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ABSTRACT The Mycobacterium abscessus complex (MABC) includes non-tuberculous mycobacteria that are widely distributed and clinically significant. Similar to tuberculosis, MABC can lead to skin and soft tissue infections and pulmonary diseases. These infections frequently occur in outbreaks, particularly among immunocompromised patients or those with preexisting pulmonary conditions. This review examines the recent progress in essential areas that define these infections as a significant challenge in medical practice, specifically the diagnostic modalities, antibiotic treatment options, and resistance of MABC to antibiotics and biocides.

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ABSTRACT Visceral leishmaniasis (VL), caused by the protozoan parasite Leishmania (Leishmania) infantum, is transmitted in Brazil through the bites of female phlebotomine sandflies. Until 2008, no cases of autochthonous VL transmission were reported in the southern Brazilian states of Paraná (PR), Santa Catarina (SC), and Rio Grande do Sul (RS). The first case of canine VL (CVL) in RS was reported in 2008, followed by that of human VL (HVL) in 2009. Since then, CVL and HVL cases have emerged in 12 and five additional municipalities in the RS, respectively. In SC, CVL was first reported in Santa Catarina Island in 2010 and is now present in 44 of 89 localities. By 2014, CVL had appeared in western SC, with new cases reported in the midwestern and southern areas in 2021and 2024, respectively. Between 2017 and 2022, five autochthonous HVL cases were diagnosed in Florianópolis. In the PR, CVL was first reported in Foz do Iguaçu in 2012, followed by HVL in 2015. Although Lutzomyia longipalpis, the primary vector of L. infantum in Brazil, has been found in certain municipalities of RS and PR, it has not been reported in other endemic or vulnerable areas of RS and SC. This suggests that other sandfly species may also contribute to disease transmission. This highlights the urgent need for research on the diversity of hosts, vectors, and parasite strains, along with enhanced epidemiological surveillance to clarify the transmission dynamics of VL in these regions.

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ABSTRACT Colombia is entirely located within the tropical latitudinal zone and is characterized by extensive biodiversity, complex ecosystems, and socio-environmental inequities that contribute to the sustained persistence of a wide range of tropical diseases. Despite the high prevalence and public health impact of these conditions, tropical medicine is not currently recognized as a clinical specialty in Colombia, and its inclusion within infectious diseases residency programs remains limited, fragmented, and primarily hospital-centered. As a result, future specialists may complete their training with insufficient clinical experience in endemic tropical diseases, particularly those affecting rural and marginalized populations. Although research-oriented postgraduate programs in tropical medicine exist, clinical training and direct patient management are largely absent. In contrast, several countries in Europe, North America, and Latin America have adopted specialized educational models that integrate fieldwork, interdisciplinary curricula, and strong clinical components to strengthen expertise in tropical medicine. To reduce persistent health inequities and enhance national preparedness for emerging tropical threats, Colombia urgently needs to strengthen tropical medicine training, either by expanding and standardizing content within existing infectious diseases residency programs or by establishing a dedicated clinical postgraduate specialty. Strengthening academic and clinical capacity in this field would improve patient care, promote applied research, and support evidence-based strategies for managing tropical diseases nationwide.

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ABSTRACT Technologies are essential for surveillance of vector-borne diseases. The increasing frequency of triatomine house invasion in the Americas highlights the need to strengthen surveillance strategies. This narrative review examines how emerging technologies can improve identification and reporting of Chagas disease vectors. We analyzed studies published between 2015 and 2025 on digital tools for triatomine surveillance. Technologies were grouped by purpose: (1) identification apps (TriatoKey, TriatoDex, automated identification); (2) community engagement platforms (WhatsBarb, TriatoChat); and (3) institutional surveillance systems (SISVetor-Chagas, GeoVin, Triatomine Information Posts). We summarize their characteristics, applications, knowledge gaps, and potential integration with national surveillance systems, and discuss implications for public health policy. Digital innovation and citizen-based surveillance may support improved prevention and control of vector-borne Chagas disease.

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ABSTRACT During the COVID-19 pandemic, an unprecedented outbreak of mucormycosis affected tens of thousands of patients, mainly in India. This study reviewed the available published cases up to 2022 and updated the epidemiological curve up to November 2025. PRISMA-guided systematic review of PubMed, Embase, and SciELO (Dec. 2019-Dec. 2022), supplemented by official reports and cohort studies published until 2025. We analyzed 1,482 cases from 39 studies (90.8% conducted in India; 69.7% male individuals; mean age 52 years). Diabetes mellitus was present in >78% of patients, and 64.3% received corticosteroids. Rhino-orbital (40.7%) and rhino-orbito-cerebral (33.9%) were the dominant forms of mucormycosis. Amphotericin B was used in 49.5% of cases, and surgical debridement in 55.5%. The mortality rate was 25%. After 2022, the incidence collapsed globally: India dropped from >47,000 cases in 2021 to <100 cases/year; Europe, the Middle East, and Latin America reported zero outbreaks in 2024-2025. COVID-19-associated mucormycosis represented a major opportunistic infection during the acute phase of the pandemic. Although its incidence declined markedly after widespread vaccination implementation, improved corticosteroid use, and better glycemic control, it remains a serious and life-threatening condition in vulnerable populations. The findings highlight important risk factors, clinical challenges, and management considerations that remain relevant to inform current clinical practice and future post-pandemic scenarios.

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ABSTRACT In this review, we examine dengue outbreak prediction and warning systems, highlighting their methodologies, variables, key findings, and existing gaps in the literature. The study was conducted in five stages: a literature survey, definition of thematic scope and eligibility criteria, exploratory review, systematization and categorization of findings, critical analysis, and comparative narrative synthesis. We selected 14 articles on prediction and seven on warning systems, encompassing statistical models, machine learning, and deep learning, as well as systems applied in various countries, with a particular focus on Brazil. The results indicated that meteorological and climatic variables are the most frequently used, followed by epidemiological and entomological data. Models such as Random Forest and Long Short-Term Memory demonstrated superior predictive performance, especially for short-term forecasts of up to 1 week. Among the warning systems, classical methods, such as the Early Aberration Reporting System, offer simplicity and speed but provide shorter lead times. In contrast, systems such as EWARS-TDR and ADSEWS excel by integrating multiple data sources and providing longer lead times (up to 13 weeks). Despite considerable advancements, challenges related to data quality and availability, model replicability across different contexts, and implementation persist in public health systems.

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ABSTRACT Chagas disease remains a major neglected tropical disease in Latin America and represents a significant public health challenge in Brazil. The progression of Trypanosoma cruzi infection is highly heterogeneous and reflects a complex interaction between parasite persistence and host immune responses. This narrative review summarizes current knowledge on host immune responses and immune evasion mechanisms during T. cruzi infection and discusses their implications for the immunopathogenesis and clinical progression of Chagas disease. The review included publications indexed in major biomedical databases, prioritizing studies on innate and adaptive immunity, parasite evasion strategies, and associations with chronic disease manifestations. Evidence indicates that innate immune mechanisms involving macrophages, dendritic cells, and natural killer cells are critical for early control of parasitemia through cytokine production, including interferon-gamma and tumor necrosis factor-alpha. Adaptive immunity, particularly CD4⁺ and CD8⁺ T lymphocytes, contributes to parasite control but may also promote chronic inflammation and tissue damage when regulatory mechanisms fail. In parallel, T. cruzi employs multiple immune evasion strategies, including complement inhibition, modulation of antigen-presenting cells, intracellular persistence, and antigenic variability, which facilitate long-term survival in host tissues. These interactions are central to chronic immunopathology, especially Chagas cardiomyopathy. Understanding these processes may contribute to improved diagnostic strategies, support identification of immunological biomarkers associated with disease progression, and inform advances in clinical management and public health approaches.

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ABSTRACT Background: Sea urchins inhabit rocky areas and lagoons near tourist bathing sites. These animals have sharp spicules on their surfaces that cause injuries to bathers. Methods: Over 24 months, the author identified sea urchin species and mapped the beaches where injuries occurred. Samples of spicules were stored. In some patients, spicules were extracted using fine watchmaker's forceps. The intensity of pain and late infections were also recorded. Results: Sixty-two patients (48 men, 77.42%) experienced injuries. The plantar regions were affected in 58 (93.55%) patients. In 26 cases, spicules were collected, being of the species Echinometra lucunter, which is not venomous. Twenty patients were randomly selected for spicule extraction using No. 10 watchmaker's forceps. Larger fragments were easily and practically painlessly removed; however, the forceps were not fully effective for small fragments. Conclusions: Injuries caused by black sea urchins were the most common among those caused by marine animals in bathers. The unique species was Echinometra lucunter, which is not venomous. The penetration of spicules occurs mainly in the plantar regions and is a significant traumatic factor, with the possibility of secondary infections and foreign body granulomas. The use of No. 10 (watchmaker's) forceps was equivalent to the needle method but much less painful and traumatic. The creation of leaflets and the placement of posters at beaches with sea urchin colonies could prevent these wounds and should be attempted by the City Councils of coastal cities.

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ABSTRACT Background: Visceral leishmaniasis remains a significant public health burden in the Americas, particularly in Brazil and its border regions. This study aims to analyze the temporal trends and spatial clusters of visceral leishmaniasis in Brazilian border municipalities in 2013-2022. Methods: An ecological study was conducted, using secondary population-based data. Joinpoint regression was used to assess temporal trends and estimate the annual percentage change (APC). Kulldorff’s scan statistics identified spatial clusters and relative risks (RR). Results: During the period, 677 visceral leishmaniasis cases were reported in the border municipalities (average annual incidence rate: 0.58). The highest cumulative IR was observed among children and adolescents (10.05, 95% CI: 9.02-11.16), males (7.17, 95% CI: 6.50-7.88), and in the Central Arc 13.55, 95% CI: 12.25-14.95). Central Arc showed a decreasing trend from 2013-2020 (APC: -11.65%, 95% CI: -27.28-5.91) and an increasing from 2020-2022 (APC: 55.76%, 95% CI: 6.70-101.96), with RR rising 21.059 (2016-2019) to 34.310 (2020-2022). Persistent high-risk clusters were identified in the North Arc (RR: 100.529-156.040) and Central Arc (RR: 20.716-34.310), alongside a high-risk cluster in the South Arc near the Foz do Iguaçu triple border (RR: 3.466). Conclusion: This study revealed that visceral leishmaniasis in the Brazilian border region presents heterogeneous spatial and temporal patterns. Achieving effective disease control by 2030 will require strengthened health interventions and coordinated multilateral collaboration among neighboring countries, focusing on high-risk areas.

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ABSTRACT Background: Owing to the recent spread of the yellow fever virus in Brazil and imminent risk of its establishment in previously disease-free areas in the northeast of the country, epidemiological surveillance actions are necessary, including knowledge of non-human primate populations and the vectors that inhabit risk areas. The objective of this study was to evaluate the movement of sylvatic and urban yellow fever vectors between an Atlantic Forest fragment and its surrounding areas. Methods: The study site was the Mata do Junco Wildlife Refuge Conservation Unit (CU) in Capela, Sergipe, Brazil. Immatures were collected using ovitraps in the forested area and in peridomestic environments surrounding the CU. Results: Fourteen species were recorded, six of which were epidemiologically relevant. The main vectors of yellow fever in Brazil were present in the CU. Aedes albopictus (Skuse, 1894) was the most abundant species and was present in all studied environments. Aedes aegypti (Linnaeus, 1762) was not collected from forested areas. Among the native species, Haemagogus leucocelaenus (Dyar & Shannon, 1924) and Haemagogus janthinomys (Dyar, 1921) were collected only in the forested area of the CU, whereas Haemagogus spegazzinii (Brètes, 1921) was collected both in the forest and in the area around the CU. Conclusion: Exotic species circulate between wild and urban areas for feeding and oviposition, but circulation to the urban area is limited among native species.

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ABSTRACT Background: Surveillance of non-human primate (NHP) deaths is vital for the early detection of yellow fever (YF) and prevention of its spread to the human population. This study assessed the YF surveillance system for NHPs in the Brazilian Federal District (FD) from 2008 to 2022. Methods: A retrospective analysis of the aggregated data from 15 years of outbreak surveillance involving NHP deaths was conducted. The analyzed variables included spatiotemporal distribution, species, sex, age, sample collection, cause of death, and YF test results. Results: In total, 1,175 outbreaks involving 1,353 NHP deaths were recorded, averaging 1.35 animals per outbreak, in urban and peri-urban areas. Twenty YF-positive outbreaks were confirmed in 2008, 2015, and 2020, affecting 27 animals, mainly adult Callithrix spp., with an overall YF positivity rate of 2%. Surveillance coverage expanded across all administrative regions of FD, with 96.7% of NHP deaths sampled for YF and pathological analysis. Over the last 5 years, the rate of conclusive diagnoses has increased by 60%, with trauma and infectious diseases being the most common causes of death. Conclusions: The strategic location of FD reinforces the need for ongoing NHP death surveillance as an early warning tool for patients with YF. Continued enhancement of the diagnostic capacity and data integration is essential for strengthening the prevention and control efforts of YF in Brazil.

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ABSTRACT Background: Streptococcus agalactiae (commonly referred to as group B streptococci [GBS]) is a leading cause of neonatal infection. Surveillance of colonization in pregnant women and the use of intrapartum antibiotic prophylaxis (IAP) are the primary strategies for preventing early-onset GBS disease. The increasing rate of antibiotic resistance among GBS isolates is a concern for the effectiveness of IAP. Our study aimed to evaluate the prevalence of GBS colonization and characterize antimicrobial resistance patterns over a five-year period in a high-risk pregnancy referral center in Northeastern Brazil. Methods: This study was conducted from 2020 to 2024 and included pregnant women at 35-37-week gestation. GBS isolates from anal-vaginal swabs were identified and tested for susceptibility to penicillin or ampicillin, clindamycin, erythromycin, levofloxacin, and tetracycline. Isolates stored from 2021 to 2024 were further analyzed for the resistance genes mef(A), erm(A/TR), erm(B), tet(M), and tet(O). Results: Of 1469 anal-vaginal samples, the overall GBS colonization rate was 12%. All isolates were susceptible to either penicillin or ampicillin. The respective resistance rates for erythromycin, clindamycin, levofloxacin, and tetracycline were 23.6%, 9.3%, 5.4%, and 82.3%. The main determinant among macrolide-resistant isolates was mef(A), and tet(M) was the most frequent tetracycline resistance gene. Furthermore, we found that erythromycin resistance increased consistently over the five years, signaling a potential impact on clindamycin efficacy due to erm genes. Conclusions: Beta-lactams (penicillin and ampicillin) remained effective for IAP in northeastern Brazil during the study period. However, high and increasing resistance to other antibiotic classes reinforces the need for maternal GBS surveillance and ongoing antimicrobial resistance monitoring.

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ABSTRACT Background: Sporotrichosis is a neglected tropical disease caused by several species of Sporothrix, of which S. brasiliensis is the most virulent. Transmission primarily occurs through scratches, bites, or direct contact with exudates from infected cats and potentially through fomites. Methods: We evaluated the efficacy of different disinfectant solutions in eliminating S. brasiliensis from contaminated surfaces, including medium-density fiberboard (MDF), tiles, stainless steel, and polyester fabric, by simulating both domestic and clinical environments. Sterile 9-cm² sections were uniformly inoculated with a standardized yeast-phase suspension. After drying, the surfaces were treated with 70% ethanol, sodium hypochlorite, quaternary ammonium compounds, or laundry soap (fabric only). Samples were collected at 0-30 min and cultured in triplicate on Mycosel medium at 30°C. Fungal viability was determined microscopically to assess the disinfection efficacy. Results: Based on our results, 70% ethanol and bleach were the most effective disinfectants and recommended for use in both household and clinical settings. Bleaching displayed the highest efficacy, whereas 70% ethanol performed well. Other disinfectants demonstrated variable effectiveness depending on the exposure time and surface type. Conclusion: This study highlights the critical role of disinfection in mitigating the environmental transmission of sporotrichosis, thereby safeguarding both human and animal health.

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ABSTRACT Background: Visceral leishmaniasis (VL) is an infectious disease that represents a considerable public health problem. In Brazil, VL was gradually expanded in all the territory and from rural to urban areas. A notable concentration of VL emerged in 2010 in the Médio Paraíba region of the state of Rio de Janeiro, where the municipality of Barra Mansa is located. However, information on the geographic distribution of VL in this municipality is scarce. Therefore, this study aimed to characterize the spatial distribution of VL in Barra Mansa from 2014 to 2023. Methods: This exploratory epidemiological study involved creating point maps for human visceral leishmaniasis (HVL) and canine visceral leishmaniasis (CVL), as well as kernel density and cluster maps for CVL. In addition, maps were produced by superimposing the point maps of human cases with the cluster maps of canine infections. Results: In total, 99.1% of CVL-infected dogs and 100% of human cases were observed in the urban areas of the municipality. Persistent spatial clusters and hotspots were identified in urban areas adjacent to rural zones. Moreover, 55% of HVL cases were located within 600 m of a CVL spatial cluster. The closest clusters primarily formed up to 3 years before the HVL cases. Conclusion: These results suggest a relationship between urban-rural interface characteristics and high density of CVL. They also highlight the spatial and temporal closeness between CVL and HVL, corroborating the influence of these factors on the maintenance of the disease cycle.

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ABSTRACT Background: The São Francisco River Integration Project (PISF) may facilitate the spread of intermediate hosts of schistosomiasis to previously unaffected areas, potentially increasing disease transmission owing to human migration and environmental changes. This study aimed to describe the distribution of freshwater mollusk fauna along the river basins involved in the PISF in the state of Ceará. Methods: A descriptive cross-sectional study was conducted in three municipalities in the state of Ceará (Brejo Santo, Jati, and Mauriti) located along the Meta 2N axis of the PISF. Mollusks were collected from 21 water bodies near the resettlement areas (productive rural villages). Morphological identification of freshwater snails and screening for Schistosoma mansoni (S. mansoni) cercariae were also performed. Environmental variables were recorded, and the potential for transmission was assessed according to the Brazilian Ministry of Health guidelines. Results: Overall, 765 Biomphalaria specimens were collected, with Biomphalaria straminea being the only species identified. This genus occurred in all three municipalities and 85.7% of the surveyed water bodies. The other identified mollusk genera included Melanoides, Drepanotrema, Physa, Pomacea, and members of the class Bivalvia. No S. mansoni larvae were found, and only nonpathogenic trematode larvae were observed. Eight water bodies were classified as having a high epidemiological risk. Conclusions: The surveyed communities represent areas with the potential to sustain schistosomiasis transmission. These findings highlight the importance of developing intersectoral strategies to address the issue from a One Health perspective and to implement effective interventions in the areas impacted by the project.

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ABSTRACT Background: Chagas disease (CD) is a neglected endemic infectious disease. Primary health care (PHC) is responsible for delivering care to patients with CD in an integrated manner with other levels of the health system. We aimed to describe the use of implementation science (IS) as a tool for developing a care pathway for patients with CD from the perspective of the Brazilian Chronic Care Model (BCCM). Methods: This study was conducted in the large municipality of Minas Gerais, Brazil. A diagnostic phase was conducted to identify barriers and facilitators related to CD care. The findings from this stage were analyzed using IS frameworks. Subsequently, the BCCM was adapted as a logical model to guide the creation of a care pathway. Health managers and professionals from the municipalities were trained to implement the proposed actions. After implementation, process and outcome indicators were monitored over a 12-month period. Results: IS proved to be an effective strategy for applying BCCM to patients with CD in PHC settings. A total of 267 health professionals were trained. After the intervention, the following indicators increased: risk factor screening, serological testing, diagnosis, and antiparasitic treatment for CD. Conclusion: The development of a CD care pathway using IS tools integrated with the BCCM enabled the incorporation of processes into PHC and suggested that this model may be replicated in other contexts as well as for other chronic conditions requiring longitudinal care.

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ABSTRACT Background: Understanding SARS-CoV-2 seroprevalence among vulnerable populations is crucial, especially in countries with universal but resource-constrained healthcare systems, such as Brazil. Methods: This was a cross-sectional, population-based household survey within the AVISA study, which aimed to assess seroprevalence among households enrolled in the Family Health Program (ESF). Two serological assays (rapid test and ECLIA) were used to detect anti-SARS-CoV-2 antibodies. Descriptive statistics were calculated and survey-adjusted Poisson regression models with robust variance were estimated, yielding prevalence ratios (PRs) and 95% confidence intervals (CIs). Results: The overall weighted seroprevalence was 35.66% (95% CI: 30.55-40.77) in 2,986 participants. Compared with individuals in the Southeast region, participants in the Northeast and North regions had a 1.48- and 1.38-times higher prevalence of SARS-CoV-2 testing positivity, respectively. Relative to individuals who self-identified as having Black or Brown skin color using IBGE-defined categories, White had a 22% lower prevalence of seropositivity (PR = 0.78, 95% CI 0.63-0.97). Compared to those living in households with four to five family members, individuals living in households with six or more family members had a higher prevalence of seropositivity (PR = 1.34, 95% CI 1.05-1.71). Individuals in the lowest per capita household income quintile were more likely to have SARS-CoV-2 infection (PR = 1.89, 95% CI 1.21-2.95) than those in the highest. Conclusion: This study is the first to assess SARS-CoV-2 seroprevalence among ESF participants, a socioeconomically vulnerable population, served by the primary care public health system. Lower socioeconomic status was associated with higher seroprevalence.

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ABSTRACT Background: Oropouche fever (OF), caused by the Oropouche virus (OROV), has historically been endemic to the Amazon region; however, it is now emerging in other Brazilian states. This study describes the sociodemographic, clinical, and spatial characteristics of OROV cases identified in Minas Gerais in 2024 and contributes to the understanding of its transmission dynamics in non-endemic regions. Methods: This descriptive epidemiological study used the official surveillance data from the State Health Department of Minas Gerais (SES/MG). The confirmed cases were those with laboratory-confirmed OROV infection by RT-PCR at the Ezequiel Dias Foundation (FUNED). Demographic, geographic, and clinical data were analyzed using descriptive statistics. Exploratory comparisons by sex and age were performed. Results: A total of 278 confirmed autochthonous cases were reported across 10 municipalities, primarily in rural and peri-urban areas. Women accounted for 55.0% of the cases, with the highest incidence among adults aged 20-59 years. Two temporal peaks were observed at epidemiological weeks 15 and 50, corresponding to distinct clusters in Joanésia and Piau, respectively. Symptom recurrence occurred in 25.5% of the cases. Headache, myalgia, gastrointestinal symptoms, dysgeusia, pruritus, and skin lesions were more common in women than in men. Hypertension and diabetes mellitus were the most common comorbidities. More than half the participants reported the presence of domestic animals nearby. Conclusions: This study confirmed the geographic expansion of OROV in southeastern Brazil and identified distinct temporal and spatial transmission patterns. These findings underscore the importance of strengthened arbovirus surveillance, improved laboratory capacity, and integrated vector control strategies.

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ABSTRACT Background: Visceral leishmaniasis (VL) is an endemic and neglected disease in several countries. In addition to affecting the visceral tissues, kidney alterations are recurrent and result from the pathophysiological implications of infection or drug action during treatment. This review mapped and described renal changes, renal biomarkers, and treatment-related nephrotoxicity in humans with confirmed VL. Methods: This scoping review was conducted in accordance with the Joanna Briggs Institute Manual for Evidence Synthesis and the PRISMA-ScR guidelines. PubMed, SciELO, ScienceDirect, Scopus, and Web of Science. were searched with no temporal or geographical restrictions. We included studies involving humans with confirmed VL that reported renal alterations, kidney injury biomarkers, or treatment-related nephrotoxicity. Two reviewers independently screened the records and extracted data. Study selection was documented using the PRISMA-ScR flowchart. Results: In total, 1,444 studies were identified, of which 15 met the eligibility criteria. The included studies reported a wide spectrum of renal alterations in VL, including urinary abnormalities, kidney injury biomarkers, and acute kidney injury. Glomerular and tubulointerstitial changes, such as mesangial alterations, membranoproliferative patterns, cryoglobulinemia, interstitial nephritis, and impaired urinary concentrating ability, have also been described. Reports have also addressed the potential treatment-related nephrotoxicity. Conclusion: This scoping review identified diverse renal alterations in patients with VL, ranging from functional changes and urinary abnormalities to glomerular and tubulointerstitial involvement. Evidence has also described biomarkers of kidney injury and potential treatment-related nephrotoxicity. The heterogeneity and limited data highlight the need for robust research to clarify the underlying mechanisms, diagnostic markers, and optimal management.

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ABSTRACT Background: Dengue remains a major public health concern in Brazil, with approximately 6 million cases and over 6,000 deaths reported in 2024. Joinville, in southern Brazil, recorded one of the highest incidence rates in the country. Understanding the clinical and demographic factors associated with dengue-related mortality in this region is essential for developing effective interventions. Methods: We conducted a retrospective matched case-control study using data from the Sistema de Informação de Agravos de Notificação database, involving adult patients with dengue who presented with warning signs or severe disease and were treated within Joinville's public health system (Sistema Único de Saúde) between January 2021 and December 2024. Cases were defined as fatal outcomes, while controls were matched survivors. Univariate and multivariate logistic regression models were used to estimate mortality risk. Results: Among 454 patients, 116 (26%) were cases and 336 (74%) were controls. Lower mortality was associated with having ≥ 2 medical consultations (odds ratio [OR] = 0.20; 95% confidence interval [CI]: 0.10-0.51) and receiving intravenous hydration of ≥ 1 L (OR = 0.32; 95% CI: 0.14-0.72). Hypotension (OR = 3.06; 95% CI: 1.33-7.03), thrombocytopenia (OR = 2.47; 95% CI: 1.21-5.02), and lethargy or irritability (OR = 15.59; 95% CI: 6.50-37.38) were significantly associated with mortality. Conclusions: Early intravenous rehydration and repeated clinical evaluations were associated with reduced mortality. Close monitoring of patients with warning signs is crucial for improving outcomes in high-incidence settings.

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ABSTRACT Background: Tuberculosis remains a major public health challenge that exerts substantial pressure on healthcare systems worldwide. Despite advances in diagnosis and treatment, the proper management of latent tuberculosis infection (LTBI) remains inefficient, especially among vulnerable populations. In the State of Santa Catarina, Brazil, the absence of comprehensive and specific records on LTBI prevalence in these at-risk groups limits effective public health planning and interventions. Methods: Interferon-gamma release assay (IGRA) test records in the State of Santa Catarina, Brazil, contained partial information on risk factors for LTBI. Multiple imputations were used to estimate the likely risk groups among individuals without such information. The study was approved by the Human Research Ethics Committee under protocol number CAAE 79499224.4.0000.5361. Results: The estimated LTBI prevalence among individuals with available IGRA results was 6.89%, with higher rates among people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (18.25%) and immigrants (3.65%). Underreporting was notable among individuals deprived of liberty, those experiencing homelessness, those who use illicit drugs, and those with diabetes mellitus. Missing data were frequent among individuals living with HIV; people of African, Indigenous, or Asian descent; and those exposed to drug-resistant TB. More than 10% of LTBI cases occurred in children and adolescents aged <15 years. Conclusion: HIV was the most prevalent risk factor among IGRA-positive individuals and was substantially underestimated. An urgent expansion of LTBI identification efforts is needed for all vulnerable populations, with special attention paid to children and adolescents who present a high risk of progressing to active TB.

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ABSTRACT Background: Leishmaniasis is a neglected tropical infectious disease caused by protozoa of the Leishmania genus and transmitted by the bite of female sand flies. It may present with various clinical manifestations depending on species, parasite load, and host immunity. Recently, a geographic expansion of the disease has been observed, along with variations in clinical manifestations. Methods: We aimed to better define this clinical entity in the Brazilian context by describing leishmaniasis cases with atypical clinical manifestations treated at the Júlio Müller University Hospital in Cuiabá, Mato Grosso, between 2013 and 2023. Results: During the study period, 1,041 cases of cutaneous and mucosal leishmaniasis and 51 suspected cases of visceral leishmaniasis were recorded, of which 47 were classified as atypical (4.5%). Atypical presentations included localized cutaneous forms with unusual morphology (91.5%), mucocutaneous forms (4.2%), one case resembling post-kala-azar dermal leishmaniasis (2.1%), and one case of mucocutaneous lesions occurring after visceral leishmaniasis (2.1%), both of which are considered atypical in Brazil, where there is no endemic description of post-kala-azar dermal leishm aniasis. Most cases involved men aged 50-59 years, who were predominantly rural workers. These cases primarily originated from the Cerrado biome. The lesions had a median evolution of 120 d and mainly affected the lower limbs and face. Uncommon symptoms included fever, weight loss, and hepatosplenomegaly. Molecular identification of the etiological agent contributed to the diagnosis of selected cases. Conclusions: This study highlights the importance of recognizing atypical clinical manifestations of leishmaniasis to improve disease diagnosis and management.

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ABSTRACT Background: Most studies evaluating COVID-19 vaccine efficacy and effectiveness were conducted over short follow-up periods due to the urgency of vaccine approval and rollout during the pandemic. This study aimed to assess the long-term effectiveness of COVID-19 vaccines among healthcare workers at a tertiary hospital. Methods: We conducted an open retrospective cohort study at Hospital das Clínicas de Ribeirão Preto, including healthcare workers employed between July 3, 2020, and February 8, 2022. A total of 7,385 workers were followed for 3,185,239 person-days. Three monovalent vaccines were administered during the study period: Coronavac™ (Sinovac), Covishield™ (AstraZeneca), and Comirnaty™ (Pfizer-BioNTech). Participants were categorized as unvaccinated, partially vaccinated, or fully vaccinated. The unadjusted relative risk (RR) of COVID-19 was calculated for vaccinated groups compared with the unvaccinated group. Results: For COVID-19 of any severity, the RR was 0.72 (95%CI: 0.59-0.89) among partially vaccinated and 1.30 (95%CI: 1.19-1.44) among fully vaccinated workers. For severe or critical cases, the RR was 0.75 (95%CI: 0.26-2.16) with partial vaccination and 0.14 (95%CI: 0.05-0.41) with full vaccination. For COVID-19-related deaths, the RR with full vaccination was 0.32 (95%CI: 0.03-3.09). Conclusions: The vaccines provided limited long-term protection against SARS-CoV-2 infection and mild COVID-19. However, protection against severe disease and death remained substantial despite the circulation of multiple variants.

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ABSTRACT Background: Acute Chagas Disease (ACD) in the Brazilian Amazon exhibits a unique epidemiological profile characterized primarily by oral transmission. The state of Pará, recognized as the world's largest producer of açaí, represents an epicenter of the disease. This study aimed to analyze the epidemiological patterns of ACD cases in Pará and investigate the relationship between its seasonality and the açaí production chain. Methods: This epidemiological study used data on 2,762 ACD cases reported to the Notifiable Diseases Information System (SINAN) between 2013 and 2023. Sociodemographic and epidemiological variables were evaluated. Time series analysis was performed to determine seasonality and assess its correlation with variations in açaí prices. Results: Oral transmission accounted for 87.44% of cases. The predominant demographic profiles were males (54.16%) and individuals with parda (mixed-race) skin color (85.41%). Temporal analysis revealed a significant seasonal trend (p < 0.001), with a peak incidence projected at the end of September, coinciding with the açaí harvest season. A moderate negative Spearman correlation was observed between ACD case numbers and açaí prices (r = -0.413; p < 0.001), suggesting that increased supply and consumption are associated with a heightened risk of infection. Conclusions: The epidemiology of ACD in Pará is closely linked to the açaí production cycle, confirming its role as the principal mode of oral transmission in the region. These results underscore the importance of public health policies focused on food safety and effective management practices throughout the entire açaí production chain to prevent new cases.

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ABSTRACT Background: The current prevalence and factors associated with non-vaccination in children born between 2017 and 2018, considering vaccination status up to 24 months of age in the State of Ceará, should be assessed to justify the need to identify the population eligible for timely vaccination with valid doses to ensure optimal protection against vaccine-preventable diseases. This study aimed to estimate the prevalence and analyze the sociodemographic factors associated with non-vaccination among children born between 2017 and 2018 residing in Fortaleza and Sobral, Ceará State, Northeast Brazil. Methods: A population-based household survey of the 2017-2018 birth cohort was conducted using cluster sampling in Fortaleza and Sobral. The prevalence of non-vaccination, including no-dose and incomplete-dose categories, was estimated using prevalence ratios from Poisson regression with robust variance and survey design adjustment. Results: Of the children, 54.55% were not fully vaccinated, and 9.91% did not receive a single valid dose of any vaccine (Fortaleza: 10.46%; Sobral: 2.71%). Missing doses were mainly for meningitis (29.14%), rotavirus diarrhea (25.46%), and pneumonia and meningitis (24.44%). Non-vaccination was associated with maternal ethnicity, specifically White (Caucasian) (aPR, 2.07; 95% CI, 1.08-3.94; p = 0.028), and with the use of private vaccination services (aPR, 1.72; 95% CI, 1.46-2.04; p < 0.001). Conclusions: Non-vaccination was highly prevalent among children born between 2017 and 2018 in Ceará. The findings highlight the need to strengthen and reorient vaccination efforts across sectors and to implement catch-up strategies for children who missed valid doses.

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ABSTRACT Background: Leishmaniasis, a neglected disease caused by Leishmania protozoa, is transmitted by phlebotomine sand flies and has a significant public health impact. The municipality of Unaí, Minas Gerais, reports human and canine cases of leishmaniasis; however, entomological data remain limited. This study aimed to describe the local phlebotomine sand fly fauna and environmental and climatic factors influencing its occurrence. Methods: Sampling was conducted monthly from January to December 2024 in ten households distributed across seven neighborhoods of Unaí. HP light traps were installed in both intradomestic and peridomestic regions. The captured specimens were morphologically identified and statistically analyzed to assess their association with environmental and climatic variables using mixed-effects linear models. Results: Overall, 504 phlebotomine sand flies, representing 11 species, were captured. Lutzomyia longipalpis (39.7%) was the most abundant species, followed by Ev. lenti (33.3%) and Ny. intermedia (15.3%). The peridomestic areas exhibited greater species diversity and abundance, particularly in the presence of chicken coops, organic matter, and vegetation. Temperature is positively associated with Lu. longipalpis and Ev. lenti, whereas precipitation negatively affected Ny. intermedia. Males comprised 69.8% of captured specimens, suggesting the presence of active breeding sites near the households. Conclusions: This study provides the first record of the phlebotomine sand fly fauna in Unaí. Environmental conditions favor vector species in settings with close human-animal interactions, increasing the risk of domiciliary transmission. These findings highlight the importance of sustained entomological surveillance and environmental management measures as complementary strategies to control leishmaniasis.

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ABSTRACT Background: Although alternatives to the Kato-Katz (KK) method for the diagnosis of schistosomiasis are not widely available, other egg detection methods may have a role, especially considering the immediate need for confirmatory diagnosis and management of individual patients. One such widely available and easy-to-perform option is the Lutz method. We aimed to compare the diagnostic accuracy of KK and Lutz to support clinical decision-making. Methods: We conducted a systematic review searching PUBMED, EMBASE, and LILACS databases. We included primary diagnostic accuracy studies comparing KK and Lutz. No restriction was imposed on the type of test used as the reference standard. QUADAS-2 and QUADAS-C tools were used to assess the risk of bias and applicability, and GRADE was used to assess the certainty of evidence. The primary outcomes were sensitivity and specificity. Due to clinical and methodological heterogeneity, a meta-analysis was not performed. Results: Out of 1,060 citations, three studies were included in our review. The studies were cross-sectional and conducted in Brazil and Ethiopia. The sensitivity of Lutz ranged from 0.34 to 0.81, while that of KK ranged from 0.64 to 0.84. Specificity for both tests ranged from 0.81 to 1.0, with no significant differences observed between the diagnostic tests evaluated. Limitations included inconsistent reference standards, lack of blinding, and small sample sizes. The certainty of evidence ranged from very low to moderate. Conclusions: Data on the relative accuracy of the KK and Lutz methods for schistosomiasis diagnosis are limited. The current evidence is insufficient to determine the best method.

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ABSTRACT Background: Chagas disease affects multiple dimensions of human functioning, requiring assessments that extend beyond the biomedical model. The International Classification of Functioning, Disability and Health (ICF) offers an integrative framework for capturing these impacts. This qualitative study aimed to identify, from the perspective of adults diagnosed with Chagas disease, the aspects of functioning most relevant to them, as a step toward developing an ICF Core Set for this population. Methods: Thirteen focus group discussions were conducted with adults diagnosed with Chagas disease, covering all ICF components. Two independent researchers extracted meaningful concepts from verbatim transcripts and linked them to ICF categories. Results: Thirty-two adults with Chagas disease participated. From the discussions, 248 concepts were identified and linked to 49 second-level ICF categories: 13 related to body functions, 5 to body structures, 18 to activities and participation, and 13 to environmental factors. The most frequently mentioned categories were sleep, pain, emotional functions, and cardiac functions. In the Activities and Participation component, limitations were noted in household tasks, mobility, and social participation, with spirituality emerging as a key coping resource. For Environmental Factors, immediate family support and access to healthcare services were identified as primary facilitators of functioning. Conclusion: Adults with Chagas disease reported impairments across a wide range of body functions and activities, underscoring the significant influence of environmental factors. The identified categories will serve as a foundation of candidate items to support the consensus process for developing an ICF Core Set for adults with Chagas disease.

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ABSTRACT Background: Scorpion envenomation frequently requires critical care intervention. Early determination of cases with a higher likelihood of clinical deterioration may allow for resource optimization and improvement of clinical endpoints. In this study, patients from a tertiary hospital with similar clinical characteristics but diverse outcomes were analyzed to propose a clinical deterioration prediction score. Methods: Demographic, clinical, laboratory, and imaging findings of patients with scorpion envenomation were retrieved from a database used in a toxicology center based on in-person attendance data from 2019 to 2024. Multivariate models were defined and evaluated using receiver operating characteristic curves. A nomogram was created to estimate the probability of ICU transfer. Optimal cutoff points, sensitivity, and specificity were computed. Multiple imputation was performed using chained equations. Normality of errors in linear regressions was assessed via QQ plots. Results: Overall, 146 patients were eligible for enrolment. Sex (p = 0.06), weight (p = 0.30), time-to-serum (p = 0.89), and exposure area (p = 0.49) were comparable between patients admitted to the intensive care unit (ICU) and other inpatients, whereas age (p = 0.006) and initial severity (p < 0.001) displayed significant differences. Logistic regression models displayed area-under-the-curve metrics ranging from 65% to 93%, with high specificity. Hyperamylasemia (p = 0.004), vomiting (p = 0.006), and cardiac dysfunction on echocardiography or point-of-care ultrasound (p < 0.001) were strongly associated with critical care. Conclusion: Prognostication of factors leading to ICU transfer from initial clinical and laboratory findings is feasible. The regression model achieved high specificity and moderate sensitivity; being a potentially useful confirmatory test in cases with clinical suspicion.

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ABSTRACT Background: Neglected tropical diseases (NTDs) comprise 21 endemic infections that affect over one billion people worldwide. This study mapped and identified evidence gaps regarding pharmacological therapies for all WHO-recognized NTDs. Methods: We systematically searched PubMed for systematic reviews (SRs) and randomized controlled trials (RCTs), and the ClinicalTrials.gov database for ongoing RCTs. Methodological quality was assessed using the AMSTAR-2 for SRs and the Cochrane Risk of Bias tool for RCTs. Data were synthesized into evidence and gap maps, and the distribution of evidence was analyzed according to quality. Results: Twenty-four maps were developed, including 74 SRs, 500 RCTs, and 70 ongoing clinical trials; of these, only seven SRs and 17 RCTs were rated as high quality or as having a low risk of bias, respectively. Trachoma exhibited the highest number of evidence gaps, while Buruli ulcer had the lowest. Taeniasis/cysticercosis presented the highest proportion (31.8%) of high-quality SRs, whereas Chagas disease showed the highest proportion of RCTs with a low risk of bias (18.4%). Conclusions: Significant gaps remain in the evidence regarding the efficacy and safety of pharmacological treatments for WHO-recognized NTDs. The currently available evidence is predominantly of low methodological quality and is often insufficient to support robust therapeutic conclusions, highlighting the urgent need for rigorously designed clinical trials.

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ABSTRACT Background: Snakebite envenomation is a significant public health problem. We aimed to analyze the clinical outcomes associated with the timing of antivenom administration in Bothrops and Crotalus snakebite envenomations. Methods: This descriptive, retrospective, census-based cohort study included patients who attended the Toxicological Information and Assistance Center-Londrina from 2017 to 2024. Sociodemographic, clinical, exposure-related, and antivenom therapy data were obtained from the national DATATOX system and clinical records. Descriptive statistics and Poisson regression (for relative risks [RRs] and 95% confidence intervals [CIs]) were used; significance was set at p<0.05. Results: Data from 1,162 cases were analyzed, with 72.8% caused by Bothrops and 27.2% by Crotalus. Most patients were male (78.6%), rural workers (59.0%), and residents of rural areas (88.4%). Antivenom therapy was administered with 98.2% adequacy, according to institutional protocols. The median time from bite to completion of antivenom infusion was 450 minutes, with 75% of patients treated within 12 hours; 2.7% of patients developed renal complications and 1.1% died. Both outcomes were more frequent among patients with longer intervals between the bite and antivenom administration (>75th percentile). In the crude analysis, delays were associated with renal complications (RR: 3.21; 95% CI: 1.61-6.41; p=0.001) and death (RR: 4.81; 95% CI: 1.59-14.59; p=0.006). After adjustment, the association remained significant for renal complications (RR: 2.88; 95% CI: 1.37-6.06; p=0.005), but not for death. Conclusions: Delayed antivenom administration is associated with an increased risk of renal complications, reinforcing the timing of therapy as a critical and modifiable factor influencing snakebite outcomes.

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ABSTRACT Background: Cutaneous leishmaniasis is a chronic parasitic condition. The association of neutrophil extracellular traps with dermal extracellular matrix degradation, parasite load, and leukocyte profiles in cutaneous leishmaniasis lesions remains underexplored. This study aimed to investigate these associations in patients with cutaneous leishmaniasis. Methods: Patients (n=78) from Cuiabá, Mato Grosso, Brazil, diagnosed with cutaneous leishmaniasis were included. Biopsy samples were collected.. Species were identified by polymerase chain reaction. Leukocytes, amastigotes, and neutrophil extracellular traps were identified and quantified, and extracellular matrix degradation was assessed using immunohistochemistry, Masson’s trichrome, Sirius Red, and reticulin stains. Statistical associations were determined using Pearson’s correlation coefficient. Results: All patients exhibited L. braziliensis infection. Most patients (76.9%) had cellular and exudative reaction lesions, while 23.1% exhibited granulomatous and exudative reaction lesions. A significant correlation was observed between extracellular matrix degradation and amastigote load in cellular and exudative reaction lesions (r=0.599; p=0.0001) but not in granulomatous and exudative reaction lesions (r=0.068; p=0.263). Similarly, in cellular and exudative reaction lesions, neutrophil extracellular trap formation showed a strong positive correlation with amastigote numbers (r=0.423; p=0.0001), a relationship absent in granulomatous and exudative reaction lesions (r=0.0009; p=0.9036). Conclusion: In L. braziliensis infection with cellular and exudative reaction lesions, neutrophil extracellular traps function as an active, proportional defense mechanism against parasite load. However, in granulomatous and exudative reaction lesions, they contribute to a more structured containment but lack a direct proportional relationship to parasite numbers. This distinction provides critical insights into cutaneous leishmaniasis pathogenesis.

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ABSTRACT Background: Mosquitoes of the genus Sabethes are widespread in South and Central America, and some species are associated with yellow fever transmission. We aimed to investigate Sabethes fauna in bamboo internodes in remnants of the Atlantic Forest. Methods: Artificial holes were made in bamboo plants and monitored for the presence of immature mosquitoes for 12 months. Results: Ten species of the genus Sabethes were identified, including Sa. aurescens, Sa. identicus, Sa. conditus, Sa. shannoni, Sa. albiprivus, Sa. purpureus, Sa. undosus, Sa.ignotus, Sa.soperi, and Sa. whitmani. Conclusion: Artificial hole placement can increase the number of Sabethes species found in faunal investigations.

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ABSTRACT Background: Co-circulation of Plasmodium vivax and arboviruses is a significant but underexplored public health concern in tropical regions. Methods: We analyzed 300 serum samples collected between 2014 and 2015 from the Brazil-French Guiana border, including 102 malaria cases and 198 controls, using rapid tests for Immunoglobulin M (IgM), Immunoglobulin G (IgG), and Non-Structural Protein 1 (NS1). Results: High IgG reactivity for dengue and chikungunya viruses was observed. Co-reactivity was frequent. Zika virus detection was minimal. Conclusions: The overlapping transmission of P. vivax and arboviruses highlights the need for integrated surveillance strategies to better address co-circulation/co-infection risks.

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ABSTRACT Background: Leprosy is endemic to Brazil. The Coronavirus disease 2019 (COVID-19) pandemic may have affected diagnosis and treatment. Methods: Study in Mossoró-RN (2018-2023) analyzing epidemiological data, treatment abandonment, and COVID-19 co-infection. Results: The average weekly number of cases declined during the post-pandemic period. The dropout rate was higher during the acute phase. Male sex was associated with dropout (odds ratio [OR], 6.32; p = 0.013). Of the 57 patients tested for COVID-19, 21 tested positive, with no clinical aggravation. Conclusions: The pandemic has affected leprosy control. Local strategies helped reduce the impact, and co-infection did not worsen the disease.

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ABSTRACT Background: Triatomines are hematophagous insects that act as vectors of Trypanosoma cruzi, the causative agent of Chagas disease. External Quality Assessment (EQA) is a tool used for monitoring and improving taxonomic identification activities performed by the health laboratories in Brazil. Methods: EQA were conducted in four municipalities in the state of Pernambuco. Boxes containing a panel of 12 adult Hemiptera specimens (male and female) were sent for species identification. Results: The results revealed 68% accuracy, with difficulty for morphologically similar species, such as those of the genus Rhodnius. Conclusions: EQA is essential for monitoring laboratory performance, highlighting the need for ongoing training.

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ABSTRACT Background: Chagas disease remains a public health challenge with underexplored prevalence and diagnosis in endemic areas. We assessed Trypanosoma cruzi infection screening among birthing individuals in three endemic provinces in northern Argentina. Methods: T. cruzi-seropositive birthing individuals with at least one positive or indeterminate test were enrolled during the postpartum period to confirm seropositivity by indirect hemagglutination (IHA) and enzyme-linked immunosorbent (ELISA) assays. Results: Among 40,035 deliveries, the T. cruzi infection rate was 1.9%. Confirmatory serology revealed 77.6% positivity, 9.3% negativity, and 13.0% discordance. Conclusions: These findings highlight the need for confirmatory testing and improved diagnostic strategies in endemic regions.

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ABSTRACT Background: This study reports the first documented occurrence of immature forms of Anopheles albitarsis in artificial breeding sites within an urban area of Acre, Brazil. Methods: Second-instar larvae were collected from a water tank. Results: The collected larvae were identified as Anopheles albitarsis, representing the first report of this species in artificial breeding sites in an urban area of Acre. Conclusions: The detection of immature forms in artificial containers suggests potential adaptation of the vector to urban settings and highlights concerns regarding the increased risk of malaria transmission in areas previously regarded as low-risk.

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ABSTRACT Background: A national dengue vaccination campaign using TAK-003 was launched in 2024, targeting adolescents. Post-licensure surveillance suggested higher-than-expected hypersensitivity reactions. Methods: We conducted a descriptive study using vaccine adverse event data and vaccination records from Belo Horizonte among individuals aged 6-14 years. Results: Of the 146,115 doses administered, 28 hypersensitivity reactions were reported (191.6 per million), including nine cases of anaphylaxis and two of anaphylactic shock. All events followed the first dose. Mean age was 9.4 years, and mean time to symptom onset was 31 minutes. Conclusions: Hypersensitivity rates exceeded expected vaccine-associated levels, reinforcing the need for continued pharmacovigilance.

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ABSTRACT Background: Dengue remains a public health challenge, driven by Aedes aegypti proliferation within complex socio-environmental conditions. Methods: This study investigated the spatiotemporal distribution of dengue in Manaus from 2016 to 2022. Temporal analysis used negative binomial regression adjusted for seasonality. Seasonal and spatial clusters were identified using scan statistics (p < 0.05, 95% CI). A Bayesian spatial model assessed sociodemographic and environmental determinants. Results: Lagged temperature and wind speed showed protective effects. The Bayesian model identified significant associations with population density, vegetation indices (NDVI), sewage infrastructure, and housing types. Conclusions: Integrating climatic and socioeconomic data is essential for intersectoral dengue control strategies.

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ABSTRACT Actinomycosis is a chronic, suppurative infection caused by Actinomyces israelii, an anaerobic bacterium that is part of the normal oral flora. A 47-year-old woman presented to the clinic with dyspnea and sore throat. Computed tomography(CT) revealed thickening of the proximal tracheal lumen and airway narrowing. Pathological examination of biopsy specimens obtained by rigid bronchoscopy revealed periodic acid-Schiff (PAS)(+) bacterial colonization with filamentous bacilli, consistent with Actinomyces. This report describes an uncommon presentation of tracheal actinomycosis in which tracheal dilatation was performed for both diagnostic sampling and therapeutic management of tracheal stenosis.

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ABSTRACT Pure neural leprosy (PNL) is infrequent and manifests exclusively in the peripheral nerves without skin involvement, making the diagnosis more complex. We report the case of a 10-year-old child with muscle atrophy and sensory loss, diagnosed through clinical evaluation, grade 2 disability, and a positive anti-PGL-I test. The slit-skin smear (SSS) was negative for acid-fast bacilli. After 12 months of multidrug therapy, esthesiometric sensitivity improved; however, neurological deficits persisted, requiring anti-inflammatory treatment and physiotherapy. This case highlights the importance of early diagnosis and treatment for preventing disabilities. Tools, such as anti-PGL-I tests and imaging, are crucial, particularly in resource-limited settings.

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ABSTRACT Dengue poses a considerable risk to individuals with sickle cell disease. This report presents six cases of male pediatric patients (mean age 9.7 ± 4.8 years) with a hemoglobin S mutation, all of whom exhibited clinical manifestations consistent with dengue infection. Diagnosis was confirmed using NS1 antigen, serology (IgM/IgG), and RT-PCR, identifying all cases as dengue virus serotype 2. All patients had warning signs at presentation; three were severe, four required intensive care, and one died from dengue shock. Early identification and management are critical to reduce mortality in children with hemoglobin S mutations during dengue epidemics.

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ABSTRACT Cholera has caused multiple pandemics and remains a significant global public health threat. After 18 years without autochthonous transmission in Brazil, a 60-year-old man with no travel history presented with abdominal discomfort and acute watery diarrhea. Laboratory testing detected Vibrio cholerae O1 Ogawa, prompting classification as a suspected cholera case. However, genomic analysis showed that the strain lacked the toxigenic virulence factor required to cause cholera, leading to its reclassification as a non-cholera case. This investigation highlights the importance of clinical suspicion, advanced laboratory diagnostics, and continuous epidemiological surveillance for accurate case identification and an appropriate public health response.

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ABSTRACT This case report describes a 43-year-old man admitted in November 2024 with recurrent deep anterior chest wall and thoracoabdominal soft-tissue infection caused by Klebsiella pneumoniae. Multidrug-resistant K. pneumoniae was isolated in December 2024. From January to April 2025, the patient required prolonged hospitalization, repeated debridements, and skin grafting, complicated by flap infection, acute kidney injury, and ICU admission. After initial improvement with polymyxin B and tigecycline, a severe recurrent infection caused by pan-resistant K. pneumoniae occurred in June 2025. Given the limited therapeutic options, treatment was changed to cefotaxime plus polymyxin B, leading to complete clinical recovery, which was later confirmed by in vitro synergy results.