Double Trouble: Dengue Followed by COVID-19 Infection Acquired in Two Different Regions: A Doctor's Case Report and Spatial Distribution of Cases in Presidente Prudente, São Paulo, Brazil.

Co-epidemics of COVID-19 and dengue in dengue-endemic countries represent a serious public health concern. In Brazil, São Paulo state ranks first for cases and deaths from COVID-19, and dengue is endemic in most regions of the country. In 2020, an outbreak of dengue occurred in western São Paulo. We determined the spatiotemporal distribution of dengue in the context of COVID-19 cases in Presidente Prudente, a mid-sized city in western São Paulo. To illustrate the burden of both infections, a case report of a doctor and his family, infected with dengue and COVID-19, is presented. There were three clusters of dengue and COVID-19 in the periphery. A dengue cluster was found in a region where there were no corresponding COVID-19 cases. Meanwhile, there were COVID-19 clusters where dengue activity was lower. In 2020, the COVID-19 epidemic emerged when dengue reached its seasonal peak, resulting in a simultaneous outbreak of both diseases. Lower rates of dengue were found in the city compared with 2019, and the fear of patients with mild dengue symptoms about remaining in hospital and acquiring COVID-19 infection may be the main cause. Simultaneous spatial clusters of dengue and COVID-19 in environmentally and socioeconomically vulnerable areas can guide public health authorities in intensive interventions to improve clinical diagnosis, epidemiological surveillance, and management of both diseases. The patient and his family were first infected with dengue and he then carried COVID-19 to his family, reinforcing the risk of health care workers spreading the virus to the community. We highlight the epidemiological significance of presenting a case report and spatial analysis of COVID-19 in the same study in the context of a dengue outbreak.

Clinical, Epidemiological, and Geospatial Characteristics of Patients Infected with Hepatitis C Virus Treated with Second-Generation Direct-Action Antivirals in a Reference Center in a Mesoregion of São Paulo State, Brazil.

Hepatitis virus infection is a major public health problem worldwide. Currently, Brazil has almost 700,000 cases. The Brazilian Unified Health System (SUS) provides therapeutic regimens for people infected with hepatitis C virus (HCV). We determined the clinical, laboratory, epidemiologic, and geospatial characteristics of patients infected with HCV treated with second-generation direct-action antivirals (DAAs) in a hospital reference center in São Paulo state, Brazil, using data from file records. A map was constructed using a geographic information system. From 2015 to 2018, 197 individuals received second-generation DAAs (mean age, 57.68 ± 1.36 years; interquartile range, 56.22-59.14 years; 58.9% male; 41.1% female). Genotypes 1a and 1b accounted for 75.7% of cases and the prevalent therapeutic regimen was sofosbuvir/simeprevir. Sustained viral response accounted for 98.9% and the METAVIR score F3/F4 for 50.8%. Increased alanine transferase was significantly correlated with an increase in α-fetoproteins (p = 0.01), and severe necro-inflammatory activity (p = 0.001). Associated comorbidities were found in 71.6%, mainly coronary artery and gastrointestinal disorders. The cumulative incidence in the region was 2.6 per 10,000 inhabitants. Our data highlight the role of reference hospitals in Brazil's public health system in the treatment of HCV. Low incidence rates demonstrated the fragility of municipalities in the active search for patients.

Infectious diseases and immunological markers associated with patients with non-Hodgkin lymphoma treated with rituximab.

BACKGROUND: The use of rituximab (RTX) is increasing, even in developing countries. It has become the first-line therapy or adjuvant to chemotherapy (CHOP; cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone) for various diseases, including B cell lymphoma and autoimmune diseases. AIM: We describe the infectious diseases and immunological markers associated with RTX treatment of patients with non-Hodgkin lymphoma (NHL). METHODS: Serum immunoglobulins were determined before and after intravenous immunoglobulin (IVIg) administration. Pneumo-23IgG-specific anti-pneumococcal antibodies were evaluated before and after vaccination. Immunophenotyping and lymphocyte proliferation were determined in the course of the treatment. RESULTS: Seven patients were followed and median age was 56.0 ± 5.0 years (range, 41.9-71.6 years). At baseline, the mean level of IgG was 333.7 ± 40.8 and IgM 40.9 ± 11.3 mg/dL, respectively; immunoglobulin A and E (IgA and IgE) were under the limit of detection. Two patients had reduced or absent B cells and T cell subsets were at normal levels in five patients. All patients failed to mount an efficient post-vaccination immune response against hepatitis B virus, tetanus, diphtheria and against the 23-valent pneumococcal polysaccharide vaccine. During RTX/CHOP treatment, human-IgG-immunoglobulin (IVIg) therapy was introduced in six patients after recurrent infections, including community-acquired pneumonia (85.7%), chronic sinusitis (85.7%) and gastroenteritis (42.9%). CONCLUSION: Poor response against pneumococcal vaccines increases the susceptibility of respiratory diseases in these patients. In patients with NHL treated with RTX, the benefits achieved with IVIg replacement for the control of recurrent infectious diseases is of paramount importance. Clinicians dealing with monoclonal antibodies against cancer therapy, especially RTX, should be aware of the increasing risks for symptomatic induced hypogammaglobulinemia and respiratory infections.