequias Pessoa de; Bellei, Jéssica Côrrea Bezerra; Scopel, Kézia Katiani Gorza; Varotti, Fernando de Pilla; Sanchez, Bruno Antônio Marinho

    Abstract in English:

    ABSTRACT Background: Based on the current need for new drugs against malaria, our study evaluated eight beta amino ketones in silico and in vitro for potential antimalarial activity. Methods: Using the Brazilian Malaria Molecular Targets (BraMMT) and OCTOPUS® software programs, the pattern of interactions of beta-amino ketones was described against different proteins of P. falciparum and screened to evaluate their physicochemical properties. The in vitro antiplasmodial activities of the compounds were evaluated using a SYBR Green-based assay. In parallel, in vitro cytotoxic data were obtained using the MTT assay. Results: Among the eight compounds, compound 1 was the most active and selective against P. falciparum (IC50 = 0.98 µM; SI > 60). Six targets were identified in BraMMT that interact with compounds exhibiting a stronger binding energy than the crystallographic ligand: P. falciparum triophosphate phosphoglycolate complex (1LYX), P. falciparum reductase (2OK8), PfPK7 (2PML), P. falciparum glutaredoxin (4N0Z), PfATP6, and PfHT. Conclusions: The physicochemical properties of compound 1 were compatible with the set of criteria established by the Lipinski rule and demonstrated its potential as a drug prototype for antiplasmodial activity.
  • Epidemiological-clinical profile and mortality in patients coinfected with Trypanosoma cruzi/HIV: experience from a Brazilian reference center Major Article

    Hasslocher-Moreno, Alejandro Marcel; Sousa, Andréa Silvestre de; Xavier, Sergio Salles; Mendes, Fernanda de Souza Nogueira Sardinha; Nunes, Estevão Portela; Grinsztejn, Beatriz Gilda Jegerhorn; Mediano, Mauro Felippe Felix

    Abstract in English:

    ABSTRACT Background: The recent urbanization of Chagas disease (CD) has contributed to a greater risk of coexistence with human immunodeficiency virus (HIV) and AIDS. Methods: This retrospective observational study included patients who were followed at INI-Fiocruz between July 1986 and October 2021. All patients underwent an assessment protocol that included sociodemographic profile, epidemiological history, and clinical evaluation. Descriptive data analyses included reports of the medians and frequencies of variables of interest. Differences in medians between groups were tested using the Mann-Whitney U test. Differences in frequency were tested using Fisher's exact test. Results: Among 2201 patients, 11 (0.5%) were identified with Trypanosoma cruzi/HIV coinfection. Of these, 63.6% were women with a median age of 51.0 years old. Two patients had the indeterminate form of CD, six had the cardiac form, two had the digestive form and one had the cardio-digestive form. Half of the patients were undergoing antiretroviral treatment at the time of coinfection diagnosis with a median CD4+ count of 350 cells/μL and a viral load of 1500 copies/μL. Four patients underwent a xenodiagnosis test at coinfection diagnosis, which all yielded positive results; two of them presented high parasitemia under the risk of reactivation. Prophylaxis for CD reactivation was administered to four patients; two with ketoconazole and two with benznidazole. Six patients died after a median follow-up of 22.5 months, with AIDS being the most common cause of death. Only one case of reactivation was observed. Conclusions: Early diagnosis and prompt treatment of CD reactivation dramatically reduced mortality. Identification of Trypanosoma cruzi/HIV co-infection is crucial to planning a close follow-up of coinfected patients.
  • Coinfection and cross-reaction of dengue and COVID-19: a case series analysis Major Article

    Machado, Maria Emilia Avelar; Kimura, Elza

    Abstract in English:

    ABSTRACT Background: The risk of possible cross-reactions between serological tests, together with the clinical similarities between dengue fever and COVID-19, can delay diagnosis and increase the risk of both COVID-19 transmission and worsening. The present study aimed to determine the possibility of cross-reactions among rapid serological tests based on clinical symptoms. Methods: Patients with COVID-19, confirmed by RT-PCR and clinical criteria for diagnosing dengue, were recruited consecutively between September 2020 and August 2021 and underwent rapid immunochromatographic diagnostic (RID) tests for AgNS1, IgM, and IgG. Patients who tested positive for acute-phase dengue IgM and AgNS1 underwent a follow-up test after 12-30 days for diagnostic confirmation. Results: A total of 43 patients were included, 38 of whom required hospital admission, and 8 received intensive care. Seven patients tested positive on the RID tests, comprising 2 NS1 positive (coinfection), one reactive for IgM and IgG (coinfection), three reactive for IgM not confirmed (false-positive), and one reactive for IgG due to previous infection. Two of the 3 patients with coinfection died. Fever, myalgia, headache, and cough were the most common clinical symptoms, while lymphopenia was the most prevalent laboratory finding. Conclusions: Cross-reactivity was found in only three patients and coinfection in another three patients, two of whom died of severe COVID-19 manifestations.
  • Malaria in indigenous and non-indigenous patients aged under 15 years between 2007-2018, Amazonas state, Brazil Major Article

    Aguiar, Mateus Ferreira de; Meireles, Bruna Martins; Monteiro, Wuelton Marcelo; Gonçalves, Maria Jacirema Ferreira

    Abstract in English:

    ABSTRACT Background: Malaria is a serious problem in children because the immune system is less developed, thus, causing more severe symptoms. This study aimed to identify factors associated with malaria in indigenous and non-indigenous patients aged under 15 years in Amazonas, Brazil, from 2007 to 2018. Methods: An epidemiological, quantitative, cross-sectional study was conducted. Cases included patients aged under 15 years, using data from health system notifications between 2007 and 2018 in the state of Amazonas, Brazil. The variables included clinical-epidemiological, laboratory findings, and monitoring of cases. The outcome was ethnicity: indigenous, non-indigenous, and entries for which no ethnicity data were provided. A multivariable logistic regression model was used to compare the indigenous and non-indigenous populations. Results: Among malaria cases in patients aged under 15 years, there was a greater chance of being indigenous and having the following associated factors: female sex, children aged 0-4 years, passive case surveillance, a high load of parasitemia and the lack of data regarding the level of parasitemia, Plasmodium falciparum infections were more frequent, and timeliness of treatment, i.e., the interval between the onset of symptoms and time of treatment was within 48 hours. Conclusions: The factors associated with malaria are more frequent in indigenous populations and highlight differences according to ethnicity, suggesting that the severity of the disease is attributable to the increased number of malarial infections within this population. As a result, malaria has a greater impact on the health of indigenous people.
  • Analysis of Three-Dimensional Scar Architecture and Conducting Channels by High-Resolution Contrast-Enhanced Cardiac Magnetic Resonance Imaging in Chagas Heart Disease Major Article

    Santos, João Bosco de Figueiredo; Gottlieb, Ilan; Tassi, Eduardo Marinho; Camargo, Gabriel Cordeiro; Atié, Jacob; Xavier, Sérgio Salles; Pedrosa, Roberto Coury; Brugada, Josep; Saraiva, Roberto Magalhães

    Abstract in English:

    ABSTRACT Background: We aimed to describe the morphology of the border zone of viable myocardium surrounded by scarring in patients with Chagas heart disease and study their association with clinical events. Methods: Adult patients with Chagas heart disease (n=22; 55% females; 65.5 years, SD 10.1) were included. Patients underwent high-resolution contrast-enhanced cardiac magnetic resonance using myocardial delayed enhancement with postprocessing analysis to identify the core scar area and border zone channels number, mass, and length. The association between border zone channel parameters and the combined end-point (cardiovascular mortality or internal cardiac defibrillator implantation) was tested by multivariable Cox proportional hazard regression analyses. The significance level was set at 0.05. Data are presented as the mean (standard deviation [SD]) or median (interquartile range). Results: A total of 44 border zone channels (1[1-3] per patient) were identified. The border zone channel mass per patient was 1.25 (0.48-4.39) g, and the extension in layers of the border zone channels per patient was 2.4 (1.0-4.25). Most border zone channels were identified in the midwall location. Six patients presented the studied end-point during a mean follow-up of 4.9 years (SD 1.6). Border zone channel extension in layers was associated with the studied end-point independent from left ventricular ejection fraction or fibrosis mass (HR=2.03; 95% CI 1.15-3.60). Conclusions: High-resolution contrast-enhanced cardiac magnetic resonance can identify border zone channels in patients with Chagas heart disease. Moreover, border zone channel extension was independently associated with clinical events.
  • Phylogenetic relationships of the supercontig of sodium channel subunit I (NaV) in 17 species of Anopheles (Diptera: Culicidae) Major Article

    Santos, Valéria Silva; Bridi, Leticia Cegatti; Rafael, Míriam Silva

    Abstract in English:

    ABSTRACT Background: Malaria is a global health problem and is transmitted by the Anopheles species. Due to the epidemiological importance of the genus, studies on biological, phylogenetic, and evolutionary aspects have contributed to the understanding of adaptation, vector capacity, and resistance to insecticides. The latter may result from different causes such as mutations in the gene that encodes the sodium channel (NaV). Methods: In this study, the NaV subunit I scaffold of 17 anopheline species was used to infer phylogenetic relationships of the genus Anopheles using Bayesian inference. The evolutionary phylogenetic tree of the NaV gene was aligned in the AliView program and analyzed utilizing Bayesian inference, using the software MrBayes. Results: The anophelines were grouped into five well-supported clusters: 1 - Anopheles darlingi and Anopheles albimanus; 2 - Anopheles sinensis and Anopheles atroparvus; 3 - Anopheles dirus; 4 - Anopheles minimus, Anopheles culicifacies, Anopheles funestus, Anopheles maculatus, and Anopheles stephensi; and 5 - Anopheles christyi, Anopheles epiroticus, Anopheles merus, Anopheles melas, Anopheles gambiae, Anopheles coluzzii, and Anopheles arabiensis. Conclusions: The topology confirms the phylogenetic relationships proposed in studies based on the genome of some anophelines and reflects the current taxonomy of the genus, which suggests that NaV undergoes selection pressure during the evolution of the species. These data are useful tools for inferring their ability to resist insecticides and also help in better understanding the evolutionary processes of the genus Anopheles.
  • Tuberculosis in prison inmates in Southern Brazil: investigating the epidemiological and operational indicators Major Article

    Busatto, Caroline; Mespaque, Julia; Schwarzbold, Pauline; Souza, Camilo Darsie de; Jarczewski, Carla Adriane; Meucci, Rodrigo Dalke; Andrews, Jason; Croda, Julio; Silva, Pedro Eduardo Almeida da; Ramis, Ivy Bastos; Possuelo, Lia Gonçalves

    Abstract in English:

    ABSTRACT Background: Tuberculosis is a worldwide public health problem and is more prevalent in specific populations, such as prisoners. The aim of this study was to analyze the epidemiological and operational indicators of tuberculosis in prisoners in a southern region of Brazil. Methods: This was a descriptive, observational study, utilizing secondary data from the Notifiable Diseases Information System on tuberculosis cases diagnosed in prisoners in the state of Rio Grande do Sul, southern Brazil, from 2014 to 2018. Prisoner data used to calculate incidence were extracted from reports by the National Penitentiary Department. Results: From 2014 to 2018, 3,557 tuberculosis cases were reported in Rio Grande do Sul prisoners. The incidence rate of tuberculosis in prisoners was 1,235/100,000 individuals in 2014 and 1,430/100,000 individuals in 2018. The proportion of new TB cases tested for HIV was high, 83.4% in this period; among those tested, 12.9% were HIV coinfected. The proportion of new cases of pulmonary tuberculosis confirmed by laboratory criteria was 52.6% in this period. In total, 18.4% of new pulmonary tuberculosis cases were initiated on directly observed treatment in this period, and 36.4% of contacts of new cases of pulmonary tuberculosis with laboratory confirmation were examined. Among retreatment pulmonary tuberculosis cases, 82.4% were laboratory-confirmed. Conclusions: Tuberculosis incidence is increasing on a per-capita and absolute basis in Rio Grande do Sul. Laboratory confirmation, HIV testing, directly observed treatment, and contact investigation rates were all low, indicating the need to improve medical and public health measures for tuberculosis control in prisons.
  • Mapping of the venomous stingrays of the Potamotrygon genus in the Tietê River, São Paulo Sstate, Brazil Major Article

    Moreira, Isleide Saraiva Rocha; Haddad Junior, Vidal

    Abstract in English:

    ABSTRACT Background: Freshwater stingrays are fish that have adapted to the rivers and lakes in South America. The expansion of the Potamotrygonidae family in the Paraná River began after the damming of the Sete Quedas Falls, reaching the mouth of the Paranapanema and Tietê rivers approximately 20 years ago via the locks of the hydroelectric power plants. They are not aggressive animals; however, they have one to four stingers on their tails covered by a venom-producing epithelium and can cause severe envenomation in fishermen and bathers if stepped on or manipulated. Methods: We conducted a descriptive, retrospective, and prospective study by monitoring the fishing of the Potamotrygon genus in the lower Tietê River, mapping the location of the rays as a fishery product of professional fishermen and/or recording images of the fish caught. Results: Sixteen stingrays of the Potamotrygon genus were mapped by monitoring fishermen's fish products in the extensive area between the municipalities of Pereira Barreto and Buritama, São Paulo state. Conclusions: The lower Tietê River is fully colonized by freshwater stingrays and this expansion likely continues upstream, reaching various sub-basins of the river. The advancement of these venomous fish in areas where they did not exist previously requires education programs and interaction with the community to avoid serious injuries in bathers and fishermen and the unreasonable extermination of the animals.
  • Sensitivity comparison for the Leishmania spp. detection in different canine tissues using PCR-HRM Major Article

    Garay, Ana Fidelina Gómez; Fraenkel, Stefania; Diaz, Jorge Javier Alfonso Ruiz; Recalde, Oscar Daniel Salvioni; Gómez, María Celeste Vega; Riquelme, Jorge Arístides Miret; Arze, Paola Verónica; Centurión, Gloria Natalia Ramírez; Britos, Milena; Rolón, Miriam

    Abstract in English:

    ABSTRACT Background: Leishmaniasis is a vector-borne disease caused by a parasite protozoon from the genus Leishmania. Among the molecular techniques applied for detecting these parasites, real-time PCR with High Resolution Melting (PCR-HRM) proved advantageous since it simultaneously determines both the presence and species of the pathogen in one step, through amplification and later analysis of curves generated by melting temperature. Methods: Based on this molecular technique, the goal of this study was to estimate the PCR-HRM sensitivity for Leishmania spp. detection in different canine tissues by evaluating biological samples obtained from popliteal, submandibular, and pre-scapular lymph nodes, from bone marrow and ear pinnae of 28 stray dogs captured in the metropolitan area of Asunción (Paraguay). Results: The rk39 immunochromatographic test showed that 25/28 tested dogs (89%) presented antibodies against L. infantum. In 20/25 dogs that tested positive for rk39 (80%), it was possible to detect Leishmania spp. by PCR-HRM and determine that the species corresponded entirely to L. infantum. Regarding the analysis of different tissues, the parasite was detected in all popliteal lymph node samples, followed by high detection in submandibular (at 95%) and pre-scapular lymph nodes (at 90%), bone marrow (at 85%), and ear pinnae (at 85%). Conclusions: This study demonstrated that the use of real-time PCR-HRM using the molecular marker hsp70 was a highly sensitive method for simultaneously detecting and identifying Leishmania species in different tissues taken from infected dogs. In addition, the usefulness of ear pinnae as easily accessible tissue for molecular diagnosis was emphasized.
  • Two Leishmania species separation targeting the ITS-rDNA and Cyt b genes by developing and evaluating HRM- qPCR Major Article

    Alaeenovin, Elnaz; Parvizi, Parviz; Ghafari, Seyedeh Maryam

    Abstract in English:

    ABSTRACT Background: Incidence of Cutaneous Leishmaniasis as an infectious and neglected disease is increasing, for the diagnosis of which several traditional methods and conventional PCR techniques have been developed, employing different genes for species identification. Methods: Leishmania parasites were sampled, DNA was extracted, and new specific and sensitive primers were designed. Two ITS-rDNA and Cyt b genes were targeted by qPCR using the High- Resolution Melting method to identify Leishmania parasites. The standard curves were drawn, compared, and identified by high-resolution melting curve analysis. Results: Melting temperature and Cycle of Threshold of ITS-rDNA was higher than Cyt b but Cyt b was more sensitive than ITS-rDNA when Leishmania major and Leishmania tropica were analyzed and evaluated. By aligning melt curves, normalizing fluorescence curves, and difference plotting melt curves, each Leishmania species was distinguished easily. L. major and L. tropica were separated at 83.6 °C and 84.7 °C, respectively, with less than 0.9 °C of temperature difference. Developing sensitivity and specificity of real-time PCR based on EvaGreen could detect DNA concentration to less than one pmol. Conclusions: Precise identification of Leishmania parasites is crucial for strategies of disease control. Real-time PCR using EvaGreen provides rapid, highly sensitive, and specific detection of parasite’s DNA. The modified High-Resolution Melting could determine unique curves and was able to detect single nucleotide polymorphisms according to small differences in the nucleotide content of Leishmania parasites.
  • Profile of natural Trypanosoma cruzi infection among dogs from rural areas of southern Espírito Santo, Brazil Major Article

    Pontes, Beathriz Giostri; Kuster, Marieta Cristina Couto; Freitas, Letícia Azeredo de; Barbosa, Wagner Miranda; Machado-Coelho, George Luiz Lins; Zanini, Marcos Santos; Bahia, Maria Terezinha; Santos, Fabiane Matos dos

    Abstract in English:

    ABSTRACT Background: The emergence of Trypanosoma cruzi infection via oral transmission has a habitual character in its primitive endemic cycle. Recent findings revealed the first death by oral transmission of T. cruzi in the state of Espírito Santo, Brazil, in 2012, which was recorded in the rural area of Guarapari. This study evaluated the characteristics related to the occurrence of natural T. cruzi infection among dogs from the rural areas of Alegre and Iconha, municipalities of Espírito Santo. Methods: Logistic regression analysis of factors contributing to serological detection of T. cruzi in dogs was performed in environments where Espírito Santo’s Department of Health Surveillance had previously notified triatomines positive for Trypanosoma spp. from 2014 to 2017. Results: A total of 36 dogs were analyzed, of which 10 (27.77%) tested positive, one was borderline (2.79%), and 25 tested negative (69.44%) for T. cruzi infection. São Caetano, a district from the Iconha municipality, presented a 25 times greater chance for the detection of positive tests (OR:25; 95% CI; 2.37->100). Dogs with updated mandatory vaccination presented with a lower risk of positive serodiagnosis (OR:0.12; 95% CI: 0.02-0.63). Conclusions: Our results highlight for the first time the occurrence of natural T. cruzi canine infection, detected in the municipality of Iconha, mainly among dogs with un-updated mandatory vaccines in the district of São Caetano.
  • Response to Chagas disease in Brazil: strategic milestones for achieving comprehensive health care Editorial

    Ramos Jr, Alberto Novaes; Souza, Eliana Amorim de; Guimarães, Maria Cristina Soares; Vermeij, Debbie; Cruz, Marly Marques; Luquetti, Alejandro O.; Diotaiuti, Liléia; Palmeira, Swamy Lima; Lima, Mayara Maia; Costa, Veruska Maia da; Andrade, Luiz Antonio Botelho; Correia, Dalmo; Sousa, Andréa Silvestre de
  • Coronavirus disease COVID-19 pandemic and the Declaration of Public Health Emergency in Brazil: administrative and epidemiological aspects Editorial

    Oliveira, Wanderson Kleber de; Cavalcanti, Luciano Pamplona de Góes; Croda, Julio
  • Secondary infection profile after snakebite treated at a tertiary referral center in the Brazilian Amazon Short Communication

    Mendes, Viviane Kici da Graça; Pereira, Handerson da Silva; Elias, Ignês Cruz; Soares, Gean Souza; Santos, Monica; Talhari, Carolina; Cordeiro-Santos, Marcelo; Monteiro, Wuelton Marcelo; Sachett, Jacqueline de Almeida Gonçalves

    Abstract in English:

    ABSTRACT Background: Bothrops envenomations can often lead to complications, such as secondary infections. Methods: This cross-sectional study analyzed the medical records of all patients diagnosed with snakebite. Results: A total of 127 patients were included. Clindamycin was the most commonly prescribed antibiotic, with 105 patients (82.7%) receiving it as the primary antibiotic regimen. In 31 (24.4%) individuals, the first-choice antibiotic did not cease the infection. Conclusions: Secondary infection is an important complication resulting from snakebites, and evidence-based management of this complication can contribute to better clinical outcomes.
  • Severe acute respiratory syndrome coronavirus 2 infection among healthcare workers in a tertiary public hospital in Curitiba, Brazil Short Communication

    Spalanzani, Regiane Nogueira; Genelhoud, Gustavo; Raboni, Sonia Mara; Almeida, Sergio Monteiro de; Pereira, Luciane Aparecida; Rotta, Indianara; Cavalli, Barbara Maria; Moreira, Francielli Brusco; Dino, Carolina Lumi Tanaka; Takahashi, Gislene Reche de Almeida; Cognialli, Regielly Caroline Raimundo; Spiri, Beatriz Sanada; Bochnia-Bueno, Lucas; Oliveira, Jaqueline Carvalho de; Adamoski, Douglas; Gradia, Daniela Fiori; Bonatto, Ana Cláudia; Wassem, Roseli; Alves, Juliana Mazini; Padilha, Raquel da Silva; Brasil, Vitor Jorge Woytuski; Almeida, Bernardo Montesanti Machado de; Nogueira, Meri Bordignon

    Abstract in English:

    ABSTRACT BACKGROUND: We aimed to describe the clinical characteristics of coronavirus disease 2019 (COVID-19) among healthcare workers (HCWs) in Curitiba, Brazil. METHODS: Upper respiratory samples from 1077 HCWs were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using reverse transcription polymerase chain reaction from June 16, 2020 to December 9, 2020. RESULTS: Overall, 32.7% of HCWs were infected. The positivity rates in symptomatic and asymptomatic HCWs were 39.2% and 15.9%, respectively. Hospital departments categorized as high-risk for exposure had the highest number of infected HCWs. CONCLUSIONS: Early diagnosis and isolation of infected HCWs remain key in controlling SARS-CoV-2 transmission because HCWs in close contact with COVID-19 patients are more likely to be infected than those who are not.
  • Clinical profile of dengue in the elderly using surveillance data from two epidemics Short Communication

    Hökerberg, Yara Hahr Marques; Kohn, Fernanda; Souza, Taís Suane de; Passos, Sonia Regina Lambert

    Abstract in English:

    ABSTRACT Background: Population aging and mobility have increased the exposure of elderly individuals to dengue. This study evaluated the clinical features of dengue in the elderly during the epidemic (2008 and 2012) and interepidemic (2009 and 2010) periods. Methods: This cross-sectional study was based on dengue surveillance data from Rio de Janeiro, Brazil: 2008 (n=31,210), 2009‒2010 (n=2,884), and 2012 (n=30,773). The analysis was stratified by age group (<60 and ≥60 years). Results: Case-fatality rates were higher in the elderly. In 2008, elderly individuals were found to be more prone to hematuria and thrombocytopenia. Conclusions: These results can improve the understanding of dengue in elderly individuals who live in or travel to tropical regions.
  • Asymptomatic Neurosyphilis in HIV infected patients at a Brazilian HIV and AIDS specialized service: a cross sectional study Short Communication

    Hirai, Cláudio Queniti; Moreira, Deborah de Castro; Granzotto, Danielle Cristina Tita; Souza, Eniuce Menezes de; Teixeira, Jorge Juarez Vieira; Bertolini, Dennis Armando

    Abstract in English:

    ABSTRACT Background: Many human immunodeficiency virus (HIV) and syphilis co-infected patients are not diagnosed, which may evolve into asymptomatic neurosyphilis (ANS). We studied the occurrence of ANS an HIV-infected population. Methods: This was a cross-sectional study of cerebrospinal fluid (CSF) samples collected from patients co-infected with HIV and Treponema pallidum. Social-demographic and clinical-laboratory characteristics were studied. Results: Of the 348 patients infected with HIV, 33 (9.5%) had reagent treponemic and non-treponemic tests. CSF was collected from 19 asymptomatic patients. Of these, 8 (42.1%) presented with laboratory alterations suggestive of ANS. Conclusion: Social-demographic and clinical-laboratory variables should be considered for the indication of CSF collection.
  • Chagas disease mortality during the coronavirus disease 2019 pandemic: A Brazilian referral center experience Short Communication

    Hasslocher-Moreno, Alejandro Marcel; Saraiva, Roberto Magalhães; Silva, Gilberto Marcelo Sperandio da; Xavier, Sergio Salles; Sousa, Andréa Silvestre de; Costa, Andrea Rodrigues da; Mendes, Fernanda de Souza Nogueira Sardinha; Mediano, Mauro Felippe Felix

    Abstract in English:

    ABSTRACT Background We investigated the mortality rates of patients with Chagas disease (CD) during the coronavirus disease 2019 (COVID-19) pandemic and assessed the association between this mortality and CD clinical presentation and comorbidities. Methods: This was an observational retrospective study with clinical data retrieved from medical records. Results: Comorbidities were more prevalent among patients who died from COVID-19 than those who died from other causes. The proportion of patients according to CD clinical presentation was similar between the two groups. Conclusions: The prevalence of comorbidities seems to be related to a poorer prognosis in CD and COVID-19.
  • Development and content validation of a mobile application for monitoring latent tuberculosis treatment Short Communication

    Novaes, Marcelle Temporim; Prado, Thiago Nascimento do; Delcarro, Jessica Cristina Silva; Rissino, Silvia das Dores; Crepaldi, Nathalia Yukie; Sanches, Tiago Lara Michelin; Arnizant, Thomaz Felipe Soares; Alves, Domingos; Maciel, Ethel Leonor Noia

    Abstract in English:

    ABSTRACT Background: Non-compliance with latent tuberculosis infection (LTBI) treatment is a reality. The objective of this study was to develop and validate an mobile device application for monitoring the treatment of LTBI. Methods: We defined the requirements, elaborated on the application's conceptual map, generated implementation and prototyping alternatives, and validated content. Results: Feedback on the validity of content were: “usefulness, consistency, clarity, objectivity, vocabulary, and precision” from professionals, and “clarity” from patients. Conclusions: The application proved to be easy to understand, according to the assessment of both professionals and people undergoing treatment for LTBI.
  • Factors associated with COVID-19 mortality in municipalities in the state of São Paulo (Brazil): an ecological study Short Communication

    Souza, Rafaela Caroline de; Almeida, Ettore Rafael Mai; Fortaleza, Carlos Magno Castelo Branco; Miot, Hélio Amante

    Abstract in English:

    ABSTRACT Background: The mortality rate of coronavirus disease (COVID-19) in the state of São Paulo is highly heterogeneous. This study investigated geographic, economic, social, and health-related factors associated with this discrepancy. Methods: An ecological study compared COVID-19 mortality rates according to geographic, economic, social, and health-related variables during initial infection of 2.5% of the population in municipalities with more than 30,000 inhabitants. Results: Mortality was positively associated with demographic density and social inequality (Gini index), and inversely associated with HDI income and longevity of these municipalities, accounting for 33.2% of the variation in mortality. Conclusions: Social determinants influenced COVID-19 outcomes.
  • Growth Curve, Morphological and Molecular Characterization of Two Strains of Trypanosoma cruzi (Kinetoplastida, Trypanosomatidae) isolated from Triatoma sherlocki (Hemiptera, Reduviidae, Triatominae) Short Communication

    Kunii, Gabriela Kinue Watase; Falcone, Rossana; Clementino, Leandro da Costa; Rosa, João Aristeu da; Nascimento, Juliana Damieli; Belintani, Tiago; Oliveira, Jader de; Ribeiro, Aline Rimoldi

    Abstract in English:

    ABSTRACT Background: Trypanosoma cruzi presents great variability in morphology, virulence, pathogenicity, avoidance of the host immune system, and antigenic constitution, associated with different clinical manifestations of the disease. Methods: Two strains of T. cruzi were cultivated in liver infusion tryptose to determine growth kinetics, morphometry and molecular characterization using restriction fragment length polymorphism polymerase chain reaction. Results: The biological parameters showed sharp growth by the 7th day. Morphologically, both strains showed short and thin forms and were classified as Group I. Conclusion: Group TcI presents cardiac manifestations and T. sherlocki is adapting to the home environment, requiring attention to future problems.
  • The CUIDA Chagas Project: towards the elimination of congenital transmission of Chagas disease in Bolivia, Brazil, Colombia, and Paraguay Short Communication

    Sousa, Andréa Silvestre de; Vermeij, Debbie; Parra-Henao, Gabriel; Lesmo, Vidalia; Fernández, Evelin Fortún; Aruni, José Jorge Chura; Mendes, Fernanda de Souza Nogueira Sardinha; Bohorquez, Laura C.; Luquetti, Alejandro O.

    Abstract in English:

    ABSTRACT Background: Mother-to-child transmission of Chagas disease (CD) has become a relevant problem in both endemic and non-endemic areas. Methods: Description of the CUIDA Chagas Project - Communities United for Innovation, Development and Attention for Chagas disease’. Results: Through innovative and strategic research, this project will provide improved diagnostic and treatment options as well as replicable implementation models that are adaptable to different contexts. Conclusions: By integrating test, treat and care actions for CD into primary health care practices, the burden of CD on people and health systems may be significantly reduced.
  • COVID-19 epidemic in remote areas of the French Amazon, March 2020 to May 2021: Another reality Short Communication

    Epelboin, Loïc; Succo, Tiphanie; Michaud, Céline; Oberlis, Margot; Bidaud, Bastien; Naudion, Pauline; Dudognon, Lise; Fernandes, Clara; Cochet, Charlène; Caspar, Cécile; Jacoud, Estelle; Teissier, Sébastien; Douine, Maylis; Rousset, Dominique; Flamand, Claude; Djossou, Félix; Nacher, Mathieu; Rousseau, Cyril; Vignier, Nicolas; Gaillet, Mélanie

    Abstract in English:

    ABSTRACT Background: French Guiana (FG) is an ultra-peripheral European region in the Amazon, and the COVID-19 epidemic has had very different kinetics from both its giant neighbors, Brazil or mainland France. Methods: This study summarized the epidemics of COVID-19 in FG. Results: The tropical climate, multiethnicity, and remoteness of the population forced healthcare providers to accordingly adapt the management of the epidemic. Incidence and mortality have been lower than that in Europe and Latin America due to a combination of prevalence of the youth in the population and highly developed healthcare system. Conclusions: Currently, vaccine hesitancy hinders the rapid expansion of vaccine coverage.
  • High lethality rate of carbapenem-resistant Acinetobacter baumannii in Intensive Care Units of a Brazilian hospital: An epidemiologic surveillance study Short Communication

    Kurihara, Mariana Neri Lucas; Sales, Romário Oliveira de; Silva, Késia Esther da; Silva, Gerlaine Damasceno; Mansano, Maria Carolina Tazinazzo; Mahmoud, Fuad Fayez; Simionatto, Simone

    Abstract in English:

    ABSTRACT Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is a growing threat to public health. Methods: A 3-year retrospective study was conducted to evaluate the prevalence and lethality of multidrug-resistant (MDR) A. baumannii isolated from Brazilian patients. Results: In this study, 219 Acinetobacter baumannii isolates were identified, of which 70.8% (155/219) were isolated from patients hospitalized in intensive care units. Of these, 57.4% (n = 89/155) were assessed, of which 92.1% (82/89) were carbapenem-resistant, and 49 were classified as infected. The lethality rate was 79.6% (39/49). Conclusions: We highlight the need of an effective epidemiological surveillance measure to contain the dissemination of CRAB in the hospital environment.
  • Malaria epidemics in Colombia, 1970-2019 Short Communication

    Rodríguez, Julio Cesar Padilla; Olivera, Mario Javier; Herrera, María Cristina Padilla; Abril, Edwin Pachón

    Abstract in English:

    ABSTRACT Background: Malaria has unstable transmission in Colombia and has variable endemic-epidemic patterns. This study describes the epidemiological characteristics of malaria epidemics registered in Colombia from 1970-2019. Methods: Data from 1979-2019 were collected from the National Public Health Surveillance System. The data was tabulated and pertinent descriptive analyses were carried out. Results: Fifteen malaria outbreaks and approximately five-year-long epidemic cycles were observed in Colombia during the study period. Conclusions: Malaria epidemics in Colombia present a five-yearly transmission pattern, mainly due to the increased vulnerability produced by seasonal population migrations in receptive areas with active transmission.
  • Seroprevalence of Trypanosoma cruzi infection in blood donors in the extreme South of Brazil Short Communication

    Bianchi, Tanise Freitas; Grala, Ana Paula da Paz; Leon, Ítalo Ferreira de; Jeske, Sabrina; Pinto, Gisele Ortiz Heidrich; Villela, Marcos Marreiro

    Abstract in English:

    ABSTRACT Background: We aimed to evaluate the seroprevalence of Chagas disease among blood donors in southern Rio Grande do Sul, Brazil. Methods: The study was conducted from 2010 to 2019 based on data registered by the Hemocentro Regional de Pelotas, Rio Grande do Sul. Results: There were 106,320 blood donations, and the discard rate of blood bags, either due to positive reactions to anti-T. cruzi antibodies or inconclusive results was 0.27% (283 bags). Conclusions: The usage of methods that enable the safe identification of donors with positive serology for Chagas disease is fundamental to ensure transfusional safety.
  • Effect of weekly versus daily primaquine on Plasmodium vivax malaria recurrences: A real-life cohort study Short Communication

    Brito-Sousa, Jose Diego; Phanor, Jeffe; Balieiro, Patricia Carvalho da Silva; Silva-Neto, Alexandre Vilhena; Cordeiro, Jady Shayenne Mota; Vitor-Silva, Sheila; Mendes, Maxwell; Sampaio, Vanderson Souza; Melo, Gisely Cardoso de; Lacerda, Marcus; Monteiro, Wuelton

    Abstract in English:

    ABSTRACT Background: Although primaquine (PQ) is indicated for G6PD-deficient patients, data on weekly PQ use in Brazil are limited. Methods: We aimed to investigate malaria recurrences among participants receiving daily and weekly PQ treatments in a real-life setting of two municipalities in the Amazon between 2019 and 2020. Results: Patients receiving weekly PQ treatment had a lower risk of recurrence than those receiving daily PQ treatment (risk ratio: 0.62, 95% confidence interval: 0.41-0.94), using a model adjusted for study site. Conclusions: Weekly PQ use did not increase the risk of malaria recurrence. Further studies with larger populations are warranted.
  • Analytical evaluation of thirty-two severe acute respiratory syndrome 2 lateral flow antigen tests demonstrates sensitivity remains with the SARS-CoV-2 Gamma lineage Short Communication

    Kontogianni, Konstantina; Bengey, Daisy; Wooding, Dominic; Buist, Kate; Greenland-Bews, Caitlin; Williams, Christopher Thomas; Vos, Margaretha de; Santos, Victor Santana; Escadafal, Camille; Adams, Emily Rebecca; Edwards, Thomas; Cubas-Atienzar, Ana Isabel

    Abstract in English:

    ABSTRACT Background: The emergence of variants of concern (VOCs) requires an ongoing assessment of the performance of antigen lateral flow tests (Ag-RDTs). The limit of detection (LOD) of 32 Ag-RDTs was evaluated using the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Gamma variant. Methods: Ag-RDTs were performed according to the manufacturer’s instructions with a clinical isolate of the Gamma variant. Results: Twenty-eight of the 32 Ag-RDTs exceeded the World Health Organization criteria. Conclusions: This comprehensive analytical evaluation of Ag-RDTs demonstrated that the test performance was maintained with Gamma VOC.
  • How to overcome the stagnation of the first dose vaccine coverage curve against coronavirus disease 2019 in Brazil? Short Communication

    Guimarães, Raphael Mendonça; Xavier, Diego Ricardo; Saldanha, Raphael de Freitas; Magalhães, Mônica de Avelar Figueiredo Mafra

    Abstract in English:

    ABSTRACT Background: A large percentage of the population has not yet started vaccination, for which the increase in coverage is almost null. Methods: We used segmented regression analysis to estimate trends in the first dose coverage curve. Results: There has been a slowdown in the application of the first doses in Brazil since epidemiological week 36 (average percent change [APC] 0.83%, 95% confidence interval [CI] 0.75-0.91%), with a trend close to stagnation. Conclusions: It is important to develop strategies to increase access to vaccination posts. Furthermore, it is recommended to expand vaccination to children, thereby increasing the eligible population.
  • Cryptosporidium diagnosis in different groups of children and characterization of parasite species Short Communication

    Pacheco, Flávia Thamiris Figueiredo; Freitas, Humberto Fonseca de; Silva, Renata Kelly Novais Rodrigues; Carvalho, Silvia Souza de; Martins, Adson Santos; Menezes, Joelma Figueiredo; Ribeiro, Tereza Cristina Medrado; Mattos, Ângela Peixoto de; Costa-Ribeiro Júnior, Hugo da; Pedreira, Joice Neves Reis; Soares, Neci Matos; Teixeira, Márcia Cristina Aquino

    Abstract in English:

    ABSTRACT Background: Microscopy and enzyme-linked immunosorbent assay (ELISA) are routinely used for Cryptosporidium diagnosis, without differentiating the parasite species. Methods: Children’s feces were analyzed by modified Ziehl-Neelsen (mZN) and ELISA for Cryptosporidium diagnosis and by polymerase chain reaction-restriction fragment length polymorphism for species identification. Results: Cryptosporidium frequency was 2.6%. The sensitivity and specificity of ELISA were 85.7% and 99.7%, respectively, with excellent concordance with mZN (kappa=0.854). Parasite species were characterized as Cryptosporidium hominis (78.3%), Cryptosporidium felis (17.4%), and Cryptosporidium parvum (4.3%). Conclusions: Coproantigen ELISA is as efficient as mZN for Cryptosporidium diagnosis. Cryptosporidium genotyping suggests anthroponotic and zoonotic transmission to children.
  • COVID-19 seroepidemiological survey among healthcare workers in the City of Ribeirão Preto, São Paulo, Brazil Short Communication

    Évora, Patricia Martinez; Siqueira, André Machado; Stabeli, Rodrigo Guerino

    Abstract in English:

    ABSTRACT Background: Coronavirus disease (COVID-19) serology testing evaluates the prevalence of COVID-19 cases. Methods: A seroepidemiological survey of COVID-19 among healthcare workers was performed (June 2020 to November 2020) in Ribeirão Preto, São Paulo, Brazil. Overall, 10,172 and 2,129 workers participated in the first and second phases, respectively. Results: First phase: 12.7% tested positive for COVID-19 (73.5% females and 35.2% aged 30-39 years), and 29.6% were nursing technicians. Second phase: 12.1% tested positive for COVID-19 (65.5% females and 33.3% aged 40-49 years), and 24.8% were nursing assistants. Conclusions: In 2020, healthcare workers in Ribeirão Preto had COVID-19 in a similar way.
  • Outbreak caused by the SARS-CoV-2 Omicron variant in the psychiatric ward of a general hospital in Brazil Short Communication

    Vanni, Tazio; Menezes, Moema Silva; Sudbrack, Letícia Olivier; Futiwaki, Fabiana; Bezerra, Linda Stéphany; Cabral Filho, Sergio; Oliveira Neto, Edinan; Cortez, Paulo Giovanni Pinheiro; Costa, Fabiano José Queiroz; Vieira, Lucas Luiz; Roll, Mariana Matos; Araújo, Wildo Navegantes de; Almiron, Maria; Siqueira, André Machado de; Ribeiro, Liliana Moscoso; Ribeiro, Julival Fagundes

    Abstract in English:

    ABSTRACT Background: An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant was detected in the psychiatric ward of a general hospital in Brasília, Brazil. Methods: We report the investigation, clinical outcomes, viral sequencing, and control measures applied to outbreak containment. Results: The overall attack rate was 95% (23/24) in a period of 13 days. Among the cases, 78% (18/23) were vaccinated and 17% (4/23) required intensive care. The Omicron variant was isolated from the 19 sequenced samples. Conclusions: The findings highlight the potential harm that highly transmissible variants may generate among hospitalized populations, particularly those with comorbidities.
  • Impact of a computer system as a triage tool in the management of pulmonary tuberculosis in a HIV reference center in Brazil Short Communication

    Libório, Mariana Pitombeira; Kritski, Afrânio; Almeida, Isabela Neves de; Miranda, Pryscila Fernandes Campino; Mesquita, Jacó Ricarte Lima de; Mota, Rosa Maria Salani; Sousa, George Jó Bezerra; Pires Neto, Roberto da Justa; Leitão, Terezinha do Menino Jesus Silva

    Abstract in English:

    ABSTRACT Background: The Neural Clinical Score for tuberculosis (NCS-TB) is a computer system developed to improve the triage of presumed pulmonary TB (pPTB). Methods: A study was performed with cohorts of pPTB patients cared for at a reference hospital in Northeast Brazil. Results: The NCS-TB sensitivity was 76.5% for TB diagnosis, which shortened the time from triage to smear microscopy results (3.3 to 2.5 days; p<0.001) and therapy initiation (6.7 to 4.1 days; p=0.045). Conclusions: Although the NCS-TB was not suitable as a screening tool, it was able to optimize laboratory diagnosis and shorten the time to treatment initiation.
  • Staphylococcus aureus and Enterococcus faecium isolated from pigeon droppings (Columba livia) in the external environment close to hospitals Short Communication

    Vasconcellos, Henrique Vieira Gartz de; Silva, Kerollyn Fernandes Bernardes; Montenegro, Horácio; Miguel, Camila Botelho; Tizioto, Polyana; Agostinho, Ferdinando; Araújo, Marcelo Costa; Ribas, Rosineide Marques; Silva, Marcos Vinícius da; Soares, Siomar de Castro; Rodrigues Júnior, Virmondes; Batistão, Deivid William da Fonseca; Oliveira, Carlo José Freire; Rodrigues, Wellington Francisco

    Abstract in English:

    ABSTRACT Background: Domestic pigeons carry pathogens in their droppings, posing a potential public health problem. Methods: The phenotypic and genotypic antimicrobial resistances of Staphylococcus aureus and Enterococcus faecium in the feces of urban pigeons near hospitals with intensive care units were measured. Results: Twenty-nine samples showed Enterococcus growth, whereas one was positive for S. aureus. The S. aureus isolate was sensitive to the antibiotics tested via antibiogram, however resistance genes were identified. E. faecium isolates showed phenotypic resistance to gentamicin, erythromycin, and ciprofloxacin. Conclusions: Antimicrobial profiles harmful to health were demonstrated in bacterial pathogens isolated from the external environment of hospitals.
  • Natural vertical cotransmission of Dengue virus and Chikungunya virus from Aedes aegypti in Brumado, Bahia, Brazil Short Communication

    Granger Neto, Henry Paul; Rocha, Cínthya Viana Souza; Correia, Thiago Macêdo Lopes; Silva, Natalia Maria Pereira da; Chaves, Bárbara Aparecida; Secundino, Nágila Francinete Costa; Pimenta, Paulo Filemon Paolucci; Melo, Fabrício Freire de

    Abstract in English:

    ABSTRACT Background: Arthropod-borne viruses have recently emerged and are pathogens of various human diseases, including dengue, zika, and chikungunya viruses. Methods: We collectedAedes aegyptilarvae (N = 20) from Brumado, Bahia, Brazil, and treated and individually preserved the specimens. We analyzed the samples for dengue, zika, and chikungunya viruses using molecular biology methods. Results: We found that 25% (N = 5) and 15% (N = 3) were positive exclusively for dengue and chikungunya viruses, respectively; 15% (N = 3) were coinfected with both. Conclusions: This is the first report of dengue and chikungunya virus coinfection in A. aegypti larvae.
  • Acute micro-outbreak of Chagas disease in the southeastern Amazon: a report of five cases Short Communication

    Brito, Andreza Karoline Souza Barros de; Sousa, Débora Raysa Teixeira de; Silva Junior, Edson Fidelis da; Ruiz, Helton Jardys da Silva; Arcanjo, Ana Ruth Lima; Ortiz, Jessica Vanina; Brito, Sabrina Silva de; Jesus, Denison Vital; Lima, Jorge Rubens Coelho de; Couceiro, Kátia do Nascimento; Silva, Mônica Regina Hosannah da Silva e; Ferreira, João Marcos Bemfica Barbosa; Guerra, Jorge Augusto Oliveira; Guerra, Maria das Graças Vale Barbosa

    Abstract in English:

    ABSTRACT Background: Chagas disease is gaining importance in the Brazilian Amazon region as a differential diagnosis of febrile syndrome. The most recent microoutbreak occurred in Ipixuna, in Amazonas state. Methods: An epidemiological survey was conducted using parasitological and serological tests, and electrocardiographic analysis. Results: The patients belonged to one family and had ingested açaí acquired from Ipixuna. All patients reported fever and initially a thick blood smear test was done to identify Trypanosoma cruzi. Benznidazole treatment was administered to all patients. Conclusions: Knowledge of the epidemiological dynamics of Chagas disease allows us to improve control and management measures for this disease.
  • Serological exposure of spotted fever group Rickettsia in capybaras (Hydrochoerus hydrochaeris) from urban parks in Campo Grande, Brazilian Midwest Short Communication

    Campos, João Bosco Vilela; Martins, Filipe Santos; Macedo, Gabriel Carvalho de; Barreto, Wanessa Teixeira Gomes; Oliveira, Carina Elisei de; Barbieri, Amália Regina Mar; Labruna, Marcelo Bahia; Oliveira-Santos, Luiz Gustavo Rodrigues; Herrera, Heitor Miraglia

    Abstract in English:

    ABSTRACT Background: Rickettsia of the spotted fever group (SFG) has been reported in ticks and domestic animals in Campo Grande (CG), Midwest Brazil. Methods: We searched for Rickettsia in the SFG in capybaras and their ticks in an urban park in the CG. Results: The seropositivity rate was 88.2% (15/17). Although 87.7% of the capybaras sampled showed infestations with Amblyomma sculptum, A. dubitatum, and Amblyomma spp., no molecular results were detected in ticks. Conclusions: Since Rickettsia from the SFG circulates among capybaras in the urban parks of Campo Grande, this large rodent species should be monitored within the One Health Agenda.
  • Characterization of insect-specific Culex flavivirus (Flaviviridae) nucleotide sequences in mosquitoes from urban parks in São Paulo, Brazil Short Communication

    Coletti, Thaís de Moura; Romano, Camila Malta; Urbinatti, Paulo Roberto; Teixeira, Renildo Souza; Pedrosa, Leila Weiss de Almeida; Nardi, Marcello Schiavo; Natal, Delsio; Costa, Antônio Charlys da; Jesus, Jaqueline Goes de; Claro, Ingra Morales; Sabino, Ester Cerdeira; Witkin, Steven S.; Marrelli, Mauro Toledo; Fernandes, Licia Natal

    Abstract in English:

    ABSTRACT Background: Despite their worldwide occurrence, the distribution and role of insect-specific flaviviruses (ISFs) remain unclear. Methods: We evaluated the presence of ISFs in mosquitoes collected in São Paulo, Brazil, using reverse transcription and semi-nested polymerase chain reaction (PCR). Some of the positive samples were subjected to nanopore sequencing. Results: Twelve mosquito pools (2.8%) tested positive for flavivirus infection. Nanopore sequencing was successfully performed on six samples. Phylogenetic analysis grouped these sequences into genotype 2 of Culex flavivirus (CxFV). Conclusions: The identification of CxFV genotype 2 at new locations in São Paulo highlights the importance of understanding the role of ISFs in mosquito vector competence.
  • Climatic factors and the incidence of dengue in Cartagena, Colombian Caribbean Region Short Communication

    Cano-Pérez, Eder; Loyola, Steev; Malambo-García, Dacia; Gómez-Camargo, Doris

    Abstract in English:

    ABSTRACT Background: The influence of climate on the epidemiology of dengue has scarcely been studied in Cartagena. Methods: The relationship between dengue cases and climatic and macroclimatic factors was explored using an ecological design and bivariate and time-series analyses during lag and non-lag months. Data from 2008-2017 was obtained from the national surveillance system and meteorological stations. Results: Cases correlated only with climatic variables during lag and non-lag months. Decreases in precipitation and humidity and increases in temperature were correlated with an increase in cases. Conclusions: Our findings provide useful information for establishing and strengthening dengue prevention and control strategies.
  • A potent inflammatory response is triggered in asymptomatic blood donors with recent SARS-CoV-2 infection Short Communication

    Martins, Marina Lobato; Silva-Malta, Maria Clara Fernandes da; Araújo, Argus Leão; Gonçalves, Fabíola Araújo; Botelho, Maiara de Lourdes; Oliveira, Isabelle Rocha de; Boy, Luciana de Souza Madeira Ferreira; Moreira, Hélinse Medeiros; Barbosa-Stancioli, Edel Figueiredo; Ribeiro, Maísa Aparecida; Chaves, Daniel Gonçalves

    Abstract in English:

    ABSTRACT Background: The inflammatory response plays a significant role in the outcome of coronavirus disease (COVID-19). Methods: We investigated plasma cytokine and chemokine concentrations in non-infected (NI), asymptomatic severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)-infected blood donors (AS), and patients with severe COVID-19 (SC). Results: The SC group showed significantly higher levels of interleukin 6 (IL-6), IL-10, and CCL5 than the AS and NI groups. The SC and AS groups had considerably greater CXCL9 and CXCL10 concentrations than the NI group. Only NI and infected people showed separate clusters in the principal component analysis. Conclusions: SC, as well as AS was characterized by an inflammatory profile.
  • Endophytic fungus Phomopsis sp. as a source of 3-nitropropionic acid with larvicidal activity against Aedes aegypti (Linnaeus 1762, Diptera: Culicidae) Short Communication

    Garcia, Armando da Costa; Menezes Júnior, Orivaldo Teixeira de; Mariano, Lissa Apolonia; Santiago, Letícia Corrêa; Araújo, Ângela Regina; Monfardini, Julia Dietsche; Simões, Rejane de Castro; Oliveira, André Correa de; Roque, Rosemary Aparecida; Tadei, Wanderli Pedro; Teles, Helder Lopes; Oliveira, Camila Martins de

    Abstract in English:

    ABSTRACT Background: Aedes aegypti is the primary vector of viruses, such as Zika, chikungunya, yellow fever, and dengue. In this context, a biomonitored chemical study was conducted to evaluate the activity of the crude extract of the endophytic fungus Phomopsis sp. against the larvae of Aedes aegypti. Methods: Crude extract, fractions, and isolated substances were evaluated in in-vitro assays against third-stage larvae of Aedes aegypti. Results: We isolated 3-nitropropionic acid with an LC50 of 15.172 ppm and LC90 of 18.178 ppm after 24 hours of larval exposure. Conclusions: The results indicated that 3-nitropropionic acid exerted larvicidal activity.
  • Anti-SARS-CoV-2 antibody immunoreactivity profiles during COVID-19 recurrence Short Communication

    Gouvea, Maria da Penha Gomes; Moulaz, Isac Ribeiro; Gouveia, Thayná Martins; Lança, Karen Evelin Monlevade; Lacerda, Bárbara Sthefany de Paula; Thompson, Beatriz Paoli; Polese, Jéssica; Lima, Marina Deorce de; Ribeiro-Rodrigues, Rodrigo; Mill, José Geraldo; Valim, Valéria

    Abstract in English:

    ABSTRACT Background: This study aimed to evaluate IgG and IgM levels in COVID-19 recurrence. Methods: The serum antibody levels and clinical data from 73 healthcare workers with SARS-CoV-2 divided into seroconverted (n=51) and non-seroconverted (n=22) groups were assessed. The presence of specific anti-nucleocapsid (anti-N) IgM and IgG for SARS-CoV-2 was evaluated. IgG antibodies to the SARS-CoV-2 spike receptor-binding domain were used to confirm non-seroconversion in all negative anti-N. Results: Four recurrent cases displayed mild symptoms and were non-seroconverted until the recurrence of symptoms. Conclusions: Undetectable anti-nucleocapsid IgM and IgG levels may be correlated with symptomatic COVID-19 recurrence.
  • Initial report of Panstrongylus rufotuberculatus (Champion, 1899) Triatominae (Hemiptera: Reduviidae) in Roraima, western Amazon state, Brazil Short Communication

    Souza, Éder dos Santos; Meneguetti, Dionatas Ulises de Oliveira; Galvão, Cleber; Paiva, Vinicius Fernandes de; Guimarães, Izabele de Souza; Silva, Ágata Cristian Lima da; Alencar, Gabriela Maciel; Guerra, Maria das Graças Vale Barbosa

    Abstract in English:

    ABSTRACT Background: This study is the first report of the species Panstrongylus rufotuberculatus in Roraima, a state in northern Brazil. Methods: We collected specimens from a residence in the municipality of Rorainópolis. Results: Our findings confirmed the occurrence of this species in Roraima, increasing the number of registered species from six to seven. Conclusions: Future studies are required to further investigate and expand our knowledge of the occurrence of this species and its epidemiological importance for this state.
  • First report of Rhodnius montenegrensis (Hemiptera: Reduviidae: Triatominae) in Bolivia Short Communication

    Menezes, André Luiz Rodrigues; Schneider, Ricardo Angelo; Ribeiro, Mariane Albuquerque Lima; Santos, Cícera Alexsandra Costa dos; Carvalho, Elaine Oliveira Costa de; Vilardi, Gabriel Cestari; Oliveira, Jader de; Rosa, João Aristeu da

    Abstract in English:

    ABSTRACT Background: The subfamily Triatominae, which comprises 157 species, carries the protozoan Trypanosoma cruzi, the etiological agent of Chagas disease. This short communication reports for the first time the occurrence of Rhodnius montenegrensis in Bolivia. Methods: Active searches were carried out on palm trees of the genus Oenocarpus in Beni district, Bolivia. Results: Fifteen R. montenegrensis specimens were collected from a rural area of the Beni district, Bolivia, and tested positive for T. cruzi. Conclusions: This new report expands the geographic distribution of the species in Latin America. Due to their ability to transmit trypanosomatids, the species deserves the attention of vector control programs.
  • Evaluation of aversive behavior in Rattus norvegicus experimentally infected by two distinct strains of Toxoplasma gondii (ME49 and VEG): study of epigenetic markers Short Communication

    Santos, Sergio Vieira dos; Fortuna, Giulio de los Santos; Barbosa, Lariane Monteiro; Meireles, Luciana Regina; Tiago, Érico Silva; Chieffi, Pedro Paulo

    Abstract in English:

    ABSTRACT Background: Behavioral changes in Rattus norvegicus infected with two strains of Toxoplasma gondii (ME49 and VEG) were investigated. Methods: Rats were evaluated for motor activity and aversion or attraction to cat urine 60 days after infection. After euthanasia, arginine-vasopressin gene methylation in the central nervous system was evaluated. Results: A significant difference was observed in the methylation of the arginine-vasopressin promoter gene between rats infected with the ME49 and VEG strains. Conclusions: Although differences were not observed in many parameters, significant differences were observed in the methylation of the arginine-vasopressin promoter gene in rats infected with the two studied strains.
  • Preliminary observations of the urbanization and domiciliation of the American cutaneous leishmaniasis in Rio Branco, Acre, Western Amazon Short Communication

    Brilhante, Andreia Fernandes; Zampieri, Ricardo Andrade; Souza, Eduardo Alcici de; Carneiro, Ana Carolina Gomes; Barroso, Edmilson Pereira; Ávila, Marcia Moreira de; Melchior, Leonardo Augusto Kohara; Souza, Janis Lunier de; Oliveira, Elizangela Soares de; Pinto, Maria Carmelinda Gonçalves; Floeter-Winter, Lucile Maria; Galati, Eunice Aparecida Bianchi

    Abstract in English:

    ABSTRACT Background: The American cutaneous leishmaniasis (ACL) is expanding in peri-urban environments. Methods: An entomological survey was conducted in the area of the occurrence of an autochthonous urban case of ACL. Sandflies and a parasitological slide of the human case were submitted for molecular diagnosis. Results: Nyssomyia whitmani and Ny. antunesi were the most frequently collected species. Ny. whitmani and Bichromomyia flaviscutellata were positive for Leishmania guyanensis and L. lainsoni, respectively. The human case tested positive for L. lainsoni. Conclusions: Sandflies and Leishmania parasites present in urban forest may occur frequently in nearby domiciliary environments; thus, these areas must be monitored.
  • Coronavirus Disease 2019 Infection and Early Diagnosis of Macrophage Activation Syndrome: A Case Report of a 62-year-old man Case Report

    Cruz, Filipe Jonas Federico da; Figueiredo, Eduardo Andrada Pessoa de; Batista, Filipe Prohaska; Gallindo, Marcos Antônio Cavalcanti; Fernandes, Andesson Carlos da Silva

    Abstract in English:

    ABSTRACT A 62-year-old man presented with a history of fever, headache, anosmia, ageusia, and diarrhea for 9 days. A clinical and epidemiological diagnosis of infection with the novel coronavirus was made. After symptom refractoriness, the second step involves using human intravenous immunoglobulin. Early diagnosis of macrophage activation syndrome (MAS) involves observation of the refractory nature of clinical support treatment associated with biochemical changes to the patient's baseline characteristics, suggesting the relevance of a favorable clinical outcome of weaning from artificial life support when there is an early suspicion of a diagnosis of MAS secondary to coronavirus disease 2019 infection.
  • Facial Angioedema after the first dose of Covishield (adenovirus-vectored severe acute respiratory syndrome coronavirus 2 vaccine): follow-up after the second and third booster doses Case Report

    Eyer-Silva, Walter de Araujo; Leme, Lidiane Simões de Carvalho Paes

    Abstract in English:

    ABSTRACT Mass vaccination campaigns are essential to control the ongoing novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) pandemic. The Covishield vaccine consists of the replication-deficient simian adenovirus vector ChAdOx1, which contains the full-length structural spike protein of SARS-CoV-2. Occasionally, it can lead to cutaneous reactions that contribute to fear of vaccination, hesitancy, and incomplete vaccination schedules. We report a case of facial angioedema following the first dose of Covishield in a 63-year-old woman with no previous history of allergies or hypersensitivity to drugs or vaccines. No rebound of angioedema was recorded after the second homologous and third heterologous doses.
  • Household outbreak of sporotrichosis: towards the One Health approach Case Report

    Andrade, Elisa Helena Paz; Bastos, Camila Valgas; Silva, Afonso Vieira da; Moreira, Simone Magela; Costa, Taiza Gonçalves de Araújo; Salvato, Lauranne Alves; Colombo, Salene Angelini; Oliveira, Camila Stefanie Fonseca de; Soares, Danielle Ferreira de Magalhães; Keller, Kelly Moura; Azevedo, Maria Isabel de

    Abstract in English:

    ABSTRACT Although sporotrichosis requires a broad approach for control, few reports have described the relationship between the index case and secondary contacts. In the present work, we report an outbreak involving a woman, a dog, and two cats from the same household environment, including the clinical and epidemiological aspects and outcomes, and discuss the importance of a One Health approach to face this neglected disease. The joint efforts of professionals such as veterinarians and physicians are essential for early diagnosis and surveillance, which contributes to the rapid identification and control of zoonotic sporotrichosis outbreaks.
  • Centipede envenomation (Chilopoda): Case report Case Report

    Haddad Junior, Vidal; Amorim, Paulo Cezar Haddad de; Cruz, Carolina Rassi da; Amaral, Antônio Lucas Sforcin

    Abstract in English:

    ABSTRACT Centipedes are venomous arthropods that have an elongated body, divided into many segments, presenting a pair of legs in each segment, adapted pairs of paws that simulate fangs and inject venom causing intense pain, with local erythema and edema, and rarely, blisters and skin necrosis. We present the case of a young woman pricked on her upper lip with intense swelling and local pain and discuss the real danger of envenomation and the therapeutic measures that should be taken.
  • Concurrent hospitalization of a married couple presenting with distinct symptoms but diagnosed with a life-threatening infectious disease Case Report

    Osawa, Eduardo Atsushi; Maciel, Alexandre Toledo

    Abstract in English:

    ABSTRACT We described the cases of a married couple hospitalized for distinct symptoms and developed a neuroparalytic syndrome with rapid progression. In Case 1, a 75-year-old woman was admitted for abdominal pain, diarrhea, and blurred vision. The patient developed acute respiratory failure, ptosis, and ophthalmoplegia. She died on day 15 because of an acute abdomen. In Case 2, her husband, a 71-year-old man, was admitted for diplopia. The patient developed abdominal distension and slurred speech. Later, he developed bilateral ptosis, ophthalmoparesis, and mydriasis. Botulism was suspected, and both patients received botulinum antitoxin. Our male patient survived but underwent prolonged rehabilitation.
  • Severe disseminated clinical presentation of monkeypox virus infection in an immunosuppressed patient: first death report in Brazil Case Report

    Menezes, Yargos Rodrigues; Miranda, Alexandre Braga de

    Abstract in English:

    ABSTRACT Since May 2022, the number of monkeypox virus infections has sharply increased in countries where the disease has not been previously endemic. At present, most reports refer to low-severity cases. Herein, we present a severe case of the disease with disseminated skin lesions that progressed to death in an immunosuppressed patient in Belo Horizonte, Minas Gerais, Brazil.
  • When to think about a Lachesis muta envenomation in the Western Brazilian Amazon: Lessons from a case report Case Report

    Sachett, Jacqueline de Almeida Gonçalves; Marinho, Ana Paula Saboia; Santos, Marizete Melo de Oliveira; Fan, Hui Wen; Bernarde, Paulo Sérgio; Monteiro, Wuelton Marcelo

    Abstract in English:

    ABSTRACT In the Brazilian Amazon, envenomations by lancehead pit vipers prevail across the region, while bushmaster (Lachesis muta) envenomations are rarely confirmed. Here, we described a moderate snakebite, diagnosed as a lancehead pit viper envenomation upon admission and treated with four vials of Bothrops antivenom. Blood remained unclottable for 4 days of hospitalization. On day 4, after admission, the patient presented pictures of the perpetrating snake to the hospital staff, which was identified as a Lachesis muta specimen. After administering 10 vials of Lachesis antivenom, blood became clottable 12 hours after treatment. The patient was discharged without complaints.
  • Delayed diagnosis of homocystinuria presenting with coronavirus disease 2019 in a 17-year-old boy Case Report

    Yakut, Nurhayat; Tuzun, Behzat; Ergun, Nurcan Ucuncu

    Abstract in English:

    ABSTRACT Homocystinuria is a treatable autosomal recessive inherited disorder. This condition may cause life-threatening complications such as thromboembolic events. Coronavirus disease 2019 (COVID-19) is associated with an increased risk of venous thromboembolic events. Here, we report a case of late diagnosis of homocystinuria presenting with deep venous thrombosis and COVID-19. This study highlights a sustained high index of suspicion for homocystinuria to prevent severe thromboembolic complications.
  • Community-acquired Acinetobacter baumannii pneumonia: a rare case in Brazil Case Report

    Brigo, Izadora Raduan; Yamamoto, Leandro de Resende; Molina, Rodrigo Juliano

    Abstract in English:

    ABSTRACT Acinetobacter baumannii, a common pathogen in nosocomial infections, is a rare cause of community-acquired pneumonia. This report highlights the difficulties in its early diagnosis and effective treatment, as it is a multidrug-resistant microorganism with rapid, unfavorable progression. To better understand its clinical outcome, we searched the literature for similar cases but found no community-acquired cases in Brazil.
  • Innovative mapping of skin sensitivity by monofilaments to record the diagnosis and therapeutic follow-up of leprosy Images In Infectious Diseases

    Bernardes Filho, Fred; Lima, Filipe Rocha; Frade, Marco Andrey Cipriani
  • Paracoccidioidomycosis as an opportunistic manifestation of acquired immunodeficiency syndrome Images In Infectious Diseases

    Santos, Paulo Ricardo Gomes dos; Abreu, Marilda Aparecida Milanez Morgado de
  • Reactivation of neurocysticercosis: calcified nodular lesion and perilesional edema Images In Infectious Diseases

    Ribeiro, Larissa Grazielle Souza; Marcusso, Helen Cristina; Abud, Lucas Giansante
  • Nocardia brain abscess in a patient with chronic lymphocytic leukemia Images In Infectious Diseases

    Wertheimer, Guilherme Soares de Oliveira; Duffles, Guilherme; Reis, Fabiano
  • Gas-forming pyogenic liver abscess due to Klebsiella pneumonia Images In Infectious Diseases

    Wu, Na; Yu, Yong-Sheng; Zhang, Yi
  • Magnetic Resonance Imaging and Histopathological Aspects of Botryomycosis Images In Infectious Diseases

    Corrêa, Diogo Goulart; Carneiro, Leonardo Hoehl; Costa, Flavia Martins
  • Broad-Snouted Caiman (Caiman latirostris) bite Images In Infectious Diseases

    Tarlé, Roberto Gomes; Haddad Junior, Vidal
  • Pseudo-honeycombing in a patient with coronavirus disease 2019 pneumonia Images In Infectious Diseases

    Hochhegger, Bruno; Zanetti, Gláucia; Marchiori, Edson
  • Amoebic liver abscess Images In Infectious Diseases

    Chang, Chee Yik; Radhakrishnan, Anuradha P.
  • Dendriform pulmonary ossification in coronavirus disease 2019 pneumonia Images In Infectious Diseases

    Torres, Pedro Paulo Teixeira e Silva; Rabahi, Marcelo Fouad; Marchiori, Edson
  • Erythema Nodosum - An atypical presentation of melioidosis Images In Infectious Diseases

    Tan, Peh Yi; Goh, Jin Yi
  • Genitourinary Tuberculosis, not Lupus Images In Infectious Diseases

    Stumpf, Matheo Augusto Morandi
  • Hydatid Cyst in the Hand Images In Infectious Diseases

    Tekin, Recep; Özkul, Emin; Ulus, Sait Anıl
  • Acute hemorrhagic encephalitis in a pregnant woman with coronavirus disease-2019 Images In Infectious Diseases

    Tekin, Rojbin Ceylan; Gökhaner, Yurdagül Tolu; Tekin, Recep
  • Cutaneous and pulmonary manifestations of sarcoidosis triggered by coronavirus disease 2019 infection Images In Infectious Diseases

    Rodrigues, Felipe Tavares; Quirino, Renata Miguel; Gripp, Alexandre Carlos
  • Septic embolism of the lung due to spondylodiscitis Images In Infectious Diseases

    Tufanoğlu, Fatih Hakan; Akyüz, Behiç; Bekirçavuşoğlu, Süleyman
  • A fatal rhino-orbit-cerebral mucormycosis infection aggravated by coronavirus disease-2019 Images In Infectious Diseases

    İşlek, Akif; Şimşek, Sadullah
  • Pott’s puffy tumor in coronavirus disease-2019 associated mucormycosis Images In Infectious Diseases

    Arora, Ripu Daman; Thangaraju, Pugazhenthan
  • Oral and ocular manifestations in a patient with coronavirus disease-2019: Clinical presentation and management Images In Infectious Diseases

    Dilsiz, Alparslan; Parlak, Emine; Gül, SemaNur Sevinc
  • Cerebral toxoplasmosis associated with the use of immunosuppressive treatments Images In Infectious Diseases

    Valadão, Ivone Melo; Sequeira, Ana Sofia; Barcelos, Vanessa
  • Tuberculous prostatitis mimicking metastatic prostate cancer Images In Infectious Diseases

    Aslan, Serdar; Eryuruk, Uluhan; Ozdemir, Burhan
  • Isolated amoebic brain abscess with excellent therapeutic response Images In Infectious Diseases

    José Wagner Leonel, Tavares-Junior; Arruda, Arnaldo Ribeiro de; Coimbra, Pablo Picasso de Araújo
  • Pericardial effusion with a ruptured mycotic pseudoaneurysm secondary to Salmonella infection Images In Infectious Diseases

    Leong, Lai Kuan; Chung, Bui Khiong; Tan, Chen Ting
  • Unilateral parotitis following mRNA coronavirus disease 2019 vaccination Images In Infectious Diseases

    Bekci, Tumay; Cakir, Ismet Mirac; Aslan, Serdar
  • Hydatid Cyst of the Tibia Images In Infectious Diseases

    Tekin, Recep; Özkul, Emin; Ulus, Sait Anıl
  • Unusual case of brucella endocarditis involving the mitral valve Images In Infectious Diseases

    Parlak, Emine; Çolak, Abdurrahim; Birdal, Oğuzhan
  • Post Coronavirus Disease 2019 Vaccine-associated Acute Myeloradiculoneuropathy Responsive to Plasmapheresis Images In Infectious Diseases

    Tavares-Júnior, José Wagner Leonel; Coimbra, Pablo Picasso de Araújo; Braga-Neto, Pedro
  • Heart-Shaped lung hydatid cyst in a chest radiograph Images In Infectious Diseases

    Aydin, Yener; Ogul, Hayri; Eroglu, Atilla
  • Disseminated paracoccidioidomycosis with skull and mandible involvement in a heart transplant recipient Images In Infectious Diseases

    Pereira, Fernanda Veloso; Alves, Katariny Parreira de Oliveira; Altemani, Albina Messias de Almeida Milani; Reis, Fabiano
  • Nosocomial Valve Endocarditis after Crimean-Congo Hemorrhagic Fever Images In Infectious Diseases

    Parlak, Emine; Birdal, Oğuzhan; Ceviz, Münacettin
  • Cystic Tuberculosis of the Humerus Images In Infectious Diseases

    Tekin, Rojbin Ceylan; Özkul, Emin; Tekin, Recep
  • A rare cause of dyspnea and cough: Diffuse tracheal papillomatosis Images In Infectious Diseases

    Ayyildiz, Veysel; Aydin, Yener; Ogul, Hayri
  • Assorted copper pennies on a scar - a case of chromoblastomycosis after knee transplant Images In Infectious Diseases

    Anjaneyan, Gopikrishnan; Krishna, Radhika; Yesodharan, Jyotsna
  • Spontaneous healing of a ruptured pulmonary hydatid cyst: a rare phenomenon Images In Infectious Diseases

    Aydin, Yener; Araz, Omer; Eroglu, Atilla
  • Diagnosis of a hepatic hydatid cyst using posteroanterior chest radiography Images In Infectious Diseases

    Aydin, Yener; Ulas, Ali Bilal; Eroglu, Atilla
  • Face located skin anthrax Images In Infectious Diseases

    Can, Fatma Kesmez
  • Alveolar echinococcosis mimicking bilateral lung metastatic cancer Images In Infectious Diseases

    Aydin, Yener; Ulas, Ali Bilal; Eroglu, Atilla
  • Acute disseminated encephalomyelitis following coronavirus disease vaccination Images In Infectious Diseases

    Pereira, Ronaldo Gonçalves; Lima, Rafael Teixeira de Hollanda; Ribeiro, Bruno Niemeyer de Freitas
  • Cutaneous lesions of bacillary angiomatosis Images In Infectious Diseases

    Keong, Seow Chee; Fu, Gan Wee; Hashim, Hasmah
  • Pulmonary actinomycosis mimicks lung cancer Images In Infectious Diseases

    Aydin, Yener; Arslan, Remzi; Filik, Mustafa
  • Widespread bilateral lung, liver, and spleen hydatid cysts Images In Infectious Diseases

    Aydin, Yener; Aksungur, Nurhak; Ulas, Ali Bilal
  • Insidious Headache: Brain Toxoplasma Abscess Images In Infectious Diseases

    Tosun, Alptekin; Tasdemir, Merve Nur; Sulun, Emrah
  • Strongyloidiasis gastritis and colitis in a patient with leprosy Images In Infectious Diseases

    Azevedo, Francisco Kennedy Scofoni Faleiros de; Miranda, Paula Maria Pinheiro; Menezes, Ivana
  • Giant lung and liver hydatid cyst in a 3-year-old child Images In Infectious Diseases

    Ozgokce, Mesut; Ayengin, Kemal; Aydin, Yener
  • Primary Giant Mediastinal Hydatid Cyst Extending to the Superior Thoracic Inlet Images In Infectious Diseases

    Aydin, Yener; Ulas, Ali Bilal; Eroglu, Atilla
  • Pulmonary and cerebral paracoccidioidomycosis Images In Infectious Diseases

    Machado, Matheus Garcia Lago; Rodrigues, Rosana Souza; Marchiori, Edson
  • Epstein-Barr virus meningitis mimicking tuberculous meningitis on neuroimaging Images In Infectious Diseases

    Corrêa, Diogo Goulart; Cañete, Luis Alcides Quevedo; Cruz Jr, Luiz Celso Hygino da
  • High-resolution vessel wall magnetic resonance imaging for the diagnosis of neurocysticercosis vasculitis Images In Infectious Diseases

    Yacoub, Vinícius Ramos Daoud; Ramos, Marcelo de Carvalho; Reis, Fabiano
  • Pott's Puffy Tumor with Intraorbital Abscess Images In Infectious Diseases

    Gozgec, Elif; Ogul, Hayri; Kılıc, Korhan
  • Pyogenic liver abscess following perforated appendicitis Images In Infectious Diseases

    Akyüz, Behiç
  • COVID-19-related acute necrotizing encephalopathy with new spectroscopy features Images In Infectious Diseases

    Wertheimer, Guilherme Soares de Oliveira; Brandão, Marcelo Barciela; Reis, Fabiano
  • A Case of Disseminated Alveolar Echinococcosis Mimicking Metastatic Malignant Disease with Cerebral Involvement Images In Infectious Diseases

    Cakir, Ismet Mirac; Bekci, Tumay; Eryuruk, Uluhan
  • Back pain and erythema nodosum in a 9-year-old child Images In Infectious Diseases

    Gicchino, Maria Francesca; Olivieri, Alma Nunzia
  • An unusual tumor mimicker in the iliac wing: A hydatid cyst Images In Infectious Diseases

    Tas, Nurmuhammet; Tuncer, Kutsi; Aydin, Yener
  • Multiple primary hydatid cysts in the left thigh Images In Infectious Diseases

    Tuncer, Kutsi; Demir, Mehmet; Aydin, Yener
  • Endobronchial actinomycosis Images In Infectious Diseases

    Kerget, Buğra; Kerget, Ferhan; Özmen, Sevilay
  • Hydatid cyst in the teres major muscle and brain Images In Infectious Diseases

    Şimşek, Sadullah
  • Giant peritoneal hydatid cyst causing pelvic venous congestion Images In Infectious Diseases

    Izgi, Emine; Ogul, Hayri; Aydin, Yener
  • Brucellosis-Related Hepatic Abscess Case Images In Infectious Diseases

    Alkan, Sevil; Demiray, Emine Kübra Dindar
  • Disseminated gonococcal infection in an immunocompetent young man Images In Infectious Diseases

    Tavares, Gabriel Castro; Victer, Cecília Schubert Xavier Lagalhard
  • Disseminated histoplasmosis diagnosed through blood smear Images In Infectious Diseases

    Santos Júnior, Claudio José dos; Rocha, Thiago José Matos; Souza, Aryanna Kelly Pinheiro
  • Multiple Streptococcus sanguinis brain abscesses misdiagnosed as cerebral manifestation of tuberculosis Images In Infectious Diseases

    Cakir, Ismet Mirac; Bekci, Tumay; Eryuruk, Uluhan
  • Glioblastoma misdiagnosed as acute disseminated encephalomyelitis following coronavirus disease vaccination Images In Infectious Diseases

    Tosun, Alptekin; Tasdemir, Merve Nur
  • Cryptococcus gattii infection complicated by immune reconstitution syndrome in a patient with common variable immunodeficiency Images In Infectious Diseases

    Fiorio, Luize Meloti; Biasutti, Claudia; Rosa-Júnior, Marcos
  • Ruptured hepatic hydatid cyst with the formation of an abscess and a cutaneous fistula Images In Infectious Diseases

    Önder, Ramazan Orkun; Bekci, Tumay; Aslan, Serdar
  • Progressive multifocal leukoencephalopathy: the challenge of opportunistic infections in patients with human immunodeficiency virus infection Images In Infectious Diseases

    Costa, Paula Pires da; Cruz, António José; Nuak, João
  • Ruptured hepatic hydatid cyst causing cholangitis Images In Infectious Diseases

    Önder, Ramazan Orkun; Bekci, Tumay; Yayla, Demet İlkim
  • Pathophysiological aspects of neuro-COVID Letter

    Finsterer, Josef; Scorza, Fulvio A; Fiorini, Ana C
  • Asymptomatic low pulse oximetry measurements in leprosy patients in the time of COVID-19: Dapsone side effect Letter

    Frade, Marco Andrey Cipriani; Bernardes Filho, Fred; Lima, Ana Laura Quirino de; Menezes, Marcelo Bezerra de; Lugão, Helena Barbosa
  • Anxiety, depression, and quality of life in mothers of children with congenital Zika syndrome: Results of a 5-year follow-up study Letter

    Oliveira, Sheila Jaqueline Gomes de; Tavares, Carolina Santos Souza; Santos, Victor Santana; Santos Jr, Hudson P.; Martins-Filho, Paulo Ricardo
  • Indeterminate Form of Chagas Disease: Some Immunological Insights Letter

    Matos, Daniel Mazza; Viana, Carlos Eduardo Menezes; Oliveira, Maria de Fátima; Queiroz, José Ajax Nogueira
  • The role of free-living amoebae in the persistence of viruses in the era of severe acute respiratory syndrome 2, should we be concerned? Letter

    Chaúque, Beni Jequicene Mussengue; Rott, Marilise Brittes
  • Factors Involved in Pain Perception and Quality of Life in Patients with Tropical Spastic Paraparesis Letter

    Criado-Martinez, Sebastian; Rivera-Lozada, Oriana
  • Heading back into the perfect storm: increasing risks for disease emergence in Brazil? Letter

    Ribeiro, Sérvio Pontes; Vale, Mariana Moncassin; Diniz-Filho, José Alexandre Felizola; Fernandes, Geraldo Wilson; Reis, Alexandre Barbosa; Grelle, Carlos Eduardo de Viveiros
  • SARS-CoV-2/influenza A (H3N2) virus coinfection: epidemiological surveillance in Northeast Brazil Letter

    Santos, Cliomar Alves dos; Bezerra, Gabriela Vasconcelos Brito; Marinho, Aline Rafaelle Rocha Almeida de Azevedo; Sena, Ludmila Oliveira Carvalho; Menezes, Vitoria de Jesus; Teixeira, Daniela Cabral Pizzi; Souza, Mércia Feitosa de; Góes, Marco Aurélio de Oliveira; Martins-Filho, Paulo Ricardo
  • Are atypical lymphocytes a new predictive factor in the development of COVID-19? Letter

    Oliveira, Claudio Bruno Silva de; Andrade, Joelma Maria de Araújo; Oliveira, Jonas Ivan Nobre
  • Lionfish envenomation on the Brazilian coast: first report Letter

    Haddad Junior, Vidal; Giarrizzo, Tommaso; Soares, Marcelo de Oliveira
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