Analysis of spatial and demographic factors associated with chikungunya in Espírito Santo state, Brazil.

BACKGROUND: Chikungunya (CHIK) emerged in Brazil in 2014 and since then several epidemics have been observed. This study aims to describe the spatial, social and demographic characteristics of individuals affected by CHIK in Espírito Santo state. METHODS: A cross-sectional study was performed using data from individuals with a confirmed diagnosis of CHIK in Espírito Santo state, Brazil, from 2018 to 2020. Monthly incidence was calculated and annual spatial distribution maps were constructed. Statistical analysis using the χ2 test identified associations between disease occurrence and sociodemographic variables. RESULTS: In the period and area analysed, a CHIK epidemic occurred in 2020, with an incidence of 219.8 cases per 100 000 inhabitants. The southern and central regions of Espirito Santo state harboured a risk five times greater than the others in the epidemic region. Females (odds ratio [OR] 1.65 [95% confidence interval {CI} 1.58 to 1.72]), black people (OR 1.22 [95% CI 1.13 to 1.33]), individuals with ≤11 y of education (OR 1.48 [95% CI 1.37 to 1.61]) and the elderly (OR 7.49 [95% CI 6.53 to 8.59]) had a greater risk for the disease. CONCLUSIONS: CHIK stands as an emerging public health problem in Brazil since its introduction in 2014. Espírito Santo suffered a substantial epidemic in 2020, possibly due to outbreaks in neighbouring states. The population at risk should be prioritized in healthcare, considering the morbidity potential of the disease.

Factors associated with hospitalization in the acute phase of Chikungunya.

OBJECTIVE: Determine characteristics associated with hospitalization in the acute phase of Chikungunya. METHODS: Cross-sectional study including data on Chikungunya cases reported in Vitória, Espírito Santo state, Brazil, between March 2016 and December 2021. RESULTS: Hospitalizations accounted for 1.42% (n = 41) of the 2,868 cases included. There were statistically significant differences between hospitalized and non-hospitalized regarding age (P 0.001), which was lower among hospitalized patients, and pregnancy, which was more frequent in the hospitalized group (P 0.010). Patients younger than two years old and older than 65 years corresponded to 31.7% of hospitalizations. Back pain (OR = 0.134; 95% CI = 0.044-0.409) and arthralgia (OR = 0.226; 95% CI = 0.083-0.613) were protective factors for hospitalization. CONCLUSION: Groups at risk of severe Chikungunya, including those under two and over 65 years of age, may require more hospitalization, even with milder manifestations.

SARS-CoV-2 infection prevalence and associated factors: a serial population-based study in Espírito Santo, Brazil, May to June 2020. / Prevalência e fatores associados à infecção por SARS-CoV-2: estudo de base populacional seriado, no Espírito Santo, de maio a junho/2020.

OBJECTIVE: To analyze SARS-CoV-2 seroprevalence and association of sociodemographic and clinical aspects in the state of Espírito Santo, Brazil. METHODS: This was a serial cross-sectional study carried out in four phases, using households as the unit of analysis, from May to June 2020. Eleven municipalities were surveyed, with a sample of 4,500 households in each phase. RESULTS: Prevalence ranged from 2.1% (95%CI 1.7;2.5) on May 10 (first phase) to 9.6% (95%CI 8.8;10.4) on June 21 (fourth phase). In the Greater Vitória Metropolitan Region, the prevalence were 2.7% (95%CI 2.2;3.3) in the first phase, and 11.5% (95%CI 10.5;12.6) in the fourth phase; in the interior region of the state, prevalence ranged from 0.4% (95%CI 0.1;0.9) to 4.4% (95%CI 3.2;5.5) between the two phases. CONCLUSION: The increase in SARS-CoV-2 seroprevalence found in the fourth phase highlighted the high transmission of the virus, information that can support management of the pandemic.

Health-Related Quality of Life and Coping Strategies in a Cohort Study of Highly Active Antiretroviral Therapy Naïve Patients Adherence.

Objective: The main objective of this study was to describe the perceived quality of life (QoL) in patients living with AIDS (PLWA) and their chosen coping strategies in a cohort of individuals managed with HAART. Methods: This is a prospective cohort study conducted at the Medication Dispensing Unit of a university hospital (MDU-UH) located in southeastern Brazil. Study population comprised HIV/AIDS patients starting antiretroviral treatment at MDU. The final sample comprised 99 participants. Patients were followed up for 24 months from their recruitment. We used a face-to-face questionnaire to determine sociodemographic and behavioural variables. Quality of life (QoL) and coping strategies (CS) were measured through validated instruments. Results: Regarding the QoL dimensions, the general perception of QoL among these participants was considered good. Regarding CS, the adherent patients scored higher than the nonadherents. Conclusions: The present study revealed that the perceived QoL can be maintained in individuals treated for HIV/AIDS. There is an association between high score of coping strategies and adherence to HAART.

Prevalência e fatores associados à infecção por SARS-CoV-2: estudo de base populacional seriado, no Espírito Santo, de maio a junho/2020 / Prevalencia y factores asociados a la infección por SARS-CoV-2: un estudio poblacional seriado en Espírito Santo, Brasil, de mayo a junio de 2020 / SARS-CoV-2 infection prevalence and associated factors: a serial population-based study in Espírito Santo, Brazil, May to June 2020

Objetivo: Analisar a soroprevalência de SARS-CoV-2 e sua associação com aspectos sociodemográficos e clínicos, no estado do Espírito Santo, Brasil. Métodos: Estudo transversal seriado, realizado em quatro fases, no período de maio a junho de 2020, utilizando os domicílios como unidade de análise. Foram pesquisados 11 municípios, com amostra de 4.500 domicílios em cada fase. Resultados: A soroprevalência de SARS-CoV-2 variou de 2,1% (IC95% 1,7;2,5), em 10 de maio (primeira etapa), a 9,6% (IC95% 8,8;10,4) em 21 de junho (quarta etapa). Na Região Metropolitana da Grande Vitória, as prevalências foram de 2,7% (IC95% 2,2;3,3), na primeira, e de 11,5% (IC95% 10,5;12,6) na quarta etapa; no interior do estado, a prevalência variou de 0,4% (IC95% 0,1;0,9) a 4,4% (IC95% 3,2;5,5) entre a primeira e a quarta etapas. Conclusão: O aumento da soroprevalência de SARS-CoV-2 observado na quarta fase destacou a elevada transmissão do vírus, informação que pode subsidiar a gestão da pandemia.

Objetivo: Analizar la seroprevalencia del SARS-CoV-2 y la asociación de aspectos sociodemográficos y clínicos en el estado de Espírito Santo, Brasil. Métodos: Estudio transversal seriado realizado en cuatro fases, utilizando los hogares como unidad de análisis, de mayo a junio de 2020. Se encuestaron 11 municipios, con una muestra de 4.500 hogares en cada fase. Resultados: La prevalencia varió de 2,1% (IC95% 1,7;2,5) el 10 de mayo (primera etapa) a 9,6% (IC95% 8,8;10,4), el 21 de junio (cuarta etapa). En la Región Metropolitana de la Gran Vitória, las prevalencias fueron de 2,7% (IC95% 2,2;3,3), en la primera, y de 11,5% (IC95% 10,5;12,6) en la cuarta etapa; en el estado osciló entre 0,4% (IC95% 0,1;0,9) y 4,4% (IC95% 3,2;5,5). Conclusión: El aumento de la seroprevalencia del SARS-CoV-2 observado en la cuarta fase destacó la alta transmisión del virus, información que puede subsidiar el manejo de la pandemia.

Objective: To analyze SARS-CoV-2 seroprevalence and association of sociodemographic and clinical aspects in the state of Espírito Santo, Brazil. Methods: This was a serial cross-sectional study carried out in four phases, using households as the unit of analysis, from May to June 2020. Eleven municipalities were surveyed, with a sample of 4,500 households in each phase. Results: Prevalence ranged from 2.1% (95%CI 1.7;2.5) on May 10 (first phase) to 9.6% (95%CI 8.8;10.4) on June 21 (fourth phase). In the Greater Vitória Metropolitan Region, the prevalence were 2.7% (95%CI 2.2;3.3) in the first phase, and 11.5% (95%CI 10.5;12.6) in the fourth phase; in the interior region of the state, prevalence ranged from 0.4% (95%CI 0.1;0.9) to 4.4% (95%CI 3.2;5.5) between the two phases. Conclusion: The increase in SARS-CoV-2 seroprevalence found in the fourth phase highlighted the high transmission of the virus, information that can support management of the pandemic.

Living conditions, seroprevalence and symptoms of COVID-19 in slums in the Metropolitan Region of Vitória (Espírito Santo).

OBJECTIVES: to estimate the prevalence of SARS-CoV-2 infection in residents of the Greater Vitória region living in subnormal and non-subnormal agglomerates, and to compare sociodemographic and clinical characteristics of total residents (infected and not infected with SARS-CoV-2) between them. METHODS: Population-based prevalence study conducted by serological testing in 2020, with a study unit in households in Greater Vitória, grouped into census tracts classified as sub-normal agglomerates and non-sub-normal agglomerates. The two groups were compared in terms of prevalence and associated factors. The significance level adopted was 5%. RESULTS: The prevalence found in the sub-normal clusters was 12.05% (95%CI 9.59-14.50), and in the non-sub-normal clusters 10.23% (95%CI 7.97-12.50) this difference was not statistically significant (p = 0.273). Comparing the sociodemographic characteristics, more people who declare themselves to be of mixed race were found in the sub-normal clusters, a higher percentage of illiterates and people with only elementary education, greater number of residents per household, longer stay in public transportation, sharing a bathroom with another household, fewer bedrooms per residence and higher frequency of irregular water supply when compared to non-sub-normal clusters (p < 0.05). CONCLUSIONS: The epidemiological characteristics of sub-normal clusters' residents show the social inequalities that can hinder control measures in a pandemic situation.

Residual malaria of Atlantic Forest systems and the influence of anopheline fauna.

In Brazil, the Amazon region comprises 99.5% of the reported malaria cases. However, another hotspot of the disease is the Atlantic Forest regions, with the sporadic occurrence of autochthonous human cases. In such context, this study sought to investigate the role of anopheline mosquitoes (Diptera: Culicidae) in the residual malaria transmission in Atlantic Forest areas. Two rural areas in the Espírito Santo state were the surveyed sites. Mosquitoes were captured using Shannon trap and CDC light traps and identified into species based on morphological characters. Ecological indexes (Shannon-Wiener diversity, Simpson's dominance, Pielou equability, and Sorensen similarity) were the tools used in the anopheline fauna characterization and comparison along with the two explored areas. The assessment of the sampling adequacy in the studied areas was possible through the generation of a species accumulation curve. A correlation test verified the influence of climatic variables on the anopheline species abundance. A total of 1471 female anopheline mosquitoes were collected from May 2019 to April 2020, representing 13 species. The species richness was higher in Valsugana Velha (hypo-endemic) than in Alto Caparaó (non-endemic). There was a significant variation in the species abundance between Valsugana Velha (n = 1438) and Alto Caparaó (n = 33). The most abundant species was Anopheles (Kerteszia) cruzii complex Dyar and Knab, 1908 representing 87% of the total anophelines collected. These results suggest that the Plasmodium spp. circulation in Brazilian Atlantic Forest areas occurs mainly due to the high frequency of Anopheles (K.) cruzii complex, considered the principal vector of simian and human malaria in the region.

Atlantic Forest Malaria: A Review of More than 20 Years of Epidemiological Investigation.

In the south and southeast regions of Brazil, cases of malaria occur outside the endemic Amazon region near the Atlantic Forest in some coastal states, where Plasmodium vivax is the recognized parasite. Characteristics of cases and vectors, especially Anopheles (Kerteszia) cruzii, raise the hypothesis of a zoonosis with simians as reservoirs. The present review aims to report on investigations of the disease over a 23-year period. Two main sources have provided epidemiological data: the behavior of Anopheles vectors and the genetic and immunological aspects of Plasmodium spp. obtained from humans, Alouatta simians, and Anopheles spp. mosquitoes. Anopheles (K.) cruzii is the most captured species in the forest canopy and is the recognized vector. The similarity between P. vivax and Plasmodium simium and that between Plasmodium malariae and Plasmodium brasilianum shared between simian and human hosts and the involvement of the same vector in the transmission to both hosts suggest interspecies transfer of the parasites. Finally, recent evidence points to the presence of Plasmodium falciparum in a silent cycle, detected only by molecular methods in asymptomatic individuals and An. (K.) cruzii. In the context of malaria elimination, it is paramount to assemble data about transmission in such non-endemic low-incidence areas.

Living conditions, seroprevalence and symptoms of COVID-19 in slums in the Metropolitan Region of Vitória (Espírito Santo) / Condições de vida, soro prevalência e sintomas de COVID-19 em favelas na Região Metropolitana de Vitória (Espírito Santo)

ABSTRACT: Objectives: to estimate the prevalence of SARS-CoV-2 infection in residents of the Greater Vitória region living in subnormal and non-subnormal agglomerates, and to compare sociodemographic and clinical characteristics of total residents (infected and not infected with SARS-CoV-2) between them. Methods: Population-based prevalence study conducted by serological testing in 2020, with a study unit in households in Greater Vitória, grouped into census tracts classified as sub-normal agglomerates and non-sub-normal agglomerates. The two groups were compared in terms of prevalence and associated factors. The significance level adopted was 5%. Results: The prevalence found in the sub-normal clusters was 12.05% (95%CI 9.59-14.50), and in the non-sub-normal clusters 10.23% (95%CI 7.97-12.50) this difference was not statistically significant (p = 0.273). Comparing the sociodemographic characteristics, more people who declare themselves to be of mixed race were found in the sub-normal clusters, a higher percentage of illiterates and people with only elementary education, greater number of residents per household, longer stay in public transportation, sharing a bathroom with another household, fewer bedrooms per residence and higher frequency of irregular water supply when compared to non-sub-normal clusters (p < 0.05). Conclusions: The epidemiological characteristics of sub-normal clusters' residents show the social inequalities that can hinder control measures in a pandemic situation.

RESUMO: Objetivo: Estimar prevalência de infecção pelo SARS-CoV-2 em residentes na região da Grande Vitória, moradores de aglomerados subnormais e não subnormais, e comparar características sociodemográficas e clínicas dos residentes totais (infectados e não infectados com o SARS-CoV-2), entre esses aglomerados. Métodos: Estudo de prevalência de base populacional, por meio de teste sorológico realizado em 2020, com unidade de estudo em domicílios da Grande Vitória, agrupados em setores censitários classificados como aglomerados subnormais e aglomerados não subnormais. Os dois grupos foram comparados quanto à prevalência e aos fatores associados. O nível de significância adotado foi de 5%. Resultados: A prevalência encontrada em não aglomerados subnormais foi 12,05% (IC95% 9,59-14,50) e no grupo aglomerados não subnormais foi 10,23% (IC95% 7,97-12,50), e essa diferença não foi estatisticamente significante (p = 0,273). Comparando-se as características sociodemográficas, encontraram-se nos aglomerados subnormais mais pessoas que se autodeclaram da raça/cor parda, percentual maior de analfabetos e de pessoas apenas com ensino fundamental, maior número de moradores por domicílio, maior permanência em transporte coletivo, compartilhamento de banheiro com outro domicílio, menos dormitórios por residência e maior frequência de abastecimento irregular de água quando comparado aos aglomerados não subnormais (p<0,05). Conclusões: As características epidemiológicas dos moradores de aglomerados subnormais evidenciam as desigualdades sociais que podem dificultar as medidas de controle em uma situação de pandemia.

Factors related to adherence to antiretroviral treatment in a specialized care facility.

The objective of this study was to verify the level of adherence to antiretroviral treatment and its associated factors. This is a descriptive cross-sectional study based on data retrieved from medical records. To achieve this, we used a questionnaire composed of sociodemographic and clinical information recorded from patients aged between thirteen and fifty-nine years who attended a specialized service from 2007 to 2014. The chi-square test was performed to verify the association of the outcome with the categorical variables. Continuous variables were compared through the Student t-test. Thirteen variables were analyzed in the bivariate model, resulting in the selection of the following variables to the multivariate model (p<0.20) age of discovery (p=0.12), age (p=0.14), skin color (p=0.12), level of education (p=0.03), time since HIV diagnosis (p<0.001) and AIDS case (p<0.001). Among the six variables selected for the multivariate model, cases of aids (p<0.001) remained significant. We concluded that having aids decreases the probability of non-adherence to antiretroviral treatment by 92%. These results indicate that symptomatic patients have better adherence to therapy.

First report of Aedes albopictus infected by Dengue and Zika virus in a rural outbreak in Brazil.

In Brazil, Dengue (DENV) and Zika (ZIKV) viruses are reported as being transmitted exclusively by Aedes aegypti in urban settings. This study established the vectors and viruses involved in an arbovirus outbreak that occurred in 2019 in a rural area of Espírito Santo state, Brazil. Mosquitoes collected were morphologically identified, sorted in samples, and submitted to molecular analysis for arboviruses detection. Phylogenetic reconstruction was performed for the viral sequence obtained. All 393 mosquitoes were identified as Aedes albopictus. DENV-1 genotype V was present in one sample and another sample was positive for ZIKV. The DENV-1 clustered with viruses that have circulated in previous years in large urban centers of different regions in Brazil. This is the first report of A. albopictus infected by DENV and ZIKV during an outbreak in a rural area in Brazil, indicating its involvement in arboviral transmission. The DENV-1 strain found in the A. albopictus was not new in Brazil, being involved previously in epidemics related to A. aegypti, suggesting the potential to A. albopictus in transmitting viruses already circulating in the Brazilian population. This finding also indicates the possibility of these viruses to disperse across urban and rural settings, imposing additional challenges for the control of the diseases.

Factors related to adherence to antiretroviral treatment in a specialized care facility

SUMMARY The objective of this study was to verify the level of adherence to antiretroviral treatment and its associated factors. This is a descriptive cross-sectional study based on data retrieved from medical records. To achieve this, we used a questionnaire composed of sociodemographic and clinical information recorded from patients aged between thirteen and fifty-nine years who attended a specialized service from 2007 to 2014. The chi-square test was performed to verify the association of the outcome with the categorical variables. Continuous variables were compared through the Student t-test. Thirteen variables were analyzed in the bivariate model, resulting in the selection of the following variables to the multivariate model (p<0.20) age of discovery (p=0.12), age (p=0.14), skin color (p=0.12), level of education (p=0.03), time since HIV diagnosis (p<0.001) and AIDS case (p<0.001). Among the six variables selected for the multivariate model, cases of aids (p<0.001) remained significant. We concluded that having aids decreases the probability of non-adherence to antiretroviral treatment by 92%. These results indicate that symptomatic patients have better adherence to therapy.

RESUMO O objetivo deste estudo foi verificar os níveis de adesão ao tratamento antirretroviral e os fatores associados a ela. Trata-se de um estudo descritivo de delineamento transversal baseado em levantamento de prontuários. Para tanto, foi utilizado um questionário composto de informações sociodemográficas e clínicas de pacientes com idade entre 13 e 59 anos atendidos em um serviço de atendimento especializado nos anos de 2007 a 2014. Foi realizado o teste do Qui-quadrado para verificar a associação do desfecho com as variáveis categóricas. As variáveis contínuas foram comparadas pelo teste t de "Student" (dois grupos). Treze variáveis foram analisadas no modelo bivariado, sendo selecionadas para o modelo multivariado (p<0,20): idade de descoberta (p=0,12), idade (p=0,14), cor da pele (p=0,12), escolaridade (p=0,03), tempo de diagnóstico do HIV (p<0,001) e caso de aids (p<0,001). Das seis variáveis selecionadas para o modelo multivariado, permaneceu significante o fato de o paciente ter aids (p<0,001). Concluiu-se que ter aids reduz a probabilidade de não adesão ao tratamento antirretroviral em cerca de 92%. Os resultados indicam que o indivíduo que é sintomático adere melhor à terapia.

Epidemiological aspects of Rickettsia parkeri in the Atlantic forest biome of Espírito Santo state, Brazil.

Since 2010, a new rickettsiosis caused by Rickettsia parkeri, a species included in the spotted fever group (SFG) and transmitted by the tick Amblyomma ovale, has been described in Brazil. Considering that A. ovale does occur in the Espírito Santo state (ES), the present study aimed at preliminarily describing the epidemiology of R. parkeri in the Atlantic forest of this state. Between June 2016 and September 2018, 33 villages from nine municipalities of the ES were included in a study for the molecular detection and isolation of SFG rickettsiae from adult Amblyomma ticks collected on dogs with free access to the forest. Serologic screenings against SFG rickettsiae in these animals and their owners (humans) were performed through immunofluorescence assay (IFA) using antigens of Rickettsia rickettsii and R. parkeri. Additionally, local health secretariats were informed on clinical manifestations of R. parkeri infection and told to communicate any suspected case. A total of 280 adult ticks were collected and taxonomically classified as A. ovale (n = 152), Amblyomma aureolatum (n = 127) and Amblyomma sculptum (n = 1). Overall, Rickettsia DNA was detected in 12/266 ticks. The sequencing of PCR products revealed that 0.7% (1/144) and 0.8% (1/121) of the analyzed A. ovale and A. aureolatum ticks were infected by R. parkeri strain Atlantic rainforest, respectively, and 8.3% (10/121) of the A. aureolatum ticks infected by Rickettsia bellii. Among the above PCR-positive ticks, only one isolate from one A. aureolatum tick was successfully established in the laboratory. DNA extracted from the third passage of this isolate was designated as strain M9A and molecularly characterized using primers targeting the Rickettsia gltA gene, whose sequence matched 100% the corresponding sequences of R. bellii. Seroprevalence against SFG rickettsiae in sampled dogs (n = 83) was 41% or 57%, depending on the rickettsial antigen (R. rickettsii strain Taiaçu or R. parkeri strain Atlantic rainforest, respectively). A total of 37 (45%) canine sera showed titers to R. parkeri at least fourfold higher than to R. rickettsii antigen. Among humans, 10% (4/41) of the samples reacted to at least one rickettsial antigen, with the highest endpoint titer varying from 64 to 128 for R. rickettsii and R. parkeri; no human serum showed ≥4-fold difference between the highest endpoint titers. Finally, during the study period, suspicions on cases of R. parkeri-rickettsiosis were not informed by the health secretariats. Our results confirm the presence and exposure to R. parkeri strain Atlantic rainforest, associated with two anthropophilic tick species (A. ovale and A. aureolatum) parasitizing domestic dogs with unrestrained access to forest areas. Consequently, the occurrence of R. parkeri infection in humans inhabiting the Atlantic forests of ES should not be discarded.

First molecular detection of Rickettsia sp. strain Atlantic rainforest in Amblyomma ovale ticks from Espírito Santo state, Brazil / Primeira detecção molecular da Rickettsia sp. cepa Mata Atlântica em carrapatos Amblyomma ovale do estado do Espírito Santo, Brasil

Abstract Espírito Santo state (southeastern Brazil) is considered an endemic area for spotted fever group rickettsioses. In February 2017, we received in our laboratory seven unfed Amblyomma ovale adult ticks collected by a farmer from his clothes and body (not attached) during a working day in the rural area of Ibiraçu municipality, Espírito Santo state. By polymerase chain reaction (PCR) analyses, targeting gltA and ompA rickettsial genes, the DNA of Rickettsia was detected in 6/7 (85.7%) A. ovale. In all cases, DNA sequencing of PCR products revealed that consensus sequences of both genes were 100% identical to gltA and ompA corresponding sequences of Rickettsia sp. strain Atlantic rainforest retrieved from GenBank. This study reports the first molecular detection of Rickettsia sp. strain Atlantic rainforest in A. ovale ticks from Espírito Santo state. Our findings indicate a new Brazilian state in the southeast region at risk of human infection with this tick-borne emerging rickettsial agent.

Resumo O estado do Espírito Santo (Sudeste do Brasil) é considerado área endêmica para riquetsioses do Grupo Febre Maculosa. Em fevereiro de 2017, recebemos em nosso laboratório sete carrapatos adultos Amblyomma ovale não ingurgitados, coletados por um fazendeiro nas suas roupas e corpo (não fixadas) durante um dia de trabalho, em área rural do municipio de Ibiraçu, estado do Espírito Santo. Por meio de reação em cadeia da polimerase (PCR), amplificando os genes riquetsiais gltA e ompA , foi detectado ADN de Rickettsia em 6/7 (85,7%) dos A. ovale . O sequenciamento dos produtos de PCR indicou que as sequências consenso de ambos genes foram 100% idênticos às sequências correspondentes dos genes gltA e ompA da Rickettsia sp. cepa Mata Atlântica recuperadas do GenBank. Este estudo relata a primeira detecção molecular da Rickettsia sp. cepa Mata Atlântica em carrapatos A. ovale do estado do Espírito Santo. Nossos resultados apontam um novo estado brasileiro da região Sudeste com risco de infecção humana por este agente rickettsial emergente transmitido por carrapatos.

Febre Maculosa por Rickettsia parkeri no Brasil: condutas de vigilância epidemiológica, diagnóstico e tratamento / Rickettsia parkeri spotted fever in Brazil: Epidemiological surveillance, diagnosis and treatment

Introdução: A febre maculosa (FM) é uma doença infecciosa, aguda, transmitida por carrapatos, e de gravidade variável. No Brasil, recentemente, tem sido descrita uma nova FM causada por Rickettsia parkeri, cujo perfil clínico, epidemiológico e laboratorial é diferente do perfil da FM causada por Rickettsia rickettsii. Metodologia: trata-se de uma revisão narrativa cujo objetivo é caracterizar a febre maculosa causada por Rickettsia parkeri no Brasil, discutindo as condutas de vigilância epidemiológica, diagnóstico e tratamento. Resultados: A febre maculosa por Rickettsia parkeri no Brasil é produzida, principalmente, pela R. parkeri cepa Mata Atlântica, presente no bioma Mata Atlântica das regiões Sul, Sudeste e Nordeste, onde o carrapato Amblyomma ovale figura como o principal vetor da doença. A suspeição clínica e epidemiológica deve considerar os pacientes que apresentam doença febril e presença da escara de inoculação, associadas à visita em área de mata e ou contatos com carrapatos. A coleta de material biológico (que inclua a escara de inoculação) deve ser realizada, oportunamente, para a caracterização do agente etiológico. O tratamento com antibioticoterapia deve ser iniciado já no início dos sintomas, e todos os casos devem ser notificados ao Ministério da Saúde e investigados imediatamente. A caracterização do ambiente de infecção é importante para melhor compreensão da ecoepidemiologia da doença e desencadeamento de medidas de prevenção e controle. Conclusão: Estabelecemos um protocolo para os profissionais de saúde com as condutas de vigilância epidemiológica, diagnóstico e tratamento para febre maculosa causada por Rickettsia parkeri no Brasil.(AU)

Introduction: Spotted fever (SF) is a tick-borne infectious disease, acute and of variable gravity. In Brazil, recently a new SF has been described, caused by Rickettsia parkeri, whose clinical, epidemiological and laboratory profile is different from the SF profile caused by Rickettsia rickettsii. Methodology: Here in, we present a narrative review with the objective of characterizing Rickettsia parkeri SF in Brazil, discussing the conduct of epidemiological surveillance, diagnosis and treatment. Results: Rickettsia parkeri SF in Brazil is mainly produced by R. parkeri strain Atlantic Forest, present in the Atlantic Forest biome of the South, Southeast and Northeast regions, where Amblyomma ovale tick is the main vector of the disease. The clinical and epidemiological suspicion should consider the patients with febrile disease with the presence of inoculation eschar, associated to the visit in forest area and or contact with ticks. The collection of biological material (including eschar) should be carried out in a timely manner to characterize the etiological agent. Antibiotic treatment should be started at the onset of symptoms and all cases should be reported to the Ministry of Health and investigated immediately. The characterization of the infection environment is important for a better understanding of the ecoepidemiology of the disease and the triggering of prevention and control measures. Conclusion: We have established a protocol for health professionals with ecoepidemiology surveillance, diagnosis and treatment for Rickettsia parkeri SF in Brazil.(AU)

First molecular detection of Rickettsia sp. strain Atlantic rainforest in Amblyomma ovale ticks from Espírito Santo state, Brazil.

Espírito Santo state (southeastern Brazil) is considered an endemic area for spotted fever group rickettsioses. In February 2017, we received in our laboratory seven unfed Amblyomma ovale adult ticks collected by a farmer from his clothes and body (not attached) during a working day in the rural area of Ibiraçu municipality, Espírito Santo state. By polymerase chain reaction (PCR) analyses, targeting gltA and ompA rickettsial genes, the DNA of Rickettsia was detected in 6/7 (85.7%) A. ovale. In all cases, DNA sequencing of PCR products revealed that consensus sequences of both genes were 100% identical to gltA and ompA corresponding sequences of Rickettsia sp. strain Atlantic rainforest retrieved from GenBank. This study reports the first molecular detection of Rickettsia sp. strain Atlantic rainforest in A. ovale ticks from Espírito Santo state. Our findings indicate a new Brazilian state in the southeast region at risk of human infection with this tick-borne emerging rickettsial agent.

Assessment of asymptomatic Plasmodium spp. infection by detection of parasite DNA in residents of an extra-Amazonian region of Brazil.

BACKGROUND: The hypotheses put forward to explain the malaria transmission cycle in extra-Amazonian Brazil, an area of very low malaria incidence, are based on either a zoonotic scenario involving simian malaria, or a scenario in which asymptomatic carriers play an important role. OBJECTIVES: To determine the incidence of asymptomatic infection by detecting Plasmodium spp. DNA and its role in residual malaria transmission in a non-Amazonian region of Brazil. METHODS: Upon the report of the first malaria case in 2010 in the Atlantic Forest region of the state of Espírito Santo, inhabitants within a 2 km radius were invited to participate in a follow-up study. After providing signed informed consent forms, inhabitants filled out a questionnaire and gave blood samples for PCR, and thick and thin smears. Follow-up visits were performed every 3 months over a 21 month period, when new samples were collected and information was updated. RESULTS: Ninety-two individuals were initially included for follow-up. At the first collection, all of them were clearly asymptomatic. One individual was positive for Plasmodium vivax, one for Plasmodium malariae and one for both P. vivax and P. malariae, corresponding to a prevalence of 3.4% (2.3% for each species). During follow-up, four new PCR-positive cases (two for each species) were recorded, corresponding to an incidence of 2.5 infections per 100 person-years or 1.25 infections per 100 person-years for each species. A mathematical transmission model was applied, using a low frequency of human carriers and the vector density in the region, and calculated based on previous studies in the same locality whose results were subjected to a linear regression. This analysis suggests that the transmission chain is unlikely to be based solely on human carriers, regardless of whether they are symptomatic or not. CONCLUSION: The low incidence of cases and the low frequency of asymptomatic malaria carriers investigated make it unlikely that the transmission chain in the region is based solely on human hosts, as cases are isolated one from another by hundreds of kilometers and frequently by long periods of time, reinforcing instead the hypothesis of zoonotic transmission.