Early detection of P.1 variant of SARS-CoV-2 in a cluster of cases in Salvador, Brazil.

We report 3 cases of severe COVID-19 due to the SARS-CoV-2 P.1 lineage in a familial cluster detected in Salvador, Bahia-Brazil. All cases were linked to travel by family members from the state of Amazonas to Bahia in late December 2020. This report indicates the cryptic transmission of the SARS-CoV-2 P.1 lineage across Brazil and highlights the importance of genomic surveillance to track the emergence of new SARS-CoV-2 variants of concern.

Bridging Learning in Medicine and Citizenship During the COVID-19 Pandemic: A Telehealth-Based Case Study.

BACKGROUND: COVID-19 presented great challenges for not only those in the field of health care but also those undergoing medical training. The burden on health care services worldwide has limited the educational opportunities available for medical students due to social distancing requirements. OBJECTIVE: In this paper, we describe a strategy that combines telehealth and medical training to mitigate the adverse effects of the COVID-19 pandemic. METHODS: A toll-free telescreening service, Telecoronavirus, began operations in March 2020. This service was operated remotely by supervised medical students and was offered across all 417 municipalities (14.8 million inhabitants) in the Brazilian state of Bahia. Students recorded clinical and sociodemographic data by using a web-based application that was simultaneously accessed by medical volunteers for supervision purposes, as well as by state health authorities who conducted epidemiological surveillance and health management efforts. In parallel, students received up-to-date scientific information about COVID-19 via short educational videos prepared by professors. A continuously updated triage algorithm was conceived to provide consistent service. RESULTS: The program operated for approximately 4 months, engaging 1396 medical students and 133 physicians. In total, 111,965 individuals residing in 343 municipalities used this service. Almost 70,000 individuals were advised to stay at home, and they received guidance to avoid disease transmission, potentially contributing to localized reductions in the spread of COVID-19. Additionally, the program promoted citizenship education for medical students, who were engaged in a real-life opportunity to fight the pandemic within their own communities. The objectives of the education, organization, and assistance domains of the Telecoronavirus program were successfully achieved according to the results of a web-based post-project survey that assessed physicians' and students' perceptions. CONCLUSIONS: In a prolonged pandemic scenario, a combination of remote tools and medical supervision via telehealth services may constitute a useful strategy for maintaining social distancing measures while preserving some practical aspects of medical education. A low-cost tool such as the Telecoronavirus program could be especially valuable in resource-limited health care scenarios, in addition to offering support for epidemiological surveillance actions.

Conjuntivite e COVID-19 / Conjunctivitis and COVID-19

RESUMO Apresentamos um caso de conjuntivite por SARS-CoV-2 em mulher de 55 anos, com hiperemia e sensação de corpo estranho em ambos os olhos. O exame oftalmológico revelou conjuntivite. A paciente apresentou reação em cadeia da polimerase de SARS-CoV-2 detectável em swab conjuntival e nasal. O tratamento foi realizado com colírio de ciprofloxacina, corticoide e trometamol por 5 dias. Após o sétimo dia de evolução, houve melhora importante da conjuntivite, e foi repetido swab conjuntival, com resultado não detectável.

ABSTRACT We present a case of SARS-CoV-2 conjunctivitis in a 55-year-old female patient, with hyperemia and foreign body sensation in both eyes. The eye examination revealed conjunctivitis. She had detectable SARS-CoV-2 by polymerase chain reaction on conjunctival and nasal swabs. She was treated with ciprofloxacin eye drops, corticosteroids and trometamol for 5 days. After the seventh day of evolution, there was a significant improvement in conjunctivitis, and repeated conjunctival swab was negative.

Histoplasmosis, An Underdiagnosed Disease Affecting People Living With HIV/AIDS in Brazil: Results of a Multicenter Prospective Cohort Study Using Both Classical Mycology Tests and Histoplasma Urine Antigen Detection.

BACKGROUND: Histoplasmosis is highly endemic in the American continent. This condition is associated with a high mortality, particularly in people living with HIV/AIDS (PLWHA). Diagnosis of histoplasmosis is usually late in South America, as Histoplasma antigen detection is rarely available. Here we determined the prevalence, risk factors, and outcome of histoplasmosis in PLWHA in Brazilian hospitals. METHODS: This was a prospective cohort study (2016-2018) involving 14 tertiary medical centers in Brazil. We included hospitalized PLWHA presenting with fever and additional clinical findings. Patients were investigated at each participant center with classical mycology methods. Also, Histoplasma antigen detection was performed in urine samples (IMMY). Probable/proven histoplasmosis was defined according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group/National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria. RESULTS: From 616 eligible patients, 570 were included. Histoplasmosis was identified in 21.6% (123/570) of patients. Urine antigen testing increased the diagnostic yield in 53.8%, in comparison with standard mycology methods. Variables independently associated with histoplasmosis were CD4+ count <50 cells/mm3, use of an antiretroviral (protective effect), and sample collection in the Northeast region of Brazil. Dyspnea at presentation was independently associated with death. Histoplasmosis was more frequent than tuberculosis in patients with low CD4+ counts. Overall 30-day mortality was 22.1%, decreasing to 14.3% in patients with antigen-based diagnosis. CONCLUSIONS: Histoplasmosis is a very frequent condition affecting PLWHA in Brazil, particularly when CD4+ counts are lower than 50 cells/mm3. Antigen detection may detect earlier disease, with a probable impact on outcomes. Access to this diagnostic tool is needed to improve clinical management of PLWHA in endemic countries.

Histoplasmosis, an underdiagnosed disease affecting people living with HIV/AIDS in Brazil: Results of a multicenter prospective cohort study using both classical mycology tests and histoplasma urine antigen detection

BACKGROUND: Histoplasmosis is highly endemic in the American continent. This condition is associated with a high mortality, particularly in people living with HIV/AIDS (PLWHA). Diagnosis of histoplasmosis is usually late in South America, as Histoplasma antigen detection is rarely available. Here we determined the prevalence, risk factors, and outcome of histoplasmosis in PLWHA in Brazilian hospitals. METHODS: This was a prospective cohort study (2016­2018) involving 14 tertiary medical centers in Brazil. We included hospitalized PLWHA presenting with fever and additional clinical findings. Patients were investigated at each participant center with classical mycology methods. Also, Histoplasma antigen detection was performed in urine samples (IMMY). Probable/proven histoplasmosis was defined according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group/National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria. RESULTS: From 616 eligible patients, 570 were included. Histoplasmosis was identified in 21.6% (123/570) of patients. Urine antigen testing increased the diagnostic yield in 53.8%, in comparison with standard mycology methods. Variables independently associated with histoplasmosis were CD4+ count <50 cells/mm3, use of an antiretroviral (protective effect), and sample collection in the Northeast region of Brazil. Dyspnea at presentation was independently associated with death. Histoplasmosis was more frequent than tuberculosis in patients with low CD4+ counts. Overall 30-day mortality was 22.1%, decreasing to 14.3% in patients with antigen-based diagnosis. CONCLUSIONS: Histoplasmosis is a very frequent condition affecting PLWHA in Brazil, particularly when CD4+ counts are lower than 50 cells/mm3. Antigen detection may detect earlier disease, with a probable impact on outcomes. Access to this diagnostic tool is needed to improve clinical management of PLWHA in endemic countries

Perfil socioeconômico e clínico dos pacientes internados com hiv/aids em hospital de Salvador, Bahia / Socioeconomic profile and clinical reports of patients with hiv/aids in Salvador, Bahia hospital / Perfil socioeconómico y clínico de pacientes ingresados con vih/sida em hospital de Salvador, Bahia

A epidemia da infecção pelo Vírus da Imunodeficiência Humana (HIV) e daSíndrome da Imunodeficiência Adquirida (AIDS) é um fenômeno global, dinâmico e instável cuja forma de ocorrência depende do comportamento humano individual e coletivo. Foram objetivos deste estudo descrever o perfil socioeconômico e cultural dos pacientes internados com HIV/AIDS no Hospital Couto Maia e conhecer o motivo da internação. A metodologiaadotada foi o estudo transversal, observacional. O instrumento de coleta de dados utilizado foi o questionário padronizado, aplicado aos pacientes internados. Os resultados apontaram que a maioria era do sexo masculino, jovem, solteira, baixa escolaridade, baixa renda familiare adquiriu por transmissão heterossexual. Concluiu-se que é necessário maior disseminação das informações de prevenção, diagnóstico mais precoce e reforço na adesão à terapia antirretroviral (TARV), para evitar as internações que ocorrem por infecções oportunistas.

The Human Immunodeficiency Virus (HIV) epidemic and AcquiredImmunodeficiency Syndrome (AIDS) is a global phenomenon whose dynamic and unstable form of occurrence depends on the individual and collective human behavior. The objective of this study was to describe the socio-economic, cultural and clinical development of hospitalized patients with HIV/AIDS, thus be acquainted with the reasons for their admissionto the Hospital Couto Maia. This is an observational Cross-sectional study, conducted through a standardized questionnaire answered by the hospitalized patients. The results showed that most of the patients were young male, unmarried, with low education, low family income andwhose virus was acquired by heterosexual transmission. It can be concluded from this study that it is necessary a greater dissemination of information on prevention, early diagnosis and an enhanced adherence program to HAART to prevent hospitalizations due to opportunisticinfections.

La epidemia de la infección por el Virus de la Inmunodeficiencia Humana (VIH) y del Síndrome de la Inmunodeficiencia Adquirida (SIDA) es un fenómeno global, dinámico e inestable, cuya forma de ocurrencia depende del comportamiento humano individual y colectivo. El objetivo fue describir el perfil socioeconómico y cultural de los pacientes ingresados con VIH/SIDA, en el Hospital Couto Maia, además de conocer el motivo de suinternamiento. Estudio de enfoque transversal, observacional. Para la recolecta de datos se utilizó un cuestionario estandarizado aplicado a los pacientes ingresados. Los resultados indican que la mayoría era hombre, joven, soltero, baja escolaridad, renta familiar baja y adquirió la infección a través de transmisión heterosexual. Se concluye que es necesariodifundir de forma más amplia las informaciones sobre prevención, un diagnóstico precoz y mejorar la adhesión a la terapia antirretroviral (TARV) para prevenir hospitalizaciones que se producen por infecciones oportunistas.