Intestinal helminths in wild Peruvian red uakari monkeys (Cacajao calvus ucayalii) in the northeastern Peruvian Amazon.

Parasites are important in the management of the health of primate populations. We examined 36 fecal samples from Peruvian red uakari monkeys (Cacajao calvus ucayalii) collected from wild animals in the northeastern Peruvian Amazon. Samples were positive for helminth infection. Nematodes egg: Strongyloididae, Trypanoxyuris sp., Spirurid, and a cestode egg were identified.

A comparative study of the effect of multiple immersions on Aedini (Diptera: Culicidae) mosquito eggs with emphasis on sylvan vectors of yellow fever virus.

The effect of multiple immersions on Haemagogus janthinomys , Haemagogus leucocelaenus , Aedes albopictus and Ochlerotatus terrens eggs was studied. Eggs were collected in April, June, October and December of 2011 in Minas Gerais, Brazil. Most of the Aedes and Ochlerotatus eggs hatched upon the first immersion, while Haemagogus eggs showed a varied instalment hatching response. The number of immersions required for hatching increased for eggs collected closer to the dry winter season.

Flight height preference for oviposition of mosquito (Diptera: Culicidae) vectors of sylvatic yellow fever virus near the hydroelectric reservoir of Simplício, Minas Gerais, Brazil.

In this study, the oviposition behavior of mosquito species exhibiting acrodendrophilic habits was investigated. The study was conducted near the Simplicio Hydroelectic Reservoir (SHR) located on the border of the states of Minas Gerais and Rio de Janeiro, Brazil. Samples were collected using oviposition traps installed in forest vegetation cover between 1.70 and 4.30 m above ground level during the months of April, June, August, October, and December of 2011. Haemagogus janthinomys (Dyar), Haemagogus leucocelaenus (Dyar and Shannon), Aedes albopictus (Skuse), and Aedes terrens (Walker) specimens were present among the collected samples, the first two of which being proven vectors of sylvatic yellow fever (SYF) in Brazil and the latter is a vector of dengue in mainland Asia. As the data set was zero-inflated, a specific Poisson-based model was used for the statistical analysis. When all four species were considered in the model, only heights used for egg laying and months of sampling were explaining the distribution. However, grouping the species under the genera Haemagogus Williston and Aedes Meigen showed a significant preference for higher traps of the former. Considering the local working population of SHR is very large, fluctuating, and potentially exposed to SYF, and that this virus occurs in almost all Brazilian states, monitoring of Culicidae in Brazil is essential for assessing the risk of transmission of this arbovirus.

Evaluation of mosquito (Diptera: Culicidae) species richness using two sampling methods in the hydroelectric reservoir of Simplício, Minas Gerais, Brazil.

We compared two types of light traps used for monitoring mosquito abundance in the hydroelectric reservoir of Simplício, Além Paraíba - Minas Gerais. Mosquitoes were captured bimonthly using automatic CDC and Shannon traps before the filling of the hydroelectric plant reservoir from December 2008 to December 2009. In total, 1474 specimens from 13 genera were captured. Among the captured specimens, several species known to be vectors of disease-causing agents for humans and/or animals were identified, including Anopheles aquasalis, Aedes albopictus, Coquillettidia venezuelensis, Haemagogus leucocelaenus, and Aedes scapularis. Sampling efficacy between the four capture sites was not found to be significantly different, irrespective of species captured or type of trap used. Poor correlation (r (x, y) = -0.0444) between the number of mosquito species and capture site was observed when not influenced by the type of trap used. Among the installation sites of the CDC and Shannon traps in the areas investigated, CDC traps fixed in livestock shelters obtained an overall higher abundance of species captured.

Biodiversity and times of activity of mosquitoes (Diptera: Culicidae) in the biome of the Atlantic Forest in the State of Rio de Janeiro, Brazil.

A temporal observational study on culicid entomofauna was conducted in a region characterized as a fragment of the Atlantic Forest that forms the Tinguá Biological Reserve in the State of Rio de Janeiro. This investigation was performed with the aim of analyzing the influence of climatic factors (temperature and relative air humidity) on the activity levels at different times of the day among mosquito species within the ecosystems that form the Tinguá Biological Reserve. The abundance index and dominance coefficient were calculated in relation to 61 mosquito species that were caught at four sampling sites, in the mornings, afternoons, and evenings. The results revealed that culicid species were distributed with greater incidence during the two diurnal periods and that their preference for times of the day was directly influenced by the climatic variables analyzed. The latter acted as limiting factors for occurrences of mosquito species.

Immature mosquitoes of Serra do Mar park, Sao Paulo State, Brazil.

With the objective of providing knowledge about the natural habitat of mosquito larvae, we conducted a study on the culicid fauna and identified larval habitat types at 3 different locations in the Serra do Mar State Park, Brazil, over the 12 months of 1991. We collected 1,425 larvae belonging to 23 species, of which the most frequent were Culex iridescens, Culex spp., Limatus durhami, and Trichoprosopon pallidiventer. The mosquito larval habitats presenting the greatest densities of specimens were bamboo, bromeliads, rubber boots, and streams. We observed that the culicids used a variety of containers as larval habitats and bred under a diversity of ecological conditions. Most of the habitats were natural, formed by bamboo, bromeliads, streams, and depressions in the ground and in rocks, along with artificial habitats consisting of rubber boots and abandoned metal cans. Seven species occurred preferentially in the internodes of closed bamboo stems, 6 in internodes of open stems, and 4 in bromeliads.

Feeding patterns of Haemagogus capricornii and Haemagogus leucocelaenus (Diptera: Culicidae) in two Brazilian states (Rio de Janeiro and Goiás).

We present the identification of bloodfeeding sources of Haemagogus (Haemagogus) capricornii Lutz and Haemagogus (Conopostegus) leucocelaenus (Dyar & Shannon) (Diptera: Culicidae) from different regions of Brazil, as analyzed by precipitin tests. Anti-sera for bird, bovine, equine, human, opossum, and rodent were used. Two hundred one mosquitoes were examined (147 Hg. leucocelaenus and 54 Hg. capricornii), of which 177 reacted for some anti-serum. For Hg. leucocelaenus, 86 (68.3%) reacted to one blood source, 38 (30.2%) to two sources, and two (1.6%) to three sources; the combinations of bird + human (18.4%), bird + rodent (15.8%), and bird + marsupial (15.8%) were the most frequent. For Hg. capricornii, 34 (66.7%) reacted to one blood source; combinations bird + rodent (37.5%) and bird + marsupial (25%) were the most frequent combinations. Mosquito preference for bloodfeeding sources was different in these areas, possibly because of the availability of sources. This diversity of sources can have important epidemiological implications.

Distribution of Haemagogus and Sabethes Species in Relation to Forest Cover and Climatic Factors in the Chapada Dos Guimarães National Park, State of Mato Grosso, Brazil.

Members of the genera Haemagogus and Sabethes are the most important biological vectors of the wild yellow fever virus (WYF) in the forested areas of the Americas. The ecologies of Haemagogus janthinomys, Hg. leucocelaenus, Sabethes chloropterus, and Sa. glaucodaemon were studied in a forest of the Chapada dos Guimarães National Park, state of Mato Grosso, Brazil, to evaluate the influence of climatic factors (temperature and relative humidity [RH]) on their abundance. We also examined the association of climate with landscape structure on species distribution patterns throughout the seasons of the year. Multiple stepwise regressions showed that RH was most likely to influence the density of mosquito populations. A multidimensional scaling (MDS) was used to evaluate the effects of forest cover on the composition of mosquito populations at different radii (100-, 250-, and 1,000-m-radius buffer areas). The MDS provided 2 dimensions with values that indicated a higher similarity in the composition of culicid populations between sites 1 and 3, while site 2 was separate from the others in the ordination space. Site 2 had a much higher forest cover ratio at 100-m radius compared with sites 1 and 3. We found a possible relationship between the forest cover and the composition of the mosquito populations only in the 100-m radius. These results enabled us to infer that RH directly favored the activity of mosquito populations and that the forest cover located closest to the sampling site may influence the species composition. Since mosquito abundance was higher in the sites with lower local forest cover, forest fragmentation may be a key factor on the presence of WYF vector.

New records of mites (Acari: Spinturnicidae) associated with bats (Mammalia, Chiroptera) in two Brazilian biomes: Pantanal and Caatinga.

A first survey of mite species that ectoparasitize bats in the states of Ceará and Mato Grosso was conducted. The specimens of bats and their mites were collected in areas of the Caatinga and Pantanal biomes. A total of 450 spinturnicids representing two genera and ten species was collected from 15 bat species in the Private Reserve of the Natural Patrimony Serra das Almas, Ceará State, Northeast Brazil and 138 spinturnicids represented by two genera and four species were found in seven bats species collected in Private Reserve of the Natural Patrimony Sesc Pantanal, Mato Grosso State, Central-Western Brazil. The occurrence of Cameronieta genus and the species Mesoperiglischrus natali as well as four new associations (Periglischrus iheringi - Chiroderma vizottoi; P. micronycteridis - Micronycteris sanborni; P. paracutisternus - Trachops cirrhosus; Spinturnix americanus - Myotis riparius) are registered for the first time in Brazil.

Biodiversity and Temporal Distribution of Immature Culicidae in the Atlantic Forest, Rio de Janeiro State, Brazil.

To increase the knowledge of biodiversity and identify larval habitats used by immature mosquitoes in the Atlantic Forest, we conducted a study in areas with various stages of preservation within the Guapiaçu Ecological Reserve in Cachoeiras de Macacu, Rio de Janeiro state. The Culicidae fauna were sampled during February, April, June, August, October, and December 2012; February, March, April, May, June, August, October, and December 2013; and January and March 2014. Immature mosquitoes were collected with dippers and suction tubes (mouth aspirators). Over the sampling period, 2697 larvae of 56 species were collected, some of which are recognized vectors of human diseases. The larval mosquito community found in artificial habitats, temporary ground water, and phytotelmata differed between sites, except for the mosquito fauna in bromeliads, which were almost 80% similar. Species segregation was more evident between larval habitats than between sites. Culex usquatus was the dominant species and colonized the highest number of larval habitats. The artificial larval habitats found in REGUA were colonized by a great diversity of species and high abundance as well, thus human artifacts left by the public in the area that collect water may promote an increase in mosquito populations. Among the species collected, some are known or suspected vectors of pathogens to humans and/or veterinary relevance, and their medical relevance is discussed.

Feeding patterns of Haemagogus janthinomys (Diptera: Culicidae) in different regions of Brazil.

New data on the feeding patterns of Haemagogus (Haemagogus) janthinomys Dyar from different geographical regions of Brazil, by using the precipitin test as the bloodmeal-identifying tool, are presented. The following antisera were used: bird, dog, human, rodent, cattle, horse, and opossum. The origins of 287 bloodmeals were identified, whereas 33 specimens were negative to the antiserums tested. Among the reactive specimens, 174 (60.6%) fed on only one food source, of which 35.1% originated from birds, 19.5% from rodents, 12.6% from humans, 10.3% from cattle, 10.3% from opossums, 7.5% from dogs, and 4.6% from horses. One hundred six (37.0%) mosquitoes fed on two sources, of which the most common combinations were bird + rodent (16.0%), bird + human (10.4%), and horse + human (9.4%). Seven (2.4%) mosquitoes fed on three different hosts. Our results suggest that Hg. janthinomys is more eclectic and opportunist than previously known in relation to its hosts and that such patterns are probably highly adaptive to a temporally and spatially variable environment.

Evidence of spotted fever group rickettsiae in state of Rio de Janeiro, Brazil.

Ticks were obtained from dogs from February to September of 1999 at weekly intervals, in the County of Piraí, State of Rio de Janeiro. Four hundred seventy four ixodids were taxonomically identified, 103 Amblyomma cajennense, seven Amblyomma ovale, 209 Rhipicephalus sanguineus, and 155 Amblyomma sp. An hemolymph test associated with Giemsa's stain revealed two specimens in 163 ticks tested (R. sanguineus and Amblyomma sp), containing rickettsia-like organisms. Direct immunofluorescence verified the presence of spotted fever group rickettsia in one specimen of R. sanguineus. Considering the limited information on rickettsiosis in Brazil, principally in relation to the vectors involved in perpetuating it in foci, these preliminary results give us an idea on the importance of infection in ticks, allowing to expand our knowledge on this zoonosis.

[Intestinal Parasitism in Terena Indigenous People of the Province of Mato Grosso do Sul, Brazil]. / Enteroparasitismo en Indígenas Terena en el Estado de Mato Grosso do Sul, Brasil.

OBJECTIVE: Considering that intestinal protozoans and helminths infect more than half of the world population, with high prevalence in the poorest regions, the objective of this study was to conduct parasitological research among indigenous Terena people established in the state of MatoGrosso do Sul. An inquiry was performed to find the incidence of parasitism in these communities. METHODOLOGY: 134 aliquots of feces from individuals of the indigenous community were examined. Samples were conserved in Merthiolate-iodine-formol solution (MIF). The laboratory exams were carried out using the techniques of Hoffman, Pons and Janer; Willis and Kinyoun. RESULTS: We identified infections of nematode helminths of the species Ascaris lumbricoides, Ancylostomidae, Enterobius vermicularis, Strongyloides stercoralis, and Trichuris trichiura; and cestodes of the species Hymenolepis nana and Taenia spp. Also found were the protozoan species: Cryptosporidium spp., Giardia lamblia, Endolimax nana, Entamoeba coli, and Entamoeba histolytica. 23.1 % of the samples studied were negative. Of the 76.9 % of samples with parasites, there were non-statistically significant differences in parasitism between men and women examined between 1 and 33 years-of-age. There were also no significant differences between monospecific parasitism and with concurrent species. In terms of parasitic diversity, seven species of nematode and cestodes helminths were found along with five species of Archamoebae protozoa: flagellates and enterozoans. CONCLUSIONS: These results were the basis for orientation and appropriate drug intervention and reveal the need for the implementation governmental, social and educational measures to improve the living conditions of that community.

New records of mites (Acari: Spinturnicidae) associated with bats (Mammalia, Chiroptera) in two Brazilian biomes: Pantanal and Caatinga / Novos registros de ácaros (Acari: Spinturnicidae) associados com morcegos (Mammalia, Chiroptera) em dois biomas brasileiros: Pantanal e Caatinga

Abstract A first survey of mite species that ectoparasitize bats in the states of Ceará and Mato Grosso was conducted. The specimens of bats and their mites were collected in areas of the Caatinga and Pantanal biomes. A total of 450 spinturnicids representing two genera and ten species was collected from 15 bat species in the Private Reserve of the Natural Patrimony Serra das Almas, Ceará State, Northeast Brazil and 138 spinturnicids represented by two genera and four species were found in seven bats species collected in Private Reserve of the Natural Patrimony Sesc Pantanal, Mato Grosso State, Central-Western Brazil. The occurrence of Cameronieta genus and the species Mesoperiglischrus natali as well as four new associations (Periglischrus iheringi - Chiroderma vizottoi; P. micronycteridis - Micronycteris sanborni; P. paracutisternus – Trachops cirrhosus; Spinturnix americanus - Myotis riparius) are registered for the first time in Brazil.

Resumo Ácaros ectoparasitos de morcegos são reportados pela primeira vez para os Estados do Ceará e Mato Grosso. Os espécimes de morcegos com seus ectoparasitos foram coletados em áreas dos biomas Caatinga e Pantanal. Foi coletado o total de 450 espinturnicídeos representados por dois gêneros e dez espécies sobre 15 espécies de morcegos na Reserva Particular do Patrimônio Natural Serra das Almas, Ceará, Nordeste Brasileiro e em sete espécies de morcegos coletadas na Reserva Particular do Patrimônio Natural Sesc Pantanal, Mato Grosso, Centro-Oeste Brasileiro foram encontrados 138 espinturnicídeos representados por dois gêneros e quatro espécies. A ocorrência do gênero Cameronieta e da espécie Mesoperiglischrus natali, além de quatro novas associações (P. iheringi - Chiroderma vizottoi; Periglischrus micronycteridis - Micronycteris sanborni; P. paracutisternus – Trachops cirrhosus; Spinturnix americanus - Myotis riparius) são registradas pela primeira vez no Brasil.

Occurrence of ticks (Acari: Ixodidae) on human hosts, in three municipalities in the State of Pará, Brazil.

Assuming the existence of tick parasitism in humans in the State of Pará, an aggregate observational study was developed along a transversal line in three cities of the State, during two years. Interviews and examinations of 2,160 townspeople and tourists were carried out, without discrimination of ethnic, sex, age, or social status, and classified for effects analyzed for four bands of age, six types of activities in the society, and two sexes. Larvae, nymphs, and adults of ticks had been identified with cases of parasitism involving six species, of the genus Amblyomma, the genus Ixodes, Rhipicephalus sanguineus, Anocentor nitens, and Ornithodorus talaje (the first case registered in Pará), infecting human beings. Adults and agricultural workers were most frequently attacked, followed by students. A. cajennense and R. sanguineus are the species most frequent in the parasitism affecting humans, and A. cajennense is the dominant species. The statistical prevalence was largest in Cachoeira do Arari, Ilha do Marajó. In Santarém the greatest average intensity of parasitism was for R. sanguineus, and in the other locations it wasfor A. cajennense. Agricultural workers faced the greatest risk from parasitism, and to place in practice elementary measures of prevention would reduce by 25% the number of cases.

Preliminary investigation of Culicidae species in South Pantanal, Brazil and their potential importance in arbovirus transmission.

In view of the high circulation of migratory birds and the environmental and climatic conditions which favor the proliferation of arthropods, the Brazilian Pantanal is susceptible to circulation of arboviruses. However, the amount of data concerning arbovirus vectors in this area is scarce; therefore the aim of this study was to conduct a preliminary investigation of Culicidae species in the Nhecolândia Sub-region of South Pantanal, Brazil and their potential importance in the arbovirus transmission. A total of 3684 specimens of mosquitoes were captured, 1689 of which caught in the rainy season of 2007, were divided into 78 pools and submitted to viral isolation, Semi-Nested RT-PCR and Nested RT-PCR, with a view to identifying the most important arboviruses in Brazil. Simultaneously, 70 specimens of ticks found blood-feeding on horses were also submitted to the same virological assays. No virus was isolated and viral nucleic-acid detection by RT-PCR was also negative. Nevertheless, a total of 22 Culicidae species were identified, ten of which had previously been reported as vectors of important arboviruses. The diversity of species found blood-feeding on human and horse hosts together with the arboviruses circulation previously reported suggest that the Nhecolândia Sub-region of South Pantanal is an important area for arbovirus surveillance in Brazil.

[Mutagenic occurrence in teleoginae of Rhipicephalus sanguineus from intradomiciliary environment at Rio de Janeiro city]. / Malformação em teleógina de Rhipicephalus sanguineus recolhida em ambiente intradomiciliar, no Rio de Janeiro, RJ.

From material collected by into a residence house at Rio de Janeiro city, using an aspirator machine during four continues hours in all house, it was captured 1,284 Rhipicephalus sanguineus including 289 females; one of them showed a mutagenic alteration like an asymmetry of opistosome, and monstrosity like a two anus. The first register of this phenomenon in R. sanguineus is reported.

Paleoparasitology at "Place d'Armes", Namur, Belgium: a biostatistics analysis of trichurid eggs between the Old and New World.

Paleoparasitological findings about human occupation and their domestic animals, from Gallo-Roman period up to recent times, were described at the archaeological site of "Place d'Armes", Namur, Belgium, by preventive archaeological excavations. Organic sediment samples from cesspools, latrines and structures-like were analyzed and revealed intestinal parasite eggs (helminthes) in all of the different archaeological contexts. The parasitic association Ascaris sp. and Trichuris sp. was found although it is not easy to determinate the specific parasite species. Trichurids were described in both New and Old Worlds since the prehistorical time. To elucidate the zoological origin of the organic remains, the parasites and the prior function of the sanitary structures Trichuris eggs were statistically analyzed for morphometric parameters, and suggest that it could be an important tool to help the whole paleoparasitological diagnosis.

[Comparative study between larvitraps and ovitraps for evaluating the presence of Aedes aegypti (Diptera: Culicidae) in Campo Grande, State of Rio de Janeiro]. / Estudo comparativo entre larvitrampas e ovitrampas para avaliação da presença de Aedes aegypti (Diptera: Culicidae) em Campo Grande, Estado do Rio de Janeiro.

With the objective of evaluating the efficiency of traps for monitoring dengue and yellow fever vectors in Rio de Janeiro, 12 larvitraps and 12 ovitraps were used simultaneously for 13 weeks. The results indicated that the larvitraps presented greater capacity for positive findings, thereby highlighting it as an important monitoring tool for vector surveillance.

Pneumocistosis asociada a la infección por el virus de la inmunodeficiencia humana en la ciudad de Río de Janeiro, Brasil / Pneumocystis associated to the human immunodeficiency virus in the city of Rio de Janeiro, Brazil

Objetivo: investigou a prevalência de pneumopatia causada por Pneumocystis jirovecii em pacientes com o Vírus da Imunodeficiência Humana (HIV). Os pacientes pesquisados foram aqueles tratados em clínicas de pneumologia de alguns hospitais da cidade do Rio de Janeiro, Estado do Rio de Janeiro, Brasil.Métodos: entre janeiro de 2009 e julho de 2010 foram examinadas 230 amostras de enxague brônquio alveolar obtidos de pacientes de ambos os sexos na faixa etária entre 14 e 41 anos. Os lavados obtidos foram corados pelo método de Giemsa e analisados por microscopia óptica.Resultados: a prevalência geral da infecção por P. jirovecii foi de 23,5 % (54 infectados de 230 amostras analisadas), sendo 22,3 % no sexo masculino (32 infectados de 142 examinados) e 25,6 % no feminino (21 mulheres infectadas de 82 examinadas), não demonstrando diferença significativa entre os gêneros (x2= 0.05, p> 0.05). A correlação entre a infecção e a faixa etária indicou que a infecção aumenta conforme o aumento da idade, porém de forma insignificante (rs= 0,78; p> 0,05). Esse aumento ocorre de tal forma que a prevalência nos grupos etários entre 26 e 41 anos representaram individualmente mais que o dobro da observada entre os pacientes mais jovens entre 15 e 25 anos.Conclusão: os pacientes com SIDA têm grande propensão a desenvolver pneumonia por Pneumocystis jirovecii, com risco especial de colapso respiratório.

Objetivo: este estudio retrospectivo investigó la prevalencia de neumopatía causada por Pneumocystis jirovecii en pacientes con el virus de la inmunodeficiencia humana (VIH). Los pacientes investigados fueron aquellos tratados en clínicas de neumología de algunos hospitales de la ciudad de Río de Janeiro, estado de Río de Janeiro, Brasil.Métodos: entre enero de 2009 y julio de 2010 se examinaron 230 muestras de lavado bronquioalveolar obtenidas de pacientes de los 2 sexos en la franja etaria entre 14 y 41 años. Los lavados obtenidos se colorearon por el método de Giemsa y se analizaron por microscopia óptica.Resultados: la prevalencia general de la infección por Pneumocystis jirovecii fue de 23,5 % (54 infectados de 230 muestras analizadas), con 22,3 % en el sexo masculino (32 infectados de 142 examinados) y 25,6 % en el femenino (21 mujeres infectadas de 82 examinadas), no demostrando diferencia significativa entre los géneros (×2= 0,05, p> 0,05). La correlacción entre la infección y la franja etaria indicó que la infección aumenta conforme el incremento de la edad, sin embargo, de modo no significativo (rs= 0,78; p> 0,05). Ese aumento ocurre de tal forma que la prevalencia en los grupos etarios entre 26 y 41 años representó, individualmente, más que el doble de la observada entre los pacientes más jóvenes de 15 a 25 años.Conclusión: los pacientes con sida son propensos a desarrollar neumonía por Pneumocystis jirovecii, con riesgo especial de colapso respiratorio.

Objective: a retrospective study was conducted to determine the prevalence of pneumopathy due to Pneumocystis jirovecii in patients with the human immunodefiency virus (HIV). The patients surveyed were being treated at pneumological clinics of several hospitals in the city of Rio de Janeiro, state of Rio de Janeiro, Brazil.Methods: 230 bronchoalveolar lavage samples from patients of both sexes aged 14-41 were examined from January 2009 to July 2010. The lavage samples were stained by Giemsa's method and analyzed by optical microscopy.Results: overall prevalence of infection due to Pneumocystis jirovecii was 23.5 % (54 infected of 230 examined), of whom 22.3 % were male (32 infected of 142 examined) and 25.6 % were female (21 infected of 82 examined), with no significant difference between the sexes (×2= 0,05, p> 0,05). On the other hand, prevalence of the infection was found to increase with age, though not significantly (rs= 0,78; p> 0,05). This increase occurs in such a way that prevalence in the 26-41 age group more than doubles that of the 15-25 age group.Conclusion: AIDS patients are prone to develop Pneumocystis jirovecii pneumonia, with a marked risk of respiratory collapse.