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.

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ABSTRACT Background: Human visceral leishmaniasis (HVL) is a neglected tropical disease that remains highly lethal if left untreated and continues to affect public health. In Brazil, Leishmania infantum is the main etiological agent, and domestic dogs are considered the primary reservoir. Considering the historic importance of leishmaniasis in Brazil, we aimed to gather information on the epidemiology of HVL in Brazil over 20 years. Methods: We conducted an integrative review through a bibliographic survey of articles published between 2002 and 2022. Results: The process resulted in the inclusion of 75 studies. Most of these studies reported data from the northeastern region, which continues to present the highest incidence rates nationwide. Most cases were concentrated in men and children under 10 years of age, particularly in urban and peri-urban areas. Although national case numbers have recently declined in Brazil, the persistence of endemic areas, driven by poverty, inadequate sanitation, deforestation, and unplanned urban growth, underscores the ongoing public health relevance of HVL. Conclusions: The ongoing spread of HVL and variation in its occurrence across regions underscore the unequal impact of the disease. HVL is not only a parasitic infection but also a manifestation of broader structural inequalities.

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ABSTRACT Sporotrichosis is a fungal infection caused by species belonging to the genus Sporothrix. It primarily affects domestic cats, which are considered definitive hosts, and can be transmitted to humans and other animals in various regions worldwide. We compiled information on the clinical aspects, diagnoses, clinical manifestations, prevention, and therapeutic management of cases reported in the literature between 2018 and 2022. The databases used were BVS-Bireme, PubMed, Scopus, and Web of Science. In total, 121 studies were included. S. brasiliensis emerged as the most prevalent species, although S. schenckii and S. globosa were also reported. This analysis highlights the global increase in zoonotic sporotrichosis and reinforces the importance of collaborative public health strategies based on the One-Health concept.

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ABSTRACT This article reviews the trypanocidal therapy for chronic Chagas disease, emphasizing its indications, efficacy, limitations, and future perspectives. The etiological treatment is based on the use of benznidazole and nifurtimox, both of which were developed over five decades ago. These drugs are most effective in the acute phase, but are also recommended for children, adolescents, and adults aged <50 years without severe organ damage, and women of childbearing age to prevent congenital transmission. Adherence to treatment is limited by adverse drug reactions, which affect approximately half of the patients, leading to treatment discontinuation in approximately 30% of cases. The cure criteria included parasitological, serological, and clinical responses that required long-term follow-up. Clinical trials and systematic reviews have shown heterogeneous results that are influenced by age, clinical stage, and geographical region. Recent public policies supported by non-governmental organizations and academic networks have expanded access to diagnosis and treatment, although structural and informational barriers persist. New therapeutic strategies include shortened benznidazole regimens, drug repositioning, and combination therapies aimed at reducing adverse drug reactions and improving efficacy. Novel molecules with distinct mechanisms and vaccines with therapeutic and preventive potentials are under investigation. Despite these advances, the challenge remains in translating these innovations into concrete benefits for affected populations, particularly in the most vulnerable regions.

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ABSTRACT Tuberculosis (TB) is among the oldest and deadliest infectious diseases, particularly when associated with human immunodeficiency virus (HIV) and antimicrobial resistance. Despite the progress in prevention, diagnosis, and treatment, global elimination remains elusive and is driven largely by socioeconomic inequalities and systemic challenges. Although scientific research is a cornerstone of the WHO End TB Strategy, it has been chronically underfunded and undervalued in Brazil’s health agenda. One critical consequence is the weakening of pipelines for future TB research. Funding shortages, lack of incentives, and the shifting attention toward s other emerging diseases have made it increasingly difficult to recruit and retain scientists in the field of TB. This opinion paper aimed to explore the historical role of Brazilian science in advancing TB control while addressing the emerging crisis of renewing the country’s TB scientific workforce. We conducted a narrative synthesis of the available literature, reviewing impactful peer-reviewed articles produced by Brazilian scientists in the field of TB science, alongside official documents from the Brazilian Ministry of Health. This was complemented by a bibliometric analysis of the output of TB-related PhD theses (2016-2024) and PubMed-indexed publications (2001-2024) from Brazilian institutions. Finally, we discuss the systemic barriers affecting early career researchers and outline strategies for revitalizing interest and sustaining scientific progress. These include targeted TB research funds through public-private partnerships, structured mentorship programs, and competitive early career fellowships. Such interventions are essential for reversing the current decline in TB research engagement and ensuring that Brazil continues to contribute to global TB elimination efforts while preserving its scientific legacy.

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ABSTRACT Digital technologies and artificial intelligence (AI) have become integral in many fields, including medicine. Neglected tropical diseases transmitted by vectors, such as arboviral diseases, spotted fever, Chagas disease, and leishmaniasis, pose a significant impact on public health, particularly in the Americas. Strengthening surveillance and control requires the use of digital technology to identify vectors. In this study, we explored how AI can aid in identifying vectors in the Americas and strengthen disease surveillance and control efforts. We reviewed the literature on the automated identification of triatomines, mosquitoes, sand flies, and ticks, focusing on advances in the Americas over the last 10 years, and provided a critical analysis of the automated identification systems for each group. Moreover, we analyzed the development stages of each study: image acquisition, image processing, algorithm training, algorithm testing, app development, app availability, and AI-based devices for vector identification and surveillance. Most studies have applied AI to identify mosquito species. The vector species databases were not diverse, and the most representative group was Triatominae, comprising 65 species (41% of all described species). Currently, approximately 30 algorithms are used for automated vector identification, with the most common being AlexNet, MobileNet, and ResNet. Most studies are in the algorithm training stage, and in the Americas, only one study has progressed to the development of applications or devices. These results highlight the potential of AI for identifying vectors in the Americas, supporting the use of automated visual identification systems as a promising approach to improve vector surveillance, while also promoting citizen science.

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ABSTRACT Acinetobacter baumannii is a gram-negative opportunistic pathogen associated with high morbidity and mortality in nosocomial infections, particularly in intensive care units. Multidrug resistance (MDR) is mediated by efflux pumps, lipopolysaccharide modifications, aminoglycoside adenylyltransferases, FosA, structural alterations, and production of enzymes that inactivate antibiotics, such as carbapenemases. These factors limit the therapeutic options and increase clinical challenges, as there are currently few drugs or combinations with therapeutic success against A. baumannii infections. Some strategies and new drugs, such as cefiderocol, eravacycline, sulbactam-darlobactam, tigecycline, and their combinations with colistin, are being tested and have shown apparent advances. This integrative review discusses the current resistance mechanisms and emerging therapeutic strategies aimed at overcoming the growing threat posed by MDR A. baumannii.

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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.

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ABSTRACT We examined the recent surge in misinformation surrounding giant hammerhead flatworms (Bipaliinae, primarily Bipalium kewense), which has generated widespread confusion across multiple countries regarding their risks to human health. Prompted by a routine taxonomic identification, this study aims to restore scientific accuracy and address the growing disconnect between science and the public concerning these worms, which have become an Internet sensation. In late 2023, we were asked to identify specimens collected in Pedro Leopoldo, Minas Gerais, Brazil, that had already attracted considerable online and regional media attention, warning of a “new, invasive, and dangerous worm” and its supposed threats. After confirming the species was B. kewense, we reviewed the literature, constructed a timeline of scientific and media reports, and compared information retrieved from Google News and Google Scholar. Our findings indicate that while academic research on invasive species has steadily increased, sensationalized and often inaccurate content on hammerhead worms proliferated in the general media, particularly between 2017 and 2018. Notably, claims (2023-2024) regarding the toxicity of Bipalium spp. lack scientific support. This case illustrates the broader challenges of health misinformation in the digital age, where misleading narratives rapidly transcend countries and languages. We discuss potential drivers, including communication gaps between academia and the public, the influence of media and social networks, and behavioral factors underlying misinformation. Finally, we highlight the urgent need for innovative strategies and coordinated efforts to strengthen online science communication and ensure the dissemination of accurate information.

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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.

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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.

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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.

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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.

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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.

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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.

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ABSTRACT Background: Rabies poses a serious public health challenge in Brazil, and its epidemiology has undergone significant changes over the past two decades. Although canine transmission of rabies has been controlled through national vaccination programs, new risks have emerged, particularly from wildlife reservoirs. Methods: We performed a retrospective analysis of human rabies cases reported in Brazil between 2001 and 2025 using epidemiological surveillance data, scientific literature, and public health reports. We focused on trends in transmission sources, changes in affected populations, and challenges in prevention and treatment, particularly regarding the availability of post-exposure prophylaxis (PEP). Results: A total of 188 human rabies cases were reported in Brazil between 2001 and 2025 (average: 7.52 cases per year). Most of the cases occurred in the northern and northeastern regions of the country. Bats were the most common source of transmission, followed by dogs and non-human primates. Although rabies is preventable, most of the cases reported within the study period resulted in death. PEP was administered in most cases; however, the treatment may have been delayed, incomplete, or initiated after the onset of symptoms, which limited its effectiveness. Only two patients survived, and both of them received intensive care and were treated using modified therapeutic protocols. Conclusion: The transition from canine- to bat-mediated rabies highlights the need for enhanced surveillance and targeted prevention strategies. Despite advances in canine rabies control, ensuring PEP accessibility and strengthening public health interventions in high-risk areas remain critical for reducing the incidence of human rabies in Brazil.

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ABSTRACT Background: This study aimed to assess the clinical and economic impacts of blood culture contamination in a hospital situated in a low-middle-income country and the breakeven to implement strategies to avoid unnecessary antimicrobials. Methods: This economic cross-sectional study was conducted at a tertiary hospital, and 8,072 blood cultures were analyzed. Antibiotic duration and cost were calculated in United States dollars (USD). A simulation with a breakeven curve to determine the balance between antimicrobial costs and time-to-result of coagulase-negative staphylococci in one blood culture (suggestive of contamination) was used to define the breakeven point between the cost of the diagnostic tests or prevention strategies and the balance with antimicrobial expense. Results: Of the 8,072 blood culture samples collected, the contamination rate was 9.9%. Antimicrobial therapy was initiated in 69.6% of the 682 cases of contamination. The median duration of unnecessary antibiotic use was 7 days. The direct costs totaled USD 83,910 annually, comprising USD 73,970 for unnecessary antimicrobials and USD 9,940 for microbiological tests. The extended length of hospital stay potentially contributed to an additional USD 3.87 million in annual hospital costs. Conclusions: This study underscores the urgent need for strategies to reduce blood culture contamination, and emphasizes the potential benefits of rapid identification techniques for optimizing patient care and healthcare resource utilization. Addressing this issue is of paramount importance for mitigating unnecessary antibiotic exposure, reducing healthcare costs, and improving patient outcomes.

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ABSTRACT Background: Patients with chronic Chagas cardiomyopathy (CCC) may present with fatigue and dyspnea, which contribute to functional impairment. However, simple and inexpensive methods for evaluation of functional impairment and identification of left ventricular (LV) systolic dysfunction in patients with CCC are lacking. The Human Activity Profile (HAP) has potential in functional evaluation of patients with CCC. This study was conducted to analyze the association between HAP, functional parameters, and LV systolic dysfunction in patients with CCC, and to demonstrate the accuracy of HAP in identifying LV systolic dysfunction in patients with CCC. Methods: One hundred and twenty-six patients with CCC (NYHA I-III, 18.9% with LV systolic dysfunction) were evaluated using echocardiography, the 60-second sit-to-stand test (STS60, for lower limb strength and endurance), and the HAP questionnaire. In addition, the gait speed and handgrip strength of each patient was measured. Results: HAP score was correlated with gait speed (r=-0.206; p=0.023), STS60 score (r=0.199, p=0.030), and handgrip strength (r=0.315, p<0.01). Binary logistic regression showed that HAP score was the only functional variable associated with LV systolic dysfunction. Patients with LV systolic dysfunction (n=24) had lower HAP scores than those without LV systolic dysfunction (n=102) (p <0.01). The area under the ROC curve indicated that HAP score had an acceptable discriminatory ability to identify LV systolic dysfunction in patients with CCC (AUC=0.713). The optimal cut-off HAP score for identifying these patients was <56 points. Conclusion: HAP score is associated with LV systolic dysfunction in patients with CCC.

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ABSTRACT Background: The genetic diversity of Trypanosoma cruzi and the epidemiological characteristics of the environments in which the parasite occurs are essential for understanding infection dynamics and controlling Chagas disease. This systematic review aimed to: (i) identify and analyze studies that evaluated the genetic variability and epidemiological aspects of T. cruzi infection in the state of Rio Grande do Norte, Brazil; (ii) summarize the information reported in the literature; and (iii) suggest new control strategies tailored to the region’s epidemiological profile. Methods: Following the application of inclusion and exclusion criteria, 13 studies catalogued in PubMed, the Brazilian Virtual Health Library, Scopus, and the Web of Science were selected. Results: T. cruzi isolates were primarily obtained from triatomine species Triatoma brasiliensis, Panstrongylus lutzi, and Triatoma pseudomaculata, as well as from wild mammals such as Euphractus sexcinctus, Galea spixii, and humans. A total of 295 T. cruzi isolates were genotyped: 46.5% (137) were identified as Discrete Typing Unit (DTU) I, 29.1% (86) as DTU II, and 20% (59) as DTU III. Mixed infections were detected in 4.4% (13/295) of hosts. Triatomine species were found in both peridomestic and intradomestic environments and were occasionally infected with T. cruzi. Conclusions: This review provides a comprehensive overview of the circulation of distinct Trypanosoma cruzi genotypes (I, II, and III) in both wild and human-modified environments in Rio Grande do Norte.

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ABSTRACT Background: Long COVID, which refers to persistent symptoms following acute COVID-19, is being increasingly reported. However, available data regarding its prevalence and characteristics are limited. This study was conducted to evaluate the occurrence and presentation of long COVID in patients with COVID-19 who were followed up in outpatient, ward, or intensive care settings. Methods: This study included patients who were diagnosed with COVID-19 at least four weeks prior to the start of the study. The patients underwent symptom assessment at baseline and 1, 3, 6, and 12 months post-infection. Functional status was evaluated using the Post-COVID-19 Functional Status (PCFS) Scale, and quality of life was assessed using the SF-36 Health Survey questionnaire. Results: A total of 134 patients (71 males [54.2%]), with a mean age of 43.7 (15.3) years, participated in this study. The distribution of patients across care settings was as follows: 51.1% outpatients, 35.9% in wards, and 13% in intensive care units (ICUs). Fatigue during exertion was the most frequently reported long COVID symptom. Patients treated in ICUs experienced a higher burden of long COVID symptoms than those treated in outpatient or ward settings. Furthermore, patients treated in ICUs and wards had a significantly poorer quality of life and functional status than the outpatients. Conclusions: Long COVID poses a significant ongoing health concern, particularly for patients who require intensive care during acute COVID-19. Vigilant monitoring of long-term sequelae, particularly those that affect quality of life and functional status, is crucial for individuals recovering from COVID-19.

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ABSTRACT Background: In the western region of Pará (Brazil), the clinical manifestations of scorpionism exhibit unique characteristics, and there is currently no proposal for a quantitative assessment of this condition. This manuscript proposes and applies a classification system for assessing the severity of scorpionism, comparing it with the system used by the Ministry of Health. Methods: This quantitative, descriptive, observational, cross-sectional study evaluated victims of scorpionism treated at the Municipal Hospital of Rurópolis in Pará, Brazil. Clinical and therapeutic data were collected using instruments and scales, particularly the International Cooperative Scale for the Evaluation of Ataxias. Results: Thirty-four patients were assessed between January and July 2023. The majority were young males. All presented with pain, an 'electric shock sensation' and myoclonus. Muscle spasms were observed in 65% of patients, postural changes in 64%, dysmetria in 55%, altered eye movements in 50%, and dysarthria in 44%. While these manifestations are transitory, they cause significant discomfort to the patient. The classification proposed in this study was compared to the Ministry of Health's Severity Classification, and low agreement between the two classifications was shown (only in 50% of cases). The proposed classification raised the severity of 17 patients by one degree: fifteen from mild to moderate and two from moderate to severe, one of whom developed rhabdomyolysis and acute kidney injury. Conclusions: The proposed classification was beneficial and could be used in the future to assess the effectiveness of therapeutic interventions for this frequent and neglected condition in the Amazon.

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ABSTRACT Background: Chagas disease, an anthropozoonosis endemic to Latin America, is caused by Trypanosoma cruzi and is a serious public health concern. Methods: We investigated the natural infection of triatomine bugs, genotyped T. cruzi, and identified the blood meal sources of the infected vectors in the Medio Araguaia region of Mato Grosso, Brazil. Results: In total, 235 triatomines were identified. The highest triatomine occurrence (95.7%) was observed in the municipality of Barra do Garças. The most prevalent species was Triatoma williami (89.7%), followed by Rhodnius neglectus (8.8%), Panstrongylus geniculatus (0.88%), and Panstrongylus diasi (0.44%). Barra do Garças showed a high rate of natural infection by T. cruzi (65.7%). Four discrete typing units were identified in the infected insects: TcIV and TcII strains in T. williami, and TcI and TcIII associated with R. neglectus and P. geniculatus, respectively. Regarding blood meal sources, T. williami, P. geniculatus, and R. neglectus predominantly fed on birds and rodents. However, human blood was detected in 32.8% of the insects. Conclusion: Overall, these findings indicate a high risk of Chagas disease vector transmission in the municipality of Barra do Garças, highlighting the need for innovative approaches to control and prevent this disease.

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ABSTRACT Background: In this study, we aimed to describe the mutations associated with first-line drug resistance in Mycobacterium tuberculosis complex (MTBC) isolates from São Paulo, Brazil, between 2019 and 2021. Methods: Mutations in the coding regions of rpoB and katG genes and in the promoter region of the inhA gene in MTBC clinical isolates were detected using the GenoType MTBDRplus assay (LPA). All mutations inferred by LPA were sequenced. Results: Of the 13,489 MTBC isolates with valid LPA results, 657 (4.9%) harbored mutations. The overall prevalence rates of rifampicin-resistant (RIF-R) tuberculosis (TB), isoniazid-resistant (INH-R) TB, and multidrug-resistant (MDR) TB were 1.5, 2.0, and 1.2%, respectively. A significant proportion of RIF-R isolates presented inferred rpoB mutations (89.1%), most of which were the borderline H445N mutation. The inhA promoter C-15T mutation was predominant among the INH-R isolates (52.8%). Most MDR isolates presented rpoB S450L + katG S315T1 mutations. Gene sequencing identified mutations not included in the catalogue of mutations published by the World Health Organization. Phenotypic drug susceptibility testing on isolates with inferred rpoB mutations revealed that the 0.5 µg/mL critical concentration of RIF failed to detect most borderline mutations when using the BACTEC MGIT 960 system. Conclusions: These findings emphasize the need for continuous surveillance and the integration of molecular and phenotypic methods to ensure an accurate detection and management of drug-resistant TB in high-burden settings.

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ABSTRACT Background: Latent tuberculosis infection (LTBI) is a significant concern among migrant populations, particularly Venezuelans, due to its adverse health and social conditions. This study aimed to construct and validate a predictive model of LTBI among Venezuelan migrants. Methods: This cross-sectional study utilized data from the project "TB and migrants in BRICS countries: The case of Brazil”, carried out in Boa Vista, Roraima, in 2020. The final sample included 427 participants. For the analysis, 22 variables were selected, and simple and multiple logistic regression analyses were applied. General measures (Nagalkerke's R2 and Brier’s score), discriminative capacity (accuracy, receiver operating characteristic curve, and area under the curve [AUC]), and calibration measures (Hosmer-Lemeshow test and calibration graph) were used to evaluate the model. The model was internally validated using bootstrapping. Finally, a nomogram and a clinical decision curve were constructed. Results: Six LTBI predictors (marital status, social benefit, documentation status, smoking status, presence of comorbidities, and fever) were included in the final model. The predictive model demonstrated moderate discriminatory capacity (AUC: 0.676), good calibration, and was also validated with an AUC of 0.678. Additionally, a clinical decision analysis revealed that the use of the model offers superior benefits compared with traditional treatment strategies. Conclusions: The predictive model and nomogram proved to be useful tools for LTBI screening in migrants, potentially guiding border health surveillance actions in this population.

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ABSTRACT Background: Piranhas are carnivorous fish that inhabit rivers in Central and South America, and they are popularly recognized as relentless hunters of continental waters. Their reputation as killers is fueled by folklore and cinematographic works, which contribute to the creation of myths, generation of fear among people, and the vilification of fish. Methods: We analyzed several media reports on piranha bites that occurred in Brazil, seeking to demystify these attacks as they are described in the lay press, using the injuries and circumstances observed as a basis. In addition, we highlighted human actions that directly affect piranha behavior. Results: Of the 711 cases reported in humans in the last 10 years, 82.27% were classified as mild, with single “punch-out”-shaped injuries associated with the behavior of males to protect nests and larvae in dams and lakes. Seasonal analysis revealed that 29.62% of attacks occurred during the breeding season and 25.92% were associated with improper disposal of food in rivers. Conclusions: Media coverage of piranha attacks tends to negatively reinforce popular perceptions of the behavior of these species toward humans, diverting attention from human responsibility for the environmental impacts that directly influence the occurrence of these injuries.

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ABSTRACT Background: To study the unfavorable outcomes of tuberculosis treatment, presenting individual, social, and program vulnerabilities in homeless, HIV-infected individuals and individuals living in areas of high social vulnerability in the city of São Paulo. Methods: Cases were reported, confirmed, and monitored using the tuberculosis control program in the city of São Paulo. Social vulnerability was assessed using the São Paulo Social Vulnerability Index (SVI). Individuals analyzed in the study with more than one vulnerability condition were allocated to more than one vulnerability group, and the outcomes were analyzed separately. The reference category included the remaining cases. The following outcomes were examined: death, treatment abandonment, tuberculosis recurrence, and drug resistance. Results: A total of 14,221 cases reported in 2019 and 2021 were studied; 11,322 lived in areas of high social vulnerability, 2,753 were HIV-infected, and 1,388 were homeless (the total exceeded 14,221, given that there were individuals with more than one vulnerability). All groups had higher incidence, prevalence, and mortality rates, as well as a higher risk of unfavorable outcomes. The risks were highest for homeless individuals, followed by HIV-infected individuals and those living in areas of high social vulnerability. Conclusions: Compared to individuals without the analyzed vulnerabilities, we found that unfavorable tuberculosis treatment outcomes were associated with different types of vulnerabilities, reflecting individual, social, and program vulnerabilities. Although the individuals studied had access to treatment, several vulnerabilities impacted the likelihood of successful treatment and challenged the tuberculosis control.

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ABSTRACT Background: Chikungunya is an emerging disease that significantly impacts global public health and is associated with various environmental and social factors. This study aimed to identify the spatial and spatiotemporal clusters of chikungunya in the state of Brazilian Bahia, as well as their relationships with environmental and socioeconomic variables. Methods: High- and low-risk clusters were analyzed for 2014-2023 using SatScan. Associations among socioeconomic, climatic, and vegetation characteristics were established using geostatistical estimates. Results: Many high-risk clusters were observed at high densities in the southern, north-central, and south-central mesoregions. The months with the highest risk were February and March. A decreasing chikungunya trend of −0.6% per year was identified in the Bahian territory when the spatial variation of the temporal trends was analyzed. High-risk municipalities within the spatial chikungunya clusters generally had higher minimum annual and summer temperatures, lower thermal amplitudes, higher monthly and average summer precipitation levels, and higher socioeconomic indicators. The lowest vegetation cover was observed in the Caatinga biome, and the highest in the Atlantic Forest. Conclusions: Bahia has many high-risk clusters for chikungunya, underscoring the need to strengthen preventive and control measures through coordinated epidemiological surveillance services across the state.

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ABSTRACT Background: Malaria remains a major public health concern, and sub-Saharan Africa accounts for a significant proportion of global cases. A key challenge in malaria control is the increasing resistance of malaria vectors to commonly used insecticides, particularly pyrethroids. This study assessed the susceptibility of Anopheles gambiae s.l. to permethrin and deltamethrin in Zuba, located in the Gwagwalada Area Council of Abuja, Nigeria. Methods: Mosquito larvae were collected in June 2024 and reared under controlled insectary conditions until adulthood. Adult mosquitoes were then tested using the Centers for Disease Control and Prevention bottle bioassays, and exposed to both standard World Health Organization recommended doses (21.5 µg/bottle for permethrin and 12.5 µg/bottle for deltamethrin) and lower, sub-lethal concentrations. Mortality rates were monitored up to 24 h post-exposure, and the results were analyzed using one-way analysis of variance at a significance level of P < 0.05. Results: At the standard dose, permethrin induced a mortality rate of 84.4% (21.10 ± 0.50) after 30 min, significantly higher (P = 0.031) than that observed at 15.0 µg/bottle (18.00 ± 0.00, 72%). Complete mortality was achieved only after 35 min. Deltamethrin caused a mortality rate of 76% at 30 min (19.00 ± 0.30), with 100% mortality observed after 40 min (P = 0.04). No mortality was recorded for sub-lethal doses (≤0.8 µg/bottle) after 24 h (P = 0.061). Conclusions: These findings highlight the resistance levels of permethrin and deltamethrin in An. gambiae s.l. population in Zuba. Routine resistance surveillance and tailored mosquito control strategies are essential for sustaining mosquito control efforts in this region.

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ABSTRACT Background: Imported malaria is regularly detected in Pernambuco, a nonendemic area, highlighting the need for surveillance by healthcare professionals. Methods: We performed a descriptive observational study of malaria cases reported in Pernambuco during 2001-2022. Results: Most of the 350 patients were men (75.1%) and Mixed-race individuals (51.1%), with a median age of 32 years. Most patients resided in urban areas (81.1%), and 32% had primary education. Travel- and construction-related activities were the primary sources of exposure, with most infections originating in Brazil (52%) or Angola (33%). The median interval from symptom onset to testing was 10 days for Indigenous individuals, 5 days for Black individuals, and 4 days for Mixed race and White individuals. The delay was also longer for those with lower educational levels (6.5 days for primary education vs. 3 days for higher education). However, multivariate analysis showed that ethnicity, educational level, and geographic displacement were not statistically significant predictors of diagnostic delay. The cases showed a significant seasonal pattern, with a higher incidence during the first half of the year (p=0.0382). Although the annual incidence showed a slightly declining trend, this was not statistically significant (p=0.138). Plasmodium vivax and P. falciparum were the predominant species, accounting for 49.7% and 47.5% of cases, respectively. Conclusions: Although disparities in median diagnostic times exist, multivariate analysis indicated that other complex factors are responsible for delayed diagnosis. Strengthening awareness among clinicians in nonendemic settings and ensuring timely testing are crucial for preventing severe outcomes and reducing malaria-related morbidity and mortality.

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ABSTRACT Background: Arboviruses, including dengue (DENV), Zika (ZIKV), and chikungunya (CHIKV), pose serious threats to neonatal health; however, the consequences of maternal peripartum infections, particularly those that are asymptomatic, remain poorly characterized. Methods: This hospital-based cross-sectional study investigated the adverse neonatal outcomes associated with maternal arbovirus infection among pregnant women hospitalized for obstetric complications in Northeast Brazil (October 2018 to May 2019). Maternal and neonatal data were collected through interviews and reviewing medical records. Acute/recent maternal infections were confirmed by molecular or serological assays. Associations between maternal infection (categorized as any arbovirus, ZIKV-only, or CHIKV-only) and neonatal outcomes were assessed using Poisson’s regression with robust variance, yielding adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs), controlled for maternal covariates. Results: Among 806 neonates, 131 (16.3%) were born to arbovirus-infected mothers and had a higher prevalence of prematurity (aPR=1.25, 95% CI: 1.00-1.56) and sepsis (aPR=1.74, 95% CI: 1.07-2.83) compared with those born to non-infected mothers. Neonates of ZIKV-infected mothers had a two-fold higher prevalence of sepsis (aPR=2.02, 95% CI: 1.00-4.11) than neonates of non-infected mothers, and a trend was observed for CHIKV (aPR=1.76, 95% CI: 0.97-3.20). Conclusions: In this hyperendemic region, a high frequency of newborns were exposed to maternal arbovirus infection during the inter-epidemic period, which was associated with increased premature births and neonatal sepsis. These findings underscore the need for increased clinical vigilance and routine screening in endemic areas, necessitating further longitudinal studies to confirm causality and guide management.

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ABSTRACT Background: Scorpion stings are a major public health concern in Turkey. This study aims to examine the demographic characteristics, clinical features, and treatment processes of scorpion sting cases in Şanlıurfa Province, located in the Southeastern Anatolia region of Turkey. Methods: This retrospective study analyzed patient data, including demographic profiles, clinical presentations, and treatment details of scorpion envenomation cases over a 5-year period (June 2019-June 2024), obtained from the Şanlıurfa Harran University Hospital Information Management System. Results: A total of 1,041 scorpion envenomation cases were analyzed. The mean age was 25.61 ± 18.50 years (mean ± standard deviation), and women (61.47%) comprised the majority of the patients. The age group of 1-17 years (39.38%) was the most affected. Most envenomation cases (63.4%) occurred during summer, and the extremities (29.5%) were the most commonly affected body regions. Most patients (94.1%) received outpatient treatment and were discharged within 24 h. Antivenom was administered to 12.0% of patients, and 15% were subjected to forensic evaluation. One patient (0.1%) developed cardiac arrest during follow-up and died. Conclusion: This study investigated the clinical and demographic characteristics of scorpion envenomation to highlight the importance of raising public awareness and implementing preventive measures in high-risk regions. It also emphasizes the critical medical and legal importance of examining the forensic aspects of scorpion stings and ensuring that physicians conduct appropriate evaluation in such cases.

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ABSTRACT Background: Delayed diagnosis remains a primary challenge in leprosy control, often resulting in severe physical impairment and significant psychological distress among those affected. The factors contributing to this delay are complex and multifactorial, encompassing both patient-related and healthcare system-related elements. To investigate the patient- and health system-related factors contributing to delayed diagnosis of leprosy in an endemic area of Northeast Brazil. Methods: This cross-sectional study included 247 leprosy patients. Demographic and clinical characteristics, along with data on patient- and health system-related determinants associated with delays in diagnosis, were collected. Univariate and multivariate Poisson regression analyses were performed to examine associations between the outcome (delay in months) and the independent variables. Results: The median time from the first healthcare visit to leprosy diagnosis was 15.0 months (interquartile range: 6.0-36.0). Approximately 17% of participants had grade 2 disability (G2D) at diagnosis. In the multivariate Poisson regression analysis, female sex, residence in rural areas, delayed healthcare seeking after symptom onset, lack of initial suspicion of leprosy, multiple referrals requiring four or more consultations before diagnostic confirmation, and prior misdiagnosis with treatment for another condition were independently associated with prolonged diagnostic delay. Conclusion: This study identified significant delays in leprosy diagnosis in Sergipe, Brazil, which may contribute to the persistently high proportion of new cases with G2D. Both patient- and health system-related factors were associated with longer diagnostic delays. Urgent interventions are warranted to increase disease awareness among the general population and strengthen the capacity of primary healthcare services.

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ABSTRACT Background: Chikungunya (CHIK) is an acute febrile arthritic illness caused by Aedes aegypti and Aedes albopictus mosquitoes. Understanding the pathophysiology of CHIK is crucial because of the wide distribution of cases and the lack of specific treatments or validated biomarkers. This study aimed to describe the cytokine profiles of female patients with laboratory-confirmed CHIK across the three clinical phases of the disease, monitored at an outpatient clinic in Northeastern Brazil. Additionally, this study evaluated whether cytokine levels were associated with persistent arthralgia and the presence of comorbidities. Methods: This was a prospective cohort study conducted from 2021 to 2024, including 40 female patients and 10 heathy controls (women aged ≥18 years, without comorbidities, not taking medications and non-reactive serologies for CHIK). Blood samples were collected at five time points (0, 21, 90, 180, and 360 days after the symptom onset). Results: More than half of the patients reported persistent pain. Among CHIK-infected women, interleukin (IL)-10 levels remained elevated from day 21, with statistically significant differences between D0 and D180 and D0 and D360 (p = 0.027). IL-18 levels increased significantly between D0 and D21 (p = 0.020). Conclusions: Dynamic cytokine behavior throughout the CHIK phase has been described in other studies and may be influenced by host immunogenetics and other factors.

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ABSTRACT Background: Schistosomiasis, caused by Schistosoma haematobium, is a neglected disease that affects millions of people, primarily in developing countries. Methods: We describe cases of urogenital schistosomiasis that occurred in Cabo Verde between 2022 and 2023 along with their possible associated risk factors. This analytical, cross-sectional study included 229 suspected cases. Results: Of 229 cases, 53 (23.1%) were confirmed. The most affected age group was 15-24 years, with an incidence rate of 12 cases per 1,000 inhabitants. Male patients were more affected, with a male-to-female ratio of 12:1. The most common symptoms were hematuria (58.7%) and dysuria (17.3%). The incidence of the disease was 6.8 times higher among individuals who had contact with water from tanks. Conclusion: This study revealed the emergence of urogenital schistosomiasis in Cabo Verde, highlighting the need to strengthen surveillance, prevention, and control measures.

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ABSTRACT Background: The rapid detection of drug resistance in Mycobacterium tuberculosis is essential for managing drug-resistant tuberculosis (DR-TB). This study evaluated the performance of molecular assays compared to phenotypic drug susceptibility testing (pDST) and targeted next-generation sequencing (T-NGS). Methods: We retrospectively analyzed 40 presumptive pulmonary DR-TB cases in Rio de Janeiro from 2018 to 2022. Xpert MTB/RIF Ultra (Xpert Ultra) and Line Probe Assay (LPA; MTBDRplus = LPA-1, MTBDRsl = LPA-2) were performed directly on clinical respiratory specimens, with pDST serving as the reference standard. T-NGS was used to identify resistance mutations and clarify discordant results. Results: Most samples (92.5%) were smear-positive. Xpert Ultra and LPA-1 demonstrated high sensitivity for detecting resistance to rifampicin (91.7% and 89.3%, respectively). However, LPA-1 exhibited lower sensitivity for isoniazid (81.5%). The performance of LPA-1 decreased in samples with cycle threshold (Ct) values ≥16, indicating low bacterial load (p = 0.001). T-NGS detected resistance to fluoroquinolones (22.5%) and injectables (15-20%) that was missed by LPA-2 and MGIT. Mixed infections were identified in 17.5% of samples and accounted for 27.8% of discordant results. Isoniazid heteroresistance was detected in 32.5% of samples by LPA-1 and in 7.5% by T-NGS. Conclusions: Xpert Ultra and LPA-1 are effective for the rapid detection of rifampicin resistance but have limitations for isoniazid and second-line drugs. T-NGS improved the detection of low-level resistance, heteroresistance, and mixed infections, supporting its implementation in reference laboratories for comprehensive DR-TB diagnosis.

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Abstract Background: Leishmaniasis undergoes geographic expansion in the Neotropical regions, driven by ecological and socioeconomic factors that contribute to urban and peri-urban outbreaks. Roadkilled wild mammals represent a potential source of eco-epidemiological data, and polymerase chain reaction (PCR)-based detection provides a sensitive tool for the surveillance of Leishmania spp. Methods: This study investigated the occurrence of Leishmania spp. in 40 roadkilled wild mammals collected along highways in the central-western and northern coastal regions of São Paulo State, Brazil between 2020 and 2022. Necropsies were performed on all specimens, and ear skin samples were collected for molecular detection of Leishmania spp. using primers targeting kinetoplast DNA (kDNA). Positive samples were further analyzed for species identification by PCR-restriction fragment length polymorphism (RFLP) targeting the hsp70 gene. Restriction patterns were compared with reference strains to confirm Leishmania species identity. Results: Leishmania spp. kDNA was detected by molecular diagnosis in skin tissue samples from several roadkilled wild mammals collected in the state of São Paulo. Subsequent species-level identification using hsp70 PCR-RFLP detected Leishmania infantum chagasi in a maned wolf (Chrysocyon brachyurus) and Leishmania amazonensis in a raccoon (Procyon cancrivorus). Conclusions: Wild mammals could be exposed to distinct Leishmania species across diverse ecological contexts, and examining roadkilled animals, combined with the molecular detection of parasites, proved to be an effective tool for passive Leishmania surveillance, highlighting the need for integrated investigations within a One Health framework.

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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.

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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.

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ABSTRACT Background: Leptospirosis is a serious zoonosis. In 2024, Rio Grande do Sul (RS) experienced floods affecting 93% of the municipalities and 8.8% of the population. In this study, we reviewed the leptospirosis notifications post-flooding. Methods: Descriptive quantitative study using secondary data from the RS Health Department Epidemiological Report. Results: A total of 7,129 suspected cases were reported, of which 788 were confirmed. Porto Alegre had the highest number of cases and Travesseiro had the highest incidence rate. Epidemiological weeks 20-24 peaked in cases and deaths (47 total cases), with significant municipal variation. Conclusions: The 2024 floods caused a significant increase in leptospirosis, underscoring the need for a One Health approach and strengthening public health policies.

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ABSTRACT Background: Chagas disease is caused by Trypanosoma cruzi and transmitted by kissing bugs. Methods: We investigated the presence of Panstrongylus megistus in Ilha Grande, RJ. The insects was analyzed for T. cruzi infection and blood meal sources (BMSs). Results: Morphological identification confirmed P. megistus. Molecular analysis revealed Gallus gallus as the BMS, with no T. cruzi infection. Conclusions: These findings represent the first record of P. megistus in the region, expanding its distribution, highlighting the need for continuous monitoring and implementation of physical barriers to reduce transmission risk. Strengthening health education and surveillance is crucial for preventing the disease.

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ABSTRACT Background: Chagas disease remains a public health problem in Guatemala, with ongoing transmission, both regionally and globally. Diagnosis is complex and often inaccessible. This study evaluated the performance of rapid diagnostic tests for Trypanosoma cruzi infection in Jutiapa. Methods: Three rapid tests were performed, and the results were compared with those of a diagnostic algorithm for chronic infection. Results: Although all tests had high specificity, their sensitivities were suboptimal. The combined use of RDTs (Rapid Diagnostic Tests) slightly improved the sensitivity, but it remained below the ideal thresholds. Conclusions: Further evaluation of RDTs is necessary to enhance access and simplify diagnostic algorithms.

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ABSTRACT Background: Erythema nodosum leprosum (ENL) is an immunological inflammatory reaction requiring precise management. Recalcitrant cases, their refractoriness to conventional therapy, and the adverse effects of standard treatments underline the need to explore alternative therapeutic options. Methods: We conducted a retrospective study of five patients treated with secukinumab between January 2023 and January 2025. Results: Patients showed clinical improvement with a reduced ENL frequency, neuritis relief, and corticosteroid sparing. Conclusions: Secukinumab appears to be a promising corticosteroid-sparing option for ENL, with a favorable safety profile. Further studies are required to confirm the efficacy and long-term safety of this treatment regimen.

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ABSTRACT Background: Aedes aegypti var. queenslandensis, a pale form of Aedes aegypti, is widespread in Asia and adapted to urbanized and warm environments. Methods: Two BG-Sentinel traps with BG-Lure were deployed in an urban forest fragment between December 19 and 24, 2024, to monitor mosquito vectors. Results: A total of 191 specimens of Ae. aegypti var. queenslandensis were collected, marking the first record of this variety in Macapá, Amapá. Conclusions: This finding suggests that the population was introduced via maritime transport and highlights the need to strengthen entomological surveillance and assess potential insecticide resistance in vector control efforts in Macapá.

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ABSTRACT Background: The collection of immature Sabethines from natural habitats is challenging. Objective: To develop a low-cost and effective trap using widely available materials. Methods: A perforated coconut endocarp filled with water was installed in the Atlantic Forest of Sergipe. Results: Sabethes albiprivus, Sa. batesi, Toxorhynchites theobaldi, and Wyeomyia nigritubus were identified after collection and rearing. Conclusion: The traps proved effective in collecting immature Sabethines and contributed to expanding the geographic range of Sa. batesi and Wyeomyia nigritubus. This method offers a new alternative for collecting sylvatic yellow fever vectors.

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ABSTRACT Background: We investigated the clinical profiles of patients with multibacillary leprosy treated with at least 12 doses of multidrug therapy (MDT), in whom intact Mycobacterium leprae bacilli were identified in skin biopsies. Methods: Clinical and therapeutic characteristics of 30 patients were analyzed, and their association with bacillary integrity was assessed. Results: Leprosy reactions were commonly observed. Two-thirds of patients completed treatment within 5 years. A strong association was observed between the 12-dose regimen and the presence of intact bacilli. Conclusions: Clinical and laboratory aspects should be considered when deciding to discontinue MDT, particularly if leprosy reactions occur.

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ABSTRACT Background: This study aimed to present historical trends and key epidemiological indicators of congenital syphilis in São Paulo, Brazil, from 1986 to 2023. Methods: This retrospective cross-sectional study used secondary data. Results: A total of 56,547 cases and 690 deaths from congenital syphilis were reported. The incidence rate steadily increased over time. The number of stillbirths and miscarriages also rose. Most cases of maternal syphilis infection were identified during prenatal care, and the rate of inadequate maternal treatment remained high. Partner treatment led to modest improvements. Conclusion: Despite improvements in prenatal care coverage and earlier diagnosis, the persistent rise in congenital syphilis incidence and mortality highlights ongoing gaps in maternal and partner treatment.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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ABSTRACT We report the case of a 17-year-old girl who was initially diagnosed with multiple sclerosis based on clinical and radiological findings and later confirmed to have neurobrucellosis via cerebrospinal fluid Brucella polymerase chain reaction positivity. Magnetic resonance imaging revealed demyelinating lesions consistent with multiple sclerosis, and Brucella infection due to epidemiological exposure was suspected. To the best of our knowledge, this is the first pediatric report of coexisting neurobrucellosis and multiple sclerosis. It underscores the diagnostic challenges in distinguishing between infectious and autoimmune demyelinating disorders, particularly in endemic regions, and highlights the importance of a comprehensive evaluation of atypical presentations.

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ABSTRACT Cutaneous leishmaniasis is endemic in Minas Gerais, Brazil; however, data on the circulating species remain limited. This study identified Leishmania species in he skin samples of patients in Montes Claros using molecular methods. Leishmania (Viannia) braziliensis was found in ten samples, and Leishmania (Leishmania) infantum in one, representing an unusual case of cutaneous leishmaniasis caused by L. infantum in an immunocompetent patient in the state. The patient, a 62-year-old woman presented with four atypical papular lesions on the arm, forearm, and back, with no systemic symptoms. These results highlighted the need for enhanced epidemiological surveillance.

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ABSTRACT Paracoccidioidomycosis (PCM), the most prevalent systemic mycosis in Brazil, is caused by dimorphic fungi of the genus Paracoccidioides and is acquired primarily through inhalation. PCM is associated with a high mortality, particularly among men living in rural areas. This case report describes a 47-year-old man with osteocutaneous involvement diagnosed by biopsy and direct fungal examination. The osseous form of PCM is rare and should be differentiated from other infections and neoplasms. Management involves prolonged antifungal therapy and follow-up for at least two years. This case highlights the diagnostic value of dermatological assessments in atypical presentations of PCM.

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ABSTRACT The reactivation of Chagas disease (RCD) by human immunodeficiency virus (HIV) is associated with high mortality and is a relevant public health problem in areas endemic for the causative agent of CD, Trypanosoma cruzi (T. cruzi). Here, we report a fatal case of meningoencephalitis caused by RCD involving the discrete typing unit (DTU) of T. cruzi I (TcI) in an HIV-coinfected patient from Paraná, Brazil. Based on computed tomography findings, a 55-year-old man initially underwent empirical treatment for neurotoxoplasmosis. However, Giemsa-stained cerebrospinal fluid and blood smears revealed T. cruzi trypomastigotes on direct microscopic examination. Protozoa were detected by fresh blood examination and blood culture. Additionally, anti-T. cruzi immunoglobulin G antibodies were detected in serum using a chemiluminescent immunoassay. Blood culture sequencing of cytochrome oxidase II confirmed the DTU TcI infection. Benznidazole therapy was administered for 76 d; however, the patient showed no clinical improvement and died nearly 7 months after hospital admission. The fatal outcome was likely related to delayed diagnosis and treatment, severe immunosuppression (CD4 = 39 cells/mm³), high viral load (94,638 copies/mL), and the involvement of TcI, which has been consistently associated with fatal RCD-related meningoencephalitis.