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ABSTRACT This review aimed to provide an update on the morphological and/or functional abnormalities related to congenital Zika virus (ZIKV) infection, based on primary data from studies conducted in Brazil since 2015. During the epidemic years (2015-2016), case series and pediatric cohort studies described several birth defects, including severe and/or disproportionate microcephaly, cranial bone overlap, skull collapse, congenital contractures (arthrogryposis and/or clubfoot), and visual and hearing abnormalities, as part of the spectrum of Congenital Zika Syndrome (CZS). Brain imaging abnormalities, mainly cortical atrophy, ventriculomegaly, and calcifications, serve as structural markers of CZS severity. Most case series and cohorts of microcephaly have reported the co-occurrence of epilepsy, dysphagia, orthopedic deformities, motor function impairment, cerebral palsy, and urological impairment. A previous large meta-analysis conducted in Brazil revealed that a confirmed ZIKV infection during pregnancy was associated with a 4% risk of microcephaly. Additionally, one-third of children showed at least one abnormality, predominantly identified in isolation. Studies examining antenatally ZIKV-exposed children without detectable abnormalities at birth reported conflicting neurodevelopmental results. Therefore, long-term follow-up studies involving pediatric cohorts with appropriate control groups are needed to address this knowledge gap. We recognize the crucial role of a national network of scientists collaborating with international research institutions in understanding the lifelong consequences of congenital ZIKV infection. Additionally, we highlight the need to provide sustainable resources for research and development to reduce the risk of future Zika outbreaks.

ABSTRACT Background: Systematic data on the occurrence of tungiasis are scarce. Methods: We analyzed data on tungiasis in humans and animals from all municipalities of Ceará State, Northeast Brazil, using a rapid assessment questionnaire. Results: Among the 184 municipalities, 181 (98.3%) reported tungiasis in the past (before 2021) or currently, 120 (65.2%) reported current occurrence, 155 (84.2%) reported severe cases in the past or currently, 47 (25.5 %) reported severe cases currently, and 132 (71.7%) reported tungiasis in animals. Conclusions: Tungiasis is a significant public health concern in Ceará. A One Health approach is required to reduce the disease burden in humans and animals.

ABSTRACT Background: This study is the first report of the species Panstrongylus rufotuberculatus in Roraima, a state in northern Brazil. Methods: We collected specimens from a residence in the municipality of Rorainópolis. Results: Our findings confirmed the occurrence of this species in Roraima, increasing the number of registered species from six to seven. Conclusions: Future studies are required to further investigate and expand our knowledge of the occurrence of this species and its epidemiological importance for this state.

ABSTRACT Background: Human visceral leishmaniasis HVL is endemic to 75 countries. The state of Ceará, the Northeast region of Brazil, is of great sanitary importance for the transmission of HVL, and it stands out as an area of interest for epidemiological aspects and control strategies. This study aimed to characterize HVL in relation to epidemiological aspects, composite incidence, and mortality rates in the state of Ceará, Brazil, from 2007 to 2021. Methods: This ecological study used temporal and spatial cuts of HVL data from the notifiable diseases information system. Epidemiological indicators such as incidence, mortality, and composite indices of incidence and mortality were calculated according to the Ministry of Health standardization. Results: There were 6,775 confirmed cases, with high incidence coefficients in 2009 6.96 cases/100,000 inhabitants and 2011 9.83 cases/100,000 inhabitants, and the highest mortality rate in 2011 6.96 deaths/100,000 inhabitants. The composite index of incidence and mortality identified municipalities in the Northern, Northwestern, and Southern regions of Ceará as having the highest risk of HVL. Conclusions: HVL remained endemic throughout the study period, with epidemiological indicators and risk of transmission expressing high magnitude, mainly in the Northeast, Northwest, and South regions of Ceará.

ABSTRACT Background: The school community was heavily impacted by the Covid-19 pandemic, especially with the long time of school closures. This study aimed to analyze the seroprevalence of SARS-CoV-2 antibodies and possible factors associated with seropositivity for COVID-19 in teachers and other school staff, and to estimate the fraction of asymptomatic individuals by sex and age group. Methods: We conducted a serological survey of SARS-CoV-2 infections. An analytical cross-sectional study was conducted in Fortaleza, Brazil. Teachers and other staff members from pre-schools to universities of higher education to were investigated. Results: A total of 1,901 professionals participated in the study, of which 1,021 were staff and 880 were teachers. The seroprevalence of SARS-CoV-2 was 8.0% (152/1901). In the seropositive group, 48.3% were asymptomatic. There was a predominance of women (68.4%); and, 47.1% of the participants were between 31 and 45 years old. There was an increase in prevalence with increasing age. An inverse relationship was found for education level: more professionals with less education tested positive for COVID-19. The presence of an infected person living in the same household was significantly associated with positive results for COVID-19 among the professionals. Conclusions: This is the first study to report the seroprevalence of IgG against SARS-CoV-2 in Brazilian educational staff after the first wave of the disease. In this study, the seroprevalence was much lower than that in the general population. During school reopening, a small fraction of school workers showed serologically detectable signs of SARS-CoV-2 exposure.

ABSTRACT Background: Haiti is one of the Caribbean countries where malaria persists. More than 99% of malaria cases are caused by Plasmodium falciparum, the main vector being the mosquito Anopheles albimanus. In this paper, we describe the epidemiological profile of malaria in Haiti between 2009 and 2018. Methods We analyzed information on cases reported by the Ministry of Health of Haiti and the World Health Organization (WHO). Results: Between 2009 and 2018, 232,479 malaria cases were reported by the Ministry of Public Health and Population (MSPP); an increase in the incidence of malaria in the country in 2010, followed by a decrease in 2011, was primarily observed. Due to recent efforts to reduce malaria by 2020, its incidence declined from 60,130 cases in 2010 to 8,978 cases in 2018. Controversially, in terms of the number of reported cases, the MSPP and WHO report conflicting data. However, the results from both datasets present the same trend in Haiti from 2009 to 2018. The results also illustrate the endemicity of the disease throughout Haiti, both in rural and urban areas, especially along the coast. Conclusions: This study emphasizes the need to promote official data collection and analyses, as well as the application of epidemiological surveillance of malaria at the municipal level, for a better understanding of the real impact of malaria on the Haitian population and to create more appropriate interventions.

Abstract Infections that cause genital ulcers are one of the themes comprising the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article addresses clinical genital ulcer syndrome caused by sexually transmitted infections and its most common etiological agents: Treponema pallidum (syphilis), herpes simplex virus-2 (genital herpes) and herpes simplex virus-1 (perioral herpes), Haemophilus ducreyi (chancroid), Chlamydia trachomatis serotypes L1, L2 and L3 (lymphogranuloma venereum), and Klebsiella granulomatis (donovanosis). Epidemiological and clinical aspects of these infections and guidelines for their diagnosis and treatment are presented, including strategies for surveillance, prevention, and control actions to support health managers and professionals in the qualification of care.

Abstract Chagas disease (CD), with approximately 10,000 deaths annually, has become a worldwide health problem. Approximately 35% of cases may show cardiac manifestations such as arrhythmias and/or conduction disorders, heart failure, thromboembolic accidents, and sudden death. The Amazon region has long been considered a non-endemic area for CD; however, in the last decades, with an increase in the number of acute and chronic cases, disease evolution has received greater attention. Here, we report the successful implementation of a cardioverter-defibrillator for the prevention of sudden death in a patient with autochthonous Chagas cardiomyopathy in the Brazilian Amazon.

Abstract INTRODUCTION: This study analyzed the magnitude and temporal trends of leprosy relapse in Ceará in 2001-2018. METHODS: Descriptive cross-sectional and ecological-time trend studies were performed. RESULTS: We diagnosed 1,777 leprosy relapse cases. Higher prevalence of relapse was observed in men, illiterates, mixed race, multibacillary leprosy, lepromatous leprosy, and persons with visible disabilities. The proportion of relapse increased throughout the study period. CONCLUSIONS: Leprosy relapse is prevalent in certain groups.

Abstract INTRODUCTION: The state of Ceará (Brazilian Northeast) has a high incidence of dengue. Therefore, we aimed to characterize the temporal patterns and spatial distribution of dengue cases in Ceará during 2001-2019. METHODS: A spatiotemporal ecological study was performed with secondary data. Time-trend analysis was performed using a segmented log-linear regression model to estimate the average annual percentage change (AAPC) and the annual percentage change (APC) in incidence of dengue. We also performed spatiotemporal analysis to identify the place, time, and relative risk (RR) of dengue clusters. RESULTS: There were 539,653 dengue cases. The AAPC reduced over time (-9.5%; 95% confidance interval [CI]: -18.3; -0.3). Three trends were identified-2001-2004: APC=-20.9% (95% CI: -65.1 to 44.8), 2005-2015: APC=7.9% (95% CI: -6.0 to 98.9), and 2016-2019: APC=-48.8% (95% CI: -83.0 to -6.1). During 2001-2007, 10 significant clusters were identified (RR=3.57-14.38: n=4 and RR=0.05-0.39: n=6). During 2008-2013, there was 1 cluster in the western region (RR= 3.40) and four other clusters (RR=0.02-0.15). The last period presented 5 high-RR clusters (RR=2.95-9.24). The low-RR clusters were located in the central-north, central-south, south, and northwest regions. However, the central-west region remained a high-RR cluster region throughout the study period. CONCLUSIONS: Dengue showed a decreasing incidence. During the epidemic years, the southern, eastern, and western regions presented high-risk clusters. Introduction of a new dengue serotype in a low-RR area can cause explosive outbreaks due to population susceptibility.

Abstract Gnathostomiasis is a parasitic zoonosis caused by the helminth Gnathostoma spp., acquired through the consumption of raw or undercooked contaminated aquatic animals.The disease is endemic in Southeast Asia and Central America. Two male patients, both middle-aged, presented with single itchy erythemato-edematous plaques on the anterior thorax and left flank. Both had consumed raw fish in the Amazon region. The clinical and epidemiological examinations suggested gnathostomiasis, and treatment with albendazole caused total regression of the lesions. Health teams should be familiar with the disease to provide correct diagnosis. The control strategy should be based on health education for the population.

Abstract INTRODUCTION: Schistosomiasis, caused by infection from Schistosoma mansoni, is a disease that represents an important public health problem for Brazil, especially for states in the Northeast region. Thus, the aim of this study is to present a new epidemiological profile for the disease in a municipality with low prevalence in the state of Alagoas, Brazil. METHODS: A cross-sectional study was conducted through a coproparasitological and malacological survey. A structured questionnaire was applied to the study participants to survey possible risk factors and a spatial analysis (kernel density) was used to measure the risk of infection. RESULTS: Of the 347 participants, 106 (30.5%) were infected by Schistosoma mansoni, most of them from the urban area of the municipality (68.9%; 73/106). A 3-fold risk of infection was found for individuals living in the urban area and a risk of 2.15 times for self-declared farmers. Biomphalaria glabrata and B. straminea were the species found in the municipality, but no animals were diagnosed as infected by the parasite. Spatial analysis showed a random distribution of vectors and human cases of the disease, and the formation of two clusters of human cases in the urban area was seen. CONCLUSIONS: A new epidemiological profile for schistosomiasis from S. mansoni infection was presented in a municipality of low endemicity: a high proportion of positive individuals in the urban area; presence of snails without positive diagnosis for S. mansoni infection; random distribution of vectors and human cases; and absence of association between classical risk factors and human infection.

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 >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

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.

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.

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.

Abstract INTRODUCTION: Haemagogus capricornii and Hg. janthinomys females are considered morphologically indistinguishable. We analyzed morphometric variability between Brazilian populations of these species using wing geometric morphometry. METHODS: Size and shape at intra- and interspecific levels were analyzed in 108 Hg. capricornii and Hg. janthinomys females. RESULTS: Geometric morphometry indicated size and shape variables can differentiate these species at interspecific level. However, at intraspecific level, results show relative differentiation. Two populations of Hg. capricornii had a smaller centroid size with no significant differences between them, whereas all Hg. janthinomys populations showed significant differences. CONCLUSIONS: Both species were correctly identified by geometric morphometry.

Abstract: INTRODUCTION: Environmental modifications caused by human activities have led to changes in mosquito vector populations, and sylvatic species have adapted to breeding in urban areas. METHODS: Mosquitoes were collected using ovitraps in three sampling sites in the Atlantic Forest in the State of Rio de Janeiro, Brazil. RESULTS: We collected 2,162 Culicidae specimens. Haemagogus janthinomys and Haemagogus leucocelaenus, both sylvatic yellow fever virus vectors, were the most common species found. CONCLUSION: There is a potential for the transmission of arboviruses in and around these natural reserves. Therefore, it is necessary to maintain entomological surveillance programs in the region.

Abstract: INTRODUCTION: The spatial distribution of disseminated histoplasmosis (DH) and acquired immunodeficiency syndrome (AIDS) co-infection in adult residents of Fortaleza, Ceará, Brazil was evaluated. METHODS: Socio-demographic data for the DH/AIDS cases were obtained from a reference hospital, and socio-environmental indicators were obtained from an official Brazilian institute. Kernel analysis and local indicators of spatial autocorrelation (LISA) cluster maps were used to estimate the case density within the city. RESULTS: DH/AIDS cases were concentrated in the Northwestern and Southwestern peripheral areas of the city, related with low human development indices, but different from AIDS cases distribution. CONCLUSION: Risk factors other than AIDS infection must affect histoplasmosis development in this area.

INTRODUCTION: This study aimed to estimate the prevalence of the most frequent oral and systemic manifestations in human immunodeficiency virus-1 (HIV-1)-positive patients. METHODS: The study was conducted on 300 HIV-1 patients attending the Reference Unit Specialized in Special Infectious Parasitic Diseases in Belém, Pará, Brazil. RESULTS: The most prevalent oral conditions were caries (32.6%), candidiasis (32%), and periodontal disease (17%). Among the systemic manifestations, hepatitis (29.2%), gastritis (16%), arterial hypertension (14.7%), and tuberculosis (12%) were the most commonly observed. CONCLUSIONS: We here reported on the most prevalent oral and systemic conditions in HIV-1-positive patients. The healthcare professional's knowledge of the various manifestations among these patients is fundamental to ensure prompt and accurate diagnosis and treatment, and for improving the quality of life of these patients.

INTRODUCTION: Bioecological aspects of anophelines (Diptera: Culicidae) near areas under the direct influence of the hydroelectric plant reservoir of Serra da Mesa in Goiás, Brazil, were analyzed. METHODS: Samples were collected at the surrounding dam area during the phases before and after reservoir impoundment. The influence of climatic and environmental factors on the occurrence of Anopheles darlingi, Anopheles albitarsis, Anopheles triannulatus, Anopheles oswaldoi and Anopheles evansae was assessed using Pearson's correlations with indicators for richness and diversity as well as the index of species abundance (ISA) and the standardized index of species abundance (SISA). RESULTS: The highest anopheline density occurred during the phase after filling the tank; however, no direct correlation with the climatic factors was observed during this stage. The reservoir formation determined the incidence of the anopheline species. An. darlingi was the predominant species (SISA = 1.00). CONCLUSIONS: The significant difference (p < 0.05) observed between the species incidence during the different reservoir phases demonstrates the environmental effect of the reservoir on anophelines.

Abstract: Dengue infection has not been routinely investigated among pregnant women and parturients with acute febrile syndrome in endemic settings. Here, we report two cases of dengue fever detected at the time of delivery in parturients enrolled in a cohort prospective study conducted in a hospital in Recife, Brazil. The parturients reported fever onset within seven days prior to delivery, and dengue infection was confirmed upon detection of viral ribonucleic acid (RNA) by using the reverse transcriptase-polymerase chain reaction. Dengue infection should be considered as a diagnostic possibility in cases of fever during pregnancy and labor, especially in endemic areas.

Introduction The year 2009 marked the beginning of a pandemic caused by a new variant of influenza A (H1N1). After spreading through North America, the pandemic influenza virus (H1N1) 2009 spread rapidly throughout the world. The aim of this study was to describe the clinical and epidemiological characteristics of cases of pandemic influenza in a tropical/semi-arid region of Brazil. Methods A retrospective study analyzed all suspected cases of pandemic influenza (H1N1) 2009 reported in the Ceará State through the National Information System for Notifiable Diseases during the pandemic period between 28 April, 2009 and November 25, 2010. Results A total of 616 suspected cases were notified, 58 (9.4%) in the containment phase and 558 (90.6%) in the mitigation phase. Most cases were of affected young people resident in the City of Fortaleza, the largest urban center in the State of Ceará. The most frequent symptoms presented by the cases with confirmed infection were fever, cough, myalgia, arthralgia, and nasal congestion. Mortality rate was 0.0009/1,000 inhabitants and lethality was 5.6%. Deaths were observed only in the mitigation phase. Mortality rates were similar for both sexes but were higher in the age group under 5 years. Conclusions The study suggests that the influenza A (H1N1) pandemic in this tropical/semi-arid region had a lower magnitude when compared to states in the Southern and Southeastern regions of Brazil.

INTRODUCTION: Little information regarding hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among Brazilian female prisoners exists. This study investigated the prevalence and risk factors associated with HBV and HCV infections and identified viral genotypes among female prisoners in Goiás, Central Brazil. METHODS:Women incarcerated in the largest prison in the State of Goiás were invited to participate in the study. All female prisoners were interviewed and tested for the detection of hepatitis B surface antigen (HBsAg), antibodies against HBsAg (anti-HBs), against hepatitis B core antigen (anti-HBc), and antibody against HCV (anti-HCV) by ELISA. HBsAg and anti-HCV positive samples were tested for HBV DNA and HCV RNA and genotyped, respectively. RESULTS:Participants (n=148; 98.6%) completed the study with an overall HBV prevalence of 18.9%. Age >30 years, a low education level, sex with a sexually transmitted diseases carrier, and a male sexual partner serving in the same penitentiary were associated with HBV infections. Only 24% of the women were anti-HBs positive suggesting previous HBV vaccination. Nine female prisoners (6.1%) were anti-HCV positive. Age >40 years, injecting drug use and length of incarceration were statistically associated with anti-HCV antibodies. Five samples were HCV RNA positive and classified as genotypes 1 (subtypes 1a; n=3 and 1b; n=1) and 3 (subtype 3a; n=1). The HBsAg-reactive sample was HBV DNA positive and genotype A. CONCLUSIONS: These findings highlight the necessity of public policies to control hepatitis B and C infections and emphasize the importance of hepatitis B vaccination in prison environments.

INTRODUCTION: Little information regarding hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among Brazilian female prisoners exists. This study investigated the prevalence and risk factors associated with HBV and HCV infections and identified viral genotypes among female prisoners in Goiás, Central Brazil. METHODS: Women incarcerated in the largest prison in the State of Goiás were invited to participate in the study. All female prisoners were interviewed and tested for the detection of hepatitis B surface antigen (HBsAg), antibodies against HBsAg (anti-HBs), against hepatitis B core antigen (anti-HBc), and antibody against HCV (anti-HCV) by ELISA. HBsAg and anti-HCV positive samples were tested for HBV DNA and HCV RNA and genotyped, respectively. RESULTS: Participants (n=148; 98.6%) completed the study with an overall HBV prevalence of 18.9%. Age >30 years, a low education level, sex with a sexually transmitted diseases carrier, and a male sexual partner serving in the same penitentiary were associated with HBV infections. Only 24% of the women were anti-HBs positive suggesting previous HBV vaccination. Nine female prisoners (6.1%) were anti-HCV positive. Age >40 years, injecting drug use and length of incarceration were statistically associated with anti-HCV antibodies. Five samples were HCV RNA positive and classified as genotypes 1 (subtypes 1a; n=3 and 1b; n=1) and 3 (subtype 3a; n=1). The HBsAg-reactive sample was HBV DNA positive and genotype A. CONCLUSIONS: These findings highlight the necessity of public policies to control hepatitis B and C infections and emphasize the importance of hepatitis B vaccination in prison environments.

INTRODUCTION: Chagas' disease is a major public health problem in Brazil and needs extensive and reliable information to support consistent prevention and control actions. This study describes the most common causes of death associated with deaths related to Chagas' disease (underlying or associated cause of death). METHODS: Mortality data were obtained from the Mortality Information System of the Ministry of Health (approximately 9 million deaths). We analyzed all deaths that occurred in Brazil between 1999 and 2007, where Chagas' disease was mentioned on the death certificate as underlying or associated cause (multiple causes of death). RESULTS: There was a total of 53,930 deaths related to Chagas' disease, 44,543 (82.6%) as underlying cause and 9,387 (17.4%) as associated cause. The main diseases and conditions associated with death by Chagas' disease as underlying cause included direct complications of cardiac involvement, such as conduction disorders/arrhythmias (41.4%) and heart failure (37.7%). Cerebrovascular disease (13.2%), ischemic heart disease (13.2%) and hypertensive diseases (9.3%) were the main underlying causes of deaths in which Chagas' disease was identified as an associated cause. CONCLUSIONS: Cardiovascular diseases were often associated with deaths related to Chagas' disease. Information from multiple causes of death recorded on death certificates allows reconstruction of the natural history of Chagas' disease and suggests preventive and therapeutic potential measures more adequate and specifics.

INTRODUÇÃO: No Brasil, a maior diversidade de flebotomíneos é encontrada na Região Amazônica, principalmente em floresta primária de terra-firme. No entanto, sua fauna ainda é pouco conhecida em outros ecossistemas desta região. MÉTODOS: a fim de conhecer a fauna de flebotomíneos de outro ecossistema amazônico, coletas com armadilhas de luz CDC foram realizadas em uma área de campina/campinarana na zona periurbana da Cidade de Manaus. RESULTADOS: foram capturados 814 flebotomíneos de 26 espécies, sendo as mais abundantes: Lutzomyia flaviscutellata (64,5%); Lutzomyia georgii (14%); Lutzomyia olmeca nociva (8,1%); Lutzomyia furcata (3,2%); Lutzomyia monstruosa (1,3%); Lutzomyia umbratilis (1,1%) outros (7,8%). CONCLUSÕES: Campina/campinarana revelou-se de grande importância epidemiológica devido a elevada abundância de Lutzomyia flaviscutellata e Lutzomyia olmeca nociva, ambas vetoras de Leishmania (Leishmania) amazonensis. Com base nestas informações, será possível traçar metas para estudos parasitológicos e conscientizar pesquisadores e estudantes, que mantém constante exposição nesta área realizando trabalhos de pesquisa, sobre o possível risco de contaminação por Leishmania.INTRODUCTION: In Brazil, the largest diversity of phlebotomines is found in the Amazon region, particularly in undisturbed terra-firma forest. However, the phlebotomine fauna in other ecosystems of this region is still not well known. METHODS: In order to investigate the phlebotomine fauna of another Amazon ecosystem, collections were made using CDC light traps in the campina/campinarana ecosystems in the periurban zone of the city of Manaus. RESULTS: Eight hundred and fourteen phlebotomines of 26 species were captured, of which the most abundant were: Lutzomyia flaviscutellata (64.5%); Lutzomyia georgii (14%); Lutzomyia olmeca nociva (8.1%); Lutzomyia furcata (3.2%); Lutzomyia monstruosa (1.3%); Lutzomyia umbratilis (1.1%); and others (7.8%). CONCLUSIONS: The campina/campinarana ecosystems showed great epidemiological importance because of the high abundance of Lutzomyia flaviscutellata and Lutzomyia olmeca nociva, which are both vectors of Leishmania (Leishmania) amazonensis. Based on this information, it will be possible to outline goals for parasitological studies and raise awareness among researchers and students who are constantly exposed in these areas while conducting research work, regarding the possible risk of contamination by Leishmania.

INTRODUÇÃO: desde seu registro, em 2005, no município de Fortaleza, o Aedes albopictus tem exibido uma rápida dispersão. Um estudo visando à identificação das áreas de sua ocorrência, os seus criadouros e a associação com Aedes aegypti e outros culicídeos foi realizado durante o ano de 2008. MÉTODOS: foram coletadas, de janeiro a julho de 2008, amostras de formas imaturas de culicídeos provenientes de imóveis situados nos bairros de Fortaleza, ressaltando-se algumas características dos criadouros, tais como localização (intradomicílio ou peridomicílio), presença de cobertura (proteção contra a incidência de raios solares e chuva), turbidez da água (água límpida e não límpida), material constituinte, volume, altura em relação ao nível do solo e presença simultânea de diferentes espécies de culicídeos no mesmo criadouro. RESULTADOS: a localização no intradomicílio foi um fator importante para os criadouros do Aedes albopictus [RP=0,52 IC95% (0,33-0,81)], por outro lado, a turbidez da água e a cobertura do depósito não se mostraram como diferenciadores para a infestação [p>0,05]. Para o Aedes aegypti a ausência de turbidez da água foi significativa para a infestação nos criadouros [RP=1,14 IC95% (1,06-1,22)]. CONCLUSÕES: a ausência de uma das espécies nos criadouros favorecia sua infestação por outra; criadouros não infestados por Aedes albopictus tinham uma prevalência de infestação de 2,05 [IC95%1,72-2,44] vezes maior pelo Aedes aegypti. Não houve associação significativa entre volume e altura do criadouro e infestação por ambas as espécies. As duas espécies encontram-se dispersas por todo o município, ocupando os mais diversos tipos de criadouros. No entanto, pode-se identificar uma ligeira separação física, com uma infestação maior do Aedes albopictus no peridomicílio.INTRODUCTION: Since the registration of Aedes albopictus in the municipality of Fortaleza in 2005, it has shown rapid dispersion. A study aiming to identify its occurrence areas, breeding sites and associations with Aedes aegypti and other culicids was carried out during 2008. METHODS: Between January and July 2008, samples of immature forms of culicids were gathered from properties located in districts of Fortaleza. Certain features of the breeding sites were highlighted, such as location (indoors or outdoors), presence of covering (protection against impact of sunlight and rain), water turbidity (water clear or not clear), constituent material, volume, height above ground level and simultaneous presence of different species of culicids in the same breeding site. RESULTS: Indoor location was an important factor for the breeding sites for Aedes albopictus [PR = 0.52; 95% CI: 0.33-0.81]. On the other hand, water turbidity and reservoir covering were not shown to be differentiators regarding infestation [p > 0.05]. Absence of water turbidity was significant for Aedes aegypti infestation in breeding sites [PR = 1.14; 95% CI: 1.06-1.22]. CONCLUSIONS: Absence of one of the species from the breeding sites enhanced the infestation by another species. Breeding sites that had not been infested by Aedes albopictus had a prevalence of infestation by Aedes aegypti that was 2.05 times greater [95% CI: 1.72-2.44]. There was no significant association between volume and height of the breeding sites and infestation by both species. Both species were found to be dispersed throughout the municipality, occupying a wide diversity of breeding sites. However, a slight physical separation could be identified, with higher infestation with Aedes albopictus outdoors.

Introduction To determine the faunal composition of immature culicids inhabiting a percolation tank in the landfill of Sapucaia, State of Rio de Janeiro, Brazil, immature mosquitoes were collected over a two-day period during the third weeks of April, August and October 2011. Results The species found were Culex usquatus, Lutzia bigoti, Anopheles argyritarsis and Limatus durhamii. This study is the first to report the colonization of eutrophic breeding sites by these species. Conclusions The oviposition behavior observed in this study suggests a secondary adaptation or change in habit to select eutrophic environments during the developmental stages of the observed species.

Apesar da redução na incidência de tétano acidental no Brasil, não houve queda significativa na letalidade. Nesta série de casos, comparamos a letalidade antes e após o estabelecimento padrão de manejo em unidade de terapia intensiva do paciente com tétano no Hospital Universitário Oswaldo Cruz, no período de 1981 a 2004. Em 24 anos, foram internados 1.971 pacientes e antes do manejo em Unidade de terapia intensiva a letalidade era de 35%. Durante 1997 foi instituída a unidade de terapia intensiva para assistência dos pacientes com tétano, e de 1998 a 2004, a letalidade caiu para 12,6%, OR= 0,27 (IC95%= 0,18- 0,39); pDespite reductions in the incidence of accidental tetanus cases in Brazil, there has not been any significant decrease in its mortality. In this case series, the mortality rates before and after establishing standard management practices for tetanus patients in the intensive care unit at the Oswaldo Cruz University Hospital are compared over the period from 1981 to 2004. Over these 24 years, 1.971 patients were admitted. Before establishing the intensive care unit management, the mortality rate was 35%. The Intensive care unit for attending to tetanus patients was established in 1997. From 1998 to 2004, the mortality rate fell to 12.6%: OR = 0.27 (95% CI = 0.18-0.39); p < 0.001. This trend was seen in all age groups and both sexes. The centralization of attendance for these patients into a single specialized service with early treatment in an intensive care unit has therefore been decisive in reducing the mortality rate. This service can count on the medical team's vast experience of tetanus management, with better treatment of symptoms that forestalls the serious complications from this disease.

As reações hansênicas são fenômenos imuno inflamatórios que ocorrem durante a evolução da hanseníase. Atualmente com os critérios de finalização de tratamento esta intercorrência pode ser observada após a alta da poliquimioterapia. Trata-se de um estudo caso-controle onde foram comparados, laboratorialmente, os casos de reação hansênica após alta da poliquimioterapia multibacilar (PQT/MB) com o grupo controle para analisar a possível associação entre a reação hansênica após alta e a carga bacilar, utilizando o ML Flow, teste sorológico para detecção de anticorpos contra o Mycobacterium leprae, e os resultados das baciloscopias cutâneas. O estudo foi realizado em dois serviços de referência na cidade de Recife - Pernambuco - Brasil, onde participaram 208 pacientes. Os resultados encontrados indicam que a reação após alta está estatisticamente associada à carga bacilar através da positividade do teste sorológico após alta. Conclui-se que existem fatores de riscos comuns entre a recidiva e a reação após alta.Leprosy (Hansen's disease, HD) reactions are immune-inflammatory phenomena that occur during the evolution of the disease. Given the current criteria for treatment of the disease, this event is often observed after the patient has been released from treatment (RFT) from multi-drug therapy (MDT). A case-control study was conducted comparing laboratory results of cases of leprosy reactions after RFT from multibacillary MDT (MDT/MB) with a control group to analyze the possible association between posttreatment reactions and bacterial load using the ML Flow serological test for detection of antibodies to Mycobacterium leprae and the results of bacilloscopic skin smears. The study was conducted in two reference centers in Recife, Pernambuco State, Brazil, involving 208 patients. The results obtained indicate that posttreatment reaction is statistically associated with bacterial load through positive serology post-RFT. In conclusion, common risk factors exist between relapses and post-RFT reactions.

INTRODUCTION: White piedra is a superficial mycosis caused by the genus Trichosporon and characterized by nodules on hair shaft. METHODS: The authors report a family referred to as pediculosis. Mycological culture on Mycosel® plus molecular identification was performed to precisely identify the etiology. RESULTS: A Trichosporon spp. infection was revealed. The molecular procedure identified the agent as Trichosporon inkin. CONCLUSIONS: White piedra and infection caused by T. inkin are rarely reported in Southern Brazil. The molecular tools are essentials on identifying the Trichosporon species.

Thirty cases of human kala-azar were diagnosed by iliac crest biopsy and myeloculture. Histological analysis of 12 patients showed diffuse thickening of reticulin fibers. To the best of our knowledge, this is the third report describing secondary bone marrow fibrosis (myelofibrosis-like) associated with kala-azar. Patients with positive bone marrow fibrosis (pbmf = 12) were compared to patients without detectable bone marrow fibrosis (wbmf = 18). There were no significant differences in clinical and blood parameters following treatment. All patients showed regression of hepatosplenomegaly.Our findings suggest that associated bone marrow fibrosis is transient and did not interfere in the evolution of treated patients.

Paracoccidioidomycosis is a systemic fungal infection caused by Paracoccidioides brasiliensis. As infectious diseases can cause DNA damage, the authors aimed at analyzing DNA breakage in peripheral blood cells of patients with paracoccidioidomycosis by using the comet assay. The results suggested that paracoccidioidomycosis does not cause genotoxicity.Paracoccidioidomicose é micose sistêmica causada pelo Paracoccidioides brasiliensis. Considerando que doenças infecciosas são capazes de induzir danos genéticos, o objetivou-se analisar quebras no DNA em células de sangue periférico de pacientes com paracoccidioidomicose utilizando o teste do cometa. Os resultados sugeriram que essa enfermidade não exerce genotoxicidade.

Foram estudados dez isolados de Schistosoma mansoni provenientes de pacientes residentes em Itaquara, Bahia, Brasil, tratados com oxamniquine eposteriormente com praziquantel, e ainda assim não curados. Caramujos (Biomphalaria glabrataj foram expostos a miracídios provenientes das fezes dos pacientes. Cercãrías eliminadas por estes caramujos e por moluscos coletados no peridomicílio dos pacientes foram utilizadas para infecção experimental de camundongos albinos. Os animais infectados foram tratados em dose única, via oral, com oxamniquine (25, 50 e 100 mg/kg) ou praziquantel (100, 200 e 400mg/kg). Foram realizados estudos de análise e comparação de DNA de cercãrías de S. mansoni eliminadas pelos caramujos e de vermes adultos recolhidos de camundongos infectados experimentalmente com os isolados dos 10 pacientes e ainda de cercãrías de S. mansoni eliminadas por moluscos naturalmente infectados coletados em Itaquara. A cepa LE (mantida rotineiramente no laboratório) foi usada como padrão de comparação da resposta aos agentes esquistossomicidas administrados. As respostas terapêuticas foram significativamente diferentes entre alguns dos isolados embora não fosse possível caracterizar nenhum como resistente. A análise dos perfis de amplificação de DNA nas cercãrías e nos vermes adultos dos isolados de S. mansoni demonstrou baixo grau de variabilidade indicando que estes são geneticamente próximos e revelando a ausência de rearranjos globais dentro dos genomas.Ten inhabitants of Itaquara, Bahia, Brazil treated with oxamniquine and subsequently praziquantel were not cured. Schistosoma mansoni isolates derived from these patients were studied. Snails were infected with miracidia derivedfrom the feces of these patients and the cercariae produced used to infect albino mice. The animals were then treated with a single oral dose of oxamniquine (25, 50 and 100mg/kg) or praziquantel (100, 200 and 400 mg/kg). Tloe response to chemotherapy was significantly different in some of the isolates although it was not possible to characterize any of them as resistant, hi addition, DNA analysis of the isolates by means of "Random Amplified Polymorfhic DNA ''indicated a low degree of variability as compared with a laboratory strain, LE. Thus, it was not possible to characterize these organisms at a genetic level as a distinct strain.

Estudou-se a incidência da Entamoeba histolytica entre aidéticos homossexuais masculinos com o objetivo de determinar se entre esses pacientes o protozoário, incapaz de produzir doença na população geral do Recife, causaria amebíase invasiva. Dos 77 pacientes incluídos na investigação, apenas um (1,3%) albergava a E. histolytica. A eletroforese em gel de amido da linhagem, isolada mostrou um perfil de isoenzimas compatível com o zimodema 1, não patogênico. Além disso, nenhum dos pacientes examinados apresentou no soro anticorpos anti-ameba, verificados pelos testes de precipitação em ágar e imunoenzimático. Estes resultados mostraram que, mesmo entre indivíduos de sistema imunológico comprometido, as linhagens de E. histolytica prevalentes no Recife carecem de potencialidades patogênicas. Não se justifica, portanto, o emprego do metronidazol nos portadores de cistos de ameba, sejam eles aidéticos ou não.