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Introdução/objetivos: Amostras do gênero Klebsiella, principalmente da espécie K. pneumoniae, estão os patógenos mais frequentes em infecções relacionadas à assistência em saúde e infecções invasivas adquiridas na comunidade. K. pneumoniae está entre os microrganismos mais frequentes entre amostras resistentes a múltiplas drogas. Nas últimas décadas, a resistência aos carbapenemas tem crescido, sendo associada a desfecho clínico desfavorável e aumento da morbidade e mortalidade, além do aumento dos custos de hospitalização, internações mais longas e do uso de antibióticos alternativos e mais caros. O objetivo do estudo foi caracterizar amostras de Klebsiella sp. produtoras de carbapenemases quanto aos clones que pertencem e aos genes e mutações que codificam resistência aos antimicrobianos. Materiais e métodos: 166 amostras de Klebsiella sp. produtoras de carbapenemases foram obtidas de diversos espécimes clínicos de um hospital no Rio de Janeiro entre janeiro de 2014 e janeiro de 2017 (n = 105) e março a outubro de 2020 (n = 61). Estas foram enviadas para sequenciamento do genoma completo. A identificação de espécie, MLST e genes de resistência aos antimicrobianos foram determinadas através das ferramentas on-line disponibilizadas pelo Center for Genomic Epidemiology. Resultados: Das 166 amostras do estudo 162 foram identificadas com K. pneumoniae, 3 como K. aerogenes e 1 como K. quasipneumoniae subsp. similipneumoniae. Observamos significativas mudanças clonais quando comparamos as amostras dos dois períodos (p < 0.005). Os dois STs mais frequentes em 2014-2017 (ST437 61% e ST340 11%) não foram observados no período de 2020, sendo substituídos pelo ST11 (46%), ST16 (26%) e ST258 (15%) no segundo período do estudo. Dentre os genes de resistência encontrados destacamos a presença das carbapenemases KPC-2 em 121 (73%) amostras, KPC-2 e OXA-370 em 22 (13%), OXA-370 em 11 (7%), KPC-2 e NDM-1 em 10 (6%) e NDM-1 em 2 (1%) e a ESBL CTX-M-15 em 86 (52%). Além destes, foi encontrada uma grande diversidade de genes conferindo resistência a aminoglicosídeos, trimetoprim, quinolonas, fenicóis, macrolídeos, tetraciclinas, fosfomicina, sulfonamidas e rifampicina e mutações conferindo resistência as polimixinas. Conclusões: Observamos significativa mudança clonal entre os períodos estudados e uma grande diversidade de genes que codificam resistência aos antimicrobianos, ressaltando a importância da vigilância epidemiológica de amostras produtoras de carbapenemases. Palavras-chave: Klebsiella, Klebsiella pneumoniae, Carbapenemases, KPC, OXA-48. Conflitos de interesse: Não houve conflitos de interesse. Ética e financiamentos: Aspectos éticos: Aprovado pelos Comitês de Ética em Pesquisa do HUCFF, CAAE 60433716.8.0000.5257, e da Sociedade de Ensino Superior Estácio de Sá, 39277320.5.0000. Estudo financiado por FAPERJ n.E-26/200.228/2022, INPRA/CNPq 465718/2014-0, CNPq 312205/2019-8 e CAPES 001.

Viagens internacionais estão associadas a disseminação de microrganismos multirresistentes possivelmente adquiridos durante a ingestão de água, alimentos, ou mesmo contato com pessoas e ambientes. A aquisição de clones de Escherichia coli, considerados pandêmicos e de alto risco, como o ST131 tem sido relatada a partir da microbiota de viajantes. A aquisição de novos clones, mais adaptados ao hospedeiro humano e albergando maior número de genes de resistência e virulência pode ampliar a disseminação dessas linhagens, bem como a resistência aos antimicrobianos no país. Objetivos: Descrever a aquisição de E.coli produtora de ESBL e os principais clones pandêmicos obtidos a partir da microbiota intestinal de viajantes partindo do Rio de Janeiro. Métodos: Viajantes com mais de 18 anos atendidos em uma clínica de medicina de viagem do Rio de Janeiro de 2015 a 2020, após assinarem o TCLE, foram orientados a colher um swab anal antes e após a viagem. Esses espécimes foram armazenados em meio STGG de onde foram retiradas alíquotas para semeadura em agar MacConkey e agar MacConkey contendo ceftriaxone. Isolados de E. coli foram identificados por MALDI-TOF. Foi feito screening para os clones pandêmicos ST131, ST69, ST73 e ST95 através de PCR em pools de até 3 isolados de ida e volta de cada participante. Quando positivo para um ou mais clones, o PCR foi repetido isoladamente. Amostras com crescimento em meio com ceftriaxone foram submetidas a teste fenotípico para produção de ESBL. Resultados: De 243 viajantes incluídos, E.coli produtora de ESBL foi detectada em 17 (7%) viajantes antes da viagem e em 49 (22%) apenas após o retorno. Dos 1344 isolados de E. coli obtidos, 197 (15) pertenciam a algum dos clones pesquisados. Comparando isolados pré e pós viagem, em 6 viajantes o mesmo clone foi detectado antes e após a viagem, em 10 um diferente clone foi observado antes e após, em 37 um ST pandêmico foi observado apenas após a viagem e em 29 apenas antes da viagem. Conclusão: Apesar de antes da viagem clones pandêmicos já serem detectados na microbiota de viajantes, as viagens podem causar impacto na circulação de clones de alto risco ao redor do planeta. Para conhecer melhor a dinâmica de aquisição desses clones planejamos expandir a investigação do número de clones estudados e selecionar amostras para sequenciamento de genoma completo.

Introdução: Escherichia coli, apesar de ser um comensal comum do intestino, pode causar infecções extraintestinais, tratadas frequentemente com ciprofloxacina. O principal mecanismo de resistência à ciprofloxacina (CIP) é mediado por mutações nos genes cromossômicos gyrA e parC, porém determinantes plasmidiais de resistência a fluoroquinolonas (DPRF) também desempenham papel importante na disseminação e aumento da prevalência de amostras resistentes a este fármaco. Objetivos: Determinar a prevalência de amostras de E. coli carreadoras de determinantes de virulência e resistência à ciprofloxacina e as variáveis associadas a esta colonização, em indivíduos na comunidade do Rio de Janeiro. Métodos: Espécimes fecais foram obtidos de indivíduos atendidos em três unidades de saúde do Rio de Janeiro entre 2015-2019. Dados clínico-demográficos foram coletados por meio de questionário. Amostras fecais foram semeadas em ágar MacConkey e identificadas por MALDI-TOF-MS. A susceptibilidade a 15 antimicrobianos foi determinada por disco-difusão (CLSI, 2020). Definimos multirresistência por resistência a ao menos um antimicrobiano em três classes. Detectamos genes DPRF e de virulência por PCR. Mutações em gyrA e parC e a variante aac(6’)-Ib-cr foram identificadas por sequenciamento. Realizamos análises estatísticas por teste do qui-quadrado ou exato de Fisher (p < 0,05). Resultados: Dentre as 623 amostras de E. coli identificadas, 13% eram MDR, 9% resistentes à CIP e 7% carreadoras de DPRF. Em relação aos demais antimicrobianos, as maiores taxas de resistência foram observadas para: ampicilina (26%), sulfametoxazol-trimetoprim (19%), cefazolina (14%) e cefotaxima (8%). A concentração inibitória mínima de CIP variou de 0,008 a 256 µg/mL. A prevalência de mutações em gyrA e parC foi de 47% e 40%, respectivamente. Os filogrupos mais frequentes foram o A ou C (49%), B2 (16%) e B1 (14%). Os genes de virulência mais frequentes foram fimH (98%), fyuA (69%) e RPai (64%). Dentre as amostras dos filogrupos B2, D/E ou F, 59% foram classificadas como E. coli patogênica extraintestinal (ExPEC). O uso de antimicrobianos (fluoroquinolonas e beta-lactâmicos) e ser profissional de saúde foram associados à colonização intestinal por amostras de E. coli resistentes à CIP (p < 0,01). Conclusão: A presença de amostras ExPEC, resistentes à CIP e carreadoras de DPRF na microbiota intestinal podem representar uma ameaça pela possibilidade de causarem quadros infecciosos de difícil tratamento.

A raiva: causa uma encefalite praticamente 100% letal e é transmitida pelo contato com saliva de mamíferos através de mordeduras, arranhaduras, ou exposição de mucosas ou pele não íntegra. A doença pode ser prevenida através de medidas adotadas após a exposição, no entanto, indivíduos com maior risco devem receber profilaxia pré-exposição. Objetivos: Avaliar a vacinação para raiva, a ocorrência de acidentes com animais e o conhecimento sobre a transmissão da doença em um grupo de estudantes de veterinária. Metodologia: Durante palestra para orientação sobre a prevenção de raiva foi aplicado um questionário, respondido online. Resultados: 25 estudantes participaram, 24 (96%) mulheres, e a idade média foi de 29 anos. 12 (48%) cursavam o 1° período e 5 (20%) o último ano. 11 referiram imunização prévia, sendo 8 (73%) pré-exposição. Destes, 6 (55%) receberam o esquema completo e 2 colheram sorologia após. Dos 6 estudantes que participam de cenários práticos, 5 relataram acidente (3 mais de um episódio), a maioria (80%) nas mãos e causados por cães e gatos. Após o acidente, 4 relataram cuidado com a lesão, 2 receberam vacinação e 1 recebeu soro. Com relação ao conhecimento sobre animais transmissores, todos incluíram o morcego, dois excluíram cães e gatos e 20 incluíram ratos e coelhos. Quanto a forma de transmissão, todos incluíram mordedura e arranhadura, 12 lambedura de mucosa, 2 lambedura de pele íntegra, 10 acidente com manipulação de sangue e 2 ingestão de carne, leite e derivados. Com relação a aérea de maior risco, 17 (68%) referiram pés, 6 cabeça e pescoço; 2 abdome e tronco; 9 os braços; 5 as mãos e 5 as pernas. Com relação à conduta após acidente com animal suspeito, nenhum optou por “sacrificar o animal”. “Observar o animal por 10 dias” foi escolhida 18 vezes (76%). “Tentar descobrir se o animal é vacinado” e “levar o animal ao veterinário” foram escolhidos 9 vezes. Conclusão: No Brasil, atualmente, os casos de raiva humana são causados por variantes de vírus que infectam morcegos e a doença seja considerada controlada em cães e gatos. No entanto, a circulação do vírus em morcegos e pequenos mamíferos, como saguis, permite a infecção acidental de cães, gatos e humanos. Dessa forma, a falta de vacinação pré-exposição adequada em populações de maior risco precisa ser corrigida. As falhas de conhecimento nesse grupo ressaltam a necessidade de investimento na informação, mas pode ser explicada pela maioria ser de estudantes de 1° período.

This article describes, analyses, and reflects on the conceptualisation and establishment of a Writing Lab at a South African university’s Faculty of Health Sciences. Drawing on the theoretical framework of New Literacy Studies, the academic literacies approach, and South African writing centre scholarship, the analysis revealed that the conceptualisation of the Writing Lab was primarily informed by the academic socialisation model but has since shifted to encompass a more transformative ideology; opening spaces where students’ own knowledges and literacies practices could contribute to new forms of thinking and representation in the academy. We argue that the shift was facilitated by collaboration with disciplinary lecturers, the faculty’s Primary Health Care ethos, and the Writing Lab’s engagement with a large postgraduate population, leading to the Writing Lab’s participation in new forms of knowledge-building that could contribute to the creation of decolonised spaces and shifts in institutional culture.

Background: There is a paucity of research on the clinical profile of women living with human immunodeficiency virus (HIV) (WLWH) admitted with acute mental health illness. Existing studies are small and did not look at factors that could have an impact on medication adherence. As a first step to inform service delivery for this vulnerable population, a thorough understanding of the composition and needs of these patients should be identified. Objectives: To describe the socio-demographic and clinical profile that could have an influence on the antiretroviral therapy (ART) adherence of WLWH at an inpatient psychiatric unit. Methods: In this retrospective audit, the medical records of all WLWH (18–59 years of age), discharged from the acute unit at Stikland Psychiatric Hospital, were reviewed over a 12-month period. Results: Of the 347 female patients discharged, 55 patients were positive for HIV (15.9%). The majority of them were unmarried (78.2%), unemployed (92.7%), had a secondary level of education (Grade 8–10) (58.2%), lived with a family member (83.6%) and had children (61.8%). The most common psychiatric diagnosis on discharge was substance use disorder with 78.2% of patients being categorised as substance users. Interpersonal violence was only reported by 5.5% of patients. Although most patients performed poorly on the Montreal Cognitive Assessment (MoCA) and International HIV Dementia Scale (IHDS), only 12% of patients received a diagnosis of HIV-associated neurocognitive disorder (HAND) upon discharge. Antiretroviral therapy (ART) was initiated in 21.8% of patients. Only eight patients had a viral load of 200 copies/mL, indicating viral suppression. Conclusion: Our findings may inform service planning and emphasise the need for targeted intervention strategies to improve treatment outcomes in this vulnerable group.

Background: Although the association between human immunodeficiency virus (HIV) and mucocutaneous diseases has been well studied within South African specialist centres, there is limited data from district-level hospitals. Available data may, therefore, fail to reflect the prevalence and full spectrum of dermatoses seen in people living with HIV (PLWH). Objectives: To determine the prevalence and spectrum of dermatoses seen in PLWH. Method: We conducted a cross-sectional, descriptive study of 970 PLWH (men and women, ≥ 18 years old) accessing care at Karl Bremer Hospital, a district-level hospital located in the Western Cape province, South Africa, between 01 September 2016 and 28 February 2017. Results: The prevalence of mucocutaneous disease in this sample was 12.7% (95% confidence interval [CI] 0.11–0.15). Non-infectious dermatoses comprised 71.0% of the disorders. Pruritic papular eruption (20.0%) and seborrheic dermatitis (6.0%) were the most common non-infectious dermatoses. Tinea corporis (8.0%) and oral candidiasis (6.0%) were the most prevalent infectious dermatoses. There was no significant association between skin disease category (infectious or non-infectious dermatoses) and patient demographics (gender and ethnicity) or HIV-disease characteristics (CD4+ cell count, viral load and duration of antiretroviral therapy [ART]). Conclusion: This study provides valuable scientific data on the prevalence and spectrum of mucocutaneous disease in PLWH attending a South African district-level hospital. Prospective studies conducted in other district-level centres across the country are required to determine the lifetime prevalence and spectrum of dermatoses in PLWH in the ART era.

Background: Breast cancer is the second most common cancer in adults and the most frequent cancer diagnosed in women. In South Africa, breast cancer accounts for 38.5% of cancers diagnosed in women. Since the presence, extent and location of distant metastases is one important prognostic factor in locally advanced breast cancer (LABC), accurate staging at diagnosis is crucial to ensure that patients receive the appropriate treatment. Increasing evidence shows that the use of 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for disease staging of LABC may improve diagnostic sensitivity. Aim: The aim of this study was to prospectively assess the difference in diagnostic accuracy between whole-body PET/PET-CT and conventional imaging (CI) for staging LABC. Setting: The breast cancer outpatient clinic at Groote Schuur Hospital in Cape Town, South Africa. Methods: A total of 42 participants with clinical stage III and a select few stage II breast cancer underwent both 18F-FDG PET/CT and CI. Results: The 18F-FDG PET/CT found significantly more (p = 0.0077) distant metastatic sites than CI (36% vs. 21%). The 18F-FDG PET/CT upstaged 9 (21.4%) of patients from clinical stage IIIa to stage IIIc, and changed in management of 54% of patients. Thirty-eight per cent of the patients had their clinical stage unchanged. One of five suspected metastatic sites 18F FDG PET/CT on biopsy was positive for malignancy. Conclusion: The 18F-FDG PET/CT is useful for staging locally advanced non-inflammatory infiltrating ductal carcinoma of the breast. Use of 18F-FDG PET/CT was superior to conventional imaging in assessing metastatic mediastinal lymphadenopathy, but with a poor specificity. The use of 18F-FDG PET/CT in LABC is useful, with the biopsy of isolated suspicious lesions for metastasis increasing its accuracy.

Background: The World Health Organization’s action plan for 2020 has identified the need for service-based data to motivate for more appropriate community-based services. To date, there is no published data from step-up or step-down facilities in South Africa. Aim: To describe the demographic and clinical profile of all patients admitted to New Beginnings between 01 January 2011 and 31 December 2015. Setting: New Beginnings is an intermediary care facility focused on psychosocial rehabilitation and accommodates 40 patients in a step-up or step-down setting. Methods: In this retrospective audit, we reviewed the medical records of all patients (N = 730) admitted to New Beginnings between 01 January 2011 and 31 December 2015. Results: Most admissions were male (n = 600; 82.2%), unmarried (92.1%) and unemployed (92.7%) patients with a mean age of 28 years. Only 20.7% had completed their schooling and 37.9% were receiving a disability grant. Most patients lived in the Cape Town Metro area (89%) with their families (94.7%), and 75.6% had no children. Schizophrenia (53.7%) was the most common primary psychiatric diagnosis, and most patients were on a combination of oral and depot treatment (46.8%). Illicit substances were used by 75.9% of patients with 30% using both cannabis and methamphetamine. Most patients (74.9%) had only one admission to New Beginnings. Conclusions: These baseline data could inform improved service delivery. Further research is needed to evaluate the success of New Beginnings and highlight the need for more of these facilities in the Western Cape and across South Africa.

Background: Eating disorders (EDs) and substance-related disorders pose a challenge when they co-occur and have implications for patient management. Clinical information on EDs and substance-related disorders as independent disorders is fairly well established in South Africa, but our understanding of the coexistence of these disorders is limited. Aim: To determine the prevalence, the concurrent nature and the possible trends of substance use among patients diagnosed with EDs at a South African tertiary hospital over a 21-year period. Setting: The ED unit at Tygerberg Hospital, Cape Town, South Africa. Methods: We performed a retrospective chart review of 162 patients who were treated for EDs between January 1993 and December 2014. Results: The prevalence of ED subtypes was 40.1% bulimia nervosa (BN), 33.3% EDs not otherwise specified (EDNOS) and 26.5% anorexia nervosa. Most participants (71.0%) used at least one substance. Alcohol was the most prevalent substance of choice (54.8%). Most patients had an additional psychiatric disorder (62.3%), of which major depressive disorder was the most prevalent (46.3%). Apart from the use of alcohol and cannabis, which remained consistent, the use of most other substances as well as the prevalence of BN declined during the study period. Conclusion: Understanding the prevalence and trends of EDs and the corresponding patterns of substance misuse is essential to improve service provision. This study emphasises the need to better understand the ongoing and changing behavioural trends in EDs to improve patient management.

Background: Severe iron deficiency is associated with anaemia, but iron deficiency with normal haemoglobin (Hb) may also affect morbidity and quality of life and contribute to psychiatric illness onset and severity. Psychiatric presentations in adolescence are often indicative of serious long-term morbidity, and addressing contributing health risk factors, such as iron deficiency, is important. Objectives: To determine rates of iron deficiency in a South African inpatient adolescent psychiatric population and possible associations between psychiatric diagnosis and iron deficiency risk factors. Methods: We conducted a retrospective chart review of all adolescent patients (13–18 years old) who were admitted to the Adolescent Psychiatric Inpatient Unit at Tygerburg Hospital (Cape Town, South Africa) during 2016. Patient records were limited to those with haemoglobin and ferritin levels available, as well as a psychiatric disorder diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders. The final sample consisted of 93 patients. Results: Of all participants, 7.6% were anaemic, while 22.6% were iron deficient. We found 29% of our population to have anaemia in the absence of iron deficiency. Gender was the only statistically significant correlate, with adolescent females at particular risk of compromised iron status as indicated by a low ferritin level (45% of female sample). Conclusion: Iron deficiency rates remain a relevant health concern, and testing Hb alone is inadequate to assess iron status in this population. Ferritin is a necessary additional parameter and should be included in the usual medical workup.

ABSTRACT BACKGROUND AND OBJECTIVES: Combined spinal-epidural (CSE) has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome. METHODS: One hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n = 55) or Non-CSE (n = 55) group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared. RESULTS: The mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%). The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group) was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5 min was similar in both groups. CONCLUSION: There were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia.

Background: Iron is a cofactor in the production and breakdown of neurotransmitters like dopamine and is vital for normal brain function. Iron deficiency potentially contributes to the development of attention deficit hyperactivity disorder (ADHD) because dopamine imbalances can cause hyperactivity, restlessness and problems with concentration and attention. However, a direct association between iron deficiency and ADHD remains to be determined. Objectives: The aim of this study was to investigate the possible correlation between iron deficiency and ADHD in children and adolescents seen at the child psychiatry outpatient service at Tygerberg Hospital, South Africa. Methods: A retrospective chart review was conducted to gather data of all outpatient children and adolescents who had their serum ferritin and/or iron levels tested between February 2011 and January 2016. Relevant demographic and clinical information was extracted from 255 records, and statistical methods were used to test for correlations between ADHD and certain variables, including iron deficiency. Results: Out of 255 patients, 88 (34.5%) had iron deficiency, 157 (61.6%) had ADHD and 54 (21.0%) had both iron deficiency and ADHD. Of those patients with ADHD, 11 (7.0%) had other psychiatric comorbidities, and more males (89.0%) had this dual diagnosis compared to females (11.0%). Variables found to be significantly associated with ADHD included gender, age, Ritalin treatment and psychiatric comorbidities, but there was no significant association between ADHD and iron deficiency (p = 0.150). Conclusion: There was no relationship between ADHD and iron deficiency in this cohort of children and adolescents. Further studies using a treatment-naïve sample are required.

Background: Despite the widespread use of traditional healers in the management of mental health problems among South Africans, there is a knowledge gap in their practices that needs to be narrowed in order to develop a more collaborative and integrated mental health system. There is a need to better understand traditional practices from the perspective of the healers themselves and how these align with Western approaches. Aim: We specifically explored the journey towards becoming a traditional healer, the types of interventions and key practices in the management of mental disorders, and the extent to which traditional healers collaborate with conventional medical practitioners. Methods: This mixed-methods study involved 77 traditional healers who practice in the Eastern Cape province of South Africa. We administered semi-structured interviews to gather data on healer training, experiences and practices. The Patient Health Questionnaire (PHQ-9) was used to screen for depression. All interviews were conducted in isiXhosa at participants’ homes. Results: Most of the healers were female (80.5%) and only half (49%) had a traditional healing certificate. Healer training typically consisted of six key steps and was mostly facilitated by a non-family member or trainer, as directed by the ancestors. Most healers treated physical illnesses (86%) and called on their ancestors to assist with diagnoses (90%). Only 40% of healers treated mental illnesses. While some healers revealed tensions in working with Western practitioners, the majority were open to collaboration (71%). Conclusion: Traditional healers may have an important role to play in the development of culturally-relevant mental health care in South Africa. This study contributes to a greater understanding of what it means to be a traditional healer, and the types of treatment provided. The findings emphasise that conventional mental health practitioners need to make equal effort to collaborate, especially if we are to provide culturally-relevant mental health care in traditional South African settings.

Body dysmorphic disorder (BDD) is a chronic and disabling condition that is characterised by distressing preoccupations with perceived defects in one’s own appearance, which might be slight or not observable to others. It is considered to be an obsessive–compulsive spectrum disorder and is associated with depression, feelings of shame and poor quality of life. It is primarily a disorder of childhood or adolescent onset, and sub-clinical BDD symptoms begin, on average, several years before an individual’s symptoms meet full criteria for the disorder. Here we report the case of an adolescent admitted to an inpatient psychiatric unit for treatment of psychotic symptoms that were poorly responsive to standard treatments. This challenging case of BDD in an adolescent highlights the various comorbidities of the disorder, as well as the difficulties associated with BDD diagnosis.

Protection at the peak of Plasmodium chabaudi blood-stage malaria infection is provided by CD4 T cells. We have shown that an increase in Th1 cells also correlates with protection during the persistent phase of malaria; however, it is unclear how these T cells are maintained. Persistent malaria infection promotes protection and generates both effector T cells (Teff), and effector memory T cells (Tem). We have previously defined new CD4 Teff (IL-7Rα-) subsets from Early (TeffEarly, CD62LhiCD27+) to Late (TeffLate, CD62LloCD27-) activation states. Here, we tested these effector and memory T cell subsets for their ability to survive and protect in vivo. We found that both polyclonal and P. chabaudi Merozoite Surface Protein-1 (MSP-1)-specific B5 TCR transgenic Tem survive better than Teff. Surprisingly, as Tem are associated with antigen persistence, Tem survive well even after clearance of infection. As previously shown during T cell contraction, TeffEarly, which can generate Tem, also survive better than other Teff subsets in uninfected recipients. Two other Tem survival mechanisms identified here are that low-level chronic infection promotes Tem both by driving their proliferation, and by programming production of Tem from Tcm. Protective CD4 T cell phenotypes have not been precisely determined in malaria, or other persistent infections. Therefore, we tested purified memory (Tmem) and Teff subsets in protection from peak pathology and parasitemia in immunocompromised recipient mice. Strikingly, among Tmem (IL-7Rαhi) subsets, only TemLate (CD62LloCD27-) reduced peak parasitemia (19%), though the dominant memory subset is TemEarly, which is not protective. In contrast, all Teff subsets reduced peak parasitemia by more than half, and mature Teff can generate Tem, though less. In summary, we have elucidated four mechanisms of Tem maintenance, and identified two long-lived T cell subsets (TemLate, TeffEarly) that may represent correlates of protection or a target for longer-lived vaccine-induced protection against malaria blood-stages.

This report describes an innovative research education tool for student exposure and training in immunology. Utilizing the wealth of transcriptomics data provided through the immunological genome project, graduate and undergraduate students can engage in hands-on experimental studies to identify and rigorously characterize novel genes in immune cells using RNA interference-mediated approaches. The SIFT activities are directly aligned with cell biology and immunology courses and serve to reinforce and expand on the foundations learned. Furthermore, the student-driven studies provide a sense of ownership and largely expose students to the breadth of experimental research approaches in the biological sciences. Finally, generation of original datasets supports the greater scientific community by contributing in assembly and delineation of the regulatory networks that govern immunity.

Leishmania RNA virus (LRV) has been shown to be a symbiotic component of Leishmania parasites in South America. Nested retro-transcription polymerase chain reaction was employed to investigate LRV1 presence in leishmaniasis lesions from Brazil. In endemic areas of Rio de Janeiro (RJ), no LRV1 infection was observed even with mucosal involvement. LRV1 was only detected in Leishmania (V.) guyanensis cutaneous lesions from the northern region, which were obtained from patients presenting with disease reactivation after clinical cure of their primary lesions. Our results indicated that the severity of leishmaniasis in some areas of RJ, where Leishmania (V.) brazi-liensis is the primary etiological agent, was not associated with Leishmania LRV1 infection.

É relatado o caso de um paciente com miopatia de apresentação clínica incomum como manifestação inicial da infecção por HIV. O paciente apresentava aumento de volume dos membros acompanhado de sinais flogísticos e elevação dos níveis séricos de enzimas musculares. A alteração histopatológica predominante consistia em necrose segmentar de fibrocélulas musculares esqueléticas. Evoluiu com pneumonia por Pneumocystis carinii, tratada satisfatoriamente com sulfametoxazol e trimetropim. Apesar do uso sucessivo de indometacina, prednisona e dexametasona, a miopatia continuava a progredir. Após administração de methotrexate, houve regressão do quadro neurológico.

Abstract Providing advice for travelers embarking on long-term trips poses a challenge in travel medicine. A long duration of risk exposure is associated with underuse of protective measures and poor adherence to chemoprophylaxis, increasing the chances of acquiring infections. Recently, in our clinic, we observed an increase in the number of travelers undertaking round-the-world trips. These individuals are typically aged around 32 years and quit their jobs to embark on one-to-two-year journeys. Their destinations include countries in two or more continents, invariably Southeast Asia and Indonesia, and mostly involve land travel and visiting rural areas. Such trips involve flexible plans, increasing the challenge, especially with regard to malaria prophylaxis. Advising round-the-world travelers is time-consuming because of the amount of information that must be provided to the traveler. Advisors must develop strategies to commit the traveler to his/her own health, and verify their learnings on disease-prevention measures. Contacting the advisor after the appointment or during the trip can be helpful to clarify unclear instructions or diagnosis made and prescriptions given abroad. Infectious diseases are among the most frequent problems affecting travelers, many of which are preventable by vaccines, medicines, and precautionary measures. The dissemination of counterfeit medicines, particularly antibiotics and antimalarial medicines, emphasizes the need for travelers to carry medicines that they may possibly need on their trip. Additional advice on altitude, scuba diving, and other possible risks may also be given. Considering the difficulties in advising this group, we present a review of the main recommendations on advising these travelers.

Abstract Sporotrichosis is the most common subcutaneous mycosis in South America and its association with zoonotic transmission remains a relevant public health problem in Rio de Janeiro, Brazil. The disease most commonly presents as subacute or chronic cutaneous lesions, although dissemination to various organs and systems occurs in rare cases, mainly in immunosuppressed individuals. This report describes a case of sporotrichosis with severe bone and subcutaneous damage in an immunocompetent patient who did not exhibit the characteristic skin lesions of sporotrichosis, including ulcers, nodules, and lymphangitis.

Abstract INTRODUCTION: Malaria is the main cause of death by infection among travelers and is preventable through a combination of chemoprophylaxis and personal protective measures. METHODS: Travelers were interviewed by phone 28-90 days after returning, to assess adherence to pre-travel advice for malaria prevention. RESULTS: A total 57 travelers were included. Adherence to chemoprophylaxis was significantly higher among participants prescribed mefloquine (n=18; 75%) than doxycycline (n=14; 45%). Adherence to mosquito repellent and bed net use was 65% and 67%, respectively. CONCLUSIONS: Adherence to malaria prophylaxis was lower than expected. Further studies testing innovative approaches to motivate travelers’ compliance are required.

Despite decades of molecular research, phylogenetic relationships in Palearctic vipers (genus Vipera) still essentially rely on a few loci, such as mitochondrial barcoding genes. Here we examined the diversity and evolution of Vipera with ddRAD-seq data from 33 representative species and subspecies. Phylogenomic analyses of ∼ 1.1 Mb recovered nine major clades corresponding to known species/species complexes which are generally consistent with the mitochondrial phylogeny, albeit with a few deep discrepancies that highlight past hybridization events. The most spectacular case is the Italian-endemic V. walser, which is grouped with the alpine genetic diversity of V. berus in the nuclear tree despite carrying a divergent mitogenome related to the Caucasian V. kaznakovi complex. Clustering analyses of SNPs suggest potential admixture between diverged Iberian taxa (V. aspis zinnikeri and V. seoanei), and confirm that the Anatolian V. pontica corresponds to occasional hybrids between V. (ammodytes) meridionalis and V. kaznakovi. Finally, all analyzed lineages of the V. berus complex (including V. walser and V. barani) form vast areas of admixture and may be delimited as subspecies. Our study sets grounds for future taxonomic and phylogeographic surveys on Palearctic vipers, a group of prime interest for toxinological, ecological, biogeographic and conservation research., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)