Portable color retinography findings in COVID-19 patients admitted to the ward.

Retinal lesions, including cotton-wool exudates, microbleeds, vascular occlusions and vasculitis, occur in a minority of Coronavirus Disease-19 (COVID-19) patients. Retinal assessments using retinography can help document these lesions. The objective of this work was to identify retinal changes in patients admitted to the ward with a positive Real Time Quantitative Polymerase Chain Reaction (RT-qPCR) exam for COVID-19. A cross-sectional, observational study was carried out of patients with mild and moderate symptoms admitted to the Hospital de Base in São José do Rio Preto. The Eyer® portable retinal camera (Phelcom® Technologies) was used to evaluate 30 male and 21 female patients. The ages ranged from 21 to 83 years (mean: 47 years). Systemic arterial hypertension was identified in 21 (41.2 %) and diabetes mellitus in 12 (23.5 %) patients. Six (11.7 %) reported worsening visual acuity, however, none of these patients had ocular findings to justify this complaint. Ten patients (19.6 %) had intraretinal hemorrhages; one (1.9 %) had cotton-wool exudates and seven (13.7 %) had dilations of veins. Thirteen patients (25.4 %) had vascular tortuosity and six (11.7 %) had pathological arteriovenous crossings. Portable retinography is useful to evaluate patients admitted to isolation wards due to COVID-19. It is important to remember that some of the patients investigated had comorbidities like diabetic maculopathy and systemic arterial hypertension. Hence, some care should be taken in attributing these observations uniquely to COVID-19 infection.

Cryptic circulation of chikungunya virus in São Jose do Rio Preto, Brazil, 2015-2019.

BACKGROUND: Chikungunya virus (CHIKV) has spread across Brazil with varying incidence rates depending on the affected areas. Due to cocirculation of arboviruses and overlapping disease symptoms, CHIKV infection may be underdiagnosed. To understand the lack of CHIKV epidemics in São José do Rio Preto (SJdRP), São Paulo (SP), Brazil, we evaluated viral circulation by investigating anti-CHIKV IgG seroconversion in a prospective study of asymptomatic individuals and detecting anti-CHIKV IgM in individuals suspected of dengue infection, as well as CHIKV presence in Aedes mosquitoes. The opportunity to assess two different groups (symptomatic and asymptomatic) exposed at the same geographic region aimed to broaden the possibility of identifying the viral circulation, which had been previously considered absent. METHODOLOGY/PRINCIPAL FINDINGS: Based on a prospective population study model and demographic characteristics (sex and age), we analyzed the anti-CHIKV IgG seroconversion rate in 341 subjects by ELISA over four years. The seroprevalence increased from 0.35% in the first year to 2.3% after 3 years of follow-up. Additionally, we investigated 497 samples from a blood panel collected from dengue-suspected individuals during the 2019 dengue outbreak in SJdRP. In total, 4.4% were positive for anti-CHIKV IgM, and 8.6% were positive for IgG. To exclude alphavirus cross-reactivity, we evaluated the presence of anti-Mayaro virus (MAYV) IgG by ELISA, and the positivity rate was 0.3% in the population study and 0.8% in the blood panel samples. In CHIKV and MAYV plaque reduction neutralization tests (PRNTs), the positivity rate for CHIKV-neutralizing antibodies in these ELISA-positive samples was 46.7%, while no MAYV-neutralizing antibodies were detected. Genomic sequencing and phylogenetic analysis revealed CHIKV genotype ECSA in São José do Rio Preto, SP. Finally, mosquitoes collected to complement human surveillance revealed CHIKV positivity of 2.76% of A. aegypti and 9.09% of A. albopictus (although it was far less abundant than A. aegypti) by RT-qPCR. CONCLUSIONS/SIGNIFICANCE: Our data suggest cryptic CHIKV circulation in SJdRP detected by continual active surveillance. These low levels, but increasing, of viral circulation highlight the possibility of CHIKV outbreaks, as there is a large naïve population. Improved knowledge of the epidemiological situation might aid in outbreaks prevention.

COVID-19-related multisystem inflammatory syndrome in adult: the first death in Brazil

ABSTRACT The precise pathogenesis of COVID-19-related multisystem inflammatory syndrome remains largely elusive, despite its rarity. The syndrome symptoms often overlap with those of other infections, posing challenges for prompt diagnosis. A male patient, 34 years old, was admitted with suspicion of severe dengue, rapidly progressing to multiple organ dysfunction. Dengue tests resulted negative, and he passed away after four days. This case occurred approximately four weeks after the initial onset of COVID-19 and met all diagnostic criteria as defined by the Centers for Disease Control and Prevention. This report presents the first documented case of fatal multisystem inflammatory syndrome in adult (MIS-A) in Brazil. Recognizing the significance of suspecting this syndrome and promptly initiating treatment at an early stage are essential for minimizing damage and mortality.

Spatiotemporal-based clusters as a method for dengue surveillance / Uso de conglomerados basados en el tiempo y el espacio como método de vigilancia del dengue / Conglomerados espaçotemporais como método de vigilância da dengue

ABSTRACT Objectives To develop and demonstrate the use of a new method for epidemiological surveillance of dengue. Methods This was a retrospective cohort study using data from the Health Department of São José do Rio Preto (São Paulo, Brazil). The geographical coordinates were obtained using QGIS™ (Creative Commons Corporation, Mountain View, California, United States), based on patient addresses in the dengue notification system of the Government of Brazil. SaTScan™ (Martin Kulldorff, Boston, Massachusetts, United States) was then used to create a space-time scan analysis to find statistically significant clusters of dengue. These results were plotted and visualized using Google Earth™ mapping service (Google Incorporated, Mountain View, California, United States). Results More clusters were detected when the maximum number of households per cluster was set to 10% (11 statistically significant clusters) rather than 50% (8 statistically significant clusters). The cluster radius varied from 0.18 - 2.04 km and the period of time varied from 6 days - 6 months. The infection rate was more than 0.5 cases/household. Conclusions When using SaTScan for space-time analysis of dengue cases, the maximum number of households per cluster should be set to 10%. This methodology may be useful to optimizing dengue surveillance systems, especially in countries where resources are scarce and government programs have not had much success controlling the disease.

RESUMEN Objetivos Elaborar un método nuevo para la vigilancia epidemiológica del dengue y hacer una demostración sobre su uso. Métodos Se realizó un estudio retrospectivo de cohortes usando datos del Departamento de Salud de São José do Rio Preto (São Paulo, Brasil). Partiendo de la dirección de los pacientes en el sistema de notificación del dengue del Gobierno de Brasil, se usó QGIS™ (Creative Commons Corporation, Mountain View, California, Estados Unidos) para obtener sus coordenadas geográficas. Luego se usó SaTScan™ (Martin Kulldorff, Boston, Massachusetts, Estados Unidos) para crear un análisis de exploración espacio-temporal a fin de detectar conglomerados de dengue estadísticamente significativos. Por último, se usó el servicio de mapas de Google Earth™ (Google Incorporated, Mountain View, California, Estados Unidos) para graficar y visualizar estos resultados. Resultados Se detectaron más conglomerados cuando el número máximo de viviendas por conglomerado se estableció en 10% (11 conglomerados estadísticamente significativos) en lugar de 50% (8 conglomerados estadísticamente significativos). El radio de los conglomerados se ubicó entre 0,18 y 2,04 km, y la duración entre 6 días y 6 meses. La tasa de infección fue de más de 0,5 casos por vivienda. Conclusiones Cuando se usa SaTScan, el número máximo de viviendas por conglomerado debe establecerse en 10% para el análisis de exploración. Este método puede ser útil para optimizar los sistemas de vigilancia del dengue, especialmente en aquellos países donde los recursos son escasos y los programas gubernamentales no han tenido mucho éxito para controlar la enfermedad.

RESUMO Objetivos Desenvolver um novo método de vigilância epidemiológica da dengue e demonstrar a sua aplicação. Métodos Estudo de coorte retrospectiva conduzido com dados obtidos da Secretaria de Saúde de São José do Rio Preto, Estado de São Paulo, Brasil. As coordenadas geográficas foram obtidas com o software QGIS™ (Creative Commons Corporation, Mountain View, Califórnia, EUA) segundo os endereços dos pacientes registrados no sistema de notificação do Programa Nacional de Controle da Dengue do Ministério da Saúde do Brasil. Foi usado o software SaTScan™ (Martin Kulldorff, Boston, Massachusetts, EUA) com o método Scan espaçotemporal para a detecção de conglomerados espaciais de casos de dengue com significância estatística. Os resultados foram representados graficamente e visualizados com a ferramenta de geomapeamento Google Earth™ (Google Incorporated, Mountain View, Califórnia, EUA). Resultados Detectou-se um número maior de conglomerados espaciais ao se estabelecer o número máximo de domicílios por conglomerado em 10% em comparação a 50% (11 versus 8 conglomerados com significância estatística). O raio dos conglomerados espaciais detectados variou de 0,18 km a 2,04 km e o período de tempo oscilou entre 6 dias e 6 meses. A taxa de infecção foi superior a 0,5 caso por domicílio. Conclusões O número máximo de domicílios por conglomerado deve ser de 10% ao conduzir a análise da distribuição espacial com o SaTScan. Este método pode contribuir para melhorar o desempenho dos sistemas de vigilância da dengue, sobretudo nos países com recursos limitados e resultados insatisfatórios nos programas nacionais de controle da doença.

Mayaro fever in an HIV-infected patient suspected of having Chikungunya fever

Abstract Arboviruses impose a serious threat to public health services. We report a case of a patient returning from a work trip to the Amazon basin with myalgia, arthralgia, fever, and headache. During this travel, the patient visited riverside communities. Both dengue and Chikungunya fevers were first suspected, tested for, and excluded. Mayaro fever was then confirmed by reverse transcription polymerase chain reaction followed by next-generation sequencing and phylogenetic reconstruction. The increased awareness of physicians and consequent detection of Mayaro virus in this case was only possible due a previous surveillance program with specific health personnel training about these neglected arboviruses.

Formas digestivas da doença de Chagas e carcinogênese: um estudo de associação / Digestive forms of Chagas disease and carcinogenesis: a study of association

Os autores analisam a relação entre carcinogênese gastrintestinal e doença de Chagas, com base em revisão pormenorizada da literatura. Para tal, foram selecionados estudos epidemiológicos, experimentais e de descrição anatomopatológica com material humano. O artigo discute a possibilidade de a proteção ser conferida por fatores celulares morfocinéticos, imunológicos e neuroendócrinos não totalmente conhecidos e que seriam secundários à degeneração plexular. Também são apresentados aspectos relacionados à interação parasito-hospedeiro, sob o ponto de vista da modulação epitelial da mucosa colônica, e suas implicações antitumorais. Por fim, expõe-se o mecanismo fisiopatológico de desenvolvimento da neoplasia de esôfago em pacientes com megaesôfago. Conclui-se que a colopatia chagásica, especialmente o dano neuronal intrínseco, constitui modelo de estudo que pode contribuir no entendimento da carcinogênese colorretal.

The authors analyze the relation between gastrointestinal carcinogenesis and Chagas disease, based on detailed review of the literature. To this end, epidemiological, experimental and human material pathology description studies have been selected. The article discusses the possibility of protection being afforded by not fully known morphokinetic cellular, immune and neuroendocrine factors that would be secondary to plexus degeneration. Also aspects related to the parasite-host interaction from the viewpoint of epithelial modulation of colonic mucosa and its antitumor implications are presented. Finally, it exposes the pathophysiological mechanism of esophageal cancer development in patients with mega-organ. In conclusion, chagasic colopathy, especially the intrinsic neuronal damage, is a study model that can contribute to the understanding of colorectal carcinogenesis.

Fungal colitis by Paracoccidioides brasiliensis: a case report

Paracoccidioidomycosis (PBM) is an infection caused by a dimorphic fungus called Paracoccidioides brasiliensis. It occurs in Latin America, with incidence of 1 to 3 per 100,000 inhabitants in endemic areas. The digestive tract is usually not affected, but when it occurs, it may lead to events similar to colorectal neoplasm and inflammatory bowel disease (IBD). This is a case report of a 68-year-old female patient, with diarrhea without blood or mucus for 6 months, weight loss of 8 kg over the period. Abdominal ultrasonography showed some mass in the right colon, suggestive of cancer and liver perihilar lymph node. Colonoscopy showed lesions suggestive of Crohn's disease. Biopsy showed chronic granulomatous colitis of fungal etiology: Paracoccidioidomycosis. The patient did not tolerate oral treatment with itraconazole and subsequently sulfadiazine, requiring hospital admission for the treatment with amphotericin B. The presence of Paracoccidioidomycosis in the digestive tract may be associated with bloody diarrhea, mucus, rectal hemorrhage, abdominal pain, malabsorption syndrome. Histopathological studies show the fungus and a chronic inflammatory infiltrate and granulation tissue. The differential diagnoses are tuberculosis, colorectal cancer and inflammatory bowel disease. The treatment is oral antifungal (itraconazole, sulfadiazine) or intravenous (amphotericin B) based. The case has caused diagnostic confusion between colon cancer (clinical and US) and Crohn's disease (colonoscopy). (AU)

Paracoccidioidomicose (PBM) é uma infecção causada por um fungo dimórfico: Paracoccidioides brasiliensis. Ocorre na América Latina, com incidência de 1 a 3 por 100.000 habitantes em áreas endêmicas. O acometimento do trato digestivo é infrequente, sendo que pode levar a manifestações semelhantes à neoplasia colorretal e doença inflamatória intestinal (DII). Relatamos o caso da paciente feminina, 68 anos, com diarreia sem sangue ou muco há seis meses, com perda ponderal de 8 kg no período. Ultrassom abdominal evidenciou massa em cólon direito sugestiva de neoplasia e linfonodomegalia peri-hilar hepática. A colonoscopia evidenciou lesões sugestivas de doença de Crohn. A biopsia mostrou colite crônica granulomatosa de etiologia fúngica: Paracoccidioidomicose. A paciente não tolerou tratamento oral com itraconazol e, posteriormente, sulfadiazina. Necessitou de internação para tratamento com anfotericina B. O acometimento da PBM no trato digestivo pode cursar com diarreia muco-sanguinolenta, retorragia, dor abdominal e síndrome de má absorção. O estudo histopatológico mostra o fungo e um infiltrado inflamatório crônico com tecido de granulação. Os diagnósticos diferenciais são tuberculose, câncer colorretal e doença inflamatória intestinal. O tratamento é feito com antifúngicos orais (itraconazol, sulfadiazina) ou endovenosos (anfotericina B). O caso levou à confusão diagnóstica entre câncer de cólon (US e quadro clínico) e doença de Crohn (colonoscopia). (AU)