Scielo RSS <![CDATA[Revista da Sociedade Brasileira de Medicina Tropical]]> http://www.scielo.br/rss.php?pid=0037-868220200001&lang=en vol. 53 num. lang. en <![CDATA[SciELO Logo]]> http://www.scielo.br/img/en/fbpelogp.gif http://www.scielo.br <![CDATA[Synanthropic rodents as virus reservoirs and transmitters]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100200&lng=en&nrm=iso&tlng=en Abstract This review focuses on reports of hepatitis E virus, hantavirus, rotavirus, coronavirus, and arenavirus in synanthropic rodents (Rattus rattus, Rattus norvegicus, and Mus musculus) within urban environments. Despite their potential impact on human health, relatively few studies have addressed the monitoring of these viruses in rodents. Comprehensive control and preventive activities should include actions such as the elimination or reduction of rat and mouse populations, sanitary education, reduction of shelters for the animals, and restriction of the access of rodents to residences, water, and food supplies. <![CDATA[Events preceding death among chikungunya virus infected patients: a systematic review.]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100201&lng=en&nrm=iso&tlng=en Abstract Since its re-emergence in the late 1990s, there have been reports of Chikungunya fever (CHIK-F) presenting with severe or atypical findings. There is little knowledge regarding the clinical events leading to the death of patients with CHIK-F. This study aimed to systematically review the literature regarding CHIK-F and identify clinical features preceding death. We searched PubMed, Scopus, Embase, Lilacs, and IsiWeb for case-reports, case-series, or cohorts of CHIK-F reporting at least one death, up to December 2019. Fifty-seven reports were analyzed, including 2140 deaths. Data about specific clinical events that precede death are scarce. The central tendency of time between disease onset and death ranged from 2 days to 150 days. The most common clinical findings among decedents were fever (22.0%), arthralgia (15.7%), myalgia (10.7%), and headache (8.2%). Excluding pediatric populations, the reported central tendency of age among the decedents was 53 or older, with a non-weighted median of 67, ranging up to 80 years old. Authors mentioned organic dysfunction in 91.2% reports. Among all the 2140 decedents, the most common dysfunctions were cardiovascular (7.2%), respiratory (6.4%), neurological (5.4%), renal (4.2%), liver (3.0%), and hematological (1.3%) dysfunction. Exacerbation of previous diabetes (5.6%) or hypertension (6.9%) was mentioned as conditions preceding death. Currently, older age, primary neurological, cardiovascular, or respiratory dysfunction and a previous diagnosis of diabetes or hypertension are the main clinical events preceding death. <![CDATA[Major environmental and socioeconomic determinants of cutaneous leishmaniasis in Brazil - a systematic literature review]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100202&lng=en&nrm=iso&tlng=en Abstract Cutaneous leishmaniasis (CL) is a zoonotic disease with complex transmission cycle. Some environmental and socioeconomic factors are known to be the major determinants of the transmission process, which are involved in configuring the spatiotemporal patterns and thus can be delimiting. However, the relevance of these socioeconomic and environmental determinants is still not well understood. In this study, we aimed to identify the major environmental and socioeconomic determinants of CL in Brazil by articulating a systematic literature review of studies that are based on this subject. The methodology included a search for studies according to a structured protocol using the scientific platforms, such as Scielo and PubMed. The references of each identified article were who referred to CL determinants were further screened, and so on. We extracted information from 41 articles and the determinants were grouped accordingly. Two measures were evaluated as follows: a) the frequency of citations of the determinants; and b) the proportion of determinants identified as having "significant association in analytical studies" with respect to the total number of determinants analyzed in other analytical studies using the same concept. The analyzed articles covered most of the regions of Brazil and 7 other countries bordering Brazil. We found 43 concepts of determinants. However, the final selection resulted in the identification of 14 major determinants. These results therefore contribute in the identification of major CL determinants and this information can be used to establish strategies for identifying risk prone areas for disease surveillance. <![CDATA[A historical review of the techniques of recovery of parasites for their detection in human stools]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100203&lng=en&nrm=iso&tlng=en Abstract Since the early 20th century, the detection of intestinal parasites has improved with the development of several techniques for parasitic structures recovery and identification, which differ in sensitivity, specificity, practicality, cost, and infrastructure demand. This study aims to review, in chronological order, the stool examination techniques and discuss their advantages, limitations, and perspectives, and to provide professionals and specialists in this field with data that lays a foundation for critical analysis on the use of such procedures. The concentration procedures that constitute the main techniques applied in routine research and in parasitological kits are a) spontaneous sedimentation; b) centrifugation-sedimentation with formalin-ethyl acetate; and c) flotation with zinc sulfate solution. While selecting a technique, one should consider the purpose of its application and the technical-operational, biological, and physicochemical factors inherent in the procedures used in stool processing, which may restrict its use. These intrinsic limitations may have undergone procedural changes driven by scientific and technological development and by development of alternative methods, which now contribute to the improvement of diagnostic accuracy. <![CDATA[Exercise tests in Chagas cardiomyopathy: an overview of functional evaluation, prognostic significance, and current challenges]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100204&lng=en&nrm=iso&tlng=en Abstract Patients with Chagas cardiomyopathy (ChC) usually progress with fatigue and dyspnea. Exercise tests are valuable for the functional evaluation of these patients. However, information about the applicability of the exercise tests is scattered, and no studies have systematically reviewed the results. Thus, the present review explored the general aspects and prognostic value of exercise tests in patients with ChC. A literature search of the MEDLINE, Web of Science, CINAHL, Scopus, and LILACS databases was performed to identify relevant studies. There were no data restrictions, and articles that met the objective of the study were selected. Articles written in English, Portuguese, and Spanish were considered, and 25 articles were finally included. The peak oxygen uptake (VO2peak) was correlated with demographic and echocardiographic variables. Echocardiographic features of the left ventricular diastolic function and right ventricular systolic function appeared to be determinants of functional capacity, in addition to age and sex. VO2peak was associated with higher mortality, especially in patients with dilated ChC. The minute ventilation/carbon dioxide production slope (VE/VCO2 slope) was a strong predictor of survival; however, more studies are needed to verify this observation. Field tests showed moderate to strong correlation with VO2peak and thus may be inexpensive tools for the functional evaluation of patients with ChC. However, few studies have verified their prognostic significance. While exercise tests are useful tools for functional assessment, information is scarce regarding further considerations, and many of the criteria are based on guidelines for other heart diseases. <![CDATA[Update on the treatment of musculoskeletal manifestations in chikungunya fever: a guideline]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100205&lng=en&nrm=iso&tlng=en Abstract Since the emergence of the chikungunya virus in Brazil in 2014, more than 700,000 cases have been reported throughout the country, corresponding to one-third of all cases reported in the Americas. In addition to its high attack rates, resulting in hundreds of thousands of cases, the disease has high chronicity rates with persistent joint manifestations for more than 3 months, which can spread to more than half of the patients affected in the acute phase. Pain associated with musculoskeletal manifestations, often disabling, has an effect on patients’ quality of life at different stages of the disease. Currently, the challenge faced by specialists is identifying the best therapy to be instituted for symptom relief despite the limited number of published intervention studies. In 2016, a multidisciplinary group published pharmacological treatment protocols for pain in patients with chikungunya, which was incorporated into the guidelines for clinical management of the Brazilian Ministry of Health in 2017; in that same year, a consensus was published by the Brazilian Society of Rheumatology about diagnosis and treatment. After 5 years of experience with chikungunya epidemics, in 2019, specialists involved in the protocols of the Brazilian Society of Rheumatology and Brazilian Ministry of Health prepared an update with the main objective of developing flowcharts for the therapeutic approach of musculoskeletal manifestations in adult patients to enable specialists at different levels of healthcare to spread and apply this guideline in a systematic and simplified manner. <![CDATA[Non-tuberculous mycobacterial lung disease: a brief review focusing on radiological findings]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100206&lng=en&nrm=iso&tlng=en Abstract The incidence and prevalence of lung disease caused by non-tuberculous mycobacteria (NTM-LD) has increased worldwide and its diagnosis represents a complex challenge. This article aims to review the tomographic findings of NTM-LD in order to facilitate their definitive diagnosis. The search for publications on the subject was performed in PMC and Scielo using the keywords ‘non-tuberculous mycobacteria’, ‘lung disease and computed tomography (CT)’ and ‘radiological findings’. The radiological findings described by 18 articles on mycobacteriosis were reviewed. In addition, CT images of patients diagnosed with NTM-LD were considered to represent radiological findings. Eighteen publications were used whose main findings were pulmonary cavitation (88.9%), bronchiectasis (77.8%), and pulmonary nodules (55.6%). Despite the overlaps in imaging-related analysis of myocobacterioses with other pulmonary infections, such as tuberculosis, the predominant involvement of the middle lobe and lingula should raise suspicion for NTM-LD. <![CDATA[Human fusariosis: An emerging infection that is difficult to treat]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100250&lng=en&nrm=iso&tlng=en Abstract Fusarium spp. has been associated with a broad spectrum of emerging infections collectively termed fusariosis. This review includes articles published between 2005 and 2018 that describe the characteristics, clinical management, incidence, and emergence of these fungal infections. Fusarium solani and F. oxysporum are globally distributed and represent the most common complexes. Few therapeutic options exist due to intrinsic resistance, especially for the treatment of invasive fusariosis. Therefore, the use of drug combinations could be an important alternative for systemic antifungal resistance. Increase in the number of case reports on invasive fusariosis between 2005 and 2018 is evidence of the emergence of this fungal infection. <![CDATA[Laboratory diagnosis for Covid-19: A mini-review]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100251&lng=en&nrm=iso&tlng=en Abstract Coronavirus disease (COVID-19) is a pandemic caused by a new coronavirus, called SARS-CoV-2. This disease was first identified in December 2019 and rapidly developed into a challenge to the public health systems around the world. In the absence of a vaccine and specific therapies, disease control and promotion of patient health are strongly dependent on a rapid and accurate diagnosis. This review describes the main laboratory approaches to making a diagnosis of COVID-19 and identifying those previously infected with SARS-CoV-2. <![CDATA[Minimum concentration of Amphotericin B in serum according to the formulation, dose, and daily or prolonged intermittent therapeutic regimen]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100300&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: The therapeutic efficacy of daily amphotericin B infusion is related to its maximum concentration in blood; however, trough levels may be useful in intermittent regimens of this antifungal drug. METHODS : High performance liquid chromatography (HPLC) was used to determine the minimum concentration (Cmin) of amphotericin B in the serum of patients receiving deoxycholate (D-Amph) or liposomal amphotericin B (L-AmB) for the treatment of cryptococcal meningitis (n=28), histoplasmosis (n=8), paracoccidioidomycosis (n=1), and leishmaniasis (n=1). RESULTS: Daily use of D-Amph 30 to 50 mg or L-AmB 50 mg resulted in a similar Cmin, but a significant increase ocurred with L-AmB 100 mg/day. The geometric mean Cmin tended to decrease with a reduction in the dose and frequency of intermittent L-AmB infusions: 357 ng/mL (100 mg 4 to 5 times/week) &gt; 263 ng/mL (50 mg 4 to 5 times/week) &gt; 227 ng/mL (50 mg 1 to 3 times/week). The impact on Cmin was variable in patients whose dose or therapeutic scheme was changed, especially when administered the intermittent infusion of amphotericin B. The mean Cmin for each L-AmB schedule of intermittent therapy was equal or higher than the minimum inhibitory concentration of amphotericin B against Cryptococcus isolates from 10/12 patients. The Cmin of amphotericin B in patients with cryptococcal meningitis was comparable between those that survived or died. CONCLUSIONS: By evaluating the Cmin of amphotericin B, we demonstrated the therapeutic potential of its intermittent use including in the consolidation phase of neurocryptococcosis treatment, despite the great variability in serum levels among patients. <![CDATA[Genotype<sup>®</sup>MTBDR<em>plus</em> and Xpert<sup>®</sup>MTB/RIF in the diagnosis of tuberculosis and resistant tuberculosis: cost analysis in a tertiary referral hospital]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100301&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: The present study sought to assess the mean and activity based cost (ABC) of the laboratory diagnosis for tuberculosis through the application of conventional and molecular techniques-Xpert®MTB/RIF and Genotype®MTBDRplus-in a tertiary referral hospital in Brazil. METHODS: The mean cost and ABC formed the basis for the cost analysis of the TB laboratory diagnosis. RESULTS: The mean cost and ABC were US$ 4.00 and US$ 3.24, respectively, for a bacilloscopy; US$ 6.73 and US$ 5.27 for a Lowenstein-Jensen (LJ) culture; US$ 105.42 and US$ 76.56 for a drug sensitivity test (DST)-proportions method (PM) in LJ; US$ 148.45 and US$ 136.80 for a DST-BACTECTM MGITTM 960 system; US$ 11.53 and US$ 9.89 for an Xpert®MTB/RIF; and US$ 84.21 and US$ 48.38 for a Genotype®MTBDRplus. CONCLUSIONS: The mean cost and ABC proved to be good decision-making parameters in the diagnosis of TB and MDR-TB. The effective implementation of algorithms will depend on the conditions at each location. <![CDATA[Relationship between antifungal susceptibility profile and virulence factors in <em>Candida albicans</em> isolated from nail specimens]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100302&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: The aim of this study was to evaluate some virulence factors in Candida albicans isolates from patients with onychomycosis and determine the correlation between these factors and the antifungal resistance profile. METHODS: Seventy species of C. albicans were confirmed using polymerase chain reaction amplification of the HWP1 gene. According to the Clinical &amp; Laboratory Standards Institute guidelines, the susceptibility profile of four antifungal agents was investigated, and the production of aspartyl protease, phospholipase, haemolysin, and biofilm was determined. The correlation between these profiles was also investigated. RESULTS: The isolates indicated different levels of resistance and production of virulence factors. Significant correlations were observed between the minimum inhibitory concentration (MIC) of fluconazole/itraconazole and biofilm production, between phospholipase production and fluconazole/itraconazole MIC, and between fluconazole MIC and hemolytic activity in C. albicans isolates. The results also showed significant correlations between phospholipase activity and biofilm production. CONCLUSIONS: Our findings will contribute to a better understanding of the pathogenesis of C. albicans and characterize the relationship between virulence factors and antifungal resistance, which may suggest new therapeutic strategies considering the possible involvement of the virulence mechanism in the effectiveness of treatment. <![CDATA[Surveillance of human retroviruses in blood samples from patients with hepatitis B and C in São Paulo, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100303&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION Human retroviruses and the hepatitis B and C viruses (HBV and HCV, respectively) share routes of transmission; thus, coinfections occur and could alter subsequent disease outcomes. A preliminary study on human T-lymphotropic virus types 1 and 2 (HTLV-1/2) in serum samples from HBV- and HCV-infected individuals in São Paulo revealed 1.3% and 5.3% rates of coinfection, respectively. These percentages were of concern since they were detected in HTLV-endemic regions and in high-risk individuals in Brazil. The present study was conducted to extend and confirm these data. METHODS HTLV-1/2 and human immunodeficiency virus (HIV) infection status were identified in 1,984 sera for HBV and HCV viral load quantification - 1,290 samples from HBV-infected individuals (53.3% men, mean age: 47.1 years) and 694 samples from HCV-infected individuals (56.3% men, mean age: 50.1 years). HTLV-1/2 antibodies were detected by enzyme immunoassay, followed by western blotting and line immunoassay; HIV infection was detected by enzyme immunoassay. RESULTS HTLV-1/-2 infection was detected in 1.9% HBV-infected individuals (0.7% HTLV-1 and 1.2% HTLV-2) and in 4.0% (2.4% HTLV-1 and 1.6% HTLV-2) HCV-infected individuals; HIV infection was detected in 9.2% and 14.5%, respectively. Strong associations with HTLV and HIV, male sex, and older age were found in HBV/HTLV and HCV/HTLV-coinfected individuals (p&lt;0.05). CONCLUSIONS HTLV-1 and HTLV-2 were confirmed to be prevalent in individuals with HBV and HCV in São Paulo; coinfected individuals deserve further clinical and laboratory investigation. <![CDATA[Association of leptin and leptin receptor polymorphisms with coronary artery disease in a North Chinese Han population]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100304&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Leptin (LEP) is a peptide hormone that acts via leptin receptor (LEPR) binding. Genetic evidence from different human populations has implicated LEP/LEPR in the pathogenesis of coronary artery disease (CAD), and suggests that certain LEP/LEPR gene polymorphisms may increase the risk of CAD. The aim of this study was to assess two single nucleotide polymorphisms (SNPs) in LEP genes (rs2167270 and rs7799039) and two in LEPR genes (rs6588147, rs1137100) for association with CAD. METHODS: We enrolled 271 North Chinese Han CAD patients, and 113 healthy age- and sex-matched controls. Genomic DNA was extracted from whole blood, and the four SNPs were assessed using a MassArray system. RESULTS: The G allele frequency at rs2167270 was significantly higher among CAD cases than among controls. The AG genotype at rs7799039 was associated with a significantly decreased risk of CAD unlike the AA genotype used as the reference. The A allele was significantly associated with the CAD patient group. Interestingly, statistically significant differences in genotype and allele frequency at LEP rs2167270 and rs7799039 existed among females but not among males. CONCLUSIONS: The current study detected a significant association between genetic variations at LEP rs7799039 and rs2167270 and the risk of CAD in a north Chinese population, and revealed that LEP rs2167270 and rs7799039 gene polymorphisms might act as predisposing factors for CAD. <![CDATA[Demographic and clinical characteristics of pulmonary arterial hypertension caused by schistosomiasis are indistinguishable from other etiologies]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100305&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Pulmonary arterial hypertension (PAH) is a serious pulmonary circulation disease caused by several etiologies, including schistosomiasis. The present study retrospectively evaluated the clinical and hemodynamic characteristics of patients with schistosomal PAH (PAH-Sch) compared to those of non-Sch PAH patients (non-Sch PAH). METHODS: Patients treated at the Pronto-Socorro Cardiológico de Pernambuco and diagnosed by right cardiac catheterization were divided into PAH-Sch and non-Sch PAH groups. Their socio-demographic and clinical characteristics, N-terminal-pro B-type natriuretic peptide (NT-proBNP), and echocardiography and hemodynamic parameters were retrospectively reviewed. RESULTS: Among the included 98 patients (mean age, 45 ± 14 years; 68 women [69.4%]), we found 56 PAH-Sch and 42 non-Sch PAH. The age distribution was heterogeneous in the PAH-Sch group, with patients predominantly ranging from 50-59 (p &lt;0.004). Dyspnea was the most common symptom, reported by 92 patients (93.8%), and commonly present for over two years prior to diagnosis. Clinical symptoms were similar in both groups, with no differences in functional class, pulmonary artery systolic pressure (p = 0.102), 6-minute walk test score (p = 0.234), NT-proBNP serum levels (p = 0.081), or hemodynamic parameters. CONCLUSIONS: Patients with PAH-Sch present clinical, laboratory, and hemodynamic profiles similar to those with PAH resulting from other etiologies of poor prognosis. PAH is an important manifestation of schistosomiasis in endemic regions that is often diagnosed late. <![CDATA[Phylogenetic Group/Subgroups Distributions, Virulence Factors, and Antimicrobial Susceptibility of <em>Escherichia coli</em> Strains from Urinary Tract Infections in Hatay]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100306&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Nosocomial and community acquired urinary tract infections (UTIs) are one of the most encountered infections in the world. METHODS: This study aimed to determine the antibiotic susceptibility, phylogeny, and virulence genes of 153 Escherichia coli strains isolated from UTIs. Antimicrobial susceptibility of the isolates to different classes of antimicrobials was determined by the VITEK-2 automated system. Presence of virulence genes and phylogenetic groups were investigated by PCR. RESULTS: Regarding susceptibility to antimicrobials, ampicillin resistance was most abundant (67.3%), followed by amoxicillin-clavulanic acid (50.9%); least abundant was resistance to amikacin (1.3%) and nitrofurantoin (1.3%). Multi drug resistance (MDR) was observed in 34.6% of the isolates, and all isolates were found to be susceptible to imipenem, meropenem and fosfomycine. The majority of the isolates belonged to the phylogenetic group B23 (35.9%), followed by A1 (20.9%), D1 (18.9%), D2 (12.4%), A0 (%5.9), B1 (3.9%) and B2 (1.9%). Among E. coli strains examined, 49% had iucD, 32.7% papE-F, 26.1% papC, 15% cnf2, 11.1% sfa, 7.8% cnf1, 1.3% afaE, 1.3% afaD, 1.3% hlyA, 0.7% f17a-A, 0.7% clpG and 0.7% eaeA genes. CONCLUSIONS Our research demonstrated that virulence factors were distributed among different phylogroup/subgroups, which play a role in UTIs pathogenesis in humans. For this reason, complex and detailed studies are required to determine the relationship between virulence factors and specific E. coli strains that cause UTIs in humans. <![CDATA[Efficacy of the Benznidazole+Posaconazole combination therapy in parasitemia reduction: An experimental murine model of acute Chagas]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100307&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Benznidazole (BZL) and Nifurtimox (NFX) are the pharmacological treatment for acute phase Chagas Disease (CD); however, therapy resistance and residual mortality development remain important unresolved issues. Posaconazole (POS) has shown a trypanocidal effect in vivo and in vitro. Thus, this study aimed at comparing the T. Cruzi parasitic load-reducing effect of the combination of BZL+POS against that of monotherapy with either, during acute phase CD, in an experimental murine model. METHODS Nineteen Wistar rats were randomly allocated to four groups and inoculated with the trypomastigotes of T. cruzi strain´s JChVcl1. The rats were administered anti-parasites from day 20-29 post-infection. The Pizzi and Brener method was used for parasitemia measurement. Longitudinal data analysis for the continuous outcome of repeated measures was performed using parasitemia as the outcome measured at days 20, 22, 24, 27, and 29 post-infection. RESULTS All four groups had similar parasitic loads (p=0.143) prior to therapy initiation. Among the three treatment groups, the BZL+POS (n=5) group showed the highest mean parasitic load reduction (p=0.000) compared with the control group. Likewise, the BZL+POS group rats showed an earlier therapeutic effect and were the only ones without parasites in their myocardial samples. CONCLUSIONS: Treatment of acute phase CD with BZL+POS was more efficacious at parasitemia and myocardial injury reduction, compared with monotherapy with either. <![CDATA[Susceptibility of <em>Aedes aegypti</em> populations to pyriproxyfen in the Federal District of Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100308&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: In Brasilia, pyriproxyfen (PPF; 0.01 mg/L) has been used for the larval control of Aedes aegypti mosquitoes since 2016. Information on the susceptibility of Ae. aegypti to PPF, and the development of resistance in populations from the Federal District of Brazil (FD) is limited. It is essential to monitor the susceptibility of Ae. aegypti to insecticides in order to improve vector control strategies. This study aimed to evaluate the susceptibility of Ae. aegypti populations from five areas of Brasilia to PPF. METHODS: We performed dose-response tests to estimate the emergence inhibition and resistance ratio of each field population, including the Rockefeller reference population. We also analyzed egg positivity, and the density and mortality of larvae and pupae. RESULTS: Populations from Vila Planalto (RR50=1.7), Regiment Guards Cavalry (RR50=2.5), and Sub-secretary of Justice Complex (RR50=3.7) presented high susceptibility to PPF, while the RR values of populations from Lago Norte (RR50=7.7) and Varjão (RR50=5.9) were moderately high, suggesting the emergence of insipient resistance to PPF in Brasilia. At 30 ng/mL, the highest larvae mortality rate was 2.7% for the population from Lago Norte, while that of pupae was 92.1% for Varjão and Vila Planalto. CONCLUSIONS: The five populations of Ae. aegypti from the FD are susceptible to PPF and there is a need to monitor the susceptibility of Ae. aegypti in new areas of the FD. <![CDATA[Increase in the risk of snakebites incidence due to changes in humidity levels: A time series study in four municipalities of the state of Rondônia]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100309&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Snakebites represent a serious global public health problem, especially in tropical countries. In Brazil, the incidence of snakebites ranges from 19 to 22 thousand cases per 100000 persons annually. The state of Rondônia, in particular, has had an increasing incidence of snakebites. METHODS: A retrospective cross-sectional study on snakebites was conducted from January 2007 to December 2018. Brazil’s Information System for Notifiable Diseases was queried for all snakebites reported in Porto Velho, Ariquemes, Cacoal, and Vilhena. Data on land surface temperatures during the day and night, precipitation, and humidity were obtained using the Google Earth Engine. A Bayesian time series model was constructed to describe the pattern of snakebites and their relationship with climate data. RESULTS: In total, 6326 snakebites were reported in Rondônia. Accidents were commonly caused by Bothrops sp. (n=2171, 81.80%). Snakebites most frequently occurred in rural areas (n=2271, 85.5%). Men, with a median age of 34 years (n=2101, 79.1%), were the most frequent bitten. Moderate clinical manifestation was the most common outcome of an accident (n=1101, 41.50%). There were clear seasonal patterns with respect to rainfall, humidity, and temperature. Rainfall and land surface temperature during the day or night did not increase the risk of snakebites in any city; however, changes in humidity increased the risk of snakebites in all cities. CONCLUSION: This study identified the population exposed to snakes and the influence of anthropic and climatic factors on the incidence of snakebites. According to climate data, changes in humidity increased the risk of snakebites. <![CDATA[Cutaneous parasitism in patients with American visceral leishmaniasis in an endemic area]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100310&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Visceral leishmaniasis (VL) represents a public health concern in several areas of the world. In the American continent, VL transmission is typically zoonotic, but humans with active VL caused by Leishmania infantum are able to infect sandflies. Thus, individuals with cutaneous parasitic infections may act as reservoirs and allow interhuman transmission. Additionally, the skin may be responsible for reactivation of the disease after therapy. This study’s objective was to evaluate cutaneous parasitism in humans with VL in an American endemic area. METHODS: A cross-sectional hospital-based study was conducted in northeast Brazil from October 2016 to April 2017. Biopsies of healthy skin for histopathology and immunohistochemistry were performed prior to treatment in all study patients. RESULTS: Twenty-two patients between the ages of five months to 78 years were included in the study. Seven patients (31.8%) tested positive for HIV. Only one patient had cutaneous parasitism, as confirmed by immunohistochemistry prior to treatment. Parasitism was not detected after treatment. CONCLUSIONS: Cutaneous parasitism in the healthy skin of humans with visceral leishmaniasis, although unusual, may be a source of infection for phlebotomine sandflies. <![CDATA[Use of tissue doppler imaging for the early detection of myocardial dysfunction in patients with the indeterminate form of Chagas disease]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100311&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Chagas disease is one of the most common diseases in Latin America and heart involvement is the main cause of death. This study aimed to determine differences in tissue Doppler imaging (TDI) parameters in the assessment left and right ventricular function in patients with the indeterminate form of Chagas disease compared to those in healthy controls. METHODS: We compared 194 patients with the indeterminate form of Chagas disease to 72 age-matched healthy individuals. We considered p-values &lt;0.05 to be statistically significant. RESULTS: TDI analysis of the right ventricular (RV) showed lengthened isovolumic relaxation time (IRT) and higher RV index of myocardial performance (RIMP) and left ventricle (LV) index of myocardial performance (LIMP) in the Chagas group than in the control group, indicating RV and LV systolic and diastolic myocardial damage. TDI analysis of the myocardial velocities of the interventricular septum and the lateral wall of the LV also showed a systolic and diastolic myocardial damage. CONCLUSIONS: The study results demonstrated early LV systolic and diastolic myocardial damage in the RV and LV in patients with the indeterminate form of Chagas disease by TDI. These early findings of RV and LV dysfunction may help identify patients who will progress to heart failure during the disease course. TDI should be included in initial patient evaluations because it allows adequate follow-up and treatment. <![CDATA[Differentiation of <em>Rhodnius neglectus</em> and <em>Rhodnius prolixus</em> (Hemiptera: Reduviidae: Triatominae) by multiple parameters]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100312&lng=en&nrm=iso&tlng=en Abstract Introduction: The genus Rhodnius in the subfamily Triatominae comprises 20 species, which can transmit Trypanosoma cruzi and Trypanosoma rangeli. Due to the development of molecular techniques, Triatominae species can now be characterized by mitochondrial and nuclear markers, making it possible to verify and/or correct the existing data on these species. The results achieved in this study provide a more detailed and accurate differentiation of the Rhodnius species, helping the establishment of a more appropriate classification. Methods: Data collection was performed by DNA analysis, morphological and morphometric studies to distinguish four populations of R. neglectus and four of R. prolixus. Phylogenetic data were compared to morphological and morphometric data. Results: The analysis of Cytb fragments suggests that the four colonies designated to Rhodnius neglectus as well as those of R. prolixus were correctly identified. Conclusions: The morphological characters observed in the specimens of the colonies originally identified as R. prolixus and R. neglectus, such as the presence or absence of collar in the eggs, the patterns of the median process of the pygophore, and anterolateral angle, are consistent with the species. Geometric morphometrics also show an intraspecific variability in R. prolixus. <![CDATA[Importance of microenvironment to arbovirus vector distribution in an urban area, São Paulo, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100313&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: The study of the landscape ecology, biological microhabitat, and epidemiological implications for the distribution of the main vectors Aedes aegypti and Aedes albopictus contribute to the prevention and control actions regarding the diseases they transmit. METHODS: This study sought to assess data on positive properties of the vector control program activities from 1998 to 2010. An entomological survey was also carried out on a sample of buildings collecting larvae and pupae from containers between October and April (spring / summer) from 2002 to 2005. We assessed the physico-chemical data of the water in 20% of positive containers. The vegetation and urbanization were assessed with the aid of satellite images and microenvironments were classified as urbanized, woods, and shrubs. The data were analyzed using statistical and geoprocessing software. RESULTS: Ae. aegypti and Ae. albopictus colonized all types of microhabitats and microenvironments, predominantly in the urbanized area, in isolation and in coexistence. The microhabitat of Ae. aegypti showed a temperature gradient greater than that of Ae. albopictus, and there was an association with urbanized areas for the first species and wooded areas for the last species. CONCLUSIONS: Landscape ecology and intra-urban differences favor different microclimates, which contribute to the coexistence of species in the urban environment in an area close to the forest, raising the risk of other arbovirus infections in urban areas. The ecological niche should be considered for Ae. albopictus. Entomological and virologic monitoring are suggested as arbovirus surveillance actions in urban infested centers near preserved forests. <![CDATA[Ecology of phlebotomine sand flies in a Brazilian area with recent leishmaniasis transmission (Itaúna, in Minas Gerais state)]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100314&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Leishmaniasis constitutes a serious but neglected tropical disease. Recently, socio-environmental, biological and physical changes have altered the range of leishmaniasis, causing it to spread into urban areas. In Minas Gerais, the disease is endemic, exhibiting regional differences and reaching urban centers. The purpose of this study was to evaluate entomological aspects related to the ecoepidemiology of leishmaniasis in Itaúna. METHODS: Monthly catches with HP traps were carried out from June 2017 to May 2018, in three ecological areas (urban, rural, and forest). The adaptability of the species to anthropic environments was assessed using the synanthropy index (SI). RESULTS: We collected 1306 specimens of phlebotomine sand flies. Of the species of medical importance, Lutzomyia longipalpis, the vector of Leishmania infantum, represented 90.4% of the specimens identified at species level (n=1260). Nyssomyia whitmani, the vector of Leishmania braziliensis, represented 1.6% of the total. Lu. longipalpis displayed an SI of +95.8, a value that denotes a marked preference for human environments. For Ny. whitmani, the SI was -25, expressing the tendency of this species to occupy uninhabited areas. The population of the three most numerous species captured increased with rain, high temperatures, and high relative humidity. Although captured at low numbers, Ny. whitmani showed a different profile concerning the climate variables analyzed. CONCLUSIONS: Understanding the epidemiology of the disease may assist the health services in formulating effective control measures for improving community health and contributing to the establishment of a dynamic relationship and a global awareness of the health/disease process. <![CDATA[Spatial diffusion of Zika fever epidemics in the Municipality of Salvador-Bahia, Brazil, in 2015-2016: does Zika fever have the same spread pattern as Dengue and Chikungunya fever epidemics?]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100315&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION The recent emergence and rapid spread of Zika and Chikungunya fevers in Brazil, occurring simultaneously to a Dengue fever epidemic, together represent major challenges to public health authorities. This study aimed to identify and compare the 2015-2016 spatial diffusion pattern of Zika, Chikungunya, and Dengue epidemics in Salvador-Bahia. METHODS We used two study designs comprising a cross-sectional-to-point pattern and an ecological analysis of lattice data. Residential addresses involving notified cases were geocoded. We used four spatial diffusion analysis techniques: (i) visual inspection of the sequential kernel and choropleth map, (ii) spatial correlogram analysis, (iii) spatial local autocorrelation (LISA) changes analysis and, (iv) nearest neighbor index (NNI) modeling. RESULTS Kernel and choropleth maps indicated that arboviruses spread to neighboring areas near the first reported cases and occupied these new areas, suggesting a diffusion expansion pattern. A greater case density occurred in central and western areas. In 2015 and 2016, the NNI best-fit model had an S-curve compatible with an expansion pattern for Zika (R2 = 0.94; 0.95), Chikungunya (R2 = 0.99; 0.98) and Dengue (R2 = 0.93; 0.99) epidemics, respectively. Spatial correlograms indicated a decline in spatial lag autocorrelations for the three diseases (expansion pattern). Significant LISA changes suggested different diffusion patterns, although a small number of changes were detected. CONCLUSIONS These findings indicate diffusion expansion, a unique spatial diffusion pattern of Zika, Chikungunya, and Dengue epidemics in Salvador-Bahia, namely. Knowing how and where arboviruses spread in Salvador-Bahia can help improve subsequent specific epidemic control interventions. <![CDATA[Estimated mortality rate and leading causes of death among individuals with chikungunya in 2016 and 2017 in Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100316&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: In 2014, the first cases of autochthonous chikungunya (CHIK) were recorded in Brazil. Lethality associated with this disease is underestimated. Thus, this study aimed to analyze the causes of death among individuals with CHIK in Brazil. METHODS: A descriptive observational study was conducted on individuals with CHIK who died within 6 months from symptom onset. Data pairing between the Information System for Notifiable Diseases and the Mortality Information System was performed. Deaths were classified according to case confirmation criterion, mention of CHIK in the death certificates (DCs), and disease phase. The lethality rate per 1,000 cases was corrected for underreporting and was estimated according to region, sex, age, years of education, race/color, and cause groups. RESULTS: We identified 3,135 deaths (mention of CHIK in the DCs, 764 [24.4%]). In 17.6% of these cases, CHIK was the underlying cause. Most deaths occurred in the acute (38.1%) and post-acute (29.6%) phases. The corrected LR (5.7; x1,000) was 6.8 times higher than that obtained from the Information System for Notifiable Diseases (0.8). The highest corrected LRs were estimated for among individuals living in the Northeast region (6.2), men (7.4), those with low years of education and those aged &lt;1 year (8.6), 65-79 years (20.7), and ≥80 years (75.4). CONCLUSIONS: The LR of CHIK estimates based on information system linkage help to reveal the relevance of this disease as the direct cause or as a cause associated with serious or fatal events, provide timely interventions, and increase the knowledge about this disease. <![CDATA[Spatial dynamics and socioeconomic factors correlated with American cutaneous leishmaniasis in Pernambuco, Brazil from 2008 to 2017]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100317&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: American cutaneous leishmaniasis (ACL) is a public health problem and has been associated with country’s territory. We aimed to analyze the spatial dynamics and socioeconomic factors correlated to the incidence of ACL in Pernambuco, Brazil from 2008 to 2017. METHODS: A cross-sectional, ecological study was conducted in the Brazilian municipalities. Patient data were obtained from the Health Hazard Notification System (SINAN); indicators and incidence for the total period and for quinquennium were obtained. Socioeconomic factors were analyzed to evaluate the association between the incidence of ACL and presence of bathroom and running water, garbage collection availability, inadequate water supply, sanitation, rural population, per capita income, and vulnerability to poverty. Spatial analysis considered the gross incidence; the Bayesian local empirical method and Moran spatial autocorrelation index were applied using Terra View and QGIS. RESULTS: The incidence of ACL reduced (0.29/100,000 inhabitants per year). Individuals with ACL were young adults (30.3%), men (60.2%), brown skinned (62.9%), rural residents (70.6%), and less educated (46.7%); had autochthonous transmission (78.8%); developed the cutaneous form (97.2%); had evolution to cure (82.7%); and were diagnosed using the clinical epidemiological criterion (70.5%). ACL occurred in the large part of the state and showed heterogeneous distribution, with persistence of two high priority intervention clusters covering Health Regions I, II, III, IV, and XII. CONCLUSIONS: Spatial analysis and epidemiological indicators complement each other. The combination of these methods can improve the understanding on ACL occurrence, which will help subsidize planning and enhance the quality and effectiveness of healthcare interventions. <![CDATA[The accuracy of the Montenegro skin test for leishmaniasis in PCR-negative patients]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100318&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: As highly specific molecular biology-based techniques may not be sensitive enough for the diagnosis of American tegumentary leishmaniasis (ATL), clinicians frequently rely on immunological tests before treatment initiation. Hence, the correct combination of diagnostic tests is imperative for ATL diagnosis. We aimed to evaluate the accuracy of the Montenegro (Leishmanin) skin test (MST) in polymerase chain reaction (PCR)-negative patients to accurately detect ATL. METHODS: Patients with a clinical picture compatible with ATL were divided into ATL (confirmed by lesion smear, culture indirect immunofluorescence, and/or histopathology) and no-ATL (diseases that can mimic leishmaniasis) groups. Conventional PCR for the minicircle kDNA of Leishmania was performed, and the MST was carried out for PCR-negative patients. RESULTS: Ninety-nine patients were included in this study, including 79 diagnosed with ATL (6 with mucocutaneous leishmaniasis) and 20 without ATL (no-ATL group). The MST showed a high sensitivity of 90.0% (95% confidence interval [CI] = 69.90-97.21) in PCR-negative patients that was 10% higher than the sensitivity reported in PCR-positive population (79.66%; 95% CI = 67.73-87.96). CONCLUSIONS: One of the most important reasons for PCR negativity among patients with active ATL is the presence of a strong cellular immunological response, especially in chronic and mucocutaneous leishmaniasis. This reinforces the considerable utility of the tests that detect cellular responses against Leishmania antigens such as the MST in PCR-negative patients when the performance in screening situations is questionable. <![CDATA[Higher congenital transmission rate of <em>Trypanosoma cruzi</em> associated with family history of congenital transmission]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100319&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Congenital transmission (CT) of Trypanosoma cruzi has led to globalization of Chagas disease and its growing relevance as a public health problem. Although the occurrence of CT has been associated with several factors, its mechanisms are still unknown. This study aimed to analyze the geographical and familiar variables of mothers and their association with CT of Chagas disease in a population living in non-endemic areas of Argentina for the last decades. METHODS: We developed a retrospective cohort study in a sample of 2120 mother-child pairs who attended three reference centers in the cities of Buenos Aires, Santa Fe, and Salta between 2002 and 2015. RESULTS: The highest CT rates were observed in children born to Argentinean mothers (10.7%) and in children born to mothers from Buenos Aires (11.7%). Considering the areas of origin of the mothers, those from areas of null-low risk for vector-borne infection had higher CT rates than those from areas of medium-high risk (11.1% vs 8.2%). We also observed a significant intra-familiar “cluster effect,” with CT rates of 35.9% in children with an infected sibling, compared to 8.2% in children without infected siblings (RR=4.4 95% CI 2.3-8.4). CONCLUSIONS: The associations observed suggest a higher CT rate in children born to mothers who acquired the infection congenitally, with familiar antecedents, and from areas without the presence of vectors. These observations are considered new epidemiological evidence about Chagas disease in a contemporary urban population, which may contribute to the study of CT and may also be an interesting finding for healthcare professionals. <![CDATA[Evaluation of the effect of intraperitoneal etanercept administration on oxidative stress and inflammation indicators in the kidney and blood of experimental sepsis-induced rats]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100320&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Sepsis is an important cause of mortality and morbidity, and inflammatory response and oxidative stress play major roles underlying its pathophysiology. Here, we evaluated the effect of intraperitoneal etanercept administration on oxidative stress and inflammation indicators in the kidney and blood of experimental sepsis-induced rats. METHODS: Twenty-eight adult Sprague Dawley rats were classified into Control (Group 1), Sepsis (Group 2), Sepsis+Cefazolin (Group 3), and Sepsis+Cefazolin+Etanercept (Group 4) groups. Kidney tissue and serum samples were obtained for biochemical and histopathological investigations and examined for the C reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), triggering receptor expressed on myeloid cells (TREM), and malondialdehyde (MDA) levels. RESULTS: The levels of TNF-α, TREM, and MDA in serum and kidney samples were significantly higher in rats from sepsis group than in rats from control group (p &lt; 0.05). Group 3 showed a significant reduction in serum levels of TNF-α, CRP, and TREM as compared with Group 2 (p &lt; 0.05). Serum TNF-α, CRP, TREM, and MDA levels and kidney TNF-α and TREM levels were significantly lower in Group 4 than in Group 2 (p &lt; 0.05). Serum TNF-α and TREM levels in Group 4 were significantly lower than those in Group 3, and histopathological scores were significantly lower in Group 3 and Group 4 than in Group 2 (p &lt; 0.05). Histopathological scores of Group 4 were significantly lower than those of Group 3 (p &lt; 0.05). CONCLUSIONS: Etanercept, a TNF-α inhibitor, may ameliorate sepsis-induced oxidative stress, inflammation, and histopathological damage. <![CDATA[Prevalence of <em>Klebsiella pneumoniae</em> carbapenemase - and New Delhi metallo-beta-lactamase-positive <em>K. pneumoniae</em> in Sergipe, Brazil, and combination therapy as a potential treatment option]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100321&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Carbapenem-resistant Klebsiella pneumoniae infection lacks treatment options and is associated with prolonged hospital stays and high mortality rates. The production of carbapenemases is one of the most important factors responsible for this multi-resistance phenomenon. METHODS: In the present study, we analyzed the presence of genes encoding carbapenemases in K. pneumoniae isolates circulating in one of the public hospitals in the city of Aracaju, Sergipe, Brazil. We also determined the best combination of drugs that display in vitro antimicrobial synergy. First, 147 carbapenem-resistant K. pneumoniae isolates were validated for the presence of blaKPC, bla GES, bla NDM, bla SPM, bla IMP, bla VIM, and bla OXA-48 genes using multiplex polymerase chain reaction. Thereafter, using two isolates (97 and 102), the role of double and triple combinational drug therapy as a treatment option was analyzed. RESULTS: Seventy-four (50.3%) isolates were positive for bla NDM, eight (5.4%) for bla KPC, and one (1.2%) for both bla NDM and bla KPC. In the synergy tests, double combinations were better than triple combinations. Polymyxin B and amikacin for isolate 97 and polymyxin B coupled with meropenem for isolate 102 showed the best response. CONCLUSIONS: Clinicians in normal practice use multiple drugs to treat infections caused by multi-resistant microorganism; however, in most cases, the benefit of the combinations is unknown. In vitro synergistic tests, such as those described herein, are important as they might help select an appropriate multi-drug antibiotic therapy and a correct dosage, ultimately reducing toxicities and the development of antibiotic resistance. <![CDATA[Evaluation of genome similarities using a wavelet-domain approach]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100322&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Tuberculosis is listed among the top 10 causes of deaths worldwide. The resistant strains causing this disease have been considered to be responsible for public health emergencies and health security threats. As stated by the World Health Organization (WHO), around 558,000 different cases coupled with resistance to rifampicin (the most operative first-line drug) have been estimated to date. Therefore, in order to detect the resistant strains using the genomes of Mycobacterium tuberculosis (MTB), we propose a new methodology for the analysis of genomic similarities that associate the different levels of decomposition of the genome (discrete non-decimated wavelet transform) and the Hurst exponent. METHODS: The signals corresponding to the ten analyzed sequences were obtained by assessing GC content, and then these signals were decomposed using the discrete non-decimated wavelet transform along with the Daubechies wavelet with four null moments at five levels of decomposition. The Hurst exponent was calculated at each decomposition level using five different methods. The cluster analysis was performed using the results obtained for the Hurst exponent. RESULTS: The aggregated variance, differenced aggregated variance, and aggregated absolute value methods presented the formation of three groups, whereas the Peng and R/S methods presented the formation of two groups. The aggregated variance method exhibited the best results with respect to the group formation between similar strains. CONCLUSION: The evaluation of Hurst exponent associated with discrete non-decimated wavelet transform can be used as a measure of similarity between genome sequences, thus leading to a refinement in the analysis. <![CDATA[Case series of sporotrichosis at a teaching hospital in Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100323&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Sporotrichosis is a subcutaneous fungal infection with a worldwide distribution and higher incidence in tropical and subtropical areas, such as the Brazilian territory, where it has been standing out due to its frequent epidemics. Thus, the present study aimed to evaluate the prevalence of sporotrichosis and profile the affected patients at a university teaching hospital in the central region of Rio Grande do Sul, Brazil. METHODS: This study was a case series of patients diagnosed with Sporothrix spp. from January 2006 to December 2015 by microscopic examination or fungal isolates. Medical records were reviewed for epidemiological data. RESULTS: Forty-three cases of sporotrichosis were diagnosed through the period. The sample comprised predominantly young male adults and rural workers. The most common disease type was lymphocutaneous (51%), followed by fixed cutaneous form (32.5%). The predominant location was the upper limbs (70%), followed by the lower limbs (16%). A significant association was observed between the lymphocutaneous form and upper limb location and between the fixed cutaneous form and lower limb location (p = 0.019). Potassium iodine and itraconazole were the most common treatments. CONCLUSIONS: This study will help update the epidemiological situation of sporotrichosis in the central region of the state of Rio Grande do Sul, Brazil, over the last decade. <![CDATA[Spatial and seroepidemiology of canine visceral leishmaniasis in an endemic Southeast Brazilian area]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100324&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Canine visceral leishmaniasis (CVL) is a public health problem, and its prevalence is associated with the coexistence of vectors and reservoirs. CVL is a protozoonosis caused by Leishmania infantum that is endemic in the southeast region of Brazil. Thus, vector and canine reservoir control strategies are needed to reduce its burden. This study aimed to verify the CVL seroprevalence and epidemiology in a municipality in Southeast Brazil to initiate disease control strategies. METHODS: A total of 833 dogs were subjected to Dual Path Platform (DPP) testing and enzyme-linked immunosorbent assays. For seropositive dogs, epidemiological aspects were investigated using a questionnaire and a global position system. The data were submitted to simple logistic regression, kernel estimation, and Bernoulli spatial scan statistical analysis. RESULTS: The overall CVL-confirmed seroprevalence was 16.08%. The 28.93% in the DPP screening test was associated with dogs maintained in backyards with trees, shade, animal and/or bird feces, and contact with other dogs and cats, with sick dogs showing the highest chances of infection (odds ratio, 2.6; 95% confidence interval, 2.38-1.98), especially in residences with elderly people. A spatial analysis identified two hotspot regions and detected two clusters in the study area. CONCLUSIONS: Our results demonstrated that residences with elderly people and the presence of trees, shade, feces, and pet dogs and cats increased an individual’s risk of developing CVL. The major regions where preventive strategies for leishmaniasis were to be initiated in the endemic area were identified in two clusters. <![CDATA[Diversity of biting midges <em>Culicoides</em> (Diptera: Ceratopogonidae), potential vectors of disease, in different environments in an Amazonian rural settlement, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100325&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: The Culicoides transmit a variety of pathogens. Our aim was to survey the Culicoides species occurring in an Amazonian rural settlement, comparing abundance, richness, and diversity in different environments. METHODS: Culicoides were captured using CDC light traps. The Shannon-Wiener (H’) and Rényi indices were used to compare species diversity and evenness between environments, the equitability (J’) index was used to calculate the uniformity of distribution among species, and similarity was estimated using the Jaccard similarity index. A permutational multivariate analysis of variance was applied to assess the influence of environment on species composition. A non-metric dimensional scale was used to represent the diversity profiles of each environment in a multidimensional space. RESULTS: 6.078 Culicoides were captured, representing 84 species (45 valid species/39 morphotypes). H’ values showed the following gradient: forest &gt; capoeira &gt; peridomicile &gt; forest edge. The equitability J’ was greater in capoeira and forests compared to peridomiciles and the forest edge. The population compositions of each environment differed statistically, but rarefaction estimates indicate that environments of the same type possessed similar levels of richness. Species of medical and veterinary importance were found primarily in peridomiciles: C. paraensis, vector of Oropouche virus; C. insignis and C. pusillus, vectors of Bluetongue virus; C. filariferus, C. flavivenula, C. foxi, and C. ignacioi, found carrying Leishmania DNA. CONCLUSIONS: This study indicates that diversity was higher in natural environments than in anthropized environments, while abundance and richness were highest in the most anthropized environment. These findings suggest that strictly wild Culicoides can adapt to anthropized environments. <![CDATA[The interference of polypharmacy and the importance of clinical pharmacy advice in the treatment of leprosy: a case-control study]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100326&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Although supervised doses are essential for reducing leprosy treatment failure, the impact of specific drug interactions has rarely been assessed. This study aimed to estimate the risk of leprosy treatment suspension in patients receiving polypharmacy. METHODS We performed this case-control study in which the primary outcome was defined as the need to discontinue multibacillary leprosy treatment for at least one supervised dose, and the main risk factor was the detection of polypharmacy. Multivariate analysis by logistic regression was used for calculating odds ratio (OR). RESULTS: This study included 103 patients, of whom 43 needed to discontinue leprosy treatment (hemolysis = 26, hepatitis = 2, hemolysis associated with hepatitis = 6, and suspected treatment resistance = 9) and the rest did not. The severity of drug interactions had no effect on treatment discontinuation. Patients who used five or more drugs in addition to leprosy treatment had almost a 4-fold greater risk of treatment suspension (OR, 3.88; 95% confidence interval: 1.79-9.12; p &lt; 0.001). The number of drugs used also positively influenced the occurrence of hemolysis (p &lt; 0.001). No patient presented evidence of molecular resistance to rifampicin, dapsone, or ofloxacin treatment, as evidenced by genetic sequencing detection of rpoB, folp1, and gyrA mutations. CONCLUSIONS: Polypharmacy has deleterious effects on the already difficult-to-adhere-to treatment of leprosy and polypharmacy induces hemolysis. Additional measures must be taken to avoid the undesirable effects of inadequate polypharmacy. <![CDATA[Hemophagocytic lymphohistiocytosis secondary to visceral leishmaniasis in an endemic area in the north of Minas Gerais, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100327&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION Visceral leishmaniasis (VL) is an ill-studied disease that is endemic to several regions of Brazil. It is often complicated by hemophagocytic lymphohistiocytosis (HLH), a potentially fatal disorder resulting from excessive non-malignant activation/proliferation of T lymphocytes and macrophages. Considering the overlapping clinical and laboratory characteristics of these diseases, diagnosing HLH is a challenge. Therefore, tracking the association between VL and HLH is necessary in endemic areas. Although HLH can be inapparent and resolve with antileishmanicides, this may not always occur. HLH causes high lethality; therefore, immunosuppressive therapy should be instituted immediately in order to avoid a fatal outcome. METHODS: We described the epidemiological, clinical, laboratory, and therapeutic profile of this association in a region of Brazil endemic for VL. RESULTS We presented 39 patients with this association in a retrospective cohort of 258 children who were admitted from January 2012 to June 2017. Of the 39 patients, 31 were from urban areas (79.5%), and 21 (53%) were males. The mean age and weight were 2.86 (2.08) years and 14.03 (5.96) kg, respectively. The main symptoms were fever (100%), hepatosplenomegaly (100%), pallor of the skin and mucosa (82.5%), edema (38.5%), bleeding (25%), and jaundice (7.5%). Hemophagocytosis was identified in 16/37 (43.24%) patients, and direct examination revealed that 26/37 (70.27%) patients were positive for VL. The patients were treated as recommended by the Ministry of Health. CONCLUSIONS It was observed that HLH is a common complication in endemic areas, and its diagnosis must consider the overlapping of clinical characteristics and pancytopenia. <![CDATA[Association of <em>TLR3</em> single nucleotide polymorphisms with susceptibility to HTLV-1 infection in Iranian asymptomatic blood donors]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100328&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: The human T-lymphotropic virus type 1 (HTLV-1) has a single-stranded RNA genome and expresses specific proteins that have oncogenic potential. Approximately 15 to 20 million people worldwide have been infected by this virus. Changes in protein or gene expression are the effects of single nucleotide polymorphisms (SNPs) within the Toll-like receptor 3 (TLR3) gene. The function and efficacy of signal transduction also lead to modified immune responses. The present study aimed to investigate the association of SNPs within TLR3 (rs3775291 and rs3775296) with susceptibility to HTLV-1 infection in Iranian asymptomatic blood donors. METHODS: This study was performed on 100 HTLV-1-infected asymptomatic blood donors and 118 healthy blood donors. Genomic DNA from all participants was purified and then amplified using specific PCR primers. SNPs within TLR3 were evaluated using the restriction fragmentation length polymorphism technique, and the results were analyzed using SPSS software (version 22). RESULTS: The frequencies of the TLR3 (rs3775296) CC, CA, AA genotypes were 70%, 24%, and 6% in the patient group, and 50.8%, 44.9%, and 4.2% in the control group, respectively. There was a significant difference in the frequency distribution of TLR3 (rs3775296) genotypes and alleles, but not in the frequency distribution of TLR3 (rs3775291) genotypes between the patient and control groups. CONCLUSIONS: The TLR3 SNP rs3775296 was significantly associated with HTLV-1 infection and may be a protective factor against this viral infection. <![CDATA[Influence of Angiotensin-converting Enzyme Insertion/Deletion Gene Polymorphism in Progression of Chagas Heart Disease]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100329&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Chagas disease (CD) is a neglected disease caused by the parasite Trypanosoma cruzi. One-third of infected patients will develop the cardiac form, which may progress to heart failure (HF). However, the factors that determine disease progression remain unclear. Increased angiotensin II activity is a key player in the pathophysiology of HF. A functional polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with plasma enzyme activity. In CD, ACE inhibitors have beneficial effects supporting the use of this treatment in chagasic cardiomyopathy. METHODS: We evaluated the association of ACE I/D polymorphism with HF, performing a case-control study encompassing 343 patients with positive serology for CD staged as non-cardiomyopathy (stage A; 100), mild (stage B1; 144), and severe (stage C; 99) forms of Chagas heart disease. For ACE I/D genotyping by PCR, groups were compared using unconditional logistic regression analysis and adjusted for nongenetic covariates: age, sex, and trypanocidal treatment. RESULTS: A marginal, but not significant (p=0.06) higher prevalence of ACE I/D polymorphism was observed in patients in stage C compared with patients in stage A. Patients in stage C (CD with HF), were compared with patients in stages A and B1 combined into one group (CD without HF); DD genotype/D carriers were prevalent in the HF patients (OR = 2; CI = 1.013.96; p = 0.04). CONCLUSIONS: Our results of this cohort study, comprising a population from the Northeast region of Brazil, suggest that ACE I/D polymorphism is more prevalent in the cardiac form of Chagas disease with HF. <![CDATA[Health system collapse 45 days after the detection of COVID-19 in Ceará, Northeast Brazil: a preliminary analysis]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100330&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: COVID-19 emerged in late 2019 and quickly became a serious public health problem worldwide. This study aim to describe the epidemiological course of cases and deaths due to COVID-19 and their impact on hospital bed occupancy rates in the first 45 days of the epidemic in the state of Ceará, Northeastern Brazil. METHODS: The study used an ecological design with data gathered from multiple government and health care sources. Data were analyzed using Epi Info software. RESULTS: The first cases were confirmed on March 15, 2020. After 45 days, 37,268 cases reported in 85.9% of Ceará’s municipalities, with 1,019 deaths. Laboratory test positivity reached 84.8% at the end of April, a period in which more than 700 daily tests were processed. The average age of cases was 67 (&lt;1 - 101) years, most occurred in a hospital environment (91.9%), and 58% required hospitalization in an ICU bed. The average time between the onset of symptoms and death was 18 (1 - 56) days. Patients who died in the hospital had spent an average of six (0 - 40) days hospitalized. Across Ceará, the bed occupancy rate reached 71.3% in the wards and 80.5% in the ICU. CONCLUSIONS: The first 45 days of the COVID-19 epidemic in Ceará revealed a large number of cases and deaths, spreading initially among the population with a high socioeconomic status. Despite the efforts by the health services and social isolation measures the health system still collapsed. <![CDATA[Computed tomography findings in a Brazilian cohort of 48 patients with pneumonia due to coronavirus disease]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100331&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: This study was conducted to retrospectively review chest computed tomography (CT) findings in a Brazilian cohort of patients with pneumonia caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: Chest CT scans of 78 patients with confirmed coronavirus disease (COVID-19), obtained in March and April 2020, were reviewed. Of 78 cases, the CT scans of 48 (61.5%) showed lung opacities. CT opacity features, their distribution, and the extent of infiltration were evaluated. RESULTS: The most common CT findings were ground-glass opacities (97.9%), crazy-paving pattern (58.3%), and mixed pattern (18.8%). Rounded lung opacities were observed most frequently (70.8%). Other findings were cystic airspace changes (37.5%), vascular dilatation (35.4%), and the organizing pneumonia pattern (14.6%). The findings were frequently bilateral (87.5%), symmetrical (68.9%), and peripheral (60.2%). CONCLUSIONS: The most common CT findings were ground-glass opacities and the crazy-paving pattern. Involvement was mostly bilateral, symmetrical, and peripheral. Round opacity morphology was frequently observed and might have some degree of specificity to viral COVID-19 pneumonia. <![CDATA[Multilocus sequence typing (MLST) of clinical and environmental isolates of <em>Cryptococcus neoformans</em> and <em>Cryptococcus gattii</em> in six departments of Colombia reveals high genetic diversity]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100332&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: The average annual incidence of cryptococcosis in Colombia is 0.23 cases per 100,000 inhabitants in the general population, and 1.1 cases per 1000 in inhabitants with Acquired Immune Deficiency Syndrome (AIDS). In addition, the causal fungus has been isolated from the environment, with serotypes A-B and C in different regions. This study aims to determine the genetic association between clinical and environmental isolates of C. neoformans/C. gattii in Colombia. METHODS: Multilocus sequence typing (MLST) was used to identify possible clones, providing information about the epidemiology, ecology, and etiology of this pathogen in Colombia. RESULTS: A total of 110 strains, both clinical (n=61) and environmental (n=49), with 21 MLST sequence types (ST) of C. neoformans (n=14STs) and C. gattii (n=7STs) were identified. The STs which shared clinical and environmental isolate sources were grouped in different geographical categories; for C. neoformans, ST93 was identified in six departments, ST77 in five departments; and for C. gattii, ST25 was identified in three departments and ST79 in two. CONCLUSIONS: High genetic diversity was found in isolates of C. neoformans/gattii by MLST, suggesting the presence of environmental sources harboring strains which may be sources of infection for humans, especially in immunocompromised patients; these data contribute to the information available in the country on the distribution and molecular variability of C. neoformans and C. gattii isolates recovered in Colombia. <![CDATA[Rationale use of Thalidomide in erythema nodosum leprosum - A non-systematic critical analysis of published case reports]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100333&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Thalidomide is an anti- tumor necrosis factor alpha (TNF-a) drug used mainly in the management of moderate to severe form of Erythema Nodosum Leprosum (ENL). Because of its teratogenic potential it has to be used under proper supervision. Our critical analysis tries to look into the rationale with which it has been used by means of case reports on lepra reaction. METHODS: We looked for the case reports between December 2005 to June 2019 in databases like Pubmed, Embase and other relevant resources. We used search words like “erythema nodosum leprosum(ENL)”, “thalidomide”, “case report” in different combinations to get relevant reports that focus on thalidomide usage atleast once at any time point during management. The information extracted were indication of thalidomide use, dose, response, outcome, complication if any, along with all the demographic details and geographical distribution. RESULTS: We found 41 case reports eligible for analysis.The information was critically evaluated. From the analysis it was found that 7 of the case report mentioned the exact indication, 4 case report showed irrational use of thalidomide in the case of neuritis without use of steroids, 7 showed proper use of Clofazimine prior to thalidomide initiation, 26 case report showed case report of rationale dose range and in 4 case reports clofazimine was used prior to thalidomide along with the rational dose of thalidomide. CONCLUSIONS: This analysis helps to guide the rationale use of thalidomide focussing on few important points that anyone should keep in mind while managing a case of ENL. <![CDATA[Increased prevalence of hypertension among people living with HIV: where to begin?]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100334&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Cardiovascular diseases (CDVs) have become increasingly important for progressively older people living with HIV (PLHIV). Identification of gaps requiring improvement in the care cascade for hypertension, a primary risk factor for CVDs, is of utmost importance. This study analyzed the prevalence of hypertensive status and described the care cascade for hypertension screening, diagnosis, treatment, treatment adherence, and management in PLHIV. METHODS: This cross-sectional study included 298 PLHIV (age &gt;40 years) who visited a referral center in the western Brazilian Amazon. Data were collected through a structured questionnaire interview and medical examinations. Thus, information regarding sociodemographic and clinical aspects, blood pressure, weight, height, body mass index, and laboratory profile was obtained. Descriptive and analytical statistics were performed, and results were considered significant ifp &lt;0.05. RESULTS: In total, 132 (44.3%) participants reported that their blood pressure was never measured. The prevalence of hypertension was found to be 35.9% (107/298). Of these 107 participants, only 36 (33.6%) had prior knowledge of their hypertensive status, and 19 of 36 (52.7%) participants had visited a physician or cardiologist to seek treatment. Adherence to the BP-lowering treatment was noted in 11 (10.2%) participants. CONCLUSIONS: An increased prevalence of hypertension was found, and most of the hypertensive participants were unaware of their hypertensive status. In addition, blood pressure control was poor in the study population. This indicated that public health professionals did not sufficiently consider the full spectrum of healthcare and disease management for PLHIV. <![CDATA[Results of Influenza Vaccination: Short Follow-Up Study of a Turkish Population]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100335&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: The trivalent inactivated influenza vaccine was approved for use in Turkey during the 2018-2019 influenza season. We evaluated beliefs regarding the vaccine and vaccination outcomes in a Turkish population. METHODS: Individuals who were vaccinated with the trivalent inactivated influenza vaccine between November 1 and December 31, 2018, at the Sisli Hamidiye Training and Research Hospital in Istanbul, Turkey, were included in this study. A 15-item questionnaire was completed by a physician during a face-to-face interview with the participants. All participants were followed during the 2018-2019 influenza season through May 2019. The participants were instructed to consult the same physician in case of sudden illness. Participants’ beliefs and outcomes were assessed by their vaccination status for the 2017-2018 influenza season. RESULTS: A total of 150 participants were recruited. Their median age was 66 (range, 22-88) years. During the 2017-2018 influenza season, 4.1% had been hospitalized, 53.5% had developed an upper respiratory disease (URD), and 16.2% had been diagnosed with pneumonia. There were no cases of influenza, pneumonia, or hospitalization in the 2019 season; 49.3% of the participants developed a URD (n = 74). Among participants who had been vaccinated during both influenza seasons, 47.5% had had and/or developed a URD, with a higher number of cases during the 2018-2019 season. CONCLUSIONS: After vaccination, no cases of influenza, hospitalization, and pneumonia were observed and the incidence of URD decreased compared with that of the previous season. <![CDATA[A systematic review of the diagnostic aspects and use of <em>Trypanosoma rangeli</em> as an immunogen for <em>Trypanosoma cruzi</em> infection]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100336&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Trypanosoma rangeli is a protozoan that infects several domestic and wild mammals and shows significant distribution in Latin American countries. T. rangeli infection is similar to Chagas disease, both in diagnostic and prophylactic terms. Thus, the objective of this work was to review the diagnostic aspects and use of T. rangeli as an immunogen for Trypanosoma cruzi infection. METHODS: For this elaboration, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adopted with descriptors derived from the Medical Subject Headings (MeSH) platform in the PubMed/MEDLINE and SciELO databases. The inclusion criteria were defined as original articles on "Trypanosoma rangeli" and diagnostic aspects of T. rangeli infection in humans and/or research on the possible vaccines developed using T. rangeli strains for T. cruzi infection. RESULTS: After applying the inclusion and exclusion criteria, 18 articles were procured, of which 4 addressed research on the possible vaccines developed using T. rangeli for T. cruzi infection in vertebrates and the remaining 14 predominantly dealt with the diagnostic aspects of T. rangeli infection in humans. CONCLUSIONS: In this study, we formulated a compilation of the essential literature on this subject, emphasizing the need for more accurate and accessible techniques for the differential diagnosis of infections caused by both protozoa, and underscored several prospects in the search for a vaccine for Chagas disease. <![CDATA[Visceral leishmaniasis lethality in Brazil: an exploratory analysis of associated demographic and socioeconomic factors]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100337&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: It is believed that delays in diagnosis and treatment of Visceral Leishmaniasis (VL) contribute significantly to the burden of VL lethality in Brazil. METHODS: This study included several parts: a descriptive cross-sectional study of the individual characteristics of deaths from disease; a descriptive ecological study of the spatial distribution of deaths from disease; and an ecological analytical study to evaluate the association between disease lethality rates and the demographic, socioeconomic, and health indicators. The study population comprised all cases diagnosed throughout the country per the National Disease Notification System (SINAN) and the total number of disease deaths recorded in the Mortality Information System (SIM) from 2007 to 2012. RESULTS: Of the 223 deaths from disease captured by pairing the databases, 59.1% were reported as "death from other causes". There were significant associations between VL lethality rate and municipalities with the highest proportion of vulnerable individuals (rate ratio (RR)=1.18, 95% confidence interval (CI): 1.01-1.27), with VL lower incidence rate (RR=0.62, 95% CI: 0.58-0.67) and a higher incidence rate of Acquired Immune Deficiency Syndrome (AIDS) (RR=1.20, 95% CI: 1.17-1.51). CONCLUSIONS: Linking the SINAN and SIM databases allowed the inclusion of 14% of otherwise underreported deaths from VL for the study period, showing that this method is useful for the surveillance of VL-related deaths. The size of the municipal population, proportion of the vulnerable population, incidence of disease, and the incidence of AIDS were associated with municipal lethality rates related to VL in Brazil. <![CDATA[Syphilis notifications among pregnant women in Campo Grande, state of Mato Grosso do Sul, Brazil, 2011 to 2017]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100338&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION Syphilis is a sexually transmitted infection caused by Treponema pallidum. Considering the high rates of syphilis in pregnancy and congenital syphilis reported in Brazil in the past, and their serious consequences, this study described the epidemiological and clinical profile of pregnant women with a confirmed diagnosis of syphilis in Campo Grande, in the state of Mato Grosso do Sul, Brazil, from 2011 to 2017. METHODS: This is a descriptive study, based on syphilis notifications among pregnant women reported to the Sistema de Informação de Agravos de Notificação (National System of Disease Notification of Brazil). RESULTS: Over the study period, 2,056 confirmed cases of syphilis in pregnancy were reported, resulting in a crude cumulative incidence of 144.76 cases per 1,000 live-born babies. The incidence increased from 9.97 cases per 1,000 live-born babies in 2011 to 36.10 cases per 1,000 live-born babies in 2017. It was more prevalent in women who were young, of mixed race, with low educational attainment. Over one third of women were diagnosed in the first trimester of pregnancy; therefore, they were at risk of reinfection if they or their sexual partners were inadequately treated. Furthermore, syphilis was not well classified according to its clinical stage, which led to inappropriate treatments. CONCLUSIONS: Despite efforts to reduce the incidence of syphilis, syphilis during pregnancy remains a public health problem, reflecting possible inadequacies in antenatal care, especially in vulnerable populations. It is important to include sexual partners in syphilis treatment during pregnancy to prevent reinfection. <![CDATA[Risk factors associated with <em>Leishmania</em> exposure among dogs in a rural area of Ilha Solteira, SP, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100340&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: We sought to determine risk factors (RFs) associated with the presence of antibodies against Leishmania in dogs from a rural area of Ilha Solteira, SP, Brazil. METHODS: Serum samples were collected from 250 dogs and tested using indirect enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence antibody tests (IFATs). Data concerning dogs, their environment, and their owners’ knowledge of leishmaniasis were collected using a questionnaire. To determine RFs for contact with the parasite, univariate statistical analysis based on chi-squared and Fisher’s exact tests, followed by logistic regression, was used. RESULTS: It was found that 79/250 (31.6%) of the dogs were positive by IFAT, and 72/250 (28.8%) by ELISA. A total of 82/250 dogs (32.8%) were positive in at least one test. The RFs associated with occurrences of Leishmania exposure were large body size (OR = 2.25; 95% CI = 1.26-4.04; p = 0.003), presence of chickens (OR = 1.94; 95% CI = 1.05-3.65; p = 0.023), and lack of knowledge about Leishmania among dog owners (OR = 1.74; 95% CI = 0.96-3.21; p = 0.049). After multivariate analysis, the RFs for occurrence of Leishmania exposure in dogs that remained significantly associated were the dog’s size (large dogs) (OR = 1.2; 95% CI = 1.06-1.35; p = 0.003) and presence of chickens on the properties (small farms) (OR = 1.15; 95% CI = 1.02-1.30; p = 0.023). CONCLUSIONS: These results may be useful for improving preventive practices to reduce the incidence of Leishmania exposure among dogs in rural areas. <![CDATA[Epidemiological profile of acute Chagas disease in individuals infected by oral transmission in northern Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100341&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Oral infection by Trypanosoma cruzi is currently the most important route of transmission of acute Chagas disease (ACD) in the North region of Brazil, and the reported outbreaks are usually related to ingestion of contaminated food, especially unprocessed açaí pulp. METHODS A retrospective cohort study was performed to analyze the epidemiological profile of individuals with suspected cases of ACD in the municipality of Breves, located in the state of Pará, Brazil. Therefore, notifications of suspected cases of ACD were collected from the Municipal Health Department of Breves from January 2007 to December 2017. RESULTS A total of 265 individuals were registered, and the majority were male (54.7%; 145/265). Age ranged from nine months to 79 years, with a greater number of notifications for individuals aged between 1 and 39 years (71.3%; 189/265). Most of them had a low level of education (74.3%, 197/265), were living in rural and urban areas (58.9%; 156/265 and 37.7%; 100/265, respectively). Infection occurred mainly in the domestic environment (96.2%; 255/265) through oral transmission (98.1%; 260/265). There were a greater number of notifications in November, December and January. CONCLUSIONS These data showed that oral transmission of T. cruzi has become increasingly high in the study region, and health education programs need to be implemented as strategies to ensure good manufacturing practices of unprocessed food. <![CDATA[Impact of fractures and orthopedic surgeries in patients with HTLV-1 associated myelopathy/tropical spastic paraparesis]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100342&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION In patients with HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) gait disturbance is a predominant feature that leads to falls and fractures, which can further aggravate disability. We sought to evaluate the impact of fractures and orthopedic surgeries in patients with HAM/TSP. METHODS: We retrieved the medical records of HAM/TSP patients enrolled in our study center’s HTLV-1 clinical cohort between 1989-2018. The selection criteria included: (1) diagnosis of HTLV-1 infection using two enzyme-linked immunosorbent assays and/or a confirmatory test, (2) clinical diagnosis of HAM/TSP by neurological assessment, and (3) fractures associated with HAM/TSP. RESULTS: We identified 24 cases of fractures, 70% of which were females. The median age at the time of fracture was 60 years (IQR=24). Six cases reported fractures in patients under 45 years old. Ten patients (42%) had hip/coccyx fractures, seven (29%) were in the lower extremities, and four (17%) in the upper extremities. Half of these patients reported the use of wheelchairs. Five patients who had previously used canes required the use of wheelchairs after the reported fracture. Eight patients underwent corrective orthopedic surgery as a result of the fracture. CONCLUSIONS: For HAM/TSP patients, fractures are a complication that can exacerbate their severe impairment. <![CDATA[Canine visceral leishmaniasis in area with recent <em>Leishmania</em> transmission: prevalence, diagnosis, and molecular identification of the infecting species]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100343&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Canine visceral leishmaniasis (CVL) is an endemic disease in Brazil, and integrated control actions have been adopted by the Brazilian Ministry of Health to control its spread. However, the transmission profile is unknown in areas with recent CVL cases, including Itaúna, located in the Brazilian state of Minas Gerais, where the present study was carried out. METHODS: A total of 2,302 dogs from 12 neighborhoods were serologically tested for canine VL using the current diagnostic protocol adopted by the Brazilian Ministry of Health. Test positivity rate (TPR) and CVL prevalence were determined for each neighborhood. The presence of Leishmania was assessed in 60 seropositive dogs which had been recommended for euthanasia. Twenty-two of them (37%) were asymptomatic, and 38 (63%) were symptomatic for CVL. Parasitological (myeloculture and smear/imprint) and molecular (PCR) methods were employed for Leishmania detection in bone marrow, spleen, mesenteric lymph nodes, and ear skin. The infecting Leishmania species was identified by DNA sequencing. RESULTS: CVL prevalence (per 1,000 dogs) varied from 0.0-166.67, depending on the neighborhood, with a mean of 68.96 (SD 51.38). Leishmania DNA was detected in at least one tissue from all seropositive dogs, with comparable TPR among tissues. Leishmania parasites were identified in most (54/60) seropositive dogs, and the infecting parasite was identified as Leishmania infantum in all of these. CONCLUSIONS: Prevalence of CVL is a contributor to the spread of visceral leishmaniasis in Itaúna. <![CDATA[Hydroalcoholic extract of <em>Caryocar brasiliense</em> Cambess. leaves affect the development of <em>Aedes aegypti</em> mosquitoes]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100344&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Curtailing the development of the aquatic immature stages of Aedes aegypti is one of the main measures to limit their spread and the diseases transmitted by them. The use of plant extracts is a promising approach in the development of natural insecticides. Thus, this research aimed to characterize the inhibitory effect of the hydroalcoholic extract of Caryocar brasiliense leaves on the emergence of adult A. aegypti and the main substances that constitute this extract. METHODS: C. brasiliense leaf extract was prepared by ethanol (70%) extraction. Bioassays using L3 larvae were performed at concentrations of 200, 300, 400, and 500 ppm. We identified the major secondary metabolites present in this extract, and performed toxicity tests on an off-target organism, Danio rerio. RESULTS: We observed a significant delay in the development of A. aegypti larvae mainly at a concentration of 500 ppm, and estimated an emergence inhibition for 50% of the population of 150 ppm. Moreover, the C. brasiliense leaf extracts exhibited low toxicity in D. rerio. The main compounds found in the extract were quercetin, violaxanthin, myricetin3-O-hexoside, methyl-elagic-3-arabinose acid, and isoquercitrin. CONCLUSIONS: Herein, we demonstrate the inhibition of mosquito development by the hydroalcoholic extract of C. brasiliense and suggest substances that may act as active principles. <![CDATA[Triatomine bugs (Hemiptera, Reduviidae, Triatominae) in the Domiciles of the Guaribas Valley Territory, in Northeastern Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100345&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION Triatomine bugs are hematophagous insects that are extremely important in public health because they are natural vectors of Trypanosoma cruzi, the causative agent of Chagas disease. In this study, we aimed to assess the occurrence of triatomine species and the natural T. cruzi infection in the Guaribas Valley territory, an endemic region for Chagas disease in northeastern Brazil. METHODS Insects were actively captured from July 2017 to October 2019 in the intra- and peridomiciles of 16 municipalities of the Guaribas Valley territory, in the southeast area of Piauí state. Triatomine species were identified following a taxonomic key, and natural infection was investigated through insects’ fresh feces exams. RESULTS A total of 430 triatomines were collected, including 211 nymphs and 219 adults. Of all collected specimens, 39 (9.1%) were from the intradomiciles and 391 (90.9%) from peridomiciles. Nine species, including two subspecies, could be identified: Triatoma brasiliensis brasiliensis, T. brasiliensis macromelasoma, T. pseudomaculata, T. sordida, T. juazeirensis, T. melanocephala, Panstrongylus lutzi, Rhodnius domesticus, R. nasutus, and R. robustus. T. brasiliensis were the most frequently collected bugs, representing 72% of all the identified insects. None of the examined invertebrates presented flagellate forms of T. cruzi. CONCLUSIONS: This is the first report of T. b. macromelasoma and T. juazeirensis in the Guaribas Valley territory. The persistence of triatomine species in the domiciles in an endemic area for Chagas disease emphasizes the relevance of entomological surveillance and vector control measures in the studied area. <![CDATA[The value of mitigating epidemic peaks of COVID-19 for more effective public health responses]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100500&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION Triatomine bugs are hematophagous insects that are extremely important in public health because they are natural vectors of Trypanosoma cruzi, the causative agent of Chagas disease. In this study, we aimed to assess the occurrence of triatomine species and the natural T. cruzi infection in the Guaribas Valley territory, an endemic region for Chagas disease in northeastern Brazil. METHODS Insects were actively captured from July 2017 to October 2019 in the intra- and peridomiciles of 16 municipalities of the Guaribas Valley territory, in the southeast area of Piauí state. Triatomine species were identified following a taxonomic key, and natural infection was investigated through insects’ fresh feces exams. RESULTS A total of 430 triatomines were collected, including 211 nymphs and 219 adults. Of all collected specimens, 39 (9.1%) were from the intradomiciles and 391 (90.9%) from peridomiciles. Nine species, including two subspecies, could be identified: Triatoma brasiliensis brasiliensis, T. brasiliensis macromelasoma, T. pseudomaculata, T. sordida, T. juazeirensis, T. melanocephala, Panstrongylus lutzi, Rhodnius domesticus, R. nasutus, and R. robustus. T. brasiliensis were the most frequently collected bugs, representing 72% of all the identified insects. None of the examined invertebrates presented flagellate forms of T. cruzi. CONCLUSIONS: This is the first report of T. b. macromelasoma and T. juazeirensis in the Guaribas Valley territory. The persistence of triatomine species in the domiciles in an endemic area for Chagas disease emphasizes the relevance of entomological surveillance and vector control measures in the studied area. <![CDATA[Influenza Sentinel Surveillance and Severe Acute Respiratory Infection in a Reference Hospital in Southern Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100600&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: We report the results of the active surveillance of influenza infections in hospitalized patients and the evaluation of the seasonality and correlation with temperature and rainfall data. METHODS: During the 2-year study period, 775 patients were tested for 15 respiratory viruses (RVs). RESULTS: Most of the 57% of (n=444) virus-positive samples were human rhinovirus and respiratory syncytial virus. However, 10.4% (n=46) were influenza virus (80% FluA; 20% FluB). Age and SARI were significantly associated with influenza. FluB circulation was higher is 2013. CONCLUSIONS: In the post-epidemic period, influenza remains an important cause of hospitalization in SARI patients. <![CDATA[Injuries caused by fish to fishermen in the Vale do Alto Juruá, Western Brazilian Amazon]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100601&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: This study aimed to document injuries caused by fish among professional fishermen in the Western Brazilian Amazon. METHODS: We undertook a descriptive, retrospective study, involving 51 professional fishermen, to determine clinical, epidemiological, and therapeutic aspects of their injuries. RESULTS: Among 51 fishermen interviewed, most injuries were due to mandi (Pimelodus spp.), and the hands were the most injured region, resulting in pain and bleeding in all cases. CONCLUSIONS: Our study findings confirm the morbidity of fish-related injuries, and reaffirm the need for relevant information regarding prevention and injury management. <![CDATA[<em>Pseudomonas aeruginosa</em> in the ICU: prevalence, resistance profile, and antimicrobial consumption]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100602&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Pseudomonas aeruginosa is one of the main pathogens causing infection in intensive care units (ICUs) and usually presents antimicrobial resistance. METHODS: Data were obtained from ICUs between 2010 and 2013. RESULTS: P. aeruginosa had a prevalence of 14.5% of which 48.7% were multidrug resistant. We observed increasing resistance to carbapenems and polymyxin B and growing consumption of aminoglycosides, meropenem, ceftazidime, and polymyxin B. The regression impact between resistance and consumption was significant with respect to amikacin, imipenem, meropenem, and polymyxin B. CONCLUSIONS: Monitoring antimicrobial consumption and resistant microorganisms should be reinforced to combat antimicrobial- and multi-drug resistance. <![CDATA[Spatiotemporal distribution of acquired immunodeficiency syndrome incidence in Brazil between 2012 and 2016]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100603&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Acquired immunodeficiency syndrome (AIDS) remains a major public health issue in Brazil. This ecological study aimed to evaluate the spatiotemporal distribution of notified new AIDS cases in Brazil between 2012 and 2016. METHODS: A Bayesian spatiotemporal model based on the Poisson distribution was used to obtain smoothed incidence estimates of AIDS in each of the 133 Brazilian intermediate regions. RESULTS: Spatial distribution of new AIDS cases is highly heterogeneous. Regions with higher gross domestic product per capita tend to have higher incidence rates of AIDS. CONCLUSIONS: Strategies to prevent and control AIDS should consider regional differences. <![CDATA[Investigation of carbapenemases and aminoglycoside modifying enzymes of <em>Acinetobacter baumannii</em> isolates recovered from patients admitted to intensive care units in a tertiary-care hospital in Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100604&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Acinetobacter baumannii are opportunistic bacteria, highly capable of acquiring antimicrobial resistance through the production of carbapenemases and aminoglycoside modifying enzymes (AMEs). METHODS: Carbapenemase and AME genes were investigated in A. baumannii recovered from inpatients of a Brazilian hospital. RESULTS: The key genes found were bla OXA-51-like, the association ISAba1- bla OXA-23-like, and the AME genes aph(3´)-VI, aac(6´)-Ib, aac(3)-Ia, and aph(3´)-Ia. Different clusters spread through the institution wards. CONCLUSIONS: The dissemination of bla OXA-23-like and AME-carrying A. baumannii through the hospital highlights the need for improved preventive measures to reduce the spread of infection. <![CDATA[Fragment detection of Coleopteran and Triatomine insects in experimentally contaminated acai pulp and sugarcane juice]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100605&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Oral transmission of acute Chagas disease is an emerging public health concern. This study aimed to detect insect fragments in experimentally contaminated food, by comparing triatomines with other insects. METHODS Food samples were experimentally contaminated with insects, processed to recover their fragments by light filth, and analyzed by microscopy and Polymerase Chain Reaction (PCR). RESULTS: Morphological differences between coleopteran and triatomine insects were observed in microscopic images. PCR was efficient in amplifying Triatominae DNA in the experimentally contaminated food. CONCLUSIONS: This methodology could be utilized by food analysts to identify possible insect contamination in food samples. <![CDATA[Seroprevalence of arenavirus and hantavirus in indigenous populations from the Caribbean, Colombia]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100606&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: In Colombia, there is insufficient epidemiological surveillance of zoonotic hemorrhagic viruses. METHODS: We performed a sero-epidemiological study in indigenous populations of Wayuü, Kankuamos, and Tuchin communities using Maciel hantavirus and Junin arenavirus antigens for IgG detection by ELISA. RESULTS IgG antibodies to hantavirus and arenavirus were found in 5/506 (1%) and 2/506 (0.4%) serum samples, respectively. CONCLUSIONS: Arenavirus and hantavirus circulate in indigenous populations from the Colombian Caribbean region, and the results indicate that the indigenous populations are exposed to these zoonotic agents, with unknown consequences on their health, despite low seroprevalence. <![CDATA[Evidence of a sylvatic enzootic cycle of <em>Leishmania infantum</em> in the State of Amapá, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100607&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Leishmania infantum was considered to be absent from Amapá until 2017 when canine infection was detected. However, there is a lack of knowledge about which reservoir species are involved in transmission in this region. METHODS: Between 2014 and 2016, 86 samples from wild mammals and 74 from domestic dogs were collected in Wajãpi Indigenous Territory and were tested for the presence of deoxyribonucleic acid (DNA) of Leishmania. RESULTS: The DNA of Le. infantum was detected in two rodent samples, Dasyprocta sp. and Proechimys cuvieri. CONCLUSIONS: This is the first evidence characterizing a sylvatic transmission cycle of Le. infantum in the State of Amapá. <![CDATA[Human immunodeficiency virus/acquired immunodeficiency syndrome epidemic in adolescents from a Brazilian metropolis (1978-2017)]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100608&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Prevalence of human immunodeficiency virus among adolescents is increasing. This study aimed to analyze this current situation in Rio de Janeiro City. METHODS: This was a retrospective longitudinal study using secondary data from the National System of Notifiable Diseases database of cases in adolescents aged 13-19 years. RESULTS: There were 885 acquired immunodeficiency syndrome cases from 1978 to 2017 and 445 human immunodeficiency virus new cases from 2014 to 2017. Over time, sexually transmitted human immunodeficiency virus/acquired immunodeficiency syndrome cases increase. CONCLUSIONS: Human immunodeficiency virus/acquired immunodeficiency syndrome epidemic in adolescents requires novel prevention policies. <![CDATA[Association of adverse drug reaction to anti-tuberculosis medication with quality of life in patients in a tertiary referral hospital]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100609&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Adverse drug reactions can develop when using anti-tuberculosis medication, and the effects of the drugs can also significantly hinder the treatment of patients. METHODS: A cross-sectional survey was conducted in 73 patients using two standardized questionnaires and the World Health Organization Quality of Life-Bref. RESULTS: All patients reported the presence of adverse drug reactions, 71.6% of which are minor and 28.3% both major and minor. The global quality of life analysis showed that patients with tuberculosis have a good average (67.3%). CONCLUSIONS: There is an association between quality of life and adverse drug reaction, educational level, and vulnerability. <![CDATA[Epidemiological aspects and spatial distribution of visceral leishmaniasis in Governador Valadares, Brazil, between 2008 and 2012]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100610&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Visceral leishmaniasis (VL) is an important parasitic disease. We evaluated the epidemiological aspects and spatial distribution of visceral leishmaniasis in Governador Valadares, Brazil. METHODS: All cases of VL, registered by the municipal health department, were analyzed and georeferenced. RESULTS: The human mortality rate was 15% and canine seroprevalence rate was 29.0%. Higher numbers of canine VL cases correlated with higher incidence of human cases. CONCLUSIONS: The high rate of canine seroprevalence, resurgence of the human disease, and correlation between canine and human VL reinforces the role of the dog in disease transmission within the municipality. <![CDATA[The austral-most record of the genus <em>Haemagogus</em> Williston (Diptera: Culicidae)]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100611&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: The genus Haemagogus Williston is restricted to Central America and North and middle of South America and it includes numerous species of yellow fever virus vectors. METHODS: Adult female and larvae mosquitoes were collected using hand aspirators and dipper and pipette, respectively. RESULTS: The first record of a species of Haemagogus and particularly of Haemagogus spegazzinii was from La Pampa, Argentina. With this registry, the number of species found in La Pampa province rises to 18. CONCLUSIONS: New information on breeding sites for the species and implications of this new record suggest a possible extension of distribution in the near future. <![CDATA[Post-exposure human rabies prophylaxis: spatial patterns of inadequate procedures in Ceará - Brazil, 2007 to 2015]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100612&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: This study investigated the spatial distribution of inappropriate post-exposure human rabies procedures in Ceará, Brazil, between 2007 and 2015. METHODS: The ecological study population was based on the records of post-exposure human rabies procedures from the Notification Disease Information System. We analyzed the data using the Moran Index (I) and the Moran Local Index. RESULTS: There were 222,036 (95.8%) records with inappropriate post-exposure human rabies procedures. There was heterogeneity in their spatial distribution, with two significant clusters in the northeast and northwest regions. CONCLUSIONS: These findings help elaborate differentiated strategies to reduce unnecessary post-exposure human rabies procedures. <![CDATA[Social determinants of mortality due to visceral leishmaniasis in Brazil (2001-2015): an ecological study]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100613&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION We aimed to analyze the relationship between visceral leishmaniasis mortality and social determinants of health (SDH). METHODS This was an ecological study of all leishmaniasis-related deaths in Brazil, from 2001 to 2015. We analyzed 49 indicators of human development and social vulnerability. The association was tested using the classical and spatial regression model. RESULTS Mortality was associated with indicators that expressed low human development and high social vulnerability: lack of garbage collection, low schooling, unemployment rate, low per capita income, and income inequality (Gini index). CONCLUSIONS: There was an association between high mortality by leishmaniasis and low SDH. <![CDATA[Gonotrophic discordance in <em>Culex quinquefasciatus</em> (Diptera: Culicidae) in the city of São Paulo, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100614&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: This study aimed to assess the occurrence of gonotrophic discordance in females of Culex quinquefasciatus in São Paulo, Brazil. METHODS: Resting females were collected monthly for 8 months. Females of Cx. quinquefasciatus were identified, and their midgut and ovaries were dissected. RESULTS: Two hundred females were dissected, out of which, 27.5% were nulliparous and 57% were parous. Most females had no blood in the midgut, but gonotrophic discordance was found in 21% females. CONCLUSIONS: Females of Cx. quinquefasciatus showed a high parity rate and gonotrophic discordance, which could favor the vector capacity of this species. <![CDATA[Prevalence of coinfections in women living with human immunodeficiency virus in Northeast Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100615&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Despite the success of antiretrovirals, human immunodeficiency virus (HIV) coinfections continue to cause mortality. We investigated the prevalence of coinfections in women with HIV/acquired immunodeficiency syndrome in Sergipe, Brazil. METHODS: We conducted a cross-sectional study. The coinfections investigated were syphilis, hepatitis B and C, toxoplasmosis, rubella, tuberculosis, and cytomegalovirus. RESULTS: Among the 435 women, 85 (19.5%) had coinfections. The most prevalent was HIV/syphilis, followed by tuberculosis, toxoplasmosis, hepatitis C, hepatitis B, and rubella. Additionally, 300 (96.2%) were seropositive for cytomegalovirus immunoglobulin G. CONCLUSIONS: Despite significant progress in the treatment for people with HIV, coinfections continued to affect this population. <![CDATA[The deadliest snake according to ethnobiological perception of the population of the Alto Juruá region, western Brazilian Amazonia]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100616&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: We examined the ethnobiological perception of the population of the Alto Juruá region about different snake species, in terms of their dangerousness and manifestations of envenomation. METHODS: We interviewed 100 villagers who were active in the forests. RESULTS: Lachesis muta was considered the most venomous snake, and Bothrops atrox appeared to be the most feared snake species. CONCLUSIONS: The high incidence, severity, and mortality of B. atrox bites and the severity and mortality of L. muta bites were the factors that contributed to these species being perceived as the most feared and venomous snakes. <![CDATA[Exposure to <em>Leishmania</em> spp. infection and <em>Lutzomyia</em> spp. in individuals living in an area endemic for visceral leishmaniasis in Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100617&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: This study aimed to investigate human exposure to Leishmania spp. infection and sandflies in an area endemic for the disease. METHODS: The presence of antibodies specific for Leishmania spp. and saliva of Lutzomyia spp. and that of L. infantum DNA in blood were evaluated. RESULTS: Antibodies against Leishmania spp. and sandfly saliva were observed in 20.8% and 37.7% of individuals, respectively. DNA of Leishmania spp. was amplified from the blood of one patient. CONCLUSIONS: The results suggest that Leishmania spp. infection may be underdiagnosed in this area. <![CDATA[Hepatitis B: Prevalence and occult infection in HIV-infected patients]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100618&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: HBV and HIV have identical transmission routes. The aim of this study was to determine the prevalence of HBV in HIV patients and to detect the presence of occult HBV infection. METHODS: All samples were tested for serology markers and using qPCR. RESULTS: This study included 232 individuals, out of which 36.6% presented with HBV markers and 11.8% presented with HBsAg or HBV-DNA, including 3 patients that showed OBI. CONCLUSIONS: We observed a high prevalence of HBV among HIV patients. In addition, the results suggest that OBI can occur in patients with serological profiles that are indicative of past infection. Therefore, the application of molecular tests may enable the identification of infections that are not evident solely based on serology. <![CDATA[Increased capture of <em>Aedes aegypti</em> (Linnaeus, 1762) (Diptera: Culicidae) by removing one ADULTRAP component]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100619&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Aedes aegypti is the main vector responsible for the transmission of numerous arboviruses. Adultrap® has been developed to catch these insects. METHODS: We tested the effectiveness of capturing adults with and without one of the components of Adultrap®. RESULTS: The mean number of insects caught by the original trap was 1.25 (standard deviation = 1.28), while the average obtained with the modified trap was 8.88 (standard deviation = 3.44). The medians were statistically different (p = 0.001) according to the Mann-Whitney test. CONCLUSIONS: The modification of Adultrap® increased the average catch of Ae. aegypti by up to seven times. <![CDATA[HIV prevalence in recently incarcerated adult males in the Federal District, Brasilia, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100620&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: This study intends to describe a HIV intake screening strategy in recently incarcerated adults in Distrito Federal, Brasilia, Brazil. METHODS: We tested 455 recently incarcerated adults in Distrito Federal in 2016 using rapid tests (RT) applied to oral samples (OS). RESULTS: The estimated frequency of positive tests was 0.88% (95% confidence interval [CI] 0.34% to 2.24%). CONCLUSIONS: The present findings reveal the potential significance of detecting new HIV infection cases in a vulnerable population using point-of-care rapid diagnostic tests. <![CDATA[<em>In vivo</em> antileishmanial activity of <em>Annona mucosa</em> extracts]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100621&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Leishmaniasis, a disease caused by a parasite endemic to large areas of tropical and subtropical countries, is a growing public health problem. METHODS: Male BALB/c mice were infected with Leishmania amazonensis and treated with extracts isolated from Annona mucosa. RESULTS: Treated groups had significantly reduced footpad swelling. The group treated intraperitoneally with hexane extract showed footpad swelling similar to groups treated with Pentamidine® and Glucantime®. Groups treated with dichloromethane extract and hexane extract presented the recovering phenotype associated with reduced parasite levels. CONCLUSIONS: Extracts of A. mucosa are promising sources of novel antileishmanial compounds. <![CDATA[Characterization of adverse reactions to benznidazole in patients with Chagas disease in the Federal District, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100622&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Benznidazole is used for treating Chagas disease (CD). This cross-sectional study aimed to characterize the adverse drug reactions (ADRs) of benznidazole at a public hospital in Brazil’s Federal District. METHODS: Medical records were analyzed and ADRs were categorized by type, intensity, seriousness, and causality. RESULTS: Of the 62 patients who started benznidazole treatment for CD, 41 (66%) presented with 105 ADRs; 23 (37%) discontinued the treatment. Most reactions were classified as probable (81%), severe (63%), serious (67%), and dose-dependent (56%). CONCLUSIONS: The high incidence of ADRs because of treatment withdrawal revealed the need for safer alternatives for CD treatment. <![CDATA[Human platelet antigen-3 polymorphism as a risk factor for rheumatological manifestations in hepatitis C]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100623&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Hepatitis C virus (HCV) infection is involved in the pathogenesis of autoimmune and rheumatic disorders. Although the human platelet antigens (HPA) polymorphism are associated with HCV persistence, they have not been investigated in rheumatological manifestations (RM). This study focused on verifying associations between allele and genotype HPA and RM in patients with chronic hepatitis C. METHODS: Patients (159) with chronic hepatitis C of both genders were analyzed. RESULTS: Women showed association between HPA-3 polymorphisms and RM. CONCLUSIONS: An unprecedented strong association between rheumatological manifestations and HPA-3 polymorphism, possibly predisposing women to complications during the disease course, was observed. <![CDATA[Chemical composition and larvicidal activities of essential oil of <em>Cinnamomum camphora</em> (L.) leaf against <em>Anopheles stephensi</em>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100624&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION Anopheles stephensi is the main malaria vector in Southeast Asia. Recently, plant-sourced larvicides are attracting great interests. METHODS: The essential oil was extracted from the leaf of Cinnamomum camphora (L.), and a bioassay was conducted to determine the larvicidal efficacy. The chemical composition of the essential oil was determined by GC-MS analysis. RESULTS: The oil showed strong, dose-dependent larvicidal activities. The onset of larvicidal efficiency was rapid. The LC50 and LC95 were determined as 0.146% and 1.057% at 1 h, 0.031% and 0.237% at 12 h, 0.026% and 0.128% at 24 h, respectively. The oil contains 32 compounds. CONCLUSIONS The essential oil of C. camphora leaf has an excellent larvicidal potential for the control of A. stephensi. <![CDATA[New report of <em>Eratyrus cuspidatus</em> Stål, 1859 (Hemiptera: Reduviidae: Triatominae) in the State of Campeche, Mexico]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100625&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Triatomine bugs are vectors of Trypanosoma cruzi, the etiological agent of Chagas disease. METHODS: Triatomine bugs were collected and identified following established protocols. In addition, infection with T. cruzi was detected by microscopic and molecular analysis. RESULTS: We captured an adult male specimen of the Eratyrus cuspidatus species that has not been reported in the state of Campeche. CONCLUSIONS: This finding provides new information on the distribution of E. cuspidatus in Mexico. However, more studies are needed to determine their epidemiological significance. <![CDATA[<em>In vitro</em> characterization of virulence factors among species of the <em>Candida parapsilosis</em> complex]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100626&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Candida parapsilosis complex species differ from each other with regard to their prevalence and virulence. METHODS: The hydrolytic enzyme activity, biofilm production, and adhesion to epithelial cells were analyzed in 87 C. parapsilosis complex strains. RESULTS: Among the studied isolates, 97.7%, 63.2%, and 82.8% exhibited very strong proteinase, esterase, and hemolysin activity, respectively. All the C. parapsilosis complex isolates produced biofilms and presented an average adherence of 96.0 yeasts/100 epithelial cells. CONCLUSIONS: Our results show that Candida parapsilosis complex isolates showed different levels of enzyme activity, biofilm production, and adhesion to epithelial cells. <![CDATA[Seroprevalence of cytomegalovirus and its coinfection with Epstein-Barr virus in adult residents from Manaus: a population-based study]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100627&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: This study assessed the seroprevalence of cytomegalovirus, associated factors, and Epstein-Barr virus coinfection among adult residents of Manaus. METHODS: Using a cross-sectional study design, we collected blood samples from 136 individuals in a household survey in 2016. Prevalence ratios were calculated using Poisson regression. RESULTS: Cytomegalovirus and Epstein-Barr virus seroprevalences were 67.6% (95% CI: 9.7-75.6%) and 97.8% (95% CI: 95.3-100.0%), respectively. Coinfection was observed in 66.2% (95% CI: 58.1-74.2%) of participants. Bivariate analysis showed no statistical association. CONCLUSIONS: Seroprevalences were high among participants and approximately 7 out of 10 individuals had cytomegalovirus and Epstein-Barr virus coinfection. <![CDATA[Evaluation of the larvicidal potential of root and leaf extracts of <em>Saussurea costus</em> (Falc.) Lipsch<em>.</em> against three mosquito vectors:<em>Anopheles stephensi</em>, <em>Aedes aegypti,</em> and <em>Culex quinquefasciatus</em>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100628&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: The larvicidal potential of Saussurea costus (Falc.) Lipsch. was studied against the early 4th instar larvae of Anopheles stephensi Liston., Aedes aegypti Linn.,and Culex quinquefasciatus Say. because of the emergence of mosquito resistance to conventional synthetic insecticides. METHODS: At concentrations of 12.5-200 ppm, larvicidal activities were studied under laboratory conditions. RESULTS: After 24 h of exposure, the methanol extract of the roots recorded the highest larvicidal activity against An. stephensi, with LC50 and LC90values of 7.96 and 34.39 ppm, respectively. CONCLUSIONS: We are developing potent larvicidal compound(s) from S. costus for controlling the mosquito larval population. <![CDATA[Absence of mutations associated with resistance to benzimidazole in the beta-tubulin gene of <em>Ascaris suum</em>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100629&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Benzimidazoles are commonly used for the control of veterinary nematodes. Resistance to benzimidazoles has been associated with three single nucleotide polymorphisms in the β-tubulin gene of common nematodes. However, these mutations are infrequent in the genus Ascaris spp. METHODS: In order to determine mutations associated with benzimidazole resistance in Ascaris suum, worms were collected from slaughtered pigs and a partial region of the β-tubulin gene was sequenced. RESULTS: All parasites showed the wildtype genotype for codons 167, 198, and 200 of the β-tubulin gene. CONCLUSIONS: This is the first report of genetic sequences associated with benzimidazole resistance in A. suum. <![CDATA[Seroprevalence of toxoplasmosis in pregnant women and its associated factors among hospital and community populations in Lambayeque, Peru]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100630&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION Toxoplasmosis is a zoonosis caused by Toxoplasma gondii. This study investigated the prevalence and factors associated with toxoplasmosis among pregnant women. METHODS We followed an analytical observational study. From July 2016 to June 2017, 218 pregnant women were selected. The infection was detected through serological dosage of anti-T.gondii Immunoglobulin(Ig) M and IgG antibodies. RESULTS The seroprevalence was 35.8%; the factors associated with infection were consumption of non-drinking water, residence in an urban area, and threatened abortion during the current pregnancy. CONCLUSIONS The seroprevalence of toxoplasmosis among pregnant women is high. The risk factors are dependent on environmental determinants. <![CDATA[Molecular detection of <em>Paracoccidioides</em> in soil from an urban area of southern Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100631&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Previous studies that detected Paracoccidioides spp. DNA in soil taken from rural areas have shown this to be a valuable tool for ecological and epidemiological studies. This study reports the detection of Paracoccidioides spp. DNA in soil samples from an urban area of southern Brazil. METHODS: Sixteen soil samples were submitted to nested-PCR and the amplicons of a representative number of positive samples were sequenced. RESULTS: Paracoccidioides spp. DNA was found in 44% of samples. Four DNA amplicons were sequenced, showing 100% homology with P. brasiliensis. CONCLUSIONS: The southern Brazilian urban population is commonly exposed to the Paracoccidioides fungus. <![CDATA[Development of an enzyme-linked immunosorbent assay for diagnosis of human herpesvirus-7 infection]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100632&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Human herpesvirus (HHV)-7 establishes a latent infection during the lifetime of the host and can reactivate after the primary infection, leading to lytic replication in immunosuppressed patients. METHODS: This study aimed to develop an enzyme-linked immunosorbent assay (ELISA) to identify HHV-7 serum antibodies and compare its performance with that of an indirect immunofluorescence assay (IFA). RESULTS: Serum samples (n=102) were tested by IgG-IFA and by ELISA. IFA and ELISA showed IgG-positive results in 77 and 73 samples, respectively. Qualitative concordance of 96% was demonstrated between the two techniques. CONCLUSIONS: ELISA may be useful to diagnose HHV-7 infection. <![CDATA[Influence of climatic variables on the <em>Aedes aegypti</em> and <em>Culex quinquefasciatus</em> populations in Mato Grosso, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100633&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Aedes aegypti and Culex quinquefasciatus are vector species responsible for the transmission of important arboviruses. METHODS: Adult mosquitoes were collected in the urban areas of four municipalities in Mato Grosso within 1 year. RESULTS: A total of 19,110 mosquitoes were collected. Among them, 16,578 (86,8%) were C. quinquefasciatus (44% female and 56% male); 2,483 (13%), A. (Stegomyia) aegypti (54% female and 46% male); and 49 (0,30%), from the genus Psorophora, Anopheles, Coquilettidia, and Sabethes. A significant correlation was observed between the number of mosquitoes from all species and dew point (female mosquitoes, p = 0.001; male mosquitoes, p = 0.001). CONCLUSIONS: The results of this study may be used as environmental indicators of mosquito populations. <![CDATA[Syphilis among pregnant women in Northeast Brazil from 2008 to 2015: a trend analysis according to sociodemographic and clinical characteristics]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100634&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: The number of syphilis cases among pregnant women in Brazil has increased. This study aimed to analyze the temporal trend of syphilis indicators among pregnant women in Northeast Brazil. METHODS: A time-series study was performed. RESULTS: We observed an increase in the detection rate of syphilis among pregnant women, those aged 15-19 years, and those of brown ethnicity. A strong correlation was observed between the detection rate of syphilis and family health strategy coverage. CONCLUSIONS: Despite an increase in primary care coverage, The increase in cases of syphilis among pregnant women is still considered a challenge. <![CDATA[New molecular target for the phylogenetic identification of <em>Leptospira</em> species directly from clinical samples: an alternative gene to 16S rRNA]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100635&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Phylogenetic analysis of the 16S ribosomal gene initial region is used to identify Leptospira isolates at the species level from clinical samples. Unfortunately, this method cannot differentiate between some intermediates and saprophytic species. METHODS: We used comparative genomic analysis between 35 Leptospira species to find new molecular targets for Leptospira species identification. RESULTS: We proposed the use of the rpoC gene, encoding the DNA-directed RNA polymerase β-subunit, for identifying 35 Leptospira species. CONCLUSIONS: The rpoC gene can be a molecular target to identify the main species of the Leptospira genus directly from clinical samples. <![CDATA[First report of <em>Rhodnius montenegrensis</em> (Hemiptera, Reduviidae, Triatominae) in Amazonas, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100636&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Triatomines are hematophagous insects of epidemiological importance because they are vectors of Chagas disease. We present here the first report of Rhodnius montenegrensis in Amazonas, Brazil. METHODS: Triatomines were collected from Attalea butyracea palm trees in the municipality of Guajará. RESULTS: Two adult female R. montenegrensis specimens were identified. CONCLUSIONS: The present study confirms that the number of triatomine species within the Amazon has increased from 10 to 11, and the number of Brazilian states with R. montenegrensis has increased from two to three. <![CDATA[Importance of epidemiological surveillance of leprosy: analysis of the occurrence of leprosy in intra-domiciliary contacts in a capital in the Brazilian northeast region]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100637&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION Intra-domiciliary contacts are a group with the highest risk of developing leprosy. METHODS A cross-sectional study of intra-domiciliary contacts of new leprosy cases was conducted. A descriptive analysis of the variables was performed. RESULTS Among 190 contacts, 63% were invited to visit the health unit, and 54.2% received the BCG vaccine. The prevalence of leprosy among the contacts was 4.7%. CONCLUSIONS The occurrence of leprosy among the contacts was high and similar to that found previously. There were failures in surveillance actions carried out by health units. Never-before treated cases were found. <![CDATA[Detection of the Asian II genotype of dengue virus serotype 2 in humans and mosquitoes in Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100638&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: DENV-2 is the cause of most dengue epidemics worldwide and is associated with severe cases. METHODS: We investigated arboviruses in 164 serum samples collected from patients presenting with clinical symptoms of dengue fever and 152 mosquito pools. RESULTS: We detected the Asian II genotype of DENV-2 in humans and mosquitoes. Our results confirmed the circulation of the Asian II genotype in Brazil, in addition to the prevalent Asian/American genotype. CONCLUSIONS: The detection of Asian II genotype of DENV-2 in mosquito pools collected in a forest park may be related to a spillback event of human dengue virus. <![CDATA[Adverse drug events and the associated factors in patients with chronic Chagas disease]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100639&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Herein, we aimed to identify the factors associated with adverse drug events (ADEs) in chronic Chagas disease (CD) patients. METHODS: We analyzed 320 medical notes from 295 patients. The Naranjo algorithm was applied to determine the cause of ADEs. Mixed effects logistic regression was performed to evaluate the factors associated with ADEs. RESULTS: ADEs were described in 102 medical notes (31.9%). Captopril was most frequently associated with ADEs. Age (RR 0.96; 95%CI 0.94-0.99) and cardiac C/D stages (RR 3.24; 95%CI 1.30-4.58) were the most important clinical factors associated with ADEs. CONCLUSIONS: Close follow-up is warranted for CD patients. <![CDATA[High prevalence of blood donor test-seeking behavior among health sciences undergraduate students]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100640&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION This study investigated the prevalence of blood donors’ test-seeking behavior and related factors among health sciences undergraduate students. METHODS A total of 750 students were invited. Data regarding sociodemographic and behavioral characteristics, blood donation practices, and test-seeking behavior were collected. RESULTS: Of the invited students, 341 (45.5%) agreed to participate and answered questions regarding test-seeking behavior. The sample comprised 83.1% females, 96.8% singles, 87.2% heterosexuals, and 32.6% of them had previously donated blood. A high prevalence of blood donor test-seeking behavior (14.4%; 95% CI: 10.8%-18.5%) was observed and associated with blood donation practices. CONCLUSIONS: Test-seeking behavior was common among the interviewed students, thereby highlighting the importance of developing a better understanding of its determinants to prevent this behavior in key populations. <![CDATA[Surveillance of the first cases of COVID-19 in Sergipe using a prospective spatiotemporal analysis: the spatial dispersion and its public health implications]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100641&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Coronavirus disease 2019 (COVID-19) has become a global public health emergency with lethality ranging from 1% to 5%. This study aimed to identify active high-risk transmission clusters of COVID-19 in Sergipe. METHODS: We performed a prospective space-time analysis using confirmed cases of COVID-19 during the first 7 weeks of the outbreak in Sergipe. RESULTS: The prospective space-time statistic detected "active" and emerging spatio-temporal clusters comprising six municipalities in the south-central region of the state. CONCLUSIONS: The Geographic Information System (GIS) associated with spatio-temporal scan statistics can provide timely support for surveillance and assist in decision-making. <![CDATA[Learning from the Italian experience in coping with COVID-19]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100642&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: In March 2020, the rapid increase in COVID-19 cases overburdened the Italian health system, with the country becoming the pandemic’s epicenter. METHODS: We present a narrative review based on manuscripts, official documents, and newspaper articles regarding COVID-19 in Italy. RESULTS: Characteristics of the epidemic, possible causes for its worsening, and the measures adopted across Italian regions are presented. CONCLUSIONS: In the early stages of an epidemic, effective decision-making is essential to contain the number of cases. Medical support for patients and social isolation measures are the most appropriate strategies currently available to reduce the spread and lethality of COVID-19. <![CDATA[Short-term forecasting of daily COVID-19 cases in Brazil by using the Holt’s model]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100643&lng=en&nrm=iso&tlng=en Abstract: INTRODUCTION: We evaluated the performance of the Holt’s model to forecast the daily COVID-19 reported cases in Brazil and three Brazilian states. METHODS: We chose the date of the first COVID-19 case to April 25, 2020, as the training period, and April 26 to May 3, 2020, as the test period. RESULTS: The Holt’s model performed well in forecasting the cases in Brazil and in São Paulo and Minas Gerais states, but the forecasts were underestimated in Rio de Janeiro state. Conclusions: The Holt’s model can be an adequate short-term forecasting method if their assumptions are adequately verified and validated by experts. <![CDATA[Infections and antimicrobial resistance in an adult intensive care unit in a Brazilian hospital and the influence of drug resistance on the thirty-day mortality among patients with bloodstream infections]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100644&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: The present study aimed to determine the incidence of health care-associated infections (HCAIs) and identify the main resistant microorganisms in intensive care unit (ICU) patients in a Brazilian university hospital. METHODS: A retrospective cohort study was conducted in a Brazilian teaching hospital between 2012 and 2014. RESULTS: Overall, 81.2% of the infections were acquired in the ICU. The most common resistant pathogenic phenotypes in all-site and bloodstream infections were oxacillin-resistant coagulase-negative staphylococci and carbapenem-resistant Acinetobacter spp. (89.9% and 87.4%; 80.6% and 70.0%), respectively. CONCLUSIONS: There is an urgent need to focus on HCAIs in ICUs in Brazil. <![CDATA[Risk factors associated with mortality among patients who had candidemia in a university hospital]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100645&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Bloodstream infection due to Candida spp. is a primary cause of morbidity and mortality in tertiary hospitals. METHODS: In this retrospective study, we included patients with a positive blood culture for Candida spp. after 48 h of hospitalization. RESULTS A total of 335 patients who had candidemia were included in this study. Risk factors associated with mortality were hospitalization in internal medicine units and surgical clinics, age &gt;60 years, mechanical ventilation, orotracheal intubation, hemodialysis, corticosteroids use, and C. parapsilosis infection. CONCLUSIONS: This study highlights the importance of health care related to invasive procedures and actions to improve patient immunity. <![CDATA[Comparative performance of four malaria rapid diagnostic tests, Vikia Malaria <em>Pf</em>/Pan, Meriline-Meriscreen <em>Pf/Pv</em>/Pan, Right Sign Malaria <em>Pf</em>/Pan, and Right Sign Malaria <em>Pf</em>, among febrile patients in Gabon]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100646&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Rapid diagnostic tests (RDTs) are selected based on their performances. Here, we compared the diagnostic performance of different malaria RDTs. METHODS: Febrile patients were tested for malaria using Vikia Malaria Pf/Pan, Meriline-Meriscreen Pf/Pv/Pan, Right Sign Malaria Pf/Pan, and Right Sign Malaria Pf RDTs at Melen Regional Hospital in Gabon. RESULTS: In total, 120 of 274 tested children (43.8%) had malaria. The sensitivity was &gt; 95% for all RDTs, while the specificity was &gt; 85% for two tests. One test generated invalid tests (8%). CONCLUSIONS: Based on their performances, all tests except one may be recommended for malaria diagnosis. <![CDATA[Transmission and prevalence of drug-resistant tuberculosis in a Brazilian setting under a directly observed therapy short-course strategy]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100647&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: We aimed to estimate the prevalence and transmission of drug-resistant tuberculosis in a high-burden Brazilian setting under directly observed therapy short-course strategy. METHODS: Isolates of culture-confirmed pulmonary tuberculosis patients from Guarulhos, Brazil, diagnosed in October 2007-2011 were subjected to drug susceptibility and IS6110-restriction fragment length polymorphism testing. RESULTS: The overall resistance prevalence was 11.5% and the multi-drug resistance rate was 4.2%. Twenty-six (43.3%) of 60 drug-resistant isolates were clustered. Epidemiological relationships were identified in 11 (42.3%) patients; 30.8% of the cases were transmitted in households. CONCLUSIONS: Drug-resistant tuberculosis was relatively low and transmitted in households and the community. <![CDATA[A Retrospective Survey of Rodent-borne Viruses in Rural Populations of Brazilian Amazon]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100648&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: The Amazon tropical rainforest has the most dense and diverse ecosystem worldwide. A few studies have addressed rodent-borne diseases as potential hazards to humans in this region. METHODS: A retrospective survey was conducted using enzyme-linked immunosorbent assay for detecting mammarenavirus and orthohantavirus antibodies in 206 samples collected from rural settlers of the Brazilian Western Amazonian region. RESULTS: Six (2.91%) individuals in the age group of 16 to 36 years were found to possess antibodies against mammarenavirus. CONCLUSION: Evidence of previous exposure to mammarenavirus in the rural population points to its silent circulation in this region. <![CDATA[Identification of plasmid IncQ1 and NTE<sub>KPC</sub>-IId harboring <em>bla</em> <sub>KPC-2</sub> in isolates from <em>Klebsiella pneumoniae</em> infections in patients from Recife-PE, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100649&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: This study investigated the genetic environment of bla KPC-2 in Klebsiella pnemoniae multi-drug resistant clinical isolates. METHODS: Four carbapenemase gene isolates resistant to carbapenems, collected from infected patients from two hospitals in Brazil, were investigated using polymerase chain reaction and plasmid DNA sequencing. RESULTS: The bla KPC-2 gene was located between ISKpn6 and a resolvase tnpR in the non-Tn4401 element (NTEKPC-IId). It was detected on a plasmid belonging to the IncQ1 group. CONCLUSIONS To our knowledge, this is the first report of the presence of the bla KPC-2 gene in the NTEKPC-IId element carried by plasmid IncQ1 from infections in Brazil. <![CDATA[Genomic surveillance of the Chikungunya Virus (CHIKV) in Northeast Brazil after the first outbreak in 2014]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100650&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: We performed an epidemiological surveillance of the Chikungunya (CHIKV) lineages in Bahia after the 2014 East/Central/South African (ECSA) genotype outbreak. METHODS: Reverse-transcription polymerase chain reaction (RT-PCR), viral isolation, and phylogenetic analyses were conducted on serum samples from 605 patients with CHIKV-like symptoms during 2014-2018. RESULTS: Of the 605 samples, 167 were CHIKV-positive. Viral isolation was achieved for 20 samples; their phylogenetic analysis (E2 protein) revealed the presence of ECSA lineage and reinforced the phylogenetic relationship between ECSA and Indian Ocean lineages. CONCLUSIONS: The genomic surveillance of CHIKV showed that only ECSA lineage circulated in Bahia since the 2014 outbreak. <![CDATA[Cost-utility analysis of interferon-free treatments for patients with early-stage genotype 1 hepatitis C virus in Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100651&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION We conducted a cost-utility analysis of available interferon-free treatments for patients with early-stage genotype 1 chronic hepatitis C based on a Brazilian public health system perspective. METHODS A Markov model was derived using a cohort of stage F0-F2 patients treated as recommended by the Brazilian national guidelines. RESULTS: Glecaprevir plus pibrentasvir was superior to all other treatments, followed by sofosbuvir plus velpatasvir. Sofosbuvir plus daclatasvir was identified as the least cost-effective option. CONCLUSIONS: The above findings were confirmed via probabilistic sensitivity analysis and the tested scenarios. <![CDATA[Clinical response to antibiotics in indigenous versus non-indigenous children under 5 years old with community-acquired pneumonia in Otavalo, Ecuador]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100652&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality worldwide. This study compares the clinical response to antimicrobials between indigenous and non-indigenous Kichwa children under 5 years old with CAP in Otavalo, Ecuador. METHODS: All children with CAP who met the inclusion criteria and were admitted at the San Luis de Otavalo Hospital between March 2017 and June 2018 were evaluated. RESULTS: No significant differences were observed in clinical responses between indigenous and non-indigenous children. CONCLUSIONS: The improved healthcare access of the Otavalo’s Kichwa population may have contributed to the observed clinical response to CAP treatment. <![CDATA[Efficacy of the 7-chloro-4-(3-hydroxy-benzilidenehydrazo)quinoline derivative against infection caused by <em>Leishmania amazonensis</em>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100653&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: The drugs currently available for leishmaniasis treatment have major limitations. METHODS: In vitro and in vivo studies were performed to evaluate the effect of a quinoline derivative, Hydraqui (7-chloro-4-(3-hydroxy-benzilidenehydrazo)quinoline, against Leishmania amazonensis. In silico analyses of absorption, distribution, metabolism, excretion, and toxicity (ADMET) parameters were performed. RESULTS: Hydraqui showed significant in vitro anti-amastigote activity. Also, Hydraqui-treated mice exhibited high efficacy in lesion size (48.3%) and parasitic load (93.8%) reduction, did not cause hepatic and renal toxicity, and showed appropriate ADMET properties. CONCLUSIONS: Hydraqui presents a set of satisfactory criteria for its application as an antileishmanial agent. <![CDATA[Sequential serological surveys in the early stages of the coronavirus disease epidemic: limitations and perspectives]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100654&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Estimates of the number of individuals infected by severe acute respiratory syndrome coronavirus 2 are important for health planning and establishment of expectations regarding herd immunity. METHODS: Seven testing rounds of a serological survey were conducted at 1-week intervals between April 19 and May 31, 2020 in Teresina municipality. RESULTS Over the 7 weeks, serological positivity increased from 0.56% (95% confidence interval [CI]: 0.18%-1.30%) to 8.33% (95% CI: 6.61%-10.33%), representing 33-53 persons infected for each reported case. CONCLUSIONS: Serological screening may be an important tool for understanding the immunity of a population and planning community interventions. <![CDATA[Covid-19 growth rate analysis: application of a low-complexity tool for understanding and comparing epidemic curves]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100655&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: The acceleration of new cases is important for the characterization and comparison of epidemic curves. The objective of this study was to quantify the acceleration of daily confirmed cases and death curves using the polynomial interpolation method. METHODS: Covid-19 epidemic curves from Brazil, Germany, the United States, and Russia were obtained. We calculated the instantaneous acceleration of the curve using the first derivative of the representative polynomial. RESULTS: The acceleration for all curves was obtained. CONCLUSIONS: Incorporating acceleration into an analysis of the Covid-19 time series may enable a better understanding of the epidemiological situation. <![CDATA[Coronavirus disease and basic sanitation: too early to be worried?]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100656&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Considering that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been detected in feces, this study aimed to verify a possible relationship between basic sanitation indices and coronavirus disease (COVID-19) numbers/rates. METHODS: Data of COVID-19 cases registered in Brazil until May 28, 2020, and independent variables associated with basic sanitation were analyzed. RESULTS: A significant correlation between the number of cases and sewage treatment index/population density was observed. In addition, COVID-19 incidence and mortality rates were significantly associated with the total water service index and lethality rate was significantly associated with the sewage treatment index. CONCLUSIONS: Precarious basic sanitation infrastructure may potentially increase the SARS-CoV-2 transmission in Brazil. <![CDATA[Care for frontline health care workers in times of COVID-19]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100657&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: The spread of the 2019 coronavirus disease (COVID-19) has generated the collapse of health care systems and significant impacts on the health of the workers involved in combatting the disease worldwide. METHODS: We conducted an integrative literature review focusing on the alternatives implemented to develop care for frontline health care workers in times of COVID-19. RESULTS: Fifteen articles disclosed the importance of physical and mental care for workers. CONCLUSIONS: A sensitive view of the health care worker’s care is urgently needed to maintain the quality of health service offered to the population and preserve the health of frontline workers. <![CDATA[Long-term forecasts of the COVID-19 epidemic: a dangerous idea]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100658&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: Mathematical models have been used to obtain long-term forecasts of the COVID-19 epidemic. METHODS: The daily COVID-19 case count in two Brazilian states was used to show the potential limitations of long-term forecasting through the application of a mathematical model to the data. RESULTS: The predicted number of cases at the end of the epidemic and at the moment that the peak occurs, is highly dependent on the length of the time series used in the predictive model. CONCLUSIONS: Predictions obtained during the course of the COVID-19 pandemic need to be viewed with caution. <![CDATA[Imputation method to reduce undetected severe acute respiratory infection cases during the coronavirus disease outbreak in Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100659&lng=en&nrm=iso&tlng=en Abstract INTRODUCTION: The coronavirus disease (COVD-19) outbreak has overburdened the surveillance of severe acute respiratory infections (SARIs), including the laboratory network. This study was aimed at correcting the absence of laboratory results of reported SARI deaths. METHODS: The imputation method was applied for SARI deaths without laboratory information using clinico-epidemiological characteristics. RESULTS: Of 84,449 SARI deaths, 51% were confirmed with COVID-19 while 3% with other viral respiratory diseases. After the imputation method, 95% of deaths were reclassified as COVID-19 while 5% as other viral respiratory diseases. CONCLUSIONS: The imputation method was a useful and robust solution (sensitivity and positive predictive value of 98%) for missing values through clinical &amp; epidemiological characteristics. <![CDATA[A rare cause of vertebral osteomyelitis: the first case report of rat-bite fever in Portugal]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100700&lng=en&nrm=iso&tlng=en Abstract Rat-bite fever is a rarely diagnosed illness caused by Streptobacillus moniliformis . Although this disease is distributed worldwide, there have been few cases reported in Europe. Here, we report a case of vertebral osteomyelitis and sternoclavicular septic arthritis caused by S. moniliformis in a Portuguese patient previously bitten by a rat. Laboratory diagnosis was performed using molecular identification. This is the first case report of rat-bite fever in Portugal. The case described here serves as a reminder for physicians to consider this diagnosis in patients who have developed fever syndromes after being in contact with rodents. <![CDATA[<em>de novo</em> Histoid leprosy: an expatriate case recently diagnosed in Johannesburg]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100701&lng=en&nrm=iso&tlng=en Abstract: Histoid leprosy (HL) is a rare variant of lepromatous leprosy with unique clinical, histopathological, and microbiological features. A 32-year-old man from Malawi who immigrated to Johannesburg 1-year-ago, presented with a 4-month history of flesh-colored nodules on the face and trunk and hyperpigmented plaques on the chest and limbs. Skin slit smears confirmed multibacillary leprosy, and skin punch biopsies showed proliferation of spindled cells containing a large number of acid-fast bacilli. The prevalence of de novo HL is increasing in the era of leprosy elimination. HL cases may act as reservoirs and negatively affect the global control of leprosy. <![CDATA[Imported hepatopulmonary echinococcosis: first report of <em>Echinococcus granulosus</em> sensu stricto (G1) in Bolivia]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100702&lng=en&nrm=iso&tlng=en Abstract Hepatopulmonary hydatidosis in young children is a rare and atypical presentation of Echinococcus granulosus infection. We report the first case of cystic echinococcosis caused by a microvariant of E. granulosus sensu stricto. Chemotherapy and systemic corticoids were administered before curative surgery was performed. Recurrence was not observed for more than 24 months of follow-up. <![CDATA[Acute disseminated encephalomyelitis (ADEM) associated with mosquito-borne diseases: Chikungunya virus X yellow fever immunization]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100703&lng=en&nrm=iso&tlng=en Abstract Acute disseminated encephalomyelitis (ADEM) is a demyelinating autoimmune neuropathic condition characterized by extensive bilateral and confluent lesions in the cerebral white matter and cerebellum. The basal ganglia and gray matter may also be involved. In most cases, the symptoms are preceded by viral infection or vaccination. In this report, we present a case of ADEM associated with optic neuritis presenting alongside two potential triggering factors: chikungunya virus infection and yellow fever immunization. <![CDATA[Urogenital tuberculosis in a patient with end-stage renal disease]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100704&lng=en&nrm=iso&tlng=en Abstract Tuberculosis is one of the most common infections worldwide with particularly high incidence rates in countries with unfavorable socioeconomic conditions and among persons with impaired immune systems. While most patients with this disease will present with pulmonary tuberculosis, immunocompromised individuals also commonly present with extrapulmonary manifestations. We report the case of a 28-year-old male patient with end-stage renal disease who presented with long-standing systemic symptoms and genitourinary manifestations, who was diagnosed with urogenital tuberculosis both by clinical and microbiologic criteria. Clinicians should always suspect tuberculosis in patients with chronic symptoms, especially in those with immunosuppression. <![CDATA[Postpartum histoplasmosis in an HIV-negative woman: a case report and phylogenetic characterization by internal transcribed spacer region analysis]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100705&lng=en&nrm=iso&tlng=en Abstract The present report describes the first case of postpartum disseminated histoplasmosis in a 24-year-old HIV-negative woman. On the tenth day after vaginal delivery, the patient presented with dyspnea, fever, hypotension, tachycardia, and painful hepatomegaly. Yeast-like Histoplasma capsulatum features were isolated in the buffy coat. The phylogenetic analysis demonstrated that the fungal isolate was similar to other H. capsulatum isolates identified in HIV patients from Ceará and Latin America. Thus, histoplasmosis development in individuals with transitory immunosuppression or during the period of immunological recovery should be carefully examined. <![CDATA[Tegumentary leishmaniasis mimicking visceralization in a cirrhotic patient: atypical cutaneous lesions and local immunological features]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100706&lng=en&nrm=iso&tlng=en Abstract Tegumentary leishmaniasis (TL) diagnosis is challenging due to the lack of a gold standard diagnostic tool. The diagnosis is significantly harder in regions where visceral leishmaniasis (VL) is also prevalent since immunological tests may present cross-reactivity. A cirrhotic patient from an endemic Brazilian region for TL and VL presented with atypical cutaneous lesions, a usual clinico-laboratory feature of VL (including a positive rk39 test result), but he was diagnosed with TL histopathologically; VL was ruled out by necropsy. Physicians working in co-prevalent areas should be aware of atypical features, unusual clinical course, and unexpected laboratory findings of leishmaniasis. <![CDATA[First report of scorpionism caused by <em>Tityus serrulatus</em>, described by Lutz and Mello, 1922 (Scorpiones, Buthidae), a species non-native to the state of Pará, Brazilian Amazon]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100707&lng=en&nrm=iso&tlng=en Abstract This reports a case of scorpionism caused by Tityus serrulatus. A male adult was stung while unloading bananas at the supply center in Belém, Pará, Brazil. The bananas originated in another state (Bahia) and were brought to Belém by truck. The patient presented with pain, edema, and erythema at the sting site, and was classified as low-risk. The specimen was identified as T. serrulatus and symptomatic treatment and clinical observation were advised. The patient was discharged later without further complications. This is the first known envenomation caused by T. serrulatus, a non-native species to Pará, in the Brazilian Amazon. <![CDATA[Rabies in <em>Callithrix</em> sp. in the urban area of Niterói, Rio de Janeiro, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100708&lng=en&nrm=iso&tlng=en Abstract In Brazil, rabies occurs mainly within an urban cycle, in which dogs and bats are reservoirs. This paper aims to report the occurrence of rabies in Callithrix sp. in Niterói, Rio de Janeiro, Brazil. In June 2019 a hybrid specimen was referred for diagnosis. The Direct Fluorescent Antibody, Mouse Inoculation, and Polymerase Chain Reaction tests were positive. A phylogenetic analysis was compatible with antigenic variant 3, characteristic of Desmodus rotundus. New studies should be undertaken to elucidate the real role of callitrichids in the urban rabies cycle. <![CDATA[Death due to acute Chagas -related myocarditis in a child: a case report]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100709&lng=en&nrm=iso&tlng=en Abstract This is a case report about the only confirmed death in the State of Espírito Santo due to acute Chagas-related myocarditis in a 2-year-old child living in the rural area of Guarapari. He presented with fever, abdominal pain, headache, and vomiting, resulting in death 21 days after the presentation of symptoms. Amastigote forms were observed in the myocardial fibers in histological examination. The boy’s mother had reported finding “kissing bugs” in the child’s hand. This case highlights the need to include Chagas disease in the differential diagnosis in health care to provide early treatment and avoid death in affected individuals. <![CDATA[Child injured by suspected catfish (<em>Cetopsis</em> sp.) bite in river, Humaitá, Amazonas, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100710&lng=en&nrm=iso&tlng=en Abstract We present the first recent reported case of traumatic injury caused by catfish in the Americas. Although 66.2% of fish-related injuries occur in the Amazon Region, they are scarcely reported. We report a traumatic injury in a 2-year-old boy who entered Madeira River. The use of traditional methods to treat the injury and his incomplete vaccination history reflect the weakness of the health system. Further, the fact that it was the second time that such an incident had occurred in the locality in 3 weeks during the dry season suggests that this could be a frequent occurrence during this period. <![CDATA[Clinical characteristics and therapeutic procedure for a critical case of novel coronavirus pneumonia treated with glucocorticoids and non-invasive ventilator treatment]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100711&lng=en&nrm=iso&tlng=en Abstract The novel coronavirus pneumonia (NCP) outbreak occurred in Wuhan, China at the end of 2019. Here, we report the clinical characteristics and therapeutic procedure for a case of severe NCP. The patient was started on glucocorticoids and non-invasive ventilator treatment. After treatment, the patient’s symptoms improved, and the status was confirmed as NCP negative. Our results may provide clues for the treatment of NCP. <![CDATA[COVID-19 and acute pulmonary embolism: what should be considered to indicate a computed tomography pulmonary angiography scan?]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100712&lng=en&nrm=iso&tlng=en Abstract The full spectrum of COVID-19 is still emerging, although several studies have highlighted that patients infected with the novel coronavirus can potentially develop a hypercoagulable state. However, several aspects related to the incidence and pathophysiology of the association between COVID-19 and pulmonary embolism are not well established. Here, we present a case of a patient with COVID-19 who developed acute pulmonary embolism. Clinical and laboratory data and findings of non-enhanced CT indicate possibility of acute pulmonary embolism, and support the decision to proceed with computed tomography pulmonary angiography that can objectively identify filling defects in pulmonary arterial branches. <![CDATA[A case of <em>Bartonella</em> neuroretinitis with macular star diagnosed by clinical, epidemiological, serological, and molecular data: resolution after initiation of antimicrobial therapy]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100713&lng=en&nrm=iso&tlng=en Abstract The differential diagnosis of optic neuritis is broad and varied. We report the case of a 24-year-old Brazilian man who presented with five-week history of fever, malaise, myalgia, severe fatigue, tender right preauricular lymphadenopathy, and acute vision blurring associated with right optic disc swelling and exudates in a macular star pattern. His illness developed soon after an infestation of fleas broke out among his cats. Diagnosis of ocular bartonellosis was confirmed by serological and molecular analyses targeting amplification of Bartonella spp. htrA gene. Signs and symptoms only improved after initiation of antimicrobial therapy. <![CDATA[Mucocutaneous leishmaniasis in a cocaine user: diagnostic and therapeutic knowledge]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100714&lng=en&nrm=iso&tlng=en Abstract Mucocutaneous leishmaniasis (MCL) is a chronic infection that can affect the skin and mucous membranes. We report a case of oral, nasopharyngeal, and penile lesions in a 35-year-old cocaine user. The patient presented with ulcerated lesions in 2014. Histopathologic analysis revealed amastigotes, and serological test results were positive for leishmaniasis. Systemic therapy with meglumine antimoniate was administered; however, the patient failed to present for follow-up. In 2018, he returned with nasal collapse, and another histopathologic test confirmed MCL. This case illustrates the importance of careful differential diagnosis of skin and mucous ulcers to identify the particular pathology. <![CDATA[Case report of a child with influenza and fatal community-associated methicillin-resistant <em>Staphylococcus aureus</em> sepsis]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100715&lng=en&nrm=iso&tlng=en Abstract In the present study, we report the incidence of septic shock syndrome associated with methicillin-resistant Staphylococcus aureus in a child who initially presented influenza-like illness and developed septic shock shortly after 48 h of hospitalization, and eventually died within a few hours of the onset of sepsis. S. aureus isolated from the blood culture was characterized as the community-associated strain carrying the staphylococcal cassette chromosome mec (SCCmec) type IV element. Therefore, it is important to better understand the community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections and their potential association with influenza for early diagnosis and successful treatment of this fatal disease. <![CDATA[Clinical repercussions of Glanders (<em>Burkholderia mallei</em> infection) in a Brazilian child: a case report]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100716&lng=en&nrm=iso&tlng=en Abstract Glanders is a relatively unknown zoonotic disease caused by Burkholderia mallei. This bacterium affect solipeds and humans, and can be used as a biological warfare. Glanders is characterized as an occupational disease. We report the case of an 11-year-old boy who was presented to an emergency department with chest pain and dyspnea. He evolved into septic shock, pneumonia, and multiple abscesses. B. mallei was found in the exudate culture. Human infection is rare and difficult to confirm. The knowledge on glanders is important for differential diagnosis from other serious illnesses causing pneumonia and multiple abscesses. <![CDATA[A new case of envenomation by neotropical opisthoglyphous snake <em>Philodryas olfersii</em> (Lichtenstein, 1823) in Recife, State of Pernambuco, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100717&lng=en&nrm=iso&tlng=en Abstract Human envenomation by the snakes Colubridae and Dipsadidae are reported in Brazil, and envenomation by the Opisthoglyphous snake Philodryas olfersii could be dangerous. Here, we present the second record of an envenomation by Philodryas olfersii in Pernambuco, northeast Brazil. The male victim presented with mild erythema pain, paraesthesia, local numbness, and swollen lymph nodes. The symptoms were similar to those of a pit viper bite, and disappeared completely after 15 days. <![CDATA[Hepatitis Relapse after Yellow Fever Infection: Is There Another Wave?]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100718&lng=en&nrm=iso&tlng=en Abstract During the yellow fever (YF) outbreak in Brazil, many cases of fulminant hepatitis were seen, although mild to moderate hepatitis was mostly observed with complete recovery. This report presents a case of late-onset hepatitis due to YF relapse. The patient sought medical attention after jaundice recurrence 40 days after the first YF hepatitis episode. This case highlights the importance of patient follow-up after the complete resolution of YF symptoms and discharge. <![CDATA[Confirmed Invasive Pulmonary Aspergillosis and COVID-19: the value of <em>postmortem</em> findings to support <em>antemortem</em> management]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100719&lng=en&nrm=iso&tlng=en Abstract We present postmortem evidence of invasive pulmonary aspergillosis (IPA) in a patient with severe COVID-19. Autopsies of COVID-19 confirmed cases were performed. The patient died despite antimicrobials, mechanical ventilation, and vasopressor support. Histopathology and peripheral blood galactomannan antigen testing confirmed IPA. Aspergillus penicillioides infection was confirmed by nucleotide sequencing and BLAST analysis. Further reports are needed to assess the occurrence and frequency of IPA in SARS-CoV-2 infections, and how they interact clinically. <![CDATA[Long-term positive severe acute respiratory syndrome coronavirus 2 ribonucleic acid and therapeutic effect of antivirals in patients with coronavirus disease: Case reports]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100720&lng=en&nrm=iso&tlng=en Abstract Coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been declared a pandemic. We herein report four COVID-19 cases with long-term positive viral ribonucleic acid (RNA) for about 61 days. Despite treatment with recombinant human interferon, convalescent plasma from COVID-19 patients, arbidol, etc., nucleic acid results were still positive for SARS-CoV-2. After treatment with ritonavir-boosted danoprevir (DNVr, 100/100 mg, once daily), all four patients showed two to three consecutive negative SARS-CoV-2 RNA and were thus discharged from hospital. Therefore, DNVr may be a potentially effective antiviral for COVID-19 patients with long-term positive SARS-CoV-2 RNA. <![CDATA[Family COVID-19 cluster analysis of an infant without respiratory symptoms]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100721&lng=en&nrm=iso&tlng=en Abstract Diagnosing cases of coronavirus disease (COVID-19) with only non-respiratory symptoms has been challenging. We reported the diagnosis of a child who tested positive for COVID-19 with abdominal pain/diarrhea and tracked his family cluster. One member of the family tested positive for COVID-19 on real-time reverse-transcription polymerase chain reaction assay and three other family members had anti-SARS-CoV-2 antibodies. <![CDATA[COVID-19 presenting as an exanthematic disease: a case report]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100722&lng=en&nrm=iso&tlng=en Abstract Coronavirus disease (COVID-19) is caused by SARS-CoV-2 and has spread rapidly and caused a global pandemic. Knowledge about clinical and laboratory manifestations in the pediatric population is necessary to guide and monitor such patients. A 3-year-old female patient diagnosed with COVID-19 presented with high fever. After defervescence, she experienced a maculopapular rash that worsened by the sixth day of the disease with self-limited evolution without relevant laboratory changes. The identification of rashes in children with COVID-19 is an unusual and important condition that must be recognized in view of the high transmissibility shown. <![CDATA[Are SARS-CoV-2 reinfection and Covid-19 recurrence possible? a case report from Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100723&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Surgical Treatment of Cutaneous Anthrax]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100800&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Erythema at the bacillus Calmette-Guerin scar after influenza vaccination]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100801&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Vertebral cryptococcosis: An uncommon cause of a paravertebral mass]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100802&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[<em>Cryptococcus neoformans</em> var. <em>gattii</em> isolate with Unusual Morphology]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100803&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Laryngotracheobronchial papillomatosis: an uncommon cause of recurrent respiratory infection]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100805&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[A Very Rare Case of Brucellosis-Related Tubo-ovarian Abscess]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100806&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Leprosy reactions: Earlier diagnosis leads to more effective treatment]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100807&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Giant Hydatid Cysts of the Lung and Liver]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100808&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Neurosyphilis vasculitis manifesting as ischemic stroke]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100809&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Renal Fungal Balls - The Importance of Radiological Findings]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100810&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Pedro Pons’ sign of brucellar spondylitis]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100811&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Tuberculous spondylodiscitis in abscess form]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100812&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Chest radiography and computed tomography findings from a Brazilian patient with COVID-19 pneumonia]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100813&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Invasive <em>Pasteurellosis</em> of the Central Nervous System - How much can we see on a CT?]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100814&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[COVID-19 - Computed tomography findings in two patients in Petrópolis, Rio de Janeiro, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100815&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Intracranial lesion increase under anti-tuberculous therapy]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100816&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Cerebral Infarction in an Elderly Patient with Coronavirus Disease]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100817&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[COVID-19 and pulmonary embolism: Do not forget the association!]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100818&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[COVID-19 and benign intracranial hypertension: A case report]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100819&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Cell Death by <em>Toxoplasma gondii</em>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100820&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Tick infestation of the eyelid]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100821&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Central nervous system infiltration by HTLV-1-associated T-cell leukemia/lymphoma in an AIDS patient]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100822&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Cutaneous cryptococcosis simulating pyoderma gangrenosum]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100823&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[The “Chik Sign” in Neonatal Chikungunya]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100824&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Reflections on vector control in Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100900&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Does the Plague Still Threaten Us?]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100901&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Driving forces for strengthening the surveillance of Chagas disease in the Brazilian Amazon by “training the eyes” of malaria microscopists]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100902&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Diagnostic confusion between seabather’s eruption as well as dermatophytosis and parasitic infestations]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100903&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Driving forces for COVID-19 clinical trials using chloroquine: the need to choose the right research questions and outcomes]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100904&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Bat lyssavirus should be further monitored in Rondônia state, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100905&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Letter to the editor regarding the paper “Evaluation of functional disability after Chikungunya infection”]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100906&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[COVID-19 in Piauí: initial scenario and perspectives for coping]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100907&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Is Brazil prepared for the new era of infectious disease epidemics?]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100908&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[New Coronavirus (SARS-CoV-2): advances to flatten the curve the prison population]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100909&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Individuals with covert severe acute respiratory syndrome coronavirus 2 infection: Are they a critical booby-trap?]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100910&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[War economy and the COVID-19 pandemic: Inequalities in stimulus packages as an additional challenge for health systems]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100911&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Spatiotemporal evolution of coronavirus disease 2019 mortality in Brazil in 2020]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100912&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[COVID-19: challenges for a new epoch]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100913&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Severe acute respiratory syndrome coronavirus 2 seroprevalence among personnel in the healthcare facilities of Croatia, 2020]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100914&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[COVID-19 in Brazilian indigenous people: a new threat to old problems]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100915&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[<em>Anopheles</em> control is considerably more complicated than <em>Aedes</em> control]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100950&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Rabies virus monitoring in bat populations in Rondônia state, Brazil]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100951&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[Counterargument to the editor’s letter about the article “Evaluation of functional disability after Chikungunya infection”]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100952&lng=en&nrm=iso&tlng=en Abstract With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19. <![CDATA[COVID-19 in Brazil: advantages of a socialized unified health system and preparation to contain cases]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000101000&lng=en&nrm=iso&tlng=en Abstract The outbreak of new coronavirus disease 2019 (COVID-19) reported for the first time in Wuhan, China in late December 2019 have rapidly spread to other countries and it was declared on January 30, 2020 as a public health emergency of international concern (PHEIC) by the World Health Organization. Before the first COVID-19 cases were reported in Brazil, several measures have been implemented including the adjustment of legal framework to carry out isolation and quarantine. As the cases increased significantly, new measures, mainly to reduce mortality and severe cases, have also been implemented. Rapid and robust preparedness actions have been undertaken in Brazil while first cases have not yet been identified in Latin-American. The outcome of this early preparation should be analyzed in future studies. <![CDATA[#StayHome: Monitoring and benchmarking social isolation trends in Caruaru and the Região Metropolitana do Recife during the COVID-19 pandemic]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000101001&lng=en&nrm=iso&tlng=en Abstract: This technical report presents information related to the Social Isolation Index (SII) of the city of Caruaru, Pernambuco, Brazil. The data was provided by In Loco, a technology startup that has collected the movement of around 60 million Brazilians through cell phone location. <![CDATA[Giovanni Gazzinelli (★1927 †2020)]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000101100&lng=en&nrm=iso&tlng=en Abstract: This technical report presents information related to the Social Isolation Index (SII) of the city of Caruaru, Pernambuco, Brazil. The data was provided by In Loco, a technology startup that has collected the movement of around 60 million Brazilians through cell phone location. <![CDATA[Ronaldo Santos do Amaral (★1945 †2020)]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000101101&lng=en&nrm=iso&tlng=en Abstract: This technical report presents information related to the Social Isolation Index (SII) of the city of Caruaru, Pernambuco, Brazil. The data was provided by In Loco, a technology startup that has collected the movement of around 60 million Brazilians through cell phone location. <![CDATA[Egler Chiari (★1934 †2020)]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000101102&lng=en&nrm=iso&tlng=en Abstract: This technical report presents information related to the Social Isolation Index (SII) of the city of Caruaru, Pernambuco, Brazil. The data was provided by In Loco, a technology startup that has collected the movement of around 60 million Brazilians through cell phone location. <![CDATA[Erratum]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000101500&lng=en&nrm=iso&tlng=en Abstract: This technical report presents information related to the Social Isolation Index (SII) of the city of Caruaru, Pernambuco, Brazil. The data was provided by In Loco, a technology startup that has collected the movement of around 60 million Brazilians through cell phone location. <![CDATA[Erratum]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000101501&lng=en&nrm=iso&tlng=en Abstract: This technical report presents information related to the Social Isolation Index (SII) of the city of Caruaru, Pernambuco, Brazil. The data was provided by In Loco, a technology startup that has collected the movement of around 60 million Brazilians through cell phone location.