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Purpose: To characterize Vanishing White Matter Disease (VWM) cases from a Brazilian University Tertiary hospital, focusing on brain magnetic resonance image (MRI) aspects, clinical and molecular data. Methods: Medical records and brain MRI of 13 genetically confirmed VWM patients were reviewed. Epidemiological data such as age at symptom onset, gender and main symptoms were analyzed, along with genetic mutations and MRI characteristics, such as the distribution of white matter lesions and atrophy. Results: The majority of patients were female, with the age of symptom onset ranging from 1 year and 6 months to 40 years. All mutations were identified in the EIF2B5 gene, the most prevalent being c.338G > A (p.Arg113His), and a novel mutation related to the disease was discovered, c.1051G > A (p.Gly351Ser). Trauma or infection were significant triggers. The most frequent symptoms were ataxia and limb spasticity. All MRI scans displayed deep white matter involvement, cystic degeneration, with U-fibers relatively spared and a predilection for the frontoparietal region. Lesions in the corpus callosum and posterior fossa were present in all patients. Follow-up exams revealed the evolution of white matter lesions and cerebral atrophy, which correlated with clinical deterioration. Conclusions: VWM affects various age groups, with a significant clinical and genetic variability. A novel mutation associated with the disease is highlighted. MRI reveals a typical pattern of white matter involvement, characterized by diffuse lesions in the periventricular and deep regions, with subsequent extension to the subcortical areas, accompanied by cystic degeneration, and plays a crucial role in diagnosis and follow-up. [ABSTRACT FROM AUTHOR]

[Display omitted] • Vector species richness is a strong predictor of Chagas disease mortality rates. • The findings give support for the Amplification Effect Hypothesis. • It is important to consider vector diversity when studying vector-borne diseases. Vector species richness may drive the prevalence of vector-borne diseases by influencing pathogen transmission rates. The dilution effect hypothesis predicts that higher biodiversity reduces disease prevalence, but with inconclusive evidence. In contrast, the amplification effect hypothesis suggests that higher vector diversity may result in greater disease transmission by increasing and diversifying the transmission pathways. The relationship between vector diversity and pathogen transmission remains unclear and requires further study. Chagas disease is a vector-borne disease most prevalent in Brazil and transmitted by multiple species of insect vectors of the subfamily Triatominae, yet the drivers of spatial variation in its impact on human populations remain unresolved. We tested whether triatomine species richness, latitude, bioclimatic variables, human host population density, and socioeconomic variables predict Chagas disease mortality rates across over 5000 spatial grid cells covering all of Brazil. Results show that species richness of triatomine vectors is a good predictor of mortality rates caused by Chagas disease, which supports the amplification effect hypothesis. Vector richness and the impact of Chagas disease may also be driven by latitudinal components of climate and human socioeconomic factors. We provide evidence that vector diversity is a strong predictor of disease prevalence and give support to the amplification effect hypothesis. [ABSTRACT FROM AUTHOR]

Background: The clinical features of central nervous system (CNS) sporotrichosis are derived from case reports and a limited series of cases. Our objective was to carry out a systematic review and meta‐analysis of CNS sporotrichosis. Methods: We searched PubMed/MEDLINE, Embase, Scopus, and LILACS on 9 September 2023. Our inclusion criteria were documentation of Sporothrix and demonstrated CNS involvement. A metaproportion or metamean analysis was performed to estimate a summary proportion with 95% confidence intervals. Results: We included 52 cases of CNS sporotrichosis published from 1966 to 2023. Forty‐six patients were male (88%, 95% CI: 77–95), and the mean age was 39 years (95% CI: 36–43). Close contact with cats was reported in 55% of cases (95% CI: 37–72). Thirty‐two (61.5%) patients were from Brazil, 18 patients from the United State of America (34.6%). Only two Sporothrix species were reported: S. schenckii (26/41, 63%), and S. brasiliensis (15/41, 37%). The most common neurological symptom was headache. Meningitis was chronic in approximately 80% of cases. A significant majority of the patients were immunocompromised. HIV infection was the primary cause of immunosuppression (85%, 95% CI: 61–95). Overall mortality was 56% (22/39). The comparison of Kaplan–Meier survival curve showed a higher mortality with a statistically significant difference in immunosuppressed patients (p =.019). Conclusion: CNS sporotrichosis represents a notable cause of chronic meningitis, especially in individuals living in the Americas with HIV infection and concurrent skin lesions. [ABSTRACT FROM AUTHOR]

Background: Given the impact of the pandemic in Brazil, vaccination is essential to prevent illness and death. Thus, this study sought to compare, after vaccination, the circulation of SARS-CoV-2 and the response to vaccination in the least and most vaccinated municipalities of a Brazilian state during the height of the pandemic when the Omicron variant was dominant. Methods: We tested for the SARS-CoV-2 antigen and confirmed infection using an RT-qPCR and measured IgM and IgG antibodies in fully vaccinated participants from municipalities with higher and lower vaccination rates. Results: We showed that participants from the least vaccinated municipalities were more likely to have detectable IgM antibodies and a positive antigen/RT-qPCR result for SARS-CoV-2 than participants from the most vaccinated municipalities. There were no differences between the vaccines used (BNT162b2, Ad26.COV2.S, AZD1222, and CoronaVac) and antibody production. Conclusions: Our study evaluated municipal vaccination coverage and its effects on mortality, infections, and anti-SARS-CoV-2 antibodies during a critical phase of the pandemic. The results suggest that higher vaccination coverage reduces acute cases and confers higher memory antibody levels against SARS-CoV-2. Even with a full vaccination schedule, individuals living in places with low vaccination rates are more susceptible to infection. [ABSTRACT FROM AUTHOR]

Integrated fish and livestock farming is an ancient practice and is used to increase production per unit area and reduce the environmental impact caused by untreated animal excreta. Although integrated aquaculture has been used in some countries, including Brazil, this practice has declined. However, many pig farmers maintain their ponds and/or have rivers near their pig farms, allowing raw manure to drain to them. The objective of this work was to verify the possibility of infection of fish by porcine circovirus 2 (PCV2) and, thus, serving as a reservoir species. Eleven specimens of Nile tilapia (Oreochromis niloticus), negative for PCV2, were inoculated with PCV2 intramuscularly and observed for 61 d post-inoculation (dpi), when they were euthanized and had their intestines, livers and gills removed to evaluate for presence of PCV2. The faeces were collected directly from the fish aquarium every four days up to 12 dpi and then once a week up to 61 dpi. The organs and faeces were tested by qualitative polymerase chain reaction (qPCR) for PCV2. This preliminary study showed that PCV2 inoculation was successful in infecting fish. In addition, PCV2 was eliminated in the faeces intermittently during the 61 d of experimentation. [ABSTRACT FROM AUTHOR]

Cryptococcosis is a systemic mycosis that causes pneumonia and meningoencephalitis. Strongyloidiasis is a chronic gastrointestinal infection caused by parasites of the genus Strongyloides. Cryptococcosis and strongyloidiasis affect the lungs and are more prevalent in the same world regions, i.e., Africa and tropical countries such as Brazil. It is undeniable that those coincidences may lead to the occurrence of coinfections. However, there are no studies focused on the interaction between Cryptococcus spp. and Strongyloides spp. In this work, we aimed to investigate the interaction between Strongyloides venezuelensis (Sv) and Cryptococcus gattii (Cg) in a murine coinfection model. Murine macrophage exposure to Sv antigens reduced their ability to engulf Cg and produce reactive oxygen species, increasing the ability of fungal growth intracellularly. We then infected mice with both pathogens. Sv infection skewed the host's response to fungal infection, increasing lethality in a murine coinfection model. In addition to increased NO levels and arginase activity, coinfected mice presented a classic Th2 anti-Sv response: eosinophilia, higher levels of alternate activated macrophages (M2), increased concentrations of CCL24 and IL-4, and lower levels of IL-1β. This milieu favored fungal growth in the lungs with prominent translocation to the brain, increasing the host's tissue damage. In conclusion, our data shows that primary Sv infection promotes Th2 bias of the pulmonary response to Cg-infection and worsens its pathological outcomes. [ABSTRACT FROM AUTHOR]

Malaria is one of the most important neglected diseases in the world, and Brazil has the largest number of cases on the American continent. In Brazil, this disease is considered to be endemic in the Amazon region, although malaria lethality in extra-Amazonian regions is higher. Recently, it has been shown that malaria cases of autochthonous origin are not uncommon in the southeastern states. Among these states, Espírito Santo (ES) has the highest percentage of reported cases. This study aimed to describe the epidemiological profile and main factors that contribute to the incidence of malaria cases in this region, which corresponded to 4155 notifications in the 2007–2017 period based on data obtained from the Special Center for Epidemiological Surveillance of Espírito Santo. The most affected group was males aged around 40 years old, and most of the cases registered were of autochthonous origin. The number of malaria cases decreased during the period 2007–2017. Among the causative species, P. vivax was predominant, and it was followed by P. falciparum as the second most common species of all malaria cases. The main cities of ES presented high records of malaria disease, with high numbers of malaria cases in Santa Tereza, Domingos Martins, Alfredo Chaves, Santa Leopoldina, and Marechal Floriano. It is up to the local governments to advise the population about the epidemiological situation and to standardize medical care for individuals with suspected malaria. [ABSTRACT FROM AUTHOR]

Microcephaly is a neurological condition characterized by anomalies in the growth of the cranial circumference. This study aims to examine the association between sociodemographic and clinical variables and the occurrence of secondary microcephaly in newborns in Brazil. It also aims to investigate the association between this congenital anomaly and teratogenic infections. This research adopts an observational approach with an ecological, descriptive, and analytical design. The sample includes infants aged ≤28 days and registered in the country's Live Births Information System from January 2015 to December 2021. Newborns were categorized into G1, consisting of newborns with one of the three infections (Zika, toxoplasmosis, or syphilis), and G2, consisting of newborns with two of the three infections. A total of 1513 samples were analyzed and divided into two groups: one infection (syphilis n = 423; toxoplasmosis n = 295; or Zika n = 739) and two infections (n = 56). The northeastern region of Brazil has the highest prevalence of microcephaly. Regarding the population profile, the Zika virus infection is more common among white mothers, while the syphilis infection is more common among black mothers. Among newborns with microcephaly, boys have a lower prevalence of toxoplasmosis infection, while girls have a lower prevalence of Zika virus infection. This study provides pertinent information on each infection and contributes to the epidemiologic understanding of the association between teratogenic infections and microcephaly. [ABSTRACT FROM AUTHOR]

Zoonotic outbreaks of sporotrichosis are increasing in Brazil. We examined and described the emergence of cat-transmitted sporotrichosis (CTS) caused by the fungal pathogen Sporothrix brasiliensis. We calculated incidence and mapped geographic distribution of cases in Curitiba, Brazil, by reviewing medical records from 216 sporotrichosis cases diagnosed during 2011-May 2022. Proven sporotrichosis was established in 84 (39%) patients and probable sporotrichosis in 132 (61%). Incidence increased from 0.3 cases/100,000 outpatient visit-years in 2011 to 21.4 cases/100,000 outpatient visityears in 2021; of the 216 cases, 58% (n = 126) were diagnosed during 2019-2021. The main clinical form of sporotrichosis was lymphocutaneous (63%), followed by localized cutaneous (24%), ocular (10%), multisite infections (3%), and cutaneous disseminated (<0.5%). Since the first report of CTS in Curitiba in 2011, sporotrichosis has increased substantially, indicating continuous disease transmission. Clinician and public awareness of CTS and efforts to prevent transmission are needed. [ABSTRACT FROM AUTHOR]

Objective: To reduce the incidence density of ventilator-associated pneumonia (VAP), central lineassociated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI) in the intensive care unit (ICU) using the Improvement Science method. Methods: This was a single-center retrospective cohort study. A collaborative quality improvement team developed and implemented local changes to HAI-related processes and protocols. Preintervention, intervention, and post-intervention periods were compared. The study was conducted at the Adult ICU of a hospital in southern Brazil. Variables were analyzed using interrupted time series analysis with segmented linear regression, simple correlation, and hypothesis testing. Results: There was a reduction in the incidence density of all infections. VAP was reduced from 27.2% to 7.2% (p < 0.001), CLABSI from 3.0% to 0.9% (p = 0.017), and CAUTI from 8.3% to 1.8% (p < 0.001). The ICU stay was also reduced from 6.7 to 6 days (p = 0.018). Conclusion: There was an improvement in all the evaluated parameters. Ongoing monitoring of related indicators and adherence to implemented measures are essential to sustain improvements. Applying the Improvement Science methodology can reduce the incidence of HAIs in the ICU. [ABSTRACT FROM AUTHOR]

Purpose: Introduced or invasive fish are susceptible to new parasites but can simultaneously carry infectious parasites from their native range towards new hosts. Screening these parasites is key to address the health of fish populations and spread of diseases. Methods: In this study, we sequenced a Coccidia parasite, for the first time from the blenny Omobranchus sewalli, introduced in the northern coast of Brazil with an Indo-Pacific origin. Results: Only one individual was infected, its genetic sequence matched (over 99%) with two lineages of undetermined species, belonging to the genus Goussia, sequenced from three marine fish species (Mulloidichthys flavolineatus, Lutjanus kasmira, and Selar crumenophthalmus) in Hawaii. Conclusions: Phylogenetic analysis suggests considerable differentiation between the Goussia detected and other Goussia spp. sequenced from North Atlantic marine fish, thus we cannot exclude the possibly that this parasite was carried by O. sewalli from its native Indo-Pacific range. [ABSTRACT FROM AUTHOR]

Our hypothesis is that annual and seasonal variations influence the structure of component communities and diversity of metazoan parasites from Colomesus asellus from the Amazon River. A total of 107 fish were collected during 2020 and 2021, and 932 metazoan parasites were recovered. In 2020, four species of parasites (one Nematoda, two Digenea and one Crustacea) were found; and in 2021, five species (one Nematoda, one Digenea, one Acanthocephala and two Crustacea) were recorded. Ergasilus colomesus was the most dominant throughout the study. Species richness and Brillouin diversity index were higher in 2021 and in the dry season. Some parasite component communities showed differences between years and between seasonal periods. The structure of parasite communities was mainly influenced by rainfall levels, seasonal availability of infective stages in the environment, and body size of the fish host. These facts corroborate the hypothesis that such variables could influence the component communities of parasites. Lastly, this is the first record of Contracaecum sp., Genarchella genarchella, Clinostomum marginatum, Brasacanthus sp. and Argulus pestifer in C. asellus. [ABSTRACT FROM AUTHOR]

Human bocavirus (HBoV) is an emerging virus detected around the world that may be associated with cases of acute gastroenteritis (AGE). However, its contribution to AGE has not been elucidated. This study aimed to describe the frequency, clinical features, and HBoV species circulation in children up to 5 years with or without AGE symptoms in Acre, Northern Brazil. A total of 480 stool samples were collected between January and December 2012. Fecal samples were used for extraction, nested PCR amplification, and sequencing for genotyping. Statistical analysis was applied to verify the association between epidemiological and clinical characteristics. Overall, HBoV-positivity was 10% (48/480), with HBoV-positive rates of 8.4% (19/226) and 11.4% (29/254) recorded in diarrheic and non-diarrheic children, respectively. The most affected children were in the age group ranging between 7 and 24 months (50%). HBoV infection was more frequent in children who live in urban areas (85.4%), use water from public networks (56.2%), and live with adequate sewage facilities (50%). Co-detection with other enteric viruses was 16.7% (8/48) and the most prevalent coinfection was RVA+ HBoV (50%, 4/8). HBoV-1 was the most frequent species detected in diarrheic and non-diarrheic children, responsible for 43.8% (21/48) of cases, followed by HBoV-3 (29.2%, 14/48) and HBoV-2 (25%, 12/48). In this study, HBoV infection was not always associated with AGE, as most HBoV cases belonged to the non-diarrheal group. Future studies are warranted in order to determine the role of HBoV in causing acute diarrhea disease. [ABSTRACT FROM AUTHOR]

This review investigated information about metacercariae of Clinostomum Leidy, 1856 published over 91 years (1928 to 2019) to search for infection and geographic distribution patterns of this digenean species in freshwater fish from Brazil. The present study used 101 samples from 60 fish species of different families distributed in Characiformes, Siluriformes, Cichliformes, Gymnotiformes, Cypriniformes, Cyprinodontiformes, and Synbranchiformes. The greatest number of parasite–host associations were found for Cichliformes species of the Cichlidae family. Metacercariae of digeneans that belonged to four species of Clinostomum were found, with Clinostomum marginatum and Clinostomum complanatum (68.7%) the dominant species, whereas 22.2% of parasites were allocated only to the genus Clinostomum. There was variation in prevalence, intensity and abundance of Clinostomum spp. in host fish, and infection sites included internal and external organs (e.g. intestine, stomach, operculum, muscle, mouth, heart, gills, body cavity, fins). There was similarity in prevalence, intensity, and abundance of Clinostomum spp. in detritivorous, omnivorous, and piscivorous host fish. Clinostomum metacercariae are distributed in the Amazon, Paraná River, São Francisco, Uruguay, Atlantic North and South, and Southeast basin systems, whereas C. marginatum and C. complanatum have distribution patterns limited to hydrographic basins of different regions. Clinostomum spp. have a cosmopolitan distribution and parasitize a diversity of host fish, and the present study constitutes the most extensive survey regarding these digeneans in fish throughout Brazil. [ABSTRACT FROM AUTHOR]

Background: Snakebites represent a significant health problem in tropical countries, with an annual incidence of 2.7 million cases worldwide. The incidence of secondary infections after snake bites is also high and is usually caused by bacteria from the oral cavity of snakes. Morganella morganii has been identified as an important cause of infections and has been guiding antibiotic therapy in several regions of Brazil and the world. Methodology/Principal findings: We performed a retrospective cross-sectional evaluation of snakebites in hospitalized patients between January 2018 and November 2019 and selected those with secondary infection in their medical records. During the period, 326 cases of snakebites were treated, and 155 (47.5%) of them eventually had secondary infections. However, only seven patients underwent culture of soft tissue fragments, in which three cases were negative culture results, while Aeromonas hydrophila was identified in four cases. Of these, 75% were resistant to ampicillin/sulbactam, 50% had intermediate sensitivity to imipenem, and 25% had intermediate sensitivity to piperacillin/tazobactam. Trimethoprim/sulfamethoxazole (TMP-SMX) was not tested on any strain. Of the 155 cases that progressed to secondary infections, 48.4% (75) were empirically treated with amoxicillin/clavulanate, 41.9% (65) with TMP-SMX, and 32 (22%) of these 144 cases required a change to a second regimen, and 10 of these 32 patients required a third therapeutic regimen. Conclusion: Wild animals act as reservoirs of resistant bacteria because their oral cavity favors biofilm formation, which explains the finding of A. hydrophila with a reduced sensitivity profile in this study. This fact is essential for the appropriate choice of empirical antibiotic therapy. Author summary: Secondary infection is among the most common complications that may occur after an ophidian accident. The associated microorganisms are those found in the oral cavity of snakes, with the bacteria Morganella Morganii being described with the highest prevalence. In the oral cavity of snakes, bacteria are protected and can develop resistance to the most common antibiotics used in clinical practice. Our study aimed to study cases of secondary infection after snakebites in a specialized service in Midwest Brazil. The investigation of which bacteria caused the infection was carried out in some cases, and only the bacteria Aeromonas hydrophila was isolated, with resistance to the antibiotic most commonly used in the service, which was Amoxicillin with Clavulanate. This led us to discuss the best therapeutic approach for this germ and also for ophidian accidents that complicate with secondary infection in general. [ABSTRACT FROM AUTHOR]

Background: Over the last decades, enormous successes have been achieved in reducing malaria burden globally. In Latin America, South East Asia, and the Western Pacific, many countries now pursue the goal of malaria elimination by 2030. It is widely acknowledged that Plasmodium spp. infections cluster spatially so that interventions need to be spatially informed, e.g. spatially targeted reactive case detection strategies. Here, the spatial signature method is introduced as a tool to quantify the distance around an index infection within which other infections significantly cluster. Methods: Data were considered from cross-sectional surveys from Brazil, Thailand, Cambodia, and Solomon Islands, conducted between 2012 and 2018. Household locations were recorded by GPS and finger-prick blood samples from participants were tested for Plasmodium infection by PCR. Cohort studies from Brazil and Thailand with monthly sampling over a year from 2013 until 2014 were also included. The prevalence of PCR-confirmed infections was calculated at increasing distance around index infections (and growing time intervals in the cohort studies). Statistical significance was defined as prevalence outside of a 95%-quantile interval of a bootstrap null distribution after random re-allocation of locations of infections. Results: Prevalence of Plasmodium vivax and Plasmodium falciparum infections was elevated in close proximity around index infections and decreased with distance in most study sites, e.g. from 21.3% at 0 km to the global study prevalence of 6.4% for P. vivax in the Cambodian survey. In the cohort studies, the clustering decreased with longer time windows. The distance from index infections to a 50% reduction of prevalence ranged from 25 m to 3175 m, tending to shorter distances at lower global study prevalence. Conclusions: The spatial signatures of P. vivax and P. falciparum infections demonstrate spatial clustering across a diverse set of study sites, quantifying the distance within which the clustering occurs. The method offers a novel tool in malaria epidemiology, potentially informing reactive intervention strategies regarding radius choices of operations around detected infections and thus strengthening malaria elimination endeavours. [ABSTRACT FROM AUTHOR]

Individuals infected with Leishmania (L.) chagasi may present different asymptomatic and symptomatic stages of infection, which vary in the clinical–immunological profiles that can be classified as asymptomatic infection (AI), subclinical resistant infection (SRI), indeterminate initial infection (III), subclinical oligosymptomatic infection (SOI), and symptomatic infection (SI) (=American visceral leishmaniasis, AVL). However, little is known about the molecular differences between individuals having each profile. Here, we performed whole-blood transcriptomic analyses of 56 infected individuals from Pará State (Brazilian Amazon), covering all five profiles. We then identified the gene signatures of each profile by comparing their transcriptome with those of 11 healthy individuals from the same area. Symptomatic individuals with SI (=AVL) and SOI profiles showed higher transcriptome perturbation when compared to those asymptomatic III, AI and SRI profiles, suggesting that disease severity may be associated with greater transcriptomic changes. Although the expression of many genes was altered on each profile, very few genes were shared among the profiles. This indicated that each profile has a unique gene signature. The innate immune system pathway was strongly activated only in asymptomatic AI and SRI profiles, suggesting the control of infection. In turn, pathways such as MHC Class II antigen presentation and NF-kB activation in B cells seemed to be specifically induced in symptomatic SI (=AVL) and SOI profiles. Moreover, cellular response to starvation was down-regulated in those symptomatic profiles. Overall, this study revealed five distinct transcriptional patterns associated to the clinical–immunological (symptomatic and asymptomatic) profiles of human L. (L.) chagasi-infection in the Brazilian Amazon. [ABSTRACT FROM AUTHOR]

Introduction: Influenza is characterized by an acute viral infection, which can lead to severe conditions and death, especially in vulnerable populations, such as older adults. Therefore, we sought to analyze cases of severe acute respiratory syndrome (SARS) due to influenza in older adults registered in Brazil and investigate the factors related to death due to this disease. Methodology: This is a cross-sectional, population-based study that used secondary data from the Influenza Epidemiological Surveillance Information System (IESIS-Influenza). Older adults aged 60 years and above with laboratory diagnosis of influenza were included. Results: A total of 3,547 older adults with SARS due to influenza were included, out of which 1,185 cases with death as the outcome were identified. Among older adults with death as the outcome, 87.4% were not vaccinated against influenza. The main risk factors for death were invasive ventilatory support use, intensive care unit admission, brown skin color and dyspnea (p < 0.001). Conclusions: This study described the profile of older adults with SARS due to influenza in Brazil. Factors associated with death in this population were identified. Moreover, the need to encourage compliance with vaccination among older adults is evident in order to prevent severe cases and unfavorable outcomes related to influenza. [ABSTRACT FROM AUTHOR]

To describe the clinical characteristics, severity, and ophthalmological changes in SARS-CoV-2 patients through ophthalmological examinations performed at the reference center of the National Institute of Infectious Diseases, Brazil. This cross-sectional study assessed the examination results of SARS-CoV-2 patients from July 2020 to November 2020. In total, 150 patients were included and allocated into three groups of 50 patients depending on the disease severity. Group 1 patients were in the intensive care unit (ICU), group 2 patients were in the semi-ICU, and group 3 patients were outpatients. Ten (6.7%) patients exhibited ophthalmological changes; five (10%), four (8%), and one (2%) patients in groups 1, 2, and 3, respectively. Ophthalmological findings included candle flame hemorrhage and cotton wool exudates. We analyzed the general characteristics of the 10 patients with ophthalmological changes. Nine were hospitalized and one was seen on an outpatient basis. We observed ophthalmic changes in patients with SARS-CoV-2 infection, despite the absence of any clinical or laboratory risk factors indicative of such changes. [ABSTRACT FROM AUTHOR]

Rare emerging pathogens such as Saprochaete clavata are associated with invasive fungal diseases, high morbidity, mortality, rapidly fatal infections, and outbreaks. However, little is known about S. clavata infections, epidemiology, risk factors, treatment, biofilms, and disease outcomes. The objective of this study was to describe a new case of severe S. clavata infection in a patient diagnosed at a referral children's hospital in Brazil, including antifungal minimal inhibitory concentration, S. clavata biofilm characterization, and molecular characterization. The S. clavata isolated from an immunocompromised 11-year-old male patient was characterized using MALDI-TOF, Gram staining, scanning electron microscopy (SEM), and next generation sequencing (NGS) of genomic DNA. Biofilm production was also evaluated in parallel with determining minimal inhibitory concentration (MIC) and biofilm sensitivity to antifungal treatment. We observed small to medium, whitish, farinose, dry, filamentous margin colonies, yeast-like cells with bacillary features, and biofilm formation. The MALDI-TOF system yielded a score of = 2,000, while NGS confirmed S. clavata presence at the nucleotide level. The MIC values (in mg L-1) for tested drugs were as follows: fluconazole = 2, voriconazole = 2, caspofungin = 8, micafungin = 2, amphotericin B = 4, flucytosine = 1, and anidulafungin = 1. Amphotericin B can be active against S. clavata biofilm and the fungus can be susceptible to new azoles. These findings were helpful for understanding the development of novel treatments for S. clavata-induced disease, including combined therapy for biofilm-associated infections. [ABSTRACT FROM AUTHOR]

In Brazil, visceral leishmaniasis (VL) has been expanding and urbanizing, mainly in non-endemic areas such as the State of Rio Grande do Sul. Considering that infected dogs are the main reservoirs of VL in urban areas, the present study aimed to evaluate the propagation of canine visceral leishmaniasis (CVL) infection from an unaffected region in transition to a VL transmission area. For this, 1159 and 1087 samples of canine serum from 2015 and 2021, respectively, were analyzed, using the indirect immunofluorescence test. In addition, necropsy reports between 2007 and 2021 were evaluated. The results showed a prevalence of anti-Leishmania spp. antibodies of 7.5% in the samples from 2015, while in 2021 samples, it was 23.5%, with an incidence of 0.4 cases per 100 dogs. It is noteworthy that in 2007, there was no record of CVL as the cause of death in the pathological reports, and in 2021, 41 diagnoses were made with the protozoan being a determinant of the death of the animal. These values indicate an increasing trend in the prevalence and incidence coefficients of CVL. The results of this study allowed us to verify the spread of the disease from an unaffected region to a transmission area of the agent, as well as provide subsidies for health authorities to implement improvements in the CVL control program in the municipality, to mitigate the emergence of human cases of the disease. [ABSTRACT FROM AUTHOR]

This study investigated the influence of temporal and seasonal (i.e., rainy and dry seasons) in communities and infracommunities of metazoan parasites in Pimelodus ornatus, a Siluriformes from the Amazon River in the state of Amapá, in northern Brazil. A total of 144 fish were collected during 2020 and 2021. In 2020, five species of parasites were found (1 Monogenea, 3 Nematoda, and 1 Cestoda), and in 2021, seven species of parasites were found (1 Monogenea, 3 Nematoda, 1 Cestoda, 1 Digenea, and 1 Crustacea). In 2020, Spirocamallanus inopinatus was dominant, while in 2021, Contracaecum sp. was dominant. Brillouin diversity, species richness, and evenness were higher in 2021. There were differences for some parasite infracommunities between years and between seasonal periods. Brillouin diversity and species richness were higher in the rainy season, but there were no differences in evenness and Berger-Parker dominance between the seasonal periods. Temporal and seasonal variations were mainly influenced by rainfall levels, oxygen levels, and environmental temperature and, later, by the availability of infective stages of parasites in the environment and the size of the hosts. Lastly, the influence of the temporal and seasonal variations on the structure of communities and infracommunities of parasites was weaker than expected due to the low infection rates of the majority of parasites found. [ABSTRACT FROM AUTHOR]

• Genomic diagnostic of a multidrug-resistant E. coli causing intestinal infection is reported. • Bioinformatic analysis confirmed aEPEC belonging to serotype ONT:H19 and ST10955. • Wide resistome supported MDR profile and trimethoprim-sulfamethoxazole failure. • Phylogenomic analysis revealed high similarity with a pan-susceptible E. coli from Brazil. • Importance of genomic diagnostic of enterical infections is discussed. This study focuses on the genomic characterization of a multidrug-resistant Escherichia coli strain responsible for a severe gastrointestinal infection in a 33-year-old male. The patient initially received sulfamethoxazole/trimethoprim treatment, which proved ineffective. Fecal culture confirmed the presence of E. coli displaying a MDR profile to ampicillin, nalidixic acid, ciprofloxacin, sulfamethoxazole, trimethoprim, and tetracycline. Serotyping identified the strain as ONT:H19. Virulence analysis indicated a highly virulent profile with numerous virulence markers. Plasmid analysis uncovered various plasmids carrying both antimicrobial resistance and virulence genes. MLST assigned the strain to ST10955. Phylogenomic analysis revealed similarity to an older Brazilian isolate, suggesting the persistence of a common lineage with evolving antimicrobial resistance. This report highlights the first identification of a multidrug-resistant ST10955 E. coli strain with a wide resistome and virulence potential, emphasizing the importance of ongoing surveillance of E. coli strains due to their potential for severe infections, resistance development, and virulence. [ABSTRACT FROM AUTHOR]

Many recent outbreaks of influenza A (H1N1) in the world, especially in Brazil, it has become clear that the severity of the disease is not known in the same form. On Wednesday, June 7, 2023, Brazil notified the WHO of a fatal case of human infection with a variant of the influenza A(H1N1) virus of swine origin, this case was confirmed in a laboratory in the region of the interior state of Paraná. This is the first human infection caused by an influenza A (H1N1) virus reported in 2023 nationwide in Brazil. To mitigate H1N1 flu in Brazil, we urge the Brazillian government through its Ministry of Health to improve on mass awareness about the signs and symptoms of H1N1 flu among the Brazillians. The Brazillian government should also implement the One Health approach towards the control of H1N1 flu in Brazil, as we believe that these recommendations would go a long way in preventing future cases and the spread of H1N1 flu in Brazil. This article aims to present the clinical presentations of the H1N1 flu and the implications, recommendations and the way forward to protect the Brazilian population against the H1N1 flu. • On Wednesday, June 7, 2023, Brazil notified the WHO of a fatal case of human infection with a variant of the influenza A(H1N1) virus of swine origin, this case confirmed in a laboratory in the region of the interior state of Paraná. • The influenza A virus is the most common infectious agent in humans, it infects about twenty percent of the world's population while causing millions of hospitalizations each year and cases of death have also been recorded. • The Brazillian government should also implement the One Health approach towards the control of H1N1 flu in Brazil, as we believed that these recommendations would go a long way in preventing future cases and spread of H1N1 flu in Brazil. [ABSTRACT FROM AUTHOR]

Monkeypox infection is rapidly spreading across the world. Despite the increasing number of cases, only a few reports have been published, and most are on people living without HIV. We report here the first two cases of monkeypox infection in Bahia, Brazil, one of them in a person living with HIV, on stable treatment. Both cases had a similar evolution, with a limited number of lesions and mild symptoms, with a complete recovery after 7–10 days. The potential route of transmission was via oral sex for the first case and was undefined for the second one. Both cases were confirmed through detection of the viral genome by PCR, and the partial sequence of the first case indicates the infection was caused by the West African clade. These cases confirm that monkeypox infection is currently being transmitted in Brazil and that people living with HIV on stable treatment are not likely to present a more severe form of monkeypox. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of skin lesions and evaluate the clinical and sociodemographic factors associated with their presence in hospitalised patients. Method: This descriptive, cross-sectional, correlational study was performed in inpatient units and intensive care units of a cancer hospital in São Paulo, Brazil, after approval by the Institutional Research Ethics Committee. Data from hospitalised adult patients with cancer were collected during physical examinations and from medical records. A Chi-squared test, univariate analysis, a logistic regression model with results expressed as odds ratio (OR) and 95% confidence intervals (CI), and Classification and Regression Tree (CART) analysis were used to evaluate the data. Results: Of 341 patients, 80 had skin lesions, equating to an overall prevalence of 23.5%. The skin lesions included pressure injuries (10%), incontinence-associated dermatitis (6.7%), skin tears (6.5%), malignant wounds (3.8%) and complicated surgical wounds (3.2%). The factors associated with skin lesions in cancer patients were the use of disposable nappies (OR: 4.436) and age (59.1±15.1 years), according to the CART analysis, and the wearing of nappies (OR: 4.466, p<0.001), presence of ecchymosis (OR: 2.532, p<0.001) and infection (OR: 6.449, p=0.040), according to multiple regression analysis. Conclusion: This study contributed to knowledge about prevalence and associated factors of skin lesions in hospitalised patients with cancer, allowing the implementation of preventive measures. [ABSTRACT FROM AUTHOR]

Piroplasm infections in domestic cats have been reported with increasing frequency in numerous countries. However, in some states of Brazil, little information is available about the occurrence of these parasites. Blood samples were collected from 250 cats treated at a private clinic in the mountainous region of Rio de Janeiro. The samples were each subjected to a blood count, microscopic examination, and molecular research on piroplasms. The animals' clinical histories and epidemiological information were analyzed to identify the risk factors associated with infection. Ticks were recovered during the clinical care and were identified and subjected to molecular analyses to determine the presence of piroplasm DNA. Piroplasms were detected in 2.7% (7/250) of the cats. Nucleotide sequences of Babesia vogeli were identified in six cats, while the Cytauxzoon sp. was identified in one cat. Cats displaying apathy/weakness/prostration and hemorrhage/bleeding were more likely to be infected. In addition, Amblyomma aureolatum was recovered from a cat PCR-negative for piroplasms. This is the first study in Rio de Janeiro that has detected Babesia vogeli in cats. The results obtained here underscore the need for further studies in Rio de Janeiro to investigate the dynamics of such infections and the vectors involved. [ABSTRACT FROM AUTHOR]

The simultaneous transmission of two lineages of the chikungunya virus (CHIKV) was discovered after the pathogen's initial arrival in Brazil. In Oiapoque (Amapá state, north Brazil), the Asian lineage (CHIKV-Asian) was discovered, while in Bahia state, the East-Central-South-African lineage (CHIKV-ECSA) was discovered (northeast Brazil). Since then, the CHIKV-Asian lineage has been restricted to the Amazon region (mostly in the state of Amapá), whereas the ECSA lineage has expanded across the country. Despite the fact that the Asian lineage was already present in the Amazon region, the ECSA lineage brought from the northeast caused a large outbreak in the Amazonian state of Roraima (north Brazil) in 2017. Here, CHIKV spread in the Amazon region was studied by a Zika–Dengue–Chikungunya PCR assay in 824 serum samples collected between 2013 and 2016 from individuals with symptoms of viral infection in the Amapá state. We found 11 samples positive for CHIKV-Asian, and, from these samples, we were able to retrieve 10 full-length viral genomes. A comprehensive phylogenetic study revealed that nine CHIKV sequences came from a local transmission cluster related to Caribbean strains, whereas one sequence was related to sequences from the Philippines. These findings imply that CHIKV spread in different ways in Roraima and Amapá, despite the fact that both states had similar climatic circumstances and mosquito vector frequencies. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 infection has received the attention of the scientific community due to its respiratory manifestations and association with evolution to severe acute respiratory syndrome (SARS-CoV-2). There are few studies characterizing SARS-CoV-2 in pediatric immunocompromised patients, such as liver transplanted patients. The aim of this study was to analyze the outcomes of the largest cohort of pediatric liver transplant recipients (PLTR) from a single center in Brazil who were infected with COVID-19 during the pandemic. Methods: Cross-sectional study. Primary outcomes: COVID-19 severity. The Cox regression method was used to determine independent predictors associated with the outcomes. Patients were divided into two groups according to the severity of COVID-19 disease: moderate–severe COVID and asymptomatic–mild COVID. Results: Patients categorized as having moderate–severe COVID-19 were younger (12.6 months vs. 82.1 months, p = 0.03), had a higher prevalence of transplantation from a deceased donor (50% vs. 4.3%, p = 0.02), and had a higher prevalence of COVID infection within 6 months after liver transplantation (LT) (75% vs. 5.7%, p = 0.002). The independent predictor of COVID-19 severity identified in the multivariate analysis was COVID-19 infection <6 months after LT (HR = 0.001, 95% CI = 0.001–0.67, p = 0.03). Conclusion: The time interval of less than 6 months between COVID-19 infection and LT was the only predictor of disease severity in pediatric patients who underwent liver transplantation. [ABSTRACT FROM AUTHOR]

H. pylori shows a great variability in genes associated with virulence, which may influence properties related to gastric adenocarcinoma initiation and progression. Among them, cagA and vacA show a strong positive association with the disease. Therefore, a cross-sectional study was carried out with 281 samples of gastric adenocarcinoma, collected at a cancer reference center in the Brazilian Amazon. Detection of H. pylori was proceeded by PCR of the ureA and 16S genes. Positive samples were subjected to the cagA detection and vacA typing. The bacteria were observed in 32.03% of the samples. Positivity for H. pylori was associated with advanced age (p = 0.0093) and metastases (p = 0.0073). Among the positive cases, 80% (72/90) had the cagA gene. For the "s" position of the vacA gene, 98.8% (83/84) of the bacteria had genotype s1 and 1.2% (1/84) were genotyped as s2. For the "m" position, the results were: 63.6% (56/88) with m1 genotype, 2.3% (2/88) genotyped as m2 and 34.1% (30/88) m1/m2. Virulence factors did not impact an increase in the association with age or metastases. In conclusion, H. pylori infection is associated with malignant phenotype cases of gastric adenocarcinoma, involving metastases. The virulence factors related to the cagA and vacA genes showed a high prevalence in the Brazilian Amazon. [ABSTRACT FROM AUTHOR]

Background Q fever is among the top 13 global priority zoonoses, however, it is still neglected and under-reported in most of the world, including Brazil. Thus, we evaluated the seroprevalence of and the risk factors for Coxiella burnetii infections in humans from Minas Gerais, a highly urbanised Brazilian state. Methods Coxiella burnetii was searched for patient samples (n=437), which were suspected of then later confirmed as negative for dengue fever, by the indirect immunofluorescence technique and real-time PCR. Risk factors for infections and spatial clusters for both C. burnetii -seropositive individuals and livestock concentration were evaluated. Results We found that 21 samples (4.8%; 95% CI 3.0 to 7.2%) were reactive for at least one class of anti- C. burnetii antibodies (titer of ≥64), with rural residence (p=0.036) being a risk factor. Also, two spatial clusters of seropositivity were found within a significant area by Scan, and a probable relationship between the Scan result and the livestock concentration by area was found. Conclusions Seropositive individuals were associated with rural residence, with a likely relationship with the livestock concentration. Thus, this study establishes baseline figures for C. burnetii seroprevalence in humans in a state of Brazil, allowing the monitoring of trends and setting of control targets, as well as more representative longitudinal and risk analysis studies. [ABSTRACT FROM AUTHOR]

• Long-COVID 2 months after full vaccination of a health care worker. • Headache and blurred vision 18 weeks after Gamma VOC breakthrough infection. • Gamma VOC detected 1 year after B.1.1.33 infection by whole-genome sequencing. • Continuous exposure to SARS-CoV-2, vaccine low efficacy and reinfection. • Does ongoing exposure to SARS-CoV-2 justify additional vaccine doses in HCWs? We describe a case of prolonged COVID-19 caused by the SARS-CoV-2 Gamma variant in a fully vaccinated healthcare worker, 387 days after an infection caused by lineage B.1.1.33. Infections were confirmed by whole-genome sequencing and corroborated by the detection of neutralizing antibodies in convalescent serum samples. Considering the permanent exposure of this healthcare worker to SARS-CoV-2, the waning immunity after the first infection, the low efficacy of the inactivated vaccine at preventing COVID-19, the immune escape of the Gamma variant (VOC), and the burden of post-COVID syndrome, this individual would have benefited from an additional dose of a heterologous vaccine. [ABSTRACT FROM AUTHOR]

In this study, we genotyped samples from environmental reservoirs (surface water and soil), colonized rat specimens, and cases of human severe leptospirosis from an endemic urban slum in Brazil, to determine the molecular epidemiology of pathogenic Leptospira and identify pathways of leptospirosis infection. We identified a well-established population of Leptospira interrogans serovar Copenhageni common to human leptospirosis cases, and animal and environmental reservoirs. This finding provides genetic evidence for a potential environmental spillover pathway for rat-borne leptospirosis through the environment in this urban community and highlights the importance of environmental and social interventions to reduce spillover infections. [ABSTRACT FROM AUTHOR]

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SARS-Cov2 has already infected over 482 million people and caused more than 6.1 million deaths. The beginning of the pandemic has led the health authorities of several countries to adopt non-pharmacological preventive measures such as daycare closures. The reopening took place when the country had the highest rates of infection and mortality (mainly due to the gamma variant (P.1) outbreak) and the beginning of the vaccination program. Therefore, we aimed to investigate the prevalence of SARS-CoV2 in daycare after educational activities resumed. The study was conducted in seven childcare facilities. Swab samples from the nasopharynx were collected from children and staff members. The viral RNA was obtained through PureLink RNA extraction kit purification and SARS-CoV2 presence was detected using the All plex SARS-CoV2 kit. The study population included 201 participants, including daycare workers and children. The average age of the workers and children is 40 and 3 years old, respectively. Among the children, 47.5% are female and among the workers, 91.4%. One (0.5%) test came out positive for the presence of SARSCoV-2, which was from a sample of an asymptomatic childcare worker, and no secondary infections were detected. Considering that the return to daycare activities occurred during a period with a high number of deaths and a lack of vaccines throughout the country, the small number of cases indicates the effectiveness of the several preventive measures used by daycare centers in preventing SARS-CoV2 transmission. [ABSTRACT FROM AUTHOR]

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Background: The impact of the COVID pandemic on liver transplant (LT) programs varied among countries. Few data are available about that impact in pediatric liver transplant (PLT) programs. This study aimed at comparing the data of our program in Brazil (2019 vs. 2020). Methods: Retrospective cohort study. Results: One hundred and seventy‐four PLT were performed in the period (93% living donors). Patients were divided into two groups according to the LT date: pre‐COVID‐19 period (march/2019–February/2020) and COVID‐19 period (March/2020–February 2021). In the pre‐COVID‐19 period, 97 LTs were performed, and 77 LTs were performed in the COVID‐19 period. Patients in the COVID‐19 period were younger (10.9 months vs. 16 months, p 0.009), had higher PELD scores (15 vs. 14, p 0.04), more ascites (66.2 vs. 51.5%, p 0.03), and more frequently hospitalized before LT (27.3 vs. 17.5%). However, there was no difference in post‐LT complications, retransplantation nor survival rates. Six (6.2%) patients from pre‐COVID‐19 period were COVID positive at a median of 15.5 months (14–17.5), and 6 (7.8%) patients from COVID‐19 period were COVID positive at a median of 3 months (20 days–6 months) from LT. There was neither mortality nor complications in those patients. Four (33%) were hospitalized, and one had prolonged intubation. Four (33%) were asymptomatic, 4 (33%) had upper airways symptoms, and the remaining had gastrointestinal symptoms. Conclusion: Overall, PLT was not affected during COVID‐19 period. Even though patients from COVID‐19 period were sicker, there was no significant impact in LT outcomes. All the recipients who tested positive for COVID had a favorable outcome. [ABSTRACT FROM AUTHOR]

Background: Several infectious diseases are associated with hypothalamic-pituitary-adrenal (HPA) axis disorders by elevating circulating glucocorticoids (GCs), which are known to have an immunosuppressive potential. We conducted this study in golden hamsters, a suitable model human visceral leishmaniasis (VL), to investigate the relationship of Leishmania (L.) infantum infection on cortisol production and VL severity. Methods: L. infantum-infected (n = 42) and uninfected hamsters (n = 30) were followed-up at 30, 120, and 180 days post-infection (dpi). Plasma cortisol was analyzed by radioimmunoassay and cytokines, inducible nitric oxide synthase (iNOS), and arginase by RT-qPCR. Results: All hamsters showed splenomegaly at 180 dpi. Increased parasite burden was associated with higher arginase expression and lower iNOS induction. Cortisol levels were elevated in infected animals in all-time points evaluated. Except for monocytes, all other leucocytes showed a strong negative correlation with cortisol, while transaminases were positively correlated. Immunological markers as interleukin (IL)-6, IL-1β, IL-10, and transforming growth-factor-β (TGF-β) were positively correlated to cortisol production, while interferon-γ (IFN-γ) presented a negative correlation. A network analysis showed cortisol as an important knot linking clinical status and immunological parameters. Conclusions: These results suggest that L. infantum increases the systemic levels of cortisol, which showed to be associated with hematological, biochemical, and immunological parameters associated to VL severity. Author summary: Visceral leishmaniasis (VL) is an infectious disease that is common in most tropical countries. VL has high morbidity and leads to death if not properly treated. In Brazil, Leishmania (Leishmania) infantum is the main causative agent of LV. Golden hamsters have proven to be a suitable model for VL. Despite the importance of hypothalamic-pituitary-adrenal (HPA) axis disturbances in infectious disease, few studies have addressed this issue in VL. In this study, we showed that L. infantum-infected hamsters present augmented levels of plasmatic cortisol in association with increased spleen parasite burden. Indeed, a strong positive correlation was observed between cortisol and biochemical parameters (AST/ALT/ALP) related to liver damage, as well pro-inflammatory cytokines (IL-6 and IL-1β), anti-inflammatory cytokines (IL-10 and TGF-β), and the arginase enzyme that may favor the progression of infection. On the other side, cortisol was negatively correlated with leucocytes, except monocytes, and with IFN-γ and iNOS, which are involved in parasite-killing macrophage function. These results shed light on an unexplored aspect of VL pathogenesis, which is the importance of cortisol production in the disease-associated immune dysfunction. [ABSTRACT FROM AUTHOR]

An outbreak of Chagas disease, possibly involving its vector Triatoma brasiliensis brasiliensis, was identified in the state of Rio Grande do Norte (RN). Given the historical significance of this vector in public health, the study aimed to evaluate its role in the transmission dynamics of the protozoan Trypanosoma cruzi in an area undergoing desertification in the Seridó region, RN, Brazil. We captured triatomines in sylvatic and anthropic ecotopes. Natural vector infection was determined using parasitological and molecular methods and we identified discrete typing units (DTUs) of T. cruzi by analyzing the COII gene of mtDNA, 24Sα rDNA, and mini-exon gene. Their blood meals sources were identified by amplification and sequencing of the mtDNA cytochrome b gene. A total of 952 T. b. brasiliensis were captured in peridomestic (69.9%) and sylvatic ecotopes (30.4%). A wide range of natural infection rates were observed in peridomestic (36.0% - 71.1%) and sylvatic populations (28.6% - 100.0%). We observed the circulation of TcI and TcII DTUs with a predominance of Tcl in sylvatic and peridomestic environments. Kerodon rupestris, rocky cavy (13/39), Homo sapiens, human (8/39), and Bos taurus, ox (6/39) were the most frequently detected blood meals sources. Thus, Triatoma b. brasiliensis is invading and colonizing the human dwellings. Furthermore, high levels of natural infection, coupled with the detection of TcI and TcII DTUs, and also the detection of K. rupestris and H. sapiens as blood meals sources of infected T. b. brasiliensis indicate a risk of T. cruzi transmission to human populations in areas undergoing desertification. Author summary: Chagas disease currently affects about six to seven million people worldwide, resulting in high morbidity, mortality, and economic burden in endemic countries of Latin America. Its etiological agent, Trypanosoma cruzi, circulates among a wide variety of mammalian and insect vectors. Triatoma brasiliensis brasiliensis is adapted to the dry and warm climate of the Caatinga biome, and is considered the main vector in the semi-arid areas of northeastern Brazil. Information on the infestation, natural infection rates, T. cruzi strains, and blood meals sources of this vector is crucial for understanding the dynamics of T. cruzi transmission in areas susceptible to desertification. Triatoma b. brasiliensis colonizes peridomestic structures, particularly in the stone walls of cattle corrals that emerge as a refuge for sylvatic populations where they access a variety of blood meals sources. The predominance of the TcI strain in the sylvatic and peridomestic environments shows an overlap of transmission cycles by T. cruzi mediated by T. b. brasiliensis. The high rates of natural infection and the evidence of their feeding on humans and the rodent K. rupestris are worrisome and indicate the threat this vector poses to human health in the area studied. [ABSTRACT FROM AUTHOR]

Zika virus (ZIKV) emerged as an important infectious disease agent in Brazil in 2016. Infection usually leads to mild symptoms, but severe congenital neurological disorders and Guillain-Barré syndrome have been reported following ZIKV exposure. Creating an effective vaccine against ZIKV is a public health priority. We describe the protective effect of an already licensed attenuated yellow fever vaccine (YFV, 17DD) in type-I interferon receptor knockout mice (A129) and immunocompetent BALB/c and SV-129 (A129 background) mice infected with ZIKV. YFV vaccination provided protection against ZIKV, with decreased mortality in A129 mice, a reduction in the cerebral viral load in all mice, and weight loss prevention in BALB/c mice. The A129 mice that were challenged two and three weeks after the first dose of the vaccine were fully protected, whereas partial protection was observed five weeks after vaccination. In all cases, the YFV vaccine provoked a substantial decrease in the cerebral viral load. YFV immunization also prevented hippocampal synapse loss and microgliosis in ZIKV-infected mice. Our vaccine model is T cell-dependent, with AG129 mice being unable to tolerate immunization (vaccination is lethal in this mouse model), indicating the importance of IFN-γ in immunogenicity. To confirm the role of T cells, we immunized nude mice that we demonstrated to be very susceptible to infection. Immunization with YFV and challenge 7 days after booster did not protect nude mice in terms of weight loss and showed partial protection in the survival curve. When we evaluated the humoral response, the vaccine elicited significant antibody titers against ZIKV; however, it showed no neutralizing activity in vitro and in vivo. The data indicate that a cell-mediated response promotes protection against cerebral infection, which is crucial to vaccine protection, and it appears to not necessarily require a humoral response. This protective effect can also be attributed to innate factors, but more studies are needed to strengthen this hypothesis. Our findings open the way to using an available and inexpensive vaccine for large-scale immunization in the event of a ZIKV outbreak. Author summary: Zika virus (ZIKV) is as an important infectious that may result in severe congenital neurological disorders. Our study reports that the current attenuated yellow fever vaccine is effective in immunizing against the infection caused by the Zika virus, due to the similarity between the two viruses. To study the efficacy of the vaccine, we used different mouse strains, including both animals with a healthy immune system (immunocompetent) and animals with compromised immune systems and therefore more susceptible to viral (immunocompromised) infections. The vaccine was given subcutaneously, as it does in humans. The animals were inoculated with the Zika virus directly into the brain—a protocol normally adopted in vaccine studies to simulate a high lethality infection. In all cases, the vaccinated mice developed a high degree of protection against Zika infection. Altogether, we demonstrate that the YFV vaccine elicits an immune response that protects against cerebral infection by ZIKV. Our findings suggest the possibility of using an available and inexpensive vaccine for large-scale immunization in the event of a ZIKV outbreak. [ABSTRACT FROM AUTHOR]

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Objectives: Antibiotic use in palliative care patients is a frequent dilemma. The benefits of their use in terms of quality of end-of-life care or survival improvement are not clear and the potential harm and futility of this practice not well established. Our aim was to characterise the prevalence of antibiotic use, documented infection and multidrug-resistant organisms (MDROs) colonisation among palliative care patients admitted to a private hospital in Brazil. Materials and Methods: Retrospective analysis of all palliative care patients admitted to our hospital during 1 year, including demographic characteristics, diagnosis of infectious disease at admission, antibiotic use during hospital stay, infectious agents isolated in cultures, documented MDRO colonisation and hospital mortality. Results: A total of 114 patients were included in the analysis. Forty-five (39%) were male and the median age was 83 years. About 78% of the patients had an infectious diagnosis at hospital admission and 80% of the patients not admitted with an infectious diagnosis used antibiotics during their stay, out of which a great proportion of large spectrum antibiotics. Previous MDRO colonisation and hospital mortality were similar between patients admitted with or without an infectious diagnosis. Conclusion: Infection is the leading cause of hospital admission in palliative care patients. However, antibiotics prescription is also very prevalent during hospital stay of patients not admitted with an infectious condition. Mortality is very high regardless of the initial reason for hospital admission. Therefore, the impact of multiple large spectrum antibiotics prescription and consequent significant cost burden should be urgently confronted with the real benefit to these patients. [ABSTRACT FROM AUTHOR]

Influenza B virus (IBV) causes respiratory tract infections with mild, moderate, or life‐threatening symptoms. This study describes the epidemiology of IBV infection in Rio Grande do Sul (RS), Brazil, over 17 years. Nasopharyngeal samples were collected from outpatients presenting acute respiratory illness (ARI) between 2003 and 2019, and from inpatients with severe acute respiratory infection (SARI) from 2009 to 2019. IBV was detected by immunofluorescence assay or quantitative real‐time polymerase chain reaction; demographic and clinical data were analyzed. In total, 48,656 cases of respiratory infection were analyzed, of which 20.45% were ARI, and 79.46% were SARI. Respiratory viruses accounted for 22.59% and 37.47% of the cases of ARI and SARI, respectively. Considering respiratory viral infections, 17.10% of ARI and 3.06% of SARI were associated with IBV. IBV circulated year‐round in RS, with an increase in autumn and winter, peaking in July (p =.005). IBV infection showed an association with age, and most outpatients positive for IBV were between 10 and 49 years old, whereas IBV infection in SARI affected mainly individuals ≤ 1 year or ≥ 60 years old. No significant association was found between sex and IBV infection. Coryza, sore throat, and myalgia were associated with ARI (p <.001). Moreover, 3.18% of the deaths associated with respiratory virus infection were positive for IBV; notably, cardiopathy (p <.001), metabolic disease (p <.001), and smoking (p =.003) were associated to fatality in IBV infection. IBV is an important cause of severe respiratory infections, and the fatality risk is high in individuals with cardiopathy and metabolic diseases. [ABSTRACT FROM AUTHOR]

Objective: To assess the diagnostic performance of lateral flow immunochromatographic assays (LFAs) of 4 different manufacturers to identify SARS-CoV-2 antibodies (IgM, IgG, or total), comparing them with the nucleic acid amplification test (NAAT) or the clinical defined test (definite or probable SARS-CoV-2 infection, respectively).Methods: One hundred nineteen serum samples were randomly selected by convenience and distributed in the following groups: (1) group with SARS-CoV-2 infection (n = 82; RT-qPCR positive [definite, n = 70] and probable [n = 12]); (2) other diseases (n = 27; other viruses identified [n = 8] and SARS of other etiologies [n = 19]); and (3) healthy control group (n = 10). LFAs of 4 manufacturers were compared: MedTest Coronavirus (COVID-19) IgG/IgM (MedLevensohn, Brazil); COVID-19 IgG/IgM ECO Test (Ecodiagnóstica, Brazil); Camtech COVID-19 IgM/IgG Rapid Test Kit (Camtech Diagnostics Pte Ltd, Singapore); and 1-Step COVID-19 Test for total antibodies (Guangzhou Wondfo Biotech Co., China).Results: The 4 tests studied showed high diagnostic performance characteristics for the diagnoses of definite or probable SARS-CoV-2 infection. The best measures were for the Wondfo test: sensitivity (86.59%; 95% CI: 77.26-93.11%), specificity (100%; 90.51-100%), DOR (257; 60-1,008), LR+ (33.43; 4.82-231.85), LR- (0.13; 0.08-0.23), accuracy (90.76%; 84.06-95.29%), and Matthews correlation coefficient (MCC) 0.82. Although considering only the probable SARS-CoV-2 infection (PCR-) cases, all the kits studied showed limited values.Conclusion: Our data demonstrate the excellent performance of LFA for the diagnoses of definite or probable SARS-CoV-2 infection. There was substantial heterogeneity in sensitivities of IgM and IgG antibodies among the different kits. LFA tests cannot replace molecular diagnostics but should be used as an additional screening tool. [ABSTRACT FROM AUTHOR]

Aelurostrogylus abstrusus is a helminthic pathogen that infects the respiratory tract of felids after the ingestion of intermediate or paratenic hosts. The present paper assesses A. abstrusus infection in domestic and wild cats in south of Brazil. Fecal samples from 97 domestic cats and from seven wild cats (Puma concolor, Puma yagouaroundi and Leopardus tigrinus) were tested using sedimentation and flotation techniques. The prevalence of first-stage larvae was 2.1% (2/97) in domestic cats, and Puma yagouaroundi was the only wild cat that turned out to be positive for this lungworm. This is the first report of A. abstrusus in Puma yagouaroundi in Brazil. The identification of this parasite raises a red flag about the presence of infected intermediate and/or paratenic hosts and about the importance of this parasitic disease even in the absence of respiratory clinical signs. The analysis of fecal samples is then suggested for the detection of A. abstrusus. [ABSTRACT FROM AUTHOR]

• This was a prospective surveillance study of dengue in Brazil from 2014 to 2018. • Dengue seroprevalence was 76%; 23% of participants reported dengue history. • Incidence of laboratory-confirmed symptomatic infection was 6.1/1000 person-years. • For each symptomatic infection, there were ∼7 inapparent primary dengue infections. • Study highlights underestimation of dengue infection in Brazil. To estimate the incidence of dengue infection across geographically distinct areas of Brazil. This prospective, household-based, cohort study enrolled participants in five areas and followed them up for up to 4 years (2014–2018). Dengue seroprevalence was assessed at each scheduled visit. Suspected dengue cases were identified through enhanced passive and active surveillance. Acute symptomatic dengue infection was confirmed through reverse-transcriptase quantitative polymerase chain reaction in combination with an antigenic assay (non-structural protein 1) and serology. Among 3300 participants enrolled, baseline seroprevalence was 76.2%, although only 23.3% of participants reported a history of dengue. Of 1284 suspected symptomatic dengue cases detected, 50 (3.9%) were laboratory-confirmed. Based on 8166.5 person-years (PY) of follow-up, the incidence of laboratory-confirmed symptomatic infection (primary endpoint) was 6.1 per 1000 PY (95% confidence interval [CI]: 4.5, 8.1). Incidence varied substantially in different years (1.8–7.4 per 1000 PY). The incidence of inapparent primary dengue infection was substantially higher: 41.7 per 1000 PY (95% CI: 31.1, 54.6). Our findings, highlighting that the incidence of dengue infection is underestimated in Brazil, will inform the design and implementation of future dengue vaccine trials. NCT01751139 [ABSTRACT FROM AUTHOR]

Trafficking in wild animals represents one of the main illicit activities in the world. In Brazil, among the main trafficked species the songbirds of the Passeriform Order stand out. The distress to which these birds are exposed, especially the newly caught ones, and the unhealthy conditions to which they are subjected, cause, in addition to the damage to well-being, an important drop in resistance, which exacerbates infectious and parasitic conditions. Clinical assessments and coproparasitological examinations were carried out using the Willis-Mollay method on 102 passerines from apprehension in western Paraná. Of the total number of animals evaluated, 76% (78/102) had hyperkeratosis in the pelvic limbs, 55% (56/102) were infested with mites on remiges and 54% (52/102) had changes in warping. The results indicated 94% (96/102) of positivity for endoparasites, of which 96% (92/96) were for coccidian oocysts, 1% (1/96) for tenia eggs and 3% (3/96) for mixed infection (coccid oocysts and tenia eggs). These findings corroborate that the poor conditions of hygiene, nutrition and the high stocking density observed in illegal housing can predispose birds to more severe clinical manifestations. [ABSTRACT FROM AUTHOR]

Background: Pediatric hematopoietic stem cell transplantation (HSCT) recipients represent a vulnerable population with regard to health care‐associated infections (HAI) with a differentiated profile of etiologic agents.1,2 There are few reports in the literature regarding HAI in the pediatric population submitted to HSCT. Methods: This is a retrospective study conducted in a pediatric HSCT unit in Curitiba, Brazil between February 2013 and December 2017 that evaluated 109 pediatric patients. The variables analyzed were: age, gender, baseline disease, type of transplantation, infection topography, etiologic agent, time of HAI occurrence, antimicrobial prophylaxis, period of neutropenia, length of stay, and outcomes Results: Of 113 HSCT procedures, 91 (83.5%) were allogenic and 18 were autologous (16.5%). The mean age of the patients was 7.9 years, with a median of 8.1 years (4.0 months–17.3 years); 71 (65.1%) were male; 55 (50.5%) presented with an oncologic diagnosis, 32 (29.4%) with a hematological diagnosis, 17 (15.6%) with immunodeficiencies, and 5 (4.6%) with other causes. During hospitalization after HSCT, 86 episodes of HAI were detected in 66 patients, with an infection density of 16.5 infections/1000 patient days, 86% of which occurred after allogeneic transplants, appearing, on average, 15.3 days after transplantation. The main topographies were bloodstream infection (BSI), with 24 (27.9%) cases, and central line‐associated bloodstream infection (CLABSI), with 11 (12.8%). Gram‐positive bacteria predominated in cultures and HAI was more frequent in patients diagnosed with immunodeficiencies and other non‐oncologic and non‐hematologic conditions. Among the Gram‐positive bacteria, Staphylococcus epidermidis was the main agent identified (77.7%), possibly because of colonization. However, Gram‐negative bacteria, with a resistance profile, comprised 40% of the cases of bacterial infections, most of them represented by Klebsiella pneumoniae (66.6%). Of the 66 patients who presented HAI, 59 patients (89.4%) were discharged, and 7 (10.6%) died. Conclusion: The main topographies were CLABSI and BSI. Patients with immunodeficiencies presented a higher risk for HAI Staphylococcus epidermidis was the main agent identified. However, Klebsiella pneumoniae posed a higher risk for Pediatric Intensive Care Unit admission and death. [ABSTRACT FROM AUTHOR]

Background: Malaria in Brazil represents one of the highest percentages of Latin America cases, where approximately 84% of infections are attributed to Plasmodium (P.) vivax. Despite the high incidence, many aspects of gestational malaria resulting from P. vivax infections remain poorly studied. As such, we aimed to evaluate the consequences of P. vivax infections during gestation on the health of mothers and their neonates in an endemic area of the Amazon. Methods and findings: We have conducted an observational cohort study in Brazilian Amazon between January 2013 and April 2015. 600 pregnant women were enrolled and followed until delivery. After applying exclusion criteria, 329 mother-child pairs were included in the analysis. Clinical data regarding maternal infection, newborn's anthropometric measures, placental histopathological characteristics, and angiogenic and inflammatory factors were evaluated. The presence of plasma IgG against the P. vivax (Pv) MSP119 protein was used as marker of exposure and possible associations with pregnancy outcomes were analyzed. Multivariate logistic regression analysis revealed that P. vivax infections during the first trimester of pregnancy are associated with adverse gestational outcomes such as premature birth (adjusted odds ratio [aOR] 8.12, 95% confidence interval [95%CI] 2.69–24.54, p < 0.0001) and reduced head circumference (aOR 3.58, 95%CI 1.29–9.97, p = 0.01). Histopathology analysis showed marked differences between placentas from P. vivax-infected and non-infected pregnant women, especially regarding placental monocytes infiltrate. Placental levels of vasomodulatory factors such as angiopoietin-2 (ANG-2) and complement proteins such as C5a were also altered at delivery. Plasma levels of anti-PvMSP119 IgG in infected pregnant women were shown to be a reliable exposure marker; yet, with no association with improved pregnancy outcomes. Conclusions: This study indicates that P. vivax malaria during the first trimester of pregnancy represents a higher likelihood of subsequent poor pregnancy outcomes associated with marked placental histologic modification and angiogenic/inflammatory imbalance. Additionally, our findings support the idea that antibodies against PvMSP119 are not protective against poor pregnancy outcomes induced by P. vivax infections. Author summary: Malaria during pregnancy is associated with adverse effects on the fetus and the newborn. As far as we know, no study has previously investigated in a single work, the link between Plasmodium vivax malaria in pregnancy and poor gestational outcomes, alteration of the newborn's anthropometric profile, placental lesions, angiogenic and inflammatory factors, and humoral immunity against the parasite. For this purpose, we investigated the association between P. vivax malaria during pregnancy and newborn's anthropometric profile, placental pathology, gestational outcomes, and the presence of IgG against P. vivax MSP119 that may confer protection against infection during pregnancy. We performed a large cohort study of malaria during pregnancy that analyzed data from mother-child pairs delivered between 2013 and 2015 in the Southwestern Brazilian Amazonian region. By evaluating data from 329 pregnancies, we found that P. vivax malaria during the first pregnancy trimester is significantly associated with the occurrence of preterm birth, low birth weight, and reduced newborn head circumference and body length. We also noted that P. vivax malaria in pregnancy promoted placental lesions and homeostasis imbalance, characterized by increased syncytial nuclear aggregates, fibrin deposition, and monocytes/leukocytes infiltrate, as well as imbalanced angiogenic factors, leptin, and cytokines. We observed that pregnant women with IgG against P. vivax MSP119 are not protected against poor pregnancy outcomes caused by P. vivax infections during pregnancy. Our observations improve our understanding of the disease and P. vivax burden during pregnancy, changing the current paradigm of the outcome of P. vivax malaria in pregnancy. That may represent a long-term severe consequence for the affected populations living in P. vivax-endemic regions. Our results also indicate that IgG against P. vivax MSP119 is not associated with protection from poor pregnancy outcomes, excluding this protein as a possible vaccination target that can prevent adverse outcomes caused by P. vivax infections during pregnancy. [ABSTRACT FROM AUTHOR]