Abstract in English:

ABSTRACT The reference methodology for evaluating antifungal susceptibility is based on determining the minimum inhibitory concentration (MIC), which is the lowest drug concentration capable of inhibiting fungal growth. However, such MIC data are insufficient to measure antifungal susceptibility if a strain is heteroresistant to the tested drug. In such cases, a minority subpopulation of fungal cells, originating from an initially susceptible lineage, can grow at antifungal drug concentrations above the MIC. In studies on fluconazole heteroresistance in Cryptococcus spp., chromosomal disomy has been shown to result in the overexpression of two genes located on chromosome 1 (Chr1) linked to antifungal resistance: ERG11 and AFR1. This review addresses the underlying mechanisms of antifungal resistance, the evolution of methods for determining antifungal susceptibility, and the clinical implications of Cryptococcus heteroresistance to fluconazole. The analysis of the findings indicated a correlation between heteroresistance and adverse clinical outcomes, although this observation still lacks definite confirmation in the literature. This highlights the need to implement more efficient therapeutic strategies and improve antifungal susceptibility and heteroresistance testing.

Abstract in English:

ABSTRACT The Subphylum Myriapoda is part of the Phylum Arthropoda, and has two Classes related to human medicine. The Diplopoda Class comprises the Millipedes that poison through contact of their toxins with the skin and mucous membranes. The Chilopoda Class, the Centipedes are venomous animals that cause painful envenomation through stings. The clinical manifestations of human injuries caused by myriapods are typical. Because of the frequency with which these animals are found in domestic environments, it is important that this information be transmitted to medical teams and the general population.

Abstract in English:

ABSTRACT Background: Low QRS complex voltage is an important predictor of death in Chagas disease. However, the parameters applied to the low-voltage classification were described by the Minnesota Code and not specifically for Chagas disease. This study aimed to analyze low QRS voltage by determining the ADOC index and averages in the frontal and horizontal electrocardiographic planes, establishing possible clinical implications. Methods: A cross-sectional study of patients with Chagas disease was performed using the Mann-Whitney U test and Spearman’s correlation. The amplitudes of each QRS were analyzed, and the sum of the DII and V5 derivations of the ADOC index and the arithmetic means of the QRS complexes in the frontal and horizontal planes were determined. Results: The ADOC index was correlated with the highest risk of stroke and death according to the Rassi score. The ADOC index (p=0.046) and mean mQRS were inversely proportional to the Rassi risk of death score (p=0.038). The ADOC index proved to be more sensitive (75.0%) and accurate (67.4%) in identifying patients at elevated death risk using the Rassi score. Finally, a positive correlation was observed between the QRSFm and QRSHm indicators and ADOC index (r=0.590 and r=0.857, respectively). Discussion: The ADOC index and mean of the QRS complexes are possible tools correlated with the Rassi score and risk of stroke in patients with Chagas disease.

Abstract in English:

ABSTRACT Background: Emerging infections have posed persistent threats to humanity throughout history. Rapid and unprecedented anthropogenic, behavioral, and social transformations witnessed in the past century have expedited the emergence of novel pathogens, intensifying their impact on the global human population. Methods: This study aimed to comprehensively analyze and compare the genomic sequences of four distinct viruses: SARS-CoV-2, SARS, MERS, and Ebola. Advanced genomic sequencing techniques and a Gated Recurrent Unit-based deep learning model were used to examine the intricate genetic makeup of these viruses. The proposed study sheds light on their evolutionary dynamics, transmission patterns, and pathogenicity and contributes to the development of effective diagnostic and therapeutic interventions. Results: This model exhibited exceptional performance as evidenced by accuracy values of 99.01%, 98.91%, 98.35%, and 98.04% for SARS-CoV-2, SARS, MERS, and Ebola respectively. Precision values ranged from 98.1% to 98.72%, recall values consistently surpassed 92%, and F1 scores ranged from 95.47% to 96.37%. Conclusions: These results underscore the robustness of this model and its potential utility in genomic analysis, paving the way for enhanced understanding, preparedness, and response to emerging viral threats. In the future, this research will focus on creating better diagnostic instruments for the early identification of viral illnesses, developing vaccinations, and tailoring treatments based on the genetic composition and evolutionary patterns of different viruses. This model can be modified to examine a more extensive variety of diseases and recently discovered viruses to predict future outbreaks and their effects on global health.

Abstract in English:

ABSTRACT Background: Tuberculosis remains a major global health concern and a leading cause of mortality. In Morocco, various forms of extrapulmonary tuberculosis are prevalent. This systematic review examines research findings on the prevalence, risk factors, and treatment outcomes of extrapulmonary tuberculosis in Morocco. Methods: We conducted searches for observational studies on extrapulmonary tuberculosis in Morocco, published between January 1991 and February 2023, using Scopus, ScienceDirect, and PubMed databases. Medical Subject Heading keywords were used to guide the search. Results: This review included 18 studies focusing on different forms of extrapulmonary tuberculosis, such as cold abscesses, lymph nodes, meningeal, cutaneous, osteoarticular, genital, breast, and gastrointestinal tuberculosis. These studies provided insights into the clinical, diagnostic, and therapeutic aspects of these extrapulmonary tuberculosis forms. Prevalence data were limited, and treatment outcomes varied considerably across studies. The only study providing prevalence data for all forms of extrapulmonary tuberculosis reported a prevalence of 43.5% among tuberculosis cases in Larach Province. Treatment success rates ranged from 64.7% to 100%. Common risk factors included low socioeconomic status, diabetes mellitus, pulmonary tuberculosis exposure, and HIV co-infection. Conclusions: This review highlights a lack of comprehensive on the prevalence of extrapulmonary tuberculosis in Morocco, with inconsistent findings on risk factors and treatment outcomes. Further controlled studies are recommended to obtain more robust evidence and inform more effective management strategies for extrapulmonary tuberculosis.

Abstract in English:

ABSTRACT Background: Triatomine recognition by the public is an important factor in Chagas disease (CD) prevention campaigns. Citizen surveillance has been demonstrated as an effective alternative strategy, increasing the possibility of monitoring vector populations on a broad geographic scale. Thus, our study aimed to explore a database built from pictorial/video records and specimens sent through citizen participation, identify the main groups confused with triatomines, and systematize the data on insect diversity. Methods: Due to demand from the local community, the “WhatsBarb” project was established using a digital platform application, to receive photos of suspected insects, or triatomines, and provide digital campaigns, with instructions for collecting insects and delivery to Entomological Surveillance Services. Results: In total, 465 insect records were obtained between 2019 and 2024. We identified taxonomic orders and families in 464 and 454 records, respectively, and estimated at least 68 genera, 42 species, and 101 distinct taxa. Triatomines represented 32.3% of the volunteer contacts. Records showed a predominance of true bugs (Hemiptera: Heteroptera), including phytophagous species and predator reduviids (54.6%; n=254). Contacts were received from 20 of the 26 states in Brazil, in addition to the Federal District. Conclusions: Our findings demonstrate the power of digital tools in public health, which could aid in describing, preventing, and controlling CD vectors, and could be applied to other neglected diseases.

Abstract in English:

ABSTRACT Background: During the Zika virus (ZIKV) epidemic in Latin America (2015-2016), a high incidence of microcephaly was observed in places with low yellow fever (YF) vaccination coverage. Cross-reactivity between ZIKV and YF virus was hypothesized as a possible explanation. Methods: We performed a case-control study to estimate the odds of ZIKV infection according to patients’ YF vaccination status. The study considered ZIKV fever as the outcome, and previous vaccination against YF as exposure. We included all confirmed cases of acute ZIKV fever in Campo Grande, Mato Grosso do Sul, from January 2015 to December 2018. The control group comprised age- and sex-matched residents of Campo Grande who had no history of acute febrile arboviruses during the study period. Results: The cumulative incidence of acute ZIKV fever was 1.87 cases per 1000 population. The case group had a predominance of women aged 20-39 years and white and mixed races. Vaccination coverage for YF was 65.5% in the case group and 60.9% in the control group. The odds ratio (OR) suggested a weak association between outcomes and exposure (OR = 1.23; 95% confidence interval [CI]: 1.05-1.44). Conclusions: Our findings provide no evidence that prior YF vaccination protects against acute ZIKV infection. Further studies are needed to analyze the development of anti-ZIKV and anti-YF neutralizing antibodies in affected individuals because new ZIKV epidemics are predicted.

Abstract in English:

ABSTRACT Background: Chagas disease (CD) is associated with significant morbidity and mortality due to cardiac and/or gastrointestinal complications. CD transmission has diverse modes, and their potential relationship with the clinical forms of CD remains unexplored. This study evaluated the association between the transmission modes and chronic clinical forms of CD. Methods: This retrospective study included patients with chronic CD referred to the outpatient clinic of INI/Fiocruz between November 1986 and August 2024. Clinical and epidemiological data were retrieved from medical records. Sociodemographic profiles, epidemiological history of CD, and clinical, cardiac, and digestive evaluations were assessed. Unadjusted and adjusted logistic regression models were fitted to assess the association between transmission modes and CD clinical forms. Results: The analysis included 2,162 patients (53.0% women; mean age 48.3 years). The CD transmission mode was evaluated as vectorial in 1962 (90.8%) patients, followed by blood transfusion in 123 (5.7%), congenital in 59 (2.7%), and oral in 18 (0.8%). Patients with congenital or oral transmission were younger, less likely to be women or self-reported as black, had lower rates of illiteracy, and a higher percentage were from non-endemic areas. No significant associations were observed between transmission modes and the cardiac or digestive forms of CD in unadjusted and adjusted analyses. Conclusions: Vectorial transmission was the most common transmission mode in patients with chronic CD. No significant association was found between the transmission mode and CD clinical forms, indicating that other mechanisms associated with progression to chronic determinate forms should be investigated.

Abstract in English:

ABSTRACT Background: Despite numerous reports of triatomines invading homes through flight, experimental studies investigating this ability under laboratory conditions remain scarce. Flight ability varies between individuals (males and females) of the same species, and wing shape modifications may be associated with the flight capacity of these vectors. Therefore, studies on this topic are crucial for the early identification of species with a greater propensity to invade human dwellings and for the implementation of appropriate surveillance and vector control strategies. However, even when exposed to the same nutritional and environmental conditions, triatomines demonstrate a range of flight abilities. To date, it remains unclear whether differences in wing morphology play a decisive role in determining this behavior. As an initial approach to addressing this issue, the present study aimed to determine whether morphometric differences exist in the wings of flying and non-flying individuals from six species of the genus Triatoma: Triatoma costalimai, Triatoma klugi, Triatoma matogrossensis, Triatoma rubrovaria, Triatoma vandae, and Triatoma williami. Methods: This study employed geometric morphometrics to investigate differences in wing size and shape between flying and non-flying individuals from six Triatoma species. Results: The findings indicated a variation in wing size between sexes. Additionally, shape variations were observed between flying and non-flying insects, particularly in females. Conclusions: Geometric morphometrics effectively identified distinct wing shape patterns in flying and non-flying specimens from six Triatoma species, revealing differences that may aid in identifying species with greater active dispersal capacity.

Abstract in English:

ABSTRACT Background: The coronavirus disease 2019 (COVID-19) pandemic posed challenges for health systems in rapidly diagnosing diseases. Methods: Community workshops and a self-administered questionnaire were implemented to determine the feasibility of self-testing for future epidemics and gain an understanding of community interest and the capacity to implement self-tests in two rural areas in Paraguay. Results: Comprehension of the self-test procedures and their application was demonstrated by 99% of the participants. The participants expressed interest in accessing these tests at home. Conclusions: Self-tests could be a valuable tool in urban and rural communities that enable health systems to focus on severe cases.

Abstract in English:

ABSTRACT Cryptococcal disease is the third most common invasive fungal infection in solid organ transplant recipients and is associated with high-morbidity and -mortality rates. Donor-derived Cryptococcus spp. infection typically manifests within the first month post-procedure and has historically been caused by C. neoformans complex, predominantly in kidney recipients, but also after liver transplantation. We report the first documented case of donor-derived, early-onset C. gattii complex meningoencephalitis following liver transplantation in a 54-year-old woman, successfully treated with amphotericin B and fluconazole, and review the relevant literature.

Abstract in English:

ABSTRACT Chikungunya virus (CHIKV) induces an acute infection known as chikungunya fever; however, the persistence of CHIKV infections has been reported. This report investigated the persistence of CHIKV over six months in the cervix of two infected women. The infectious CHIKV was isolated from three samples. Our findings demonstrated the persistence of CHIKV in the cervix, highlighting the importance of evaluating other tissue types.

Abstract in English:

ABSTRACT Patients with chronic Chagas disease (CD) and autoimmune rheumatic disorders (ARD) receiving immunosuppressive therapy are at risk for CD reactivation (CDR). This study monitored parasitemia over 9-121 months in six patients with CD and ARD using conventional and quantitative PCR and parasitology. Five patients showed parasitemia; two had elevated levels of parEq/mL (49-458.7). One patient received benznidazole with a marked decrease in parasitemia; in the other, treatment was discontinued after 12 days due to toxicity. No CDR occurred. These findings support the need for qPCR standardization for preemptive therapy and suggest that benznidazole may prevent CDR in patients with high parasitemia.

Abstract in English:

ABSTRACT Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral hemorrhagic fever caused by Nairovirus and characterized by fever, myalgia, arthralgia, and hemorrhagic manifestations. Severe bradycardia is a rare complication of the disease. We present a 30-year-old male patient with CCHF who developed severe bradycardia, which was successfully treated with intravenous and oral theophylline. This case highlights the need to recognize cardiac complications in CCHF and highlights the role of pharmacological interventions in improving patient outcomes.

Abstract in English:

ABSTRACT The wide distribution of angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2) in oral tissues, especially in the salivary glands, which are natural reservoirs of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), contributes to the classification of the oral cavity as a potential target for the development of lesions. Despite the effective response produced by next-generation immunizers, the possibility of immune escape by new lineages of SARS-CoV-2 cannot be refuted. Therefore, we describe here the occurrence of cytogenetic alterations in orally exfoliated cells of immunized individuals and, based on the literature review, call attention to the need to monitor these cases in the post-pandemic period.

Abstract in English:

ABSTRACT The incidence of skin nontuberculous mycobacterial (NTM) infections has been rising in recent years, paralleling the increase in invasive procedures and immunosuppression. We present a case involving a patient undergoing treatment with a tumor necrosis factor blocker (Etanercept®) for psoriatic dactylitis, who showed clinical deterioration 30 days following intra-articular corticosteroid therapy. Liquid culture media identified M. abscessus, prompting the initiation of combination antibiotic therapy. To the best of our knowledge, this is the first reported case of an NTM superinfection in dactylitis, underscoring the importance of screening for these infections in immunosuppressed patients receiving localized injectable treatments.

Abstract in English:

ABSTRACT Cutaneous cryptococcosis is a manifestation of systemic cryptococcal infection, characterized by polymorphic skin lesions that can make diagnosis challenging. We report an HIV-positive patient with a solitary facial nodule, initially diagnosed as keratoacanthoma. Histopathology, fungal culture, and cerebrospinal fluid analysis confirmed disseminated cryptococcosis with central nervous system involvement caused by Cryptococcus neoformans genotype VNI. He was treated with amphotericin B followed by fluconazole, resulting in complete clinical resolution. This case underscores the need to consider disseminated cryptococcosis in the differential diagnosis of tumorlike skin lesions, particularly in HIV-positive patients.

Abstract in English:

ABSTRACT Streptococcus constellatus, a member of the Streptococcus anginosus group, is a commensal bacterium that causes pyogenic infections, particularly abscesses. This report describes the case of a 28-year-old immunocompetent man who developed a brain abscess and epidural empyema after pneumonia. MRI suggested an abscess, which was confirmed by culture, revealing S. constellatus. Treatment included abscess drainage and ceftriaxone administration, which led to a full recovery. Diagnosis is challenging because of overlapping features with other bacteria. Imaging and culturing are crucial for identification. This case highlights the importance of considering S. constellatus in central nervous system infections, even in immunocompetent individuals.

Abstract in English:

ABSTRACT Secondary infection following snakebites is a common complication, and few studies exist in the literature regarding the most frequent microorganisms and the most appropriate antibiotic regimens. This article reports two cases of patients who progressed to death due to infection by Aeromonas hydrophila following a snakebite from the genus Bothrops in southeastern Brazil. This bacterium is not commonly reported as an agent of this complication in the national literature; however, it should be considered for the treatment of secondary infections following snakebites because of their potentially severe progression.

Abstract in English:

ABSTRACT Electrical eels, or poraqués or temblones (Electrophorus spp. Gill, 1864), are highly feared animals in the Amazon, mainly because of their electric discharge of up to 860 volts. We report two cases of human injuries caused by electric eels, one of which was fatal. The shocks caused muscle rigidity, and the victim likely drowned because of muscle contracture. Strong electric shocks increase the levels of cardiac enzymes in the blood, as observed with the elevation of total creatine phosphokinase (CPK) and creatine phosphokinase myocardial band (CPK-MB) in surviving victims, which is potentially indicative of injuries caused by poraqués.