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We verified the clinical-epidemiological, microbiological, and molecular aspects of feline sporotrichosis in Espírito Santo, Brazil, as well as demonstrated the degree of reliability of the cytopathological examination in diagnosis, when compared to fungal culture. From March 2019 to April 2020, 154 suspicious cats were evaluated by collecting data and biological samples. The Cohen's kappa coefficient and the Chi-square independence defined the degree of agreement and the accuracy parameters, respectively. The interobserver agreement was high (Kappa coefficient = 0.96). Sensitivity, specificity, predictive (positive and negative), and accuracy values were 95.0, 97.0, 99.1, 84.2, and 95.5%, respectively. All isolates evaluated were identified as Sporothrix brasiliensis by species-specific PCR. A digital image bank (Padlet) was created with different types of clinical forms and positive slide profiles. We concluded that the cytopathological technique used demonstrated a high degree of reliability. We report an overwhelming occurrence of S. brasiliensis during epizooties in ES.

Evidence of sylvatic yellow fever was first reported in Atlantic Forest areas in Espírito Santo, Brazil, during a yellow fever virus (YFV) outbreak in 1931. An entomological survey was conducted in six forest sites during and after an outbreak reported ~80 years after the last case in the area. Among 10,658 mosquitoes of 78 species, Haemagogus leucocelaenus, and Hg. janthinomys/capricornii were considered the main vectors as they had a relatively high abundance, co-occurred in essentially all areas, and showed high YFV infection rates. Sabethes chloropterus, Sa. soperi, Sa. identicus, Aedes aureolineatus, and Shannoniana fluviatilis may have a secondary role in transmission. This is the first report of Sa. identicus, Ae. aureolineatus, and Sh. fluviatilis infected with YFV. Our study emphasizes the importance of entomological monitoring and maintenance of high vaccination coverage in receptive areas to YFV transmission.

The severity of lesions that develop in patients infected by Leishmania braziliensis is mainly associated with a highly cytotoxic and inflammatory cutaneous environment. Recently, we demonstrated that senescent T and NK cells play a role in the establishment and maintenance of this tissue inflammation. Here, we extended those findings using transcriptomic analyses that demonstrate a strong co-induction of senescence and pro-inflammatory gene signatures in cutaneous leishmaniasis (CL) lesions. The senescence-associated signature was characterized by marked expression of key genes such as ATM, Sestrin 2, p16, p21 and p38. The cell type identification from deconvolution of bulk sequencing data showed that the senescence signature was linked with CD8+ effector memory and TEMRA subsets and also senescent NK cells. A key observation was that the senescence markers in the skin lesions are age-independent of patients and were correlated with lesion size. Moreover, a striking expression of the senescence-associated secretory phenotype (SASP), pro-inflammatory cytokine and chemokines genes was found within lesions that were most strongly associated with the senescent CD8 TEMRA subset. Collectively, our results confirm that there is a senescence transcriptomic signature in CL lesions and supports the hypothesis that lesional senescent cells have a major role in mediating immunopathology of the disease.

Paracoccidioidomycosis (PCM) is a systemic mycosis endemic to Latin America caused by thermodimorphic fungi of the genus Paracoccidioides. In the last two decades, enhanced understanding of the phylogenetic species concept and molecular variations has led to changes in this genus’ taxonomic classification. Although the impact of the new species on clinical presentation and treatment remains unclear, they can influence diagnosis when serological methods are employed. Further, although the infection is usually acquired in rural areas, the symptoms may manifest years or decades later when the patient might be living in the city or even in another country outside the endemic region. Brazil accounts for 80% of PCM cases worldwide, and its incidence is rising in the northern part of the country (Amazon region), owing to new settlements and deforestation, whereas it is decreasing in the south, owing to agriculture mechanization and urbanization. Clusters of the acute/subacute form are also emerging in areas with major human intervention and climate change. Advances in diagnostic methods (molecular and immunological techniques and biomarkers) remain scarce, and even the reference center’s diagnostics are based mainly on direct microscopic examination. Classical imaging findings in the lungs include interstitial bilateral infiltrates, and eventually, enlargement or calcification of adrenals and intraparenchymal central nervous system lesions are also present. Besides itraconazole, cotrimoxazole, and amphotericin B, new azoles may be an alternative when the previous ones are not tolerated, although few studies have investigated their use in treating PCM.

Background Paracoccidioidomycosis (PCM) is an endemic disease in Latin America. In immunocompetent hosts, PCM occurs in two main clinical forms: acute and chronic. However, in HIV-infected patients PCM may show up simultaneous manifestations of acute and chronic forms. Case report We present the case of a patient diagnosed with HIV who had disseminated skin lesions and generalized lymphadenopathy, as well as respiratory and central nervous system involvement. The PCM diagnosis was confirmed by direct KOH examination, double immunodiffusion and the isolation of the fungus in samples of an abscess in the subcostal region. The isolate was identified as Paracoccidioides brasiliensis S1 by species-specific PCR using primers for protein-coding gene GP43 (exon 2) followed by PCR-RFLP of the alpha-tubulin gene. Conclusions There are few data in literature reporting species-specific molecular identification of Paracoccidioides in HIV/PCM patients. Therefore, this case report may contribute to improve the knowledge about this severe disease, its causative cryptic species, and its consequences to patients.

Background Sporotrichosis is a subcutaneous mycosis caused by Sporothrix species that affects humans and animals. Little information on the genetic diversity and population structure of the pathogen is available for Brazil, which is needed to design effective strategies to tackle the advance of sporotrichosis in endemic areas. Objectives We assessed the genetic diversity and mating-type distribution of Sporothrix isolates recovered from human and feline cases of sporotrichosis in Espirito Santo-Brazil to better understand the population structure, epidemiology, and diversification of this pathogen, as well as to explore the possible routes of transmission involved in the ongoing outbreaks. Methods In all, 75 Sporothrix isolates were identified with phenotypic characteristics. Then, fungal DNA extraction was performed, and the species-specific PCR technique was applied, using markers directed to the calmodulin gene. The mating-type idiomorph of species was identified by PCR using primers targeting the MAT1-1 and MAT1-2 loci. Results Among the 75 Sporothrix isolates, 76% were confirmed as S. brasiliensis and 24% as S. schenckii sensu stricto. S. brasiliensis was more prevalent in the metropolitan area and S. schenckii s. str. in the mountainous region of the state. In both species, the presence of the two sexual idiomorphs was detected, suggesting that they are heterothallic species. Conclusions Our data suggest that sporotrichosis takes on an epidemic-urban character involving S. brasiliensis. This species in Espirito Santo is likely to originate from Rio de Janeiro, as most isolates harbor the same MAT 1-2 locus. We confirm that S. brasiliensis has significantly broadened its area of occurrence, an essential feature of emerging pathogens.

Paracoccidioidomycosis (PCM) is an endemic systemic mycosis that is of great importance in Latin America. Its occurrence in solid organ transplantation (SOT) is rare, but with high mortality rate. In this report, we describe a case of PCM in a liver transplant recipient 19 months after transplantation. The patient presented with multiple skin abscesses, arthritis, osteolytic lesions, and pulmonary and adrenal involvement. Despite the presence of disseminated disease and the patient’s immunosuppressed condition, the patient responded well to prolonged antifungal treatment with no sequelae, thus suggesting that early diagnosis and correct treatment may lead to favorable outcomes in SOT recipients with PCM.

Trypanosoma cruzi requires a triatomine insect vector for its life cycle, which can be complex in different enzootic scenarios, one of which is the unique transmission network in the Atlantic Forest of south-eastern Brazil. In Espirito Santo (ES) State, highly infected Triatoma vitticeps are frequently reported invading domiciles. However, triatomines were not found colonizing residences and mammals in the surrounding areas did not present T. cruzi infection. To date, the biotic and abiotic variables that modulate T. vitticeps occurrence and T. cruzi infection in ES State are still unknown. The aim of this study was to identify the environmental variables that modulate their occurrence. Local thematic maps were generated for two response variables: T. vitticeps occurrence and T. cruzi infection. The following explanatory variables were tested: climate (temperature, relative air humidity and rainfall), altitude elevation, mammalian species richness as well as soil and vegetation types. Spatiotemporal distribution patterns and correlation levels between response and explanatory variables were assessed through spatial statistics and map algebra modelling. The central and southern mesoregions presented higher T. vitticeps and T. cruzi distributions and can be considered transmission hotspots. The explanatory variables that can explain these phenomena were relative air humidity, average temperature, soil type, altitude elevation and mammalian species richness. Algebra map modelling demonstrated that central and southern mesoregions presented the environmental conditions needed for T. vitticeps occurrence and T. cruzi infection. The consideration of environmental variables is essential for understanding the T. cruzi transmission cycle. Cartographic and statistical methodologies used in parasitology have been demonstrated to be reliable and enlightening tools that should be incorporated routinely to expand the understanding of vector-borne parasite transmission.

Trypanosoma cruzi requires a triatomine insect vector for its life cycle, which can be complex in different enzootic scenarios, one of which is the unique transmission network in the Atlantic Forest of south-eastern Brazil. In Espírito Santo (ES) State, highly infected Triatoma vitticeps are frequently reported invading domiciles. However, triatomines were not found colonizing residences and mammals in the surrounding areas did not present T. cruzi infection. To date, the biotic and abiotic variables that modulate T. vitticeps occurrence and T. cruzi infection in ES State are still unknown. The aim of this study was to identify the environmental variables that modulate their occurrence. Local thematic maps were generated for two response variables: T. vitticeps occurrence and T. cruzi infection. The following explanatory variables were tested: climate (temperature, relative air humidity and rainfall), altitude elevation, mammalian species richness as well as soil and vegetation types. Spatiotemporal distribution patterns and correlation levels between response and explanatory variables were assessed through spatial statistics and map algebra modelling. The central and southern mesoregions presented higher T. vitticeps and T. cruzi distributions and can be considered transmission hotspots. The explanatory variables that can explain these phenomena were relative air humidity, average temperature, soil type, altitude elevation and mammalian species richness. Algebra map modelling demonstrated that central and southern mesoregions presented the environmental conditions needed for T. vitticeps occurrence and T. cruzi infection. The consideration of environmental variables is essential for understanding the T. cruzi transmission cycle. Cartographic and statistical methodologies used in parasitology have been demonstrated to be reliable and enlightening tools that should be incorporated routinely to expand the understanding of vector-borne parasite transmission.

Trypanosoma cruzi requires a triatomine insect vector for its life cycle, which can be complex in different enzootic scenarios, one of which is the unique transmission network in the Atlantic Forest of south-eastern Brazil. In Espírito Santo (ES) State, highly infected Triatoma vitticeps are frequently reported invading domiciles. However, triatomines were not found colonizing residences and mammals in the surrounding areas did not present T. cruzi infection. To date, the biotic and abiotic variables that modulate T. vitticeps occurrence and T. cruzi infection in ES State are still unknown. The aim of this study was to identify the environmental variables that modulate their occurrence. Local thematic maps were generated for two response variables: T. vitticeps occurrence and T. cruzi infection. The following explanatory variables were tested: climate (temperature, relative air humidity and rainfall), altitude elevation, mammalian species richness as well as soil and vegetation types. Spatiotemporal distribution patterns and correlation levels between response and explanatory variables were assessed through spatial statistics and map algebra modelling. The central and southern mesoregions presented higher T. vitticeps and T. cruzi distributions and can be considered transmission hotspots. The explanatory variables that can explain these phenomena were relative air humidity, average temperature, soil type, altitude elevation and mammalian species richness. Algebra map modelling demonstrated that central and southern mesoregions presented the environmental conditions needed for T. vitticeps occurrence and T. cruzi infection. The consideration of environmental variables is essential for understanding the T. cruzi transmission cycle. Cartographic and statistical methodologies used in parasitology have been demonstrated to be reliable and enlightening tools that should be incorporated routinely to expand the understanding of vector-borne parasite transmission.

This article shows reports of the clinical–epidemiological characteristics and serological screening in patients assisted by a reference center for PCM care, University Hospital Cassiano Antonio Moraes, Federal University of Espirito Santo, Brazil. The patient’s sera with PCM were analyzed by DID test at the beginning and the end treatment. Clinical and demographic data were also collected to characterize the sample. One hundred patients with a suspected diagnosis of PCM were evaluated. Serology by DID test was used as a screen in all patients. The test was positive for 79 patients (72 for Paracoccidioides brasiliensis and 7 for Paracoccidioides lutzii). Serology was negative in 21 sera, although all of them were diagnosed PCM by histopathologic or direct exam. Serological follow-up was performed during the treatment of all patients. After treatment, 58(58%) had negative serology and 33(33%) low levels of antibodies (≤ 1:16). Our results indicate the importance of the DID test for the screening and monitoring of PCM and that the incidence of P. lutzii might be greater than expected in areas where it is not the predominant PCM species. Therefore, this article may contribute to improving the knowledge and clinical management about this disease.

Leishmaniasis is a tropical infectious disease caused by Leishmania spp. protozoa and is transmitted by insects from the Phlebotominae subfamily. It can manifest as cutaneous leishmaniasis, a painless ulcer that can develop into a more serious systemic affliction as the protozoa spreads lymphatically or hematogenously, depending on the host's immunity. In this case series, the authors present a rare form of genital mucocutaneous leishmaniasis, with consideration of epidemiologic characteristics, clinical presentation, differential diagnosis, and treatments offered.

INTRODUCTION: Rhodnius domesticus Neiva & Pinto, 1923 is a rare sylvatic triatomine endemic to the Atlantic Forest, with one known record for Espírito Santo (ES), Brazil from 1969. We present here its rediscovery in ES, 42 years after its first record. METHODS: In January 2011, a triatomine specimen was collected from a rural area of the municipality of Santa Teresa, ES. RESULTS: We confirmed this as a new record of R. domesticus in the Baixo Caldeirão locality. CONCLUSIONS: This finding supports the possibility of a wild population of R. domesticus in the mountainous region of the Atlantic forest of ES.

Visceral leishmaniasis (VL) is an infectious disease caused by the protozoa Leishmania chagasi, whose main vector in South America is Lutzomyia longipalpis. The disease was diagnosed in the Brazilian state of Espirito Santo (ES) for the first time in 1968. Currently, this disease has been considered endemic in 10 municipalities. Furthermore, the presence of L. longipalpis has been detected in eight other municipalities where the transmission has not been reported thus far. In this study, we performed species distribution modeling (SDM) to identify new and most likely receptive areas for VL transmission in ES. The sandflies were both actively and passively collected in various rural area of ES between 1986 and 2017. The collection points were georeferenced using a global positioning system device. Climatic data were retrieved from the WorldClim database, whereas geographic data were obtained from the National Institute for Space Research and the Integrated System of Geospatial Bases of the State of Espirito Santo. The maximum entropy algorithm was used through the MIAmaxent R package to train and test the distribution models for L. longipalpis. The major contributor to model generation was rocky outcrops, followed by temperature seasonality. The SDM predicted the expansion of the L. longipalpis-prone area in the Doce River Valley and limited the probability of expanding outside its watershed. Once the areas predicted suitable for L. longipalpis occurrence are determined, we can avoid the inefficient use of public resources in conducting canine serological surveys where the vector insect does not occur.

Visceral leishmaniasis (VL) is an infectious disease caused by the protozoa Leishmania chagasi, whose main vector in South America is Lutzomyia longipalpis. The disease was diagnosed in the Brazilian state of Espírito Santo (ES) for the first time in 1968. Currently, this disease has been considered endemic in 10 municipalities. Furthermore, the presence of L. longipalpis has been detected in eight other municipalities where the transmission has not been reported thus far. In this study, we performed species distribution modeling (SDM) to identify new and most likely receptive areas for VL transmission in ES. The sandflies were both actively and passively collected in various rural area of ES between 1986 and 2017. The collection points were georeferenced using a global positioning system device. Climatic data were retrieved from the WorldClim database, whereas geographic data were obtained from the National Institute for Space Research and the Integrated System of Geospatial Bases of the State of Espírito Santo. The maximum entropy algorithm was used through the MIAmaxent R package to train and test the distribution models for L. longipalpis. The major contributor to model generation was rocky outcrops, followed by temperature seasonality. The SDM predicted the expansion of the L. longipalpis-prone area in the Doce River Valley and limited the probability of expanding outside its watershed. Once the areas predicted suitable for L. longipalpis occurrence are determined, we can avoid the inefficient use of public resources in conducting canine serological surveys where the vector insect does not occur.

Background: Paracoccidioidomycosis (PCM) is the most prevalent endemic systemic fungal infection in Latin America. In Brazil, it stands out as the eighth-highest cause of mortality among chronic or recurrent infections and has the highest mortality rate among systemic mycoses. Oral mucosal lesions may be the first visible physical manifestation of the disease. This study traced the epidemiological and clinical profiles of patients with oral lesions treated at the University Hospital Cassiano Antonio Moraes, Federal University of Espirito Santo. Methods: A retrospective cross-sectional analysis of patient medical records was performed. Results: Among the 161 patients identified with a confirmed diagnosis of PCM, 97 (60.24%) presented with oral lesions. The male:female ratio was 15:1, the mean age was 50.5 years, and the chronic form of paracoccidioidomycosis was predominant. Most of the patients had smoking habits and were rural workers. The most common oral lesions present in various anatomical sites were mulberry-like ulcers, more frequently observed in the gingiva, with regression within one to three months. Patients completed the treatment in one to two years (32.99%), and 47.42% of cases discontinued treatment. Conclusions: In addition to the characteristics of the oral lesions, information from the clinical profiles of patients with oral PCM is a central tool for dentists for early diagnosis. Earlier diagnosis may result in fewer consequences, especially respiratory ones that may cause an inability to work and poor quality of life. Keywords: Paracoccidioidomycosis, Oral lesions, Epidemiology, Clinical manifestations

Paracoccidioidomycosis is an endemic disease in Latin America that is rarely associated with immunosuppression and biological therapy. Herein, we report for the first time a case of pulmonary paracoccidioidomycosis reactivation after infliximab treatment. A 47-year-old man from Brazil received infliximab to treat psoriatic spondyloarthropathy and presented with cough, dyspnea, weight loss, and fever. Chest computed tomography revealed a pulmonary nodule and biopsy confirmed paracoccidioidomycosis. Treatment with sulfamethoxazole and trimethoprim was initiated for fungal infection and infliximab was reintroduced two months later. Considering his clinical improvement and favorable radiologic evolution, antifungal therapy was discontinued after 29 months.

In the south and southeast of Brazil, autochthonous malaria cases can be found near Atlantic Forest fragments. The transmission is not totally clarified; thus, the behaviour of the possible vectors in those regions must be observed. An entomological and natural infection study was performed on anophelines (Diptera: Culicidae) captured in the municipalities of the mountainous region of Espírito Santo state in 2004-2005. Similarly, between the years 2014 and 2015, 12 monthly collections were performed at the permanent trapping station of the study mentioned above (Valsugana Velha, Santa Teresa, ES). Light traps with CO2 (CO2-baited Center for Disease Control [CDC] traps) were set in open areas, at the edge of the forest (canopy and ground) and inside the forest (canopy and ground), whereas Shannon traps were set on the edge of the forest. A total of 1,414 anophelines were collected from 13 species. Anopheles (Kerteszia) cruzii Dyar and Knab remained the most captured species in the CO2-baited CDC traps set in the forest canopy and was also the vector with the highest prevalence of Plasmodium vivax infection according to molecular PCR techniques. Regarding mosquitoes of the subgenus Nyssorhynchus, P. vivax was found only in abdomens, weakening the hypothesis that this subgenus also plays a role in malaria transmission in this specific region.SponsorshipEspírito Santo Research Foundation (Fundação de Amparo à Pesquisa e Inovação do Espírito Santo – FAPES).

Paracoccidioidomycosis (PCM) is an endemic disease in the southeast region of Brazil, which includes the state of Espírito Santo (ES). This historic case series analyses 546 patients treated in this state from 1978 to 2012. Patients aged from 7 to 83 years, 509 males and 37 females, yielding a ratio of 13.7:1. Most of the patients (81.4%) originated from rural areas in ES, 71.0% being farmers. A higher concentration of cases was observed in municipalities located along the western range of the state. Sixty patients (11.0%) had an acute/subacute form of the disease, 485 (88.9%) had a chronic form, and one had a subclinical form. The most affected organs included the lungs, oropharyngeal mucosa, lymph nodes, skin, and larynx. The diagnosis was confirmed by histopathology in 252 (46.2%) cases, direct examination in 168 (30.7%), both exams in 111 (20.3%) and serology in 15 (2.8%). Tuberculosis, acquired immune deficiency syndrome, leishmaniasis, and intestinal parasites were the most frequently associated infectious diseases. From 328 patients followed up, total regression of the lesions was observed in 17.4%, partial regression in 77.4%, and no regression in 17 (5.2%) cases. Regarding the number of cases in this series, ES emerges as an important endemic area for PCM in Brazil.

Paracoccidioidomycosis (PCM) is a fungal disease caused by Paracoccidioides spp., which can cause a systemic granulomatous infection with tegumentary and visceral involvement. Sarcoid-like skin lesions are uncommon and can be misdiagnosed due to similarities with other granulomatous diseases. We report a case of a women presenting with erythematous infiltrated plaques on her face that was treated for leprosy and rosacea with no response and was later diagnosed with PCM, presenting positive serology for Paracoccidioides lutzii.

Cytotoxic activity mediated by CD8+ T cells is the main signature of the immunopathogenesis of cutaneous leishmaniasis (CL). Here, we performed a broad evaluation of natural killer (NK) cell phenotypic and functional features during cutaneous leishmaniasis. We demonstrate for the first time that CL patients present the accumulation of circulating NK cells with multiple features of replicative senescence including low proliferative capacity and shorter telomeres, elevated expression of CD57, KLRG1 but diminished CD27 stimulatory receptor expression. Moreover, they exhibited higher cytotoxic and inflammatory potential than agematched controls. The accumulation of circulating senescent NK cells (CD56dim CD57bright) correlated positively with skin lesion size in the same patients, suggesting that they, like circulating senescent CD8+ T cells, may contribute to the immunopathology of CL. However, this senescent population had lower cutaneous lymphocyte antigen expression and so had diminished skin-homing potential compared with total or senescent CD8+ T cells. This was confirmed in CL skin lesions where we found a predominance of CD8+ T cells (both senescent and non-senescent) that correlated with the severity of the disease. Although there was also a correlation between the proportions of senescent NK cells (CD56+ CD57+ ) in the skin and lesion size, this was less evident. Collectively our results demonstrate first-hand that senescent cytotoxic cells may mediate skin pathology during human cutaneous leishmaniasis. However, as senescent cytotoxic CD8+ T cells predominate in the skin lesions, they may have a greater role than NK cells in mediating the non-specific skin damage in CL.

BACKGROUND AND PURPOSE: Paracoccidioidomycosis is a fungal infection mainly caused by the thermodimorphic fungus Paracoccidioides. The purpose of our study was to demonstrate the neuroimaging findings from 24 patients with CNS paracoccidioidomycosis. MATERIALS AND METHODS: We performed a retrospective analysis focusing on the radiologic characteristics of CNS paracoccidioidomycosis. The 24 selected patients underwent MR imaging and/or CT, and the diagnosis was made by the presence of typical neuroimaging features, combined with fungus isolation, a serologic test, or the presence of disseminated disease. RESULTS: Headache was the most common neurologic symptom, while the pseudotumoral form was the most common pattern. The number of lesions ranged from 1 to 11, with most localized on the frontal lobe with >2-cm lesions. CT showed mainly hypoattenuating lesions, whereas MR imaging demonstrated mainly hyposignal lesions on T1WI and T2WI. Furthermore, ring enhancement was present in most patients. The “dual rim sign” on SWI occurred in 100% of our patients with lesions of >2 cm. CONCLUSIONS: The diagnosis of CNS paracoccidioidomycosis is difficult. Nevertheless, imaging examinations can play an important role in the diagnosis and evaluation of the disease.

International audience; The yellow fever virus (YFV) caused a severe outbreak in Brazil in 2016-2018 that rapidly spread across the Atlantic Forest in its most populated region without viral circulation for almost 80 years. A comprehensive entomological survey combining analysis of distribution, abundance and YFV natural infection in mosquitoes captured before and during the outbreak was conducted in 44 municipalities of five Brazilian states. In total, 17,662 mosquitoes of 89 species were collected. Before evidence of virus circulation, mosquitoes were tested negative but traditional vectors were alarmingly detected in 82% of municipalities, revealing high receptivity to sylvatic transmission. During the outbreak, five species were found positive in 42% of municipalities. Haemagogus janthinomys and Hg. leucocelaenus are considered the primary vectors due to their large distribution combined with high abundance and natural infection rates, concurring together for the rapid spread and severity of this outbreak. Aedes taeniorhynchus was found infected for the first time, but like Sabethes chloropterus and Aedes scapularis, it appears to have a potential local or secondary role because of their low abundance, distribution and infection rates. There was no evidence of YFV transmission by Aedes albopictus and Aedes aegypti, although the former was the most widespread species across affected municipalities, presenting an important overlap between the niches of the sylvatic vectors and the anthropic ones. The definition of receptive areas, expansion of vaccination in the most affected age group and exposed populations and the adoption of universal vaccination to the entire Brazilian population need to be urgently implemented.

Leishmania (Viannia) braziliensis induces American tegumentary leishmaniasis that ranges in severity from the milder form, cutaneous (CL) to severe disseminated cutaneous leishmaniasis. Patients with CL develop a cell-mediated Th1 immune response accompanied by production of inflammatory cytokines, which contribute to parasite control and pathogenesis of disease. Here, we describe the accumulation of circulating T cells with multiple features of telomere dependent-senescence including elevated expression of CD57, KLRG-1, and γH2AX that have short telomeres and low hTERT expression during cutaneous L. braziliensis infection. This expanded population of T cells was found within the CD45RA+CD27− (EMRA) subset and produced high levels of inflammatory cytokines, analogous to the senescence-associated secretory profile (SASP) that has been described in senescent non-lymphoid cells. There was a significant correlation between the accumulation of these cells and the extent of systemic inflammation, suggesting that they are involved in the inflammatory response in this disease. Furthermore, these cells expressed high level of the skin homing receptor CLA and there was a highly significant correlation between the number of these cells in the circulation and the size of the Leishmania-induced lesions in the skin. Collectively our results suggest that extensive activation during the early stages of leishmaniasis drives the senescence of T cells with the propensity to home to the skin. The senescence-related inflammatory cytokine secretion by these cells may control the infection but also contribute to the immunopathology in the disease. publishersversion published

Leishmania (Viannia) braziliensis induces American tegumentary leishmaniasis that ranges in severity from the milder form, cutaneous (CL) to severe disseminated cutaneous leishmaniasis. Patients with CL develop a cell-mediated Th1 immune response accompanied by production of inflammatory cytokines, which contribute to parasite control and pathogenesis of disease. Here, we describe the accumulation of circulating T cells with multiple features of telomere dependent-senescence including elevated expression of CD57, KLRG-1, and γH2AX that have short telomeres and low hTERT expression during cutaneous L. braziliensis infection. This expanded population of T cells was found within the CD45RA+CD27− (EMRA) subset and produced high levels of inflammatory cytokines, analogous to the senescence-associated secretory profile (SASP) that has been described in senescent non-lymphoid cells. There was a significant correlation between the accumulation of these cells and the extent of systemic inflammation, suggesting that they are involved in the inflammatory response in this disease. Furthermore, these cells expressed high level of the skin homing receptor CLA and there was a highly significant correlation between the number of these cells in the circulation and the size of the Leishmania-induced lesions in the skin. Collectively our results suggest that extensive activation during the early stages of leishmaniasis drives the senescence of T cells with the propensity to home to the skin. The senescence-related inflammatory cytokine secretion by these cells may control the infection but also contribute to the immunopathology in the disease.

This study discusses a historical patient series and is designed to describe clinical and epidemiological characteristics of human sporotrichosis in the state of Espirito Santo, Brazil. Data were derived from patients treated at the Infectious Diseases service of Cassiano Antonio Moraes University Hospital in Vitoria, the state capital, from July 1982 to June 2012. A total of 171 patients were diagnosed with sporotrichosis, mostly men (80.7%) with a median age of 33 years and 5 months. We can presume an approximate average incidence rate of 4.9 cases per 100,000 inhabitants during the studied period. All the patients were involved in occupational or leisure activities with direct contact with soil or plants. Most cases were recorded in the mountainous region of the state during the hot and rainy periods. The average time elapsed from lesion progression to diagnosis was 3 months, with the lymphocutaneous form being the most common (70.2%), followed by the fixed cutaneous form (28.6%). Diagnosis was confirmed in 93.6% of the cases by culturing Sporothrix spp. in Sabouraud dextrose agar, and from the clinical features in the remaining cases. Aspiration of cutaneous nodule secretions was the best method for the collection of clinical specimens for disease diagnosis. A 25% saturated solution of potassium iodide (SSKI) was provided to almost all patients (98.8%), with therapeutic success. In conclusion, in this retrospective study in the state of Espirito Santo, we found that sporotrichosis affects primarily the ≥ 10-year-old population, and the most common presentation is the lymphocutaneous form affecting the lower and upper limbs, and the infection appeared to be acquired predominantly through occupational activities. Treatment with SSKI was safe and effective.

Background: In rural areas of Espírito Santo state, southeast Brazil, triatomine species attracted by light frequently invade residences. The aim of this study was to investigate the Trypanosoma cruzi discrete typing units (DTUs) harbored by these triatomines. Methods: Triatomine’s intestinal contents were examined, inoculated in mice, and the positive samples were cultivated. Flagellates obtained from infected mice hemoculture were submitted to DNA extraction using a salting-out method and to TcSC5D gene amplification. The amplified samples were sequenced, and polymorphism was analyzed for DTU identification. Results: Three hundred and ninety-four triatomines were identified: Triatoma vitticeps (90.03%), Panstrongylus geniculatus (8.89%), Panstrongylus megistus (0.54%), Panstrongylus diasi (0.27%), and Triatoma tibiamaculata (0.27%). Among the specimens, 251/394 (67.65%) presented flagellated forms similar to T. cruzi. After triatomine intestinal content inoculation into mice, 134 mice presented T. cruzi-like trypomastigotes from Tr. vitticeps and P. geniculatus and 89 samples were positive in hemoculture. Sixty-two samples were analyzed for the TcSC5D gene and TcI, TcII, TcIII, and TcIV DTUs were identified. Conclusions: We observed T. cruzi DTU diversity in Tr. vitticeps and P. geniculatus, which showed the predominance of TcII and occurrence of TcI, TcIII and TcIV. Triatomines presented high T. cruzi infection rates. Since little is known regarding the possible mammalian hosts that maintain the T. cruzi cycle, further studies are necessary to obtain a better understanding of the parasite transmission cycle in this region.

Mucocutaneous leishmaniasis and paracoccidioidomycosis are infectious diseases with similar epidemiological and clinical aspects. Cases of both diseases may manifest similar lesions in the mucosa. Therefore, the determination of distinguishing characteristics for the purpose of differential diagnosis is critical for better management of the diseases. The present study evaluated factors that assist in the differentiation of mucosal lesions between these diseases. This cross-sectional study included data from medical records of 122 cases of mucocutaneous leishmaniasis and 83 cases of paracoccidioidomycosis attended at the university hospital Cassiano Antonio Moraes, located in Vitoria, Espirito Santo State, Brazil. Comparison between the diseases included the following variables: sex, age, time of disease evolution, location of the lesion and symptoms. Adults and males were affected by both diseases at higher rates. Lesions in the nasal region (95.1%; p-value = 0.000) and the pharynx (20.5%; p-value = 0.009) and nasal obstruction (34.4%; p-value = 0.000) were associated with leishmaniasis. Paracoccidioidomycosis was associated with lesions in the oral region (90.4%; p-value = 0.000), oral pain (16.9%; p-value = 0.000), and hoarseness (14.5%; p-value = 0.008). In leishmaniasis, lesions in oral regions were not associated with oral pain and were frequently located close to the nasal area. The manifestations cited above could improve the differential diagnosis of leishmaniasis and paracoccidioidomycosis, and thereby potentially aid in the choice of appropriate confirmatory diagnostic testing.

Paracoccidioidomycosis is an infectious disease characterized primarily by pulmonary involvement and potential dissemination to other organs, mainly mucosa and skin; however, it can affect any organ in the body. Although difficult to diagnose purely based on imaging, imaging is important for diagnosis, follow-up, and assessment of disease-related complications. We provide a comprehensive review of the most notable imaging findings of paracoccidioidomycosis.

Mosquitoes comprehend a group with a major impact on public health, because some species transmit parasites vertebrate hosts. Comparative studies between preserved environment and disturbed areas provide important epidemiological information, due to the major knowledge on species populational dynamics and the possibility of a contact between vector species and human population. This work aims to characterize and compare the fauna of mosquitoes in the Goytacazes National Forest (GNF) and surrounding area, in the State of Espírito Santo, in Brazil. Collections occurred simultaneously in a preserved environment and in a peridomicile, from 15:00 to 18:00, between July 2008 and May 2009. In each environment, it was used a modified trap of Shannon type. As a result, 1,490 specimens from 14 genera and 19 identified species were collected. The species diversity (H = 1.95), species richness (S = 17), equitability index (J = 0.68) and the number of collected specimens (n = 1,100) were higher in the forest environment. The plentiful species were respectively Aedes (Ochlerotatus) scapularis (Rondani, 1848), Culex (Culex) nigripalpus Theobald, 1901 and Aedes (Ochlerotatus) fulvus (Wiedemann, 1828). Our results demonstrate that the occurrence of vector species in this region increases the potential risk of diverse arboviruses occurrence, especially wild-type yellow fever. Resumo Os mosquitos compreendem um grupo importante para a saúde pública, porque algumas espécies estão envolvidas na transmissão de várias doenças para os seres humanos. Estudos comparativos entre ambiente florestal e áreas perturbadas fornecem importantes informações epidemiológicas, dado o maior conhecimento da dinâmica populacional das espécies e a possibilidade de contato entre as espécies de vetores e população humana. O objetivo deste estudo foi caracterizar e comparar a fauna de mosquitos na Floresta Nacional de Goytacazes e área adjacente, no estado do Espírito Santo, Brasil. As coletas ocorreram simultaneamente no ambiente florestal e peridomicílio, de 15:00 às 18:00 horas, entre junho de 2008 e maio de 2009. Em cada ambiente foi utilizada uma armadilha do tipo Shannon modificada. Como resultado, foram coletados 1.490 espécimes pertencentes a 14 gêneros e 19 espécies identificadas. A diversidade de espécies (H = 1,95), riqueza de espécies (S = 17), índice de equitabilidade (J = 0,68) e o número de espécimes coletados (n = 1.100) foram maiores no ambiente florestal. As espécies mais abundantes foram respectivamente Aedes (Ochlerotatus) scapularis (Rondani, 1848), Culex (Culex) nigripalpus Theobald, 1901 and Aedes (Ochlerotatus) fulvus (Wiedemann, 1828). Os resultados demonstram que a ocorrência de espécies vetores na região, aumenta o risco potencial de ocorrência de diversas arboviroses, com destaque para a febre amarela silvestre.

OBJETIVO: analisar os fatores associados à infecção pelo vírus da hepatite B entre usuários da atenção primária em saúde em São Mateus-ES, Brasil. MÉTODOS: estudo de caso-controle com 74 casos e 74 controles, pareados por sexo, idade e local de atendimento; para a análise multivariável, foi empregada regressão logística condicional (odds ratio - OR - e respectivos intervalos de confiança de 95% - IC95%). RESULTADOS: a análise bivariada identificou como adequadas para o modelo de análise multivariada (p

A 59-year-old female patient, previously healthy, immunocompetent, presented left bulbar conjunctiva lesions and nodular-ulcerated lesions on the arms and cervical region, besides left cervical and retroauricular lymphadenopathy. She had previous contact with domestic cats that excoriated her face. The diagnosis was conclusive of disseminated sporotrichosis through clinical and epidemiological history and cultures of skin and ocular secretions. It evolved with good response to oral antifungal therapy.

Paracoccidioidomycosis (PCM) is a fungal disease caused by Paracoccidioides spp., which can cause a systemic granulomatous infection with tegumentary and visceral involvement. Sarcoid-like skin lesions are uncommon and can be misdiagnosed due to similarities with other granulomatous diseases. We report a case of a women presenting with erythematous infiltrated plaques on her face that was treated for leprosy and rosacea with no response and was later diagnosed with PCM, presenting positive serology for Paracoccidioides lutzii.

BackgroundThe transmission of malaria in the extra-Amazonian regions of Brazil, although interrupted in the 1960s, has persisted to the present time in some areas of dense Atlantic Forest, with reports of cases characterized by particular transmission cycles and clinical presentations. Bromeliad-malaria, as it is named, is particularly frequent in the state of Espírito Santo, with Plasmodium vivax being the parasite commonly recognized as the etiologic agent of human infections. With regard to the spatial and temporal distances between cases reported in this region, the transmission cycle does not fit the traditional malaria cycle. The existence of a zoonosis, with infected simians participating in the epidemiology, is therefore hypothesized. In the present study, zoonotic transmission of bromeliad-malaria in Espírito Santo is investigated, based on the complete mitochondrial genome of DNA extracted from isolates of Plasmodium species which had infected humans, a simian from the genus Allouata, and Anopheles mosquitoes. Plasmodium vivax/simium was identified in the samples by both nested-PCR and real-time PCR. After amplification, the mitochondrial genome was completely sequenced and compared in a haplotype network, including all sequences of P. vivax/simium mitochondrial genomes sampled from humans and simians from all regions in Brazil.ResultsThe haplotype network demonstrates that humans and simians from the Atlantic Forest share the same haplotype, but some isolates from humans are not identical to the simian isolate. In addition, the plasmodial DNA extracted from mosquitoes revealed sequences different from those obtained from simians, but similar to two isolates from humans.ConclusionsThese findings reinforce the hypothesis that in the Atlantic Forest, and especially in the state with the highest frequency of bromeliad-malaria in Brazil, the same parasite species is shared by humans and simians, at least in part. The difference between the sequences of mosquitoes and simians raises two hypotheses: (1) two distinct transmission cycles for human malaria exist in the study area, one of them involving simians and the other exclusive to human hosts, or (2) there is only one transmission cycle involving humans and simians, but the identification of variations among simians was not possible due to a lack of other samples.

Additional file 1: Table S1. GenBank accession numbers of published sequences used to construct the haplotype networks and the phylogenetic tree.

We report for the first time the parasitism of eggs of two triatomine Chagas disease vectors,Triatoma infestansandT. vitticeps, by the microhymenopterous parasitoidAprostocetus asthenogmus. We also describe the first identification of this parasitoid in South America.A. asthenogmuswere captured near unparasitized triatomine colonies in the municipality of Vitória, state of Espírito Santo, Brazil, and placed into pots with recently laid triatomine eggs. After 24 days, we observed wasps emerging fromT. infestansandT. vitticepseggs. Several characteristics of this parasitoid species suggest that it could be a potential biological control agent of triatomine species.

Two new species of Sycorax from the Atlantic Rain Forest of Espírito Santo, Sycorax canaanensis Santos, Bravo & Falqueto sp. nov. and Sycorax tuberculata Santos, Bravo & Falqueto sp. nov. are described and illustrated. Male speci-mens were collected with CDC light traps in the Biological Reserve of Augusto Ruschi, municipality of Santa Teresa, state of Espírito Santo, Brazil. This finding raises the number of described Western Hemisphere Sycorax species to 15.

Knowledge of the fauna composition of anopheline mosquitoes, their ecological aspects and behavior, and influence of climatic variables on their population dynamics can help in understanding the transmission of Plasmodium parasites and thus develop more efficient strategies for the control of malaria. In the Central Atlantic Forest Biodiversity Corridor, southeastern Brazil, foci of introduced malaria have been reported among people returning from the Amazon region, north Brazil. Our objective was to evaluate and compare the anopheline fauna from a preserved environment and an adjacent peridomiciliary modified environment at the Central Atlantic Forest Biodiversity Corridor. We collected anopheline mosquitoes on a monthly basis from June 2004 to May 2006 from both these environments to understand the ecological aspects and their association with the occurrence of malaria. We captured 5,491 anopheline mosquitoes belonging to two subgenera and 11 species and studied the correlations between anopheline mosquito species and climatic variables. We considered Anopheles darlingi (Root) as the principal malaria vector and Anopheles albitarsis s. l. (Arribalzaga) as the secondary vector.

Amphotericin B deoxycholate is the main option for intravenous (i.v.) treatment of severe paracoccidioidomycosis (PCM). This is the first report of amphotericin B lipid complex (ABLC) in the treatment of PCM. Among 28 patients, cure was achieved in all patients (100%) using ABLC. Mean and median daily doses of ABLC were 3.39 mg/kg/day and 3.35 mg/kg/day, respectively. ABLC may be a choice in the treatment of severe forms of PCM or when i.v. options are required.

Cutaneous leishmaniasis (CL) is caused by a protozoan of the genus Leishmania and is transmitted by sand flies. The state of Espirito Santo (ES), an endemic area in southeast Brazil, has shown a considerably high prevalence in recent decades. Environmental niche modelling (ENM) is a useful tool for predicting potential disease risk. In this study, ENM was applied to sand fly species and CL cases in ES to identify the principal vector and risk areas of the disease. Sand flies were collected in 466 rural localities between 1997 and 2013 using active and passive capture. Insects were identified to the species level, and the localities were georeferenced. Twenty-one bioclimatic variables were selected from WorldClim. Maxent was used to construct models projecting the potential distribution for five Lutzomyia species and CL cases. ENMTools was used to overlap the species and the CL case models. The Kruskal–Wallis test was performed, adopting a 5% significance level. Approximately 250,000 specimens were captured, belonging to 43 species. The area under the curve (AUC) was considered acceptable for all models. The slope was considered relevant to the construction of the models for all the species identified. The overlay test identified Lutzomyia intermedia as the main vector of CL in southeast Brazil. ENM tools enable an analysis of the association among environmental variables, vector distributions and CL cases, which can be used to support epidemiologic and entomological vigilance actions to control the expansion of CL in vulnerable areas.

To assess the effect of the rapid removal of potentially infectious dogs on the prevalence and incidence of canine infections, a prospective study was undertaken in an area endemic for Leishmania infantum. We used serological testing based on the rapid DPP rK28 fusion protein chromatographic immunoassay for this dog screening-and-culling intervention trial. The outcome was evaluated by measuring seropositivity and sero-conversion/-reversion rates for canine infection. Our estimates indicated that concomitant detection and elimination of seropositive dogs with active disease may affect the numbers of canine infections and disease burden temporarily, although it is insufficient as a measure to interrupt the zoonotic L. infantum transmission. However, most of the asymptomatic, seropositive dogs continuously exhibit low levels of antibodies and/or reverted, remaining seronegative thereafter. In the process of waiting for an effective vaccine, one option for canine reservoir control may be to identify these possibly genetically resistant animals and promote their expansion in the population.

Introduction Sporotrichosis is a mycosis caused by the dimorphic fungus Sporothrix spp., and the primary mode of transmission is traumatic inoculation of fungus conidia from plants and other organic matter. Methods Sporotrichosis was established in a cat and in three members of one family from a rural area, by fungal growth in culture. Results The cutaneous lesions developed on the lower buttock and limbs with no report of any injury. Conclusion Although sporotrichosis should be considered for differential diagnosis in people working with soil and plants, cases of chronic lesions on skin of cats and in households is probably a new epidemiological approach in a given geographic region.

The inventories on sand flies are usually conducted for a long period in leishmaniasis-endemic regions. Thus, there is little data on the sand fly fauna in areas where no leishmaniasis cases have been reported. Therefore, we conducted an inventory to study the sand fly fauna in the National Forest of Rio Preto (NFRP). We carried out a brief inventory by using four CDC light traps in 2009 during winter and summer. We collected 1,403 sand flies belonging to 11 genera and 22 species. As expected, we did not find in the NFRP region sand flies species that have been reported as vectors of Leishmania. However, we found some species of sand flies with few records and that rarely have been reported in southeastern Brazil. Nevertheless, the diversity and species richness of the sand flies in NFRP were similar to those reported in other Atlantic Forest conservation areas. Hence, we drew the following conclusions: (i) it is necessary to carry out inventories not only in leishmaniasis-endemic areas but also in areas with no records of this disease; and (ii) brief inventories can be useful in describing the sand fly fauna in such areas.

Canine visceral leishmaniasis (CVL) is the major source of human visceral leishmaniasis (VL) and is transmitted from dogs to sand flies to humans. To control the spread of this disease, early and accurate detection of infected dogs is critical but challenging. Here we demonstrate the potential of the Dual-Path Platform (DPP(®)) CVL rapid test for detecting K26/K39-reactive antibodies in sera from clinically symptomatic (n=60) and asymptomatic (n=60) Leishmania infantum-infected dogs. For the specificity evaluation, assays were performed using known negative diagnostic serum samples (n=59) and cross-reaction control sera (n=11) from animals born in a VL-free area of Brazil. The diagnostic kit displayed high specificity (96%) but low sensitivity (47%) in identifying parasite-positive dogs without signs of CVL. However, the test sensitivity was significantly higher (98%) in diseased cases, indicating that this convenient test may be useful to identify the most infectious dogs. Efforts should be pursued to obtain a more sensitive DPP-multiplexed test parameter (i.e. based on simultaneous yet separate antibody detection of carefully selected multiple antigens of diagnostic utility) for effective serodiagnosis of early-infected dogs, as this will likely allow more efficient canine removal regimens than those used in practice by public health services.