Rickettsia slovaca infection in humans, Portugal.

Fifteen years after the initial detection of Rickettsia slovaca in ticks in Portugal, 3 autochthonous cases of R. slovaca infection were diagnosed in humans. All patients had an eschar on the scalp and lymphadenopathy; 2 patients had facial edema. R. slovaca infection was confirmed by serologic testing, culture, and PCR.

Histopathology and immunophenotyping of late onset cutaneous manifestations of COVID-19 in elderly patients: Three case reports.

BACKGROUND: Several cutaneous manifestations such as urticarial rash, erythematous patches and chilblain-like lesions have been described in young adults with coronavirus disease 2019 (COVID-19) and are present in up to 20% patients, but few reports exist describing histopathological and immunophenotypic characteristics of dermatological lesions in older patients. Our aim was to characterize skin lesions in elderly patients during late stages of COVID-19 from clinical, histological and immunophenotypic perspectives. CASE SUMMARY: Three patients, admitted for COVID-19, and who developed cutaneous manifestations underwent skin biopsies. Immunophenotypic analysis for CD20, CD3, CD4 and CD8 was performed on skin biopsies to assess immune cell infiltrates. CD1a was used as a marker of Langerhans cells, and CD31 as a marker of endothelial cells. In the three study patients, cutaneous manifestations were evident in the late-stage of COVID-19 (mean time from the first positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) swab to rash onset was 35 d). Skin biopsies showed a similar pattern of T lymphocyte infiltration in all patients. Indeed, a chronic dermatitis with perivascular lymphocytic infiltrate was observed with predominance of CD3+ T-cell (CD3+). CONCLUSION: Our study confirms previous reports. Histological and immunophenotypic patterns in our patients confirm results described in the two previous reported experiences. This pattern is similar to what is found in some lympho-proliferative disorders. Therefore, since these findings are non-specific, SARS-CoV-2 infection should be suspected.

[Transfusion-transmitted protozoal infections: what is the risk in non-endemic countries?]. / Infecções parasitárias transmitidas por transfusão de sangue: qual o risco nos países não endémicos?

Protozoal infections that are efficiently transmitted by blood transfusion include Malaria, Chagas Disease, African Trypanosomiasis, Leshmaniasis, Toxoplasmosis and Babesiosis. With exception of Toxoplasmosis and Leishmaniasis, these diseases are endemic in mainly tropical low income countries and, in non-endemic countries like Portugal, the reported cases are imported from these endemic areas by travelers or immigrants. Globalization, with increasing travel and immigration poses the risk of exposition to these infectious agents and raises the issue of possible transmission by blood transfusion. According to recommendations of the Council of Europe, strategies to prevent the transmission of these infections by blood transfusion have been implemented. Given that the risk is introduced by a specific group of donors, travelers or immigrants from endemic areas, the main strategy to prevent this transmission depends on the identification of these groups of donors using questionnaires during the pre-donation procedures. Additional measures, like serological testing and pathogen inactivation procedures, when available, contribute not only to reduce the risk of transmission but also to avoid unnecessary rejections.