Post-mortem diagnosis of human rabies in SARS-CoV-2 coinfected patient with minimally invasive autopsy in northeastern Brazil.

INTRODUCTION: Human rabies (HR) is a lethal zoonotic disease caused by lyssaviruses with increase in the number of cases post-coronavirus disease 2019 (COVID-19) pandemic. METHODOLOGY: We report a case of human rabies in a patient from a rural area of Ceará, northeastern Brazil in 2023, who was bitten by a white-tufted-ear marmoset (Callithrix jacchus jacchus). The patient was co-infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and was diagnosed by minimally invasive autopsy (MIA). RESULTS: MIA offers many advantages related to biosafety, and speed of sample acquisition; and markedly reduces disfigurement of the body compared with complete autopsy. It is a great alternative in COVID-19 patients. CONCLUSIONS: New methods such as MIA are a promising tool for diagnosis, and have the potential to improve family cooperation and support rabies surveillance.

Histoplasmosis in non-immunosuppressed patients from an endemic area in Northeastern Brazil.

Differently from immunocompromised patients, very little information is available in the literature regarding the clinical presentation, epidemiology, and outcomes of histoplasmosis in non-immunosuppressed individuals living in endemic areas. This retrospective case series study was carried out by reviewing the medical records of non-immunocompromised patients with histoplasmosis, residents in a hyperendemic area in northeastern Brazil, between 2011 and 2022. Thirty HIV-negative patients were identified with histoplasmosis, and 19 cases met the inclusion criteria: three had acute, five subacute and one chronic pulmonary forms; two with mediastinal picture and eight had disseminated disease (two with severe symptoms). The median age of our sample was 32.7 years old [interquartile range: 24-45]. Most of the patients were male (male-to-female ratio = 15:4) and resided in the state capital (n = 9). The majority had a previous history of exposure to well-known risk factors for Histoplasma infection. Pulmonary nodules were observed in all subacute form, two patients (acute and subacute forms) were initially treated empirically for pulmonary tuberculosis; one death was registered in the subacute form. The chronic pulmonary form of histoplasmosis was diagnosed in one patient only after the symptoms persisted despite specific treatment. The primary clinical manifestations of the moderate form of DH were enlarged lymph nodes, with histopathology being the main diagnostic method. The cases were detected as isolated occurrences and not as an outbreak, suggesting that exposure to Histoplasma can be more widespread than presumed. Despite the self-limiting nature of the disease, death can occur even in previously heathy patients.

This study aimed to describe the presentation of histoplasmosis outside the context of immunosuppression, including the diagnostic methods, epidemiology, and main radiological and clinical features. A better understanding of the various forms of this disease will help improve case management.

COVID-19 IN INFLAMMATORY BOWEL DISEASE: SHOULD WE BE MORE CAREFUL WITH THE USE OF SALICYLATES?

BACKGROUNDS: Fortunately, much has been studied about COVID-19 in patients with inflammatory bowel diseases (IBD). Evidence suggests that these patients do not appear to be at increased risk of severe COVID-19. However, there are still some uncertainties regarding the clinical manifestations of COVID-19 in patients with immune-mediated diseases. OBJECTIVE: This study aimed to describe the main symptoms of COVID-19 and their frequency in IBD patients and evaluate the impact of the IBD therapeutic drugs on clinical presentation of COVID-19 and to determine factors associated with COVID-19 in this population. METHODS: Adult patients with IBD from three tertiary-care public, teaching hospitals in Ceará, Northeastern Brazil, were evaluated during one scheduled appointment from March to December 2020. Patients with possible or confirmed COVID-19 were compared with patients without COVID-19. Furthermore, incidences of each symptom were evaluated based on the use of IBD therapeutic drugs. RESULTS: A total of 515 patients with IBD were included in the study: 234 with CD, and 281 with UC. Of these, 174 patients (34%) had possible/confirmed COVID-19 of whom 156 (90%) were symptomatic. Main symptoms were fever (65%) and headache (65%); gastrointestinal symptoms occurred in one third of patients and were higher than COVID-19 in general population. The factors associated with having COVID-19 were female gender (OR 1.71, 95%CI: 1.17-2.50); contact at home (OR 5.07, 95%CI: 3.31-7.78) and outside the home (OR 3.14, 95%CI: 2.10-4.71) with a case of COVID-19; work outside of the home (OR 1.87, 95%CI: 1.26-2.78); family history of COVID-19 (OR 2.29, 95%CI 1.58-3.33) use of salicylate (OR 1.71, 95%CI: 1.17-4.28); and asthma (OR 7.10, 95%CI: 1.46-34.57). CONCLUSION: IBD patients at high risk of COVID-19 infection may need to avoid salicylate therapy but further studies are necessary to confirm this association.

Human Rabies during the COVID-19 Pandemic: Insights into Rabies Worldwide and Brazil.

Human Rabies (HR) is a fatal zoonotic disease caused by lyssaviruses, with the rabies virus (RABV) identified as the causative agent. While the incidence of HR transmitted by dogs has decreased in Latin America, there has been a corresponding rise in transmission via wild animals. Given the lack of effective treatments and specific therapies, the management of HR relies on the availability of post-exposure prophylaxis and animal control measures. This review examines the dynamics and spread of HR during the global pandemic.

Two cases of testicular tuberculosis in HIV patients with distinct clinical presentations.

Genito-urinary tuberculosis (TB) corresponds to the second most common cause of extrapulmonary tuberculosis EPTB worldwide. It is however rare and is often clinically indistinguishable from testicular malignancy and infarction. HIV hugely increases the risk of TB in unusual sites; we present two such cases of testicular tuberculosis. The diagnosis was based respectively on histopathological findings, acid-bacilli smear of biopsy, semen, and culture.

COVID-19 na doença inflamatória intestinal: devemos ser mais cautelosos com o uso dos salicilatos? / Covid-19 in inflammatory bowel disease: should we be more careful with the use of salicylates?

ABSTRACT Backgrounds: Fortunately, much has been studied about COVID-19 in patients with inflammatory bowel diseases (IBD). Evidence suggests that these patients do not appear to be at increased risk of severe COVID-19. However, there are still some uncertainties regarding the clinical manifestations of COVID-19 in patients with immune-mediated diseases. Objective: This study aimed to describe the main symptoms of COVID-19 and their frequency in IBD patients and evaluate the impact of the IBD therapeutic drugs on clinical presentation of COVID-19 and to determine factors associated with COVID-19 in this population. Methods: Adult patients with IBD from three tertiary-care public, teaching hospitals in Ceará, Northeastern Brazil, were evaluated during one scheduled appointment from March to December 2020. Patients with possible or confirmed COVID-19 were compared with patients without COVID-19. Furthermore, incidences of each symptom were evaluated based on the use of IBD therapeutic drugs. Results: A total of 515 patients with IBD were included in the study: 234 with CD, and 281 with UC. Of these, 174 patients (34%) had possible/confirmed COVID-19 of whom 156 (90%) were symptomatic. Main symptoms were fever (65%) and headache (65%); gastrointestinal symptoms occurred in one third of patients and were higher than COVID-19 in general population. The factors associated with having COVID-19 were female gender (OR 1.71, 95%CI: 1.17-2.50); contact at home (OR 5.07, 95%CI: 3.31-7.78) and outside the home (OR 3.14, 95%CI: 2.10-4.71) with a case of COVID-19; work outside of the home (OR 1.87, 95%CI: 1.26-2.78); family history of COVID-19 (OR 2.29, 95%CI 1.58-3.33) use of salicylate (OR 1.71, 95%CI: 1.17-4.28); and asthma (OR 7.10, 95%CI: 1.46-34.57). Conclusion: IBD patients at high risk of COVID-19 infection may need to avoid salicylate therapy but further studies are necessary to confirm this association.

RESUMO Contexto: Felizmente, muito se tem estudado sobre a COVID-19 em pacientes com doenças inflamatórias intestinais (DII). As evidências sugerem que esses pacientes não parecem ter risco aumentado de COVID-19 grave. Mas ainda se tem algumas incertezas com relação às manifestações clínicas da COVID-19 em portadores de doenças imunomediadas. Objetivo: Este estudo teve como objetivo descrever os principais sintomas da COVID-19 e sua frequência em pacientes com DII e avaliar o impacto dos medicamentos utilizados no tratamento das DII na apresentação clínica da COVID-19. Métodos: Pacientes adultos com DII de três hospitais públicos terciários de ensino do Ceará, Nordeste do Brasil, foram avaliados em consulta ambulatorial no período de março a dezembro de 2020. Pacientes com COVID-19 possível ou confirmada foram comparados com pacientes sem COVID-19. Além disso, as incidências de cada sintoma foram avaliadas com base no uso de medicamentos utilizados para tratamento da DII. Resultados: Foram incluídos no estudo 515 pacientes com DII: 234 com DC e 281 com RCU. Destes, 174 pacientes (34%) tinham COVID-19 possível/confirmado, dos quais 156 (90%) eram sintomáticos. Os principais sintomas foram febre (65%) e dor de cabeça (65%); sintomas gastrointestinais ocorreram em um terço dos pacientes, sendo mais frequentes do que na população geral com COVID-19. Os fatores associados a ter COVID-19 foram sexo feminino (OR 1,71, IC95%: 1,17-2,50); ter contato com caso de COVID-19, tanto intradomiciliar (OR 5,07; IC95%: 3,31-7,78) como fora do domicílio (OR 3,14; IC95%: 2,10-4,71); trabalhar fora de casa (OR 1,87; IC95%: 1,26-2,78); história familiar de COVID-19 (OR 2,29, IC95% 1,58-3,33), uso de salicilato (OR 1,71, IC95%: 1,17-4,28) e asma (OR 7,10; IC95%: 1,46-34,57). Conclusão: Pacientes com DII com alto risco de infecção por COVID-19 podem precisar evitar a terapia com salicilatos, mas mais estudos são necessários para confirmar esta associação.

Human Rabies during the COVID-19 Pandemic: Insights into Rabies Worldwide and Brazil

ABSTRACT Human Rabies (HR) is a fatal zoonotic disease caused by lyssaviruses, with the rabies virus (RABV) identified as the causative agent. While the incidence of HR transmitted by dogs has decreased in Latin America, there has been a corresponding rise in transmission via wild animals. Given the lack of effective treatments and specific therapies, the management of HR relies on the availability of post-exposure prophylaxis and animal control measures. This review examines the dynamics and spread of HR during the global pandemic.

Development of H51Y and E157Q mutations for integrase inhibitor resistance in a patient undergoing treatment for pulmonary tuberculosis: A case report.

Background: Failure of first-line regimens with dolutegravir, a high genetic barrier antiretroviral of the integrase inhibitor class, although uncommon, tends to increase in prevalence due to broader use. Objective: To describe the clinical case of an HIV/Tuberculosis coinfected patient who developed Human Immunodeficieny Virus (HIV) treatment failure during dolutegravir therapy. Case report: Male, 29 years old, presented with a right cervical mass, dry cough, and hyporexia, which lasted 2 weeks. Diagnostic tests were positive for tuberculosis and HIV. The viral load was 437,927 cp/mL (Log = 5.64). Antiretroviral therapy was initiated with Tenofovir/Lamivudine and Dolutegravir (TDF/3TC and DTG), the latter at a dose of 50 mg/day, as was a regimen for tuberculosis. After 8 months, therapeutic failure was verified. Genotyping was requested, with detection of the H51Y and E157Q mutations in the integrase. Conclusion: Attention when determining the antiretroviral therapy treatment regimen of HIV/TB coinfected patients is paramount. Poor adherence to antiretroviral therapy and follow-up may have contributed to treatment failure and resistance.

Severe mpox in patients with advanced AIDS: long-term disease and fatal outcome.

Herein, we report two cases of severe mpox in patients with advanced acquired immunodeficiency syndrome from Brazil who developed atypical lesions and prolonged illness, one of whom had a fatal outcome. Both patients experienced serious complications involving the perianal and genital regions and prolonged disease with persistent viremia.

Epidemiology and Economic Burden of Chikungunya: A Systematic Literature Review.

Chikungunya (CHIK) is a re-emerging viral infection endemic in tropical and subtropical areas. While the typical clinical presentation is an acute febrile syndrome, long-term articular complications and even death can occur. This review characterizes the global epidemiological and economic burden of chikungunya. The search included studies published from 2007 to 2022 in MEDLINE, Embase, LILACS, and SciELO for a thorough evaluation of the literature. Rayyan software was used for data analysis, and data were summarized descriptively and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventy-six publications were included. Chikungunya is widely distributed in the tropics, including Africa, Asia, South America, and Oceania/the Pacific Islands, and co-circulates with other simultaneous arboviruses such as DENV, ZIKV, and YFV. Chikungunya infection can lead to chronic articular manifestations with a significant impact on the quality of life in the long term. In addition, it generates absenteeism and economic and social losses and can cause fatal infections in vulnerable populations, mainly in high-risk patients with co-morbidities and at the extremes of age. Reported costs associated with CHIKV diseases are substantial and vary by region, age group, and public/private delivery of healthcare services. The chikungunya disease burden includes chronicity, severe infections, increased hospitalization risks, and associated mortality. The disease can impact the economy in several spheres, significantly affecting the health system and national economies. Understanding and measuring the full impact of this re-emerging disease is essential.

A fatal case of COVID-19-associated meningoencephalitis in a patient coinfected with influenza A.

We report a case of COVID-19-associated meningoencephalitis with a fatal outcome in a male patient with concomitant influenza A, who had been hospitalized at the beginning of 2022, in the Northeastern region of Brazil. He died due to cardiopulmonary arrest after developing status epilepticus on the third day of hospitalization. The SARS-CoV-2 RNA was detected in cerebrospinal fluid and Influenza A was detected in the nasopharyngeal swab. Meningoencephalitis due to COVID-19 is a rare manifestation and physicians must be aware of this complication, mainly during the pandemic. In viral co-circulation situations, the possibility of respiratory coinfections should be remembered.

Case Report: Successful Treatment of Recurrent Urinary Tract Infection Due to Extensively Drug-Resistant Klebsiella Pneumoniae in a Kidney Transplant Recipient Using Chloramphenicol.

Effective therapies for multidrug-resistant (MDR) microorganisms, especially Gram-negative bacteria, are becoming rare. Also, solid-organ transplant recipients are at high risk of MDR Gram-negative bacilli infection. Urinary tract infections are the most frequent bacterial infections in kidney transplant recipients and are an important cause of mortality after renal transplantation. We describe a case of complicated urinary tract infection in a kidney transplant patient due to extensively drug-resistant (XDR) K. pneumoniae treated successfully with a regimen comprising a combination of chloramphenicol and ertapenem. We do not recommend chloramphenicol as a first-line choice for treating complicated urinary tract infections. Still, we believe it is an alternative for infections caused by MDR and/or XDR pathogens in renal transplant patients, as other options are nephrotoxic.

Streptococcus constellatus causing concomitant extra and intracranial abscesses complicated with sagittal sinus thrombosis.

Streptococcus constellatus is a gram-positive coccus member of the Streptococcus anginosus group (SAG). It can be found in the oral flora, and may cause abscess more commonly in the gastrointestinal tract, lungs, and heart. Brain abscesses are severe neurological infections with high mortality rates. Streptococcus species other than S. pneumoniae are rare causes of brain abscesses. This case report highlights a severe case of extra and intracranial abscesses due to S. constellatus in an immunocompetent host.

Infectious endocarditis due to Bacillus Cereus in a patient with a pacemaker: case report and literature review / Endocardite infecciosa por Bacillus Cereus em paciente portador de marcapasso: relato de caso e revisão de literatura

Introduction: Infective endocarditis (IE) is an infectious process of the cardiac endothelium, often related to the use of pacemakers and valve prostheses, which may facilitate microorganism" proliferation. Case Report: In this article, we describe the case of an 81-year-old man with infective endocarditis due to Bacillus Cereus related to the use of a pacemaker and perform a brief literature review. Discussion: Bacillus Cereus is a Gram-positive, aerobic, spore-forming, large, and generally motile bacterium that constitutes a rare cause of endocarditis, but few cases like this are described in the literature. Conclusion: Determining the etiology of IE through culture-guided methods plays a pivotal role in selecting appropriate antibiotic treatment. Maintain a high clinical suspicion for IE is paramount, especially when fever arises in patients with cardiac devices after surgical or dental procedures.

Introdução: A endocardite infecciosa é um processo infeccioso do endotélio cardíaco, muitas vezes relacionado ao uso de marca-passos e próteses valvares, que pode facilitar a proliferação de microrganismos. Relato de Caso: Neste artigo descrevemos o caso de um homem de 81 anos com endocardite infecciosa por Bacillus Cereus relacionada ao uso de marca-passo e realizamos uma breve revisão da literatura. Discussão: Bacillus Cereus é uma bactéria Gram-positiva, aeróbia, formadora de esporos, grande e geralmente móvel, que constitui uma causa rara de endocardite, com poucos casos descritos na literatura. Conclusão: A determinação da etiologia da EI através de métodos guiados por cultura desempenha um papel fundamental na seleção do tratamento antibiótico apropriado. Manter alta suspeita clínica de EI é fundamental, principalmente quando surge febre em pacientes portadores de dispositivos cardíacos após procedimentos cirúrgicos ou odontológicos.

A fatal case of COVID-19-associated meningoencephalitis in a patient coinfected with influenza A

ABSTRACT We report a case of COVID-19-associated meningoencephalitis with a fatal outcome in a male patient with concomitant influenza A, who had been hospitalized at the beginning of 2022, in the Northeastern region of Brazil. He died due to cardiopulmonary arrest after developing status epilepticus on the third day of hospitalization. The SARS-CoV-2 RNA was detected in cerebrospinal fluid and Influenza A was detected in the nasopharyngeal swab. Meningoencephalitis due to COVID-19 is a rare manifestation and physicians must be aware of this complication, mainly during the pandemic. In viral co-circulation situations, the possibility of respiratory coinfections should be remembered.

Streptococcus constellatus causing concomitant extra and intracranial abscesses complicated with sagittal sinus thrombosis

ABSTRACT Streptococcus constellatus is a gram-positive coccus member of the Streptococcus anginosus group (SAG). It can be found in the oral flora, and may cause abscess more commonly in the gastrointestinal tract, lungs, and heart. Brain abscesses are severe neurological infections with high mortality rates. Streptococcus species other than S. pneumoniae are rare causes of brain abscesses. This case report highlights a severe case of extra and intracranial abscesses due to S. constellatus in an immunocompetent host

Severe mpox in patients with advanced AIDS: long-term disease and fatal outcome

ABSTRACT Herein, we report two cases of severe mpox in patients with advanced acquired immunodeficiency syndrome from Brazil who developed atypical lesions and prolonged illness, one of whom had a fatal outcome. Both patients experienced serious complications involving the perianal and genital regions and prolonged disease with persistent viremia.

Experiencia en bypass gástrico reseccional laparoscópico en pacientes con obesidad mórbida. Primer estudio en Venezuela / Experience in laparoscopic resectional gastric bypass in patients with morbid obesity. First study in Venezuela

El Bypass Gástrico Reseccional, consiste en realizar gastrectomía casi total más anastomosis gastro-yeyunal, con las desventajas de no ser reversible, y disminuir la absorción de los elementos que requieren ácidos gástricos. Objetivo: Describir la experiencia en Bypass Gástrico Reseccional Laparoscópico en pacientes con Obesidad Mórbida, intervenidos en el Centro Quirúrgico Carabobo 200 y en el Instituto Docente de Urología, Carabobo ­ Venezuela, durante el periodo comprendido entre enero ­ diciembre 2.021. Materiales: Investigación descriptiva, retrospectiva, longitudinal y multicéntrica, no probabilístico, comprendiendo 3 pacientes. Se utilizó una ficha de recolección de datos confeccionada para tal fin que incluyó datos clínicos y de laboratorio, previos y posterior a la cirugía, siendo evaluados a los 3, 6 y 12 meses respectivamente. Resultados: Causa más frecuente: presencia de lesiones gástricas benignas en 66.66% de los casos, y falla de técnica bariátrica primaria en 33.33%. Todos los pacientes del estudio presentaban comorbilidades cardiovasculares y metabólicas, siendo las más relevantes; Hipertensión Arterial Sistémica 100%, resistencia a insulina 66.66%, apnea del sueño 66.66% y Diabetes Mellitus tipo 2, en 33.33%. Conclusiones: El Bypass Gástrico Reseccional Laparoscópico tiene buenos resultados en pacientes obesos, con riesgo a desarrollar cáncer gástrico y en fallo de técnica primaria. No hubo complicación transoperatoria. La pérdida de exceso de peso fue exitosa (promedio 85.78% al año). Solo 1 caso presentó complicación postoperatoria tardía de anemia leve con diagnóstico y resolución oportuna. No se evidenciaron otras complicaciones(AU)

The Resectional Gastric Bypass consists of performing almost total gastrectomy plus gastro-jejunal anastomosis, with the disadvantages of not being reversible, and decreasing the absorption of elements that require gastric acids. Objective: To describe the experience in Laparoscopic Resectional Gastric Bypass in patients with Morbid Obesity, operated on at the Carabobo 200 Surgical Center and at the Teaching Institute of Urology, Carabobo - Venezuela, during the period between January - December 2021. Materials: Descriptive, retrospective, longitudinal, and multicenter, non-probabilistic research, involving 3 patients. A data collection sheet prepared for this purpose was drawn up, which included clinical and laboratory data, before and after surgery, being evaluated at 3, 6 and 12 months respectively. Results: Most frequent cause: presence of benign gastric lesions in 66.66% of cases, and primary bariatric technique failure in 33.33%. All the patients in the study presented cardiovascular and metabolic comorbidities, being the most relevant; Systemic Arterial Hypertension 100%, insulin resistance 66.66%, sleep apnea 66.66% and Diabetes Mellitus type 2, in 33.33%. Conclusions: Laparoscopic Resectional Gastric Bypass has good results in obese patients, at risk of developing gastric cancer and in primary technique failure. There were no intraoperative complications. Excess weight loss was successful (average 85.78% per year). Only 1 case presented late postoperative complication of mild anemia with timely diagnosis and resolution. No other complications were found(AU)

Post-Mortem Diagnosis of Pediatric Dengue Using Minimally Invasive Autopsy during the COVID-19 Pandemic in Brazil.

We report the first pediatric disease in which the use of minimally invasive autopsy (MIA) confirmed severe dengue as the cause of death. During the COVID-19 pandemic, a previously healthy 10-year-old girl living in north-eastern Brazil presented fever, headache, diffuse abdominal pain, diarrhoea, and vomiting. On the fourth day, the clinical symptoms worsened and the patient died. An MIA was performed, and cores of brain, lungs, heart, liver, kidneys, and spleen were collected with 14G biopsy needles. Microscopic examination showed diffuse oedema and congestion, pulmonary intra-alveolar haemorrhage, small foci of midzonal necrosis in the liver, and tubular cell necrosis in the kidneys. Dengue virus RNA and NS1 antigen were detected in blood and cerebrospinal fluid samples. Clinical, pathological, and laboratory findings, in combination with the absence of other lesions and microorganisms, allowed concluding that the patient had died from complications of severe dengue.

Floral biology and reproductive system of physic nut (Jatropha curcas L., Euphorbiaceae) in 'Recôncavo da Bahia', Brazil.

Understanding the floral and reproductive biology of botanical species is crucial for the development of strategies in plant breeding systems. Jatropha curcas L. is a promising species for the manufacture of biofuels, being previously studied mainly in genetic improvement to develop characteristics suitable to biofuels. In order to contribute with data for hybridization and breeding programs, this paper studies the floral biology and reproductive system in two experimental populations of different ages of Jatropha curcas in Cruz das Almas/BA. Both of them were examined about their anthesis, durability, number of flowers, stigma receptivity, P:O ratio, and reproduction tests. As observed, Jatropha curcas is a monoecious species and its flowering occurs between September and April. Inflorescences are composed of unisexual flowers with daytime anthesis (♂: 05-06h; ♀: 07-08h), where the staminates last 10h and pistillates 60h. The physic nut is self-compatible, forming fruits by self-fecundation and cross-pollination, although the greatest number of fruits/seeds is generated by natural pollination. Experiment 02, presented a larger number of flowers, probably due to the plant's age and physiology. Performing artificial pollination between 08:00h and 09:30h is recommended for larger production since the stigma is receptive and the flowers have a large amount of pollen available.