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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.
  • 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.
  • 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.
  • 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.
  • 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
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