Trajetórias de adolescentes que vivem com o vírus HIV por transmissão vertical / Trajectories of adolescents living with vertical transmission-HIV virus

Resumo Este estudo analisa as histórias de vida de oito jovens vivendo com HIV por transmissão vertical, visando compreender suas percepções marcadas pelo segredo e silêncio sobre suas vivências com o vírus. Realizado em ambulatório especializado no Rio de Janeiro, o estudo adotou como ferramenta de cuidado a dança circular, considerada uma Prática Integrativa e Complementar em Saúde. Utilizando abordagem qualitativa e a História de Vida como método de coleta, o foco foi compreender as experiências dos jovens, não apenas relacionadas à doença, mas também a aspectos cruciais de suas vidas. Participaram do estudo três meninas e cinco meninos, todos cientes de seu diagnóstico. Os principais temas emergentes incluíram dinâmica familiar, conexão com o ambiente escolar, desafios na adesão ao tratamento, idade no momento da revelação do diagnóstico e tempo decorrido desde então. A análise das narrativas desses jovens, permitiu explorar aspectos individuais e sociais da experiência, revelando similaridades e diferenças entre eles. As oficinas de dança circular ofereceram um espaço lúdico para a expressão de emoções e sentimentos por meio dos movimentos corporais, ampliando as perspectivas dos jovens em relação ao futuro.

Abstract This study analyzes the life stories of eight young people living with vertically transmitted HIV in order to understand their perceptions marked by secrecy and silence regarding their experiences with the virus. Conducted at a specialized outpatient clinic in Rio de Janeiro, the study adopted circle dance, a Complementary and Integrative Health Practice, as a care tool. Using a qualitative approach and Life History as a data collection method, the focus was to understand the youth's experiences related to the disease and the crucial aspects of their lives. Three girls and five boys participated in the study, all aware of their diagnosis. The principal emerging themes included family dynamics, school environment connection, challenges in treatment adherence, age at the time of diagnosis disclosure, and time elapsed since then. Analyzing these young people's narratives allowed us to explore individual and social aspects of their experiences, revealing their similarities and differences. The circle dance workshops provided a playful space for expressing emotions and feelings through body movements, expanding young people's perspectives on the future.

Equidae pythiosis in Brazil and the world: a systematic review of the last 63 years (1960-2023).

This systematic review compiles reports of clinical pythiosis in horses, mules and donkeys from 1960 to 2023 worldwide, focusing on Brazil. We searched databases and included 71 articles detailing clinical characteristics, geographic distribution, epidemiology, diagnostic methods, therapies, and outcomes. The results showed that publications on equine pythiosis have significantly increased since 2010. Brazil reported the highest incidence, comprising 55% of cases, predominantly in the southern, northeastern, and central-western regions during summer and autumn. Cutaneous pythiosis was the most prevalent form, generally presenting as single lesions in the appendicular region, and affected females more than males. Diagnosis typically involved histopathology, used alone or with other methods. Various treatments have been employed, with surgery, often combined with chemotherapy and immunotherapy, being the most common. Notably, 80.84% of treated animals recovered, highlighting the effectiveness of these therapies in enhancing survival rates. The limitations of the study included the lack of data in published case reports, which made it difficult to collect and calculate epidemiological data. Additionally, we recognize that pythiosis in Brazil is underreported, since this disease does not have mandatory notification and several cases are not registered and/or reported in the literature. Lastly, it is hypothesized that equid pythiosis may be more widespread than currently known, and its real occurrence in Brazil remains uncertain.

Pooled Cohort Profile: ReCoDID Consortium's Harmonized Acute Febrile Illness Arbovirus Meta-Cohort.

Infectious disease (ID) cohorts are key to advancing public health surveillance, public policies, and pandemic responses. Unfortunately, ID cohorts often lack funding to store and share clinical-epidemiological (CE) data and high-dimensional laboratory (HDL) data long term, which is evident when the link between these data elements is not kept up to date. This becomes particularly apparent when smaller cohorts fail to successfully address the initial scientific objectives due to limited case numbers, which also limits the potential to pool these studies to monitor long-term cross-disease interactions within and across populations. CE data from 9 arbovirus (arthropod-borne viruses) cohorts in Latin America were retrospectively harmonized using the Maelstrom Research methodology and standardized to Clinical Data Interchange Standards Consortium (CDISC). We created a harmonized and standardized meta-cohort that contains CE and HDL data from 9 arbovirus studies from Latin America. To facilitate advancements in cross-population inference and reuse of cohort data, the Reconciliation of Cohort Data for Infectious Diseases (ReCoDID) Consortium harmonized and standardized CE and HDL from 9 arbovirus cohorts into 1 meta-cohort. Interested parties will be able to access data dictionaries that include information on variables across the data sets via Bio Studies. After consultation with each cohort, linked harmonized and curated human cohort data (CE and HDL) will be made accessible through the European Genome-phenome Archive platform to data users after their requests are evaluated by the ReCoDID Data Access Committee. This meta-cohort can facilitate various joint research projects (eg, on immunological interactions between sequential flavivirus infections and for the evaluation of potential biomarkers for severe arboviral disease).

Zoonotic assemblages A and B of Giardia duodenalis in Chiroptera from Brazilian Amazon biome.

Bats are important reservoirs and spreaders of pathogens. Giardia duodenalis is a globally important protozoan that infects humans and other mammals with considerable public health burden, particularly on the child development. Based on genetic variation and host specificity, G. duodenalis is categorized into eight genotypes/assemblages A-H. Assemblages A and B are widespread globally and are associated with human and animal disease. There is evidence of Giardia in the bat feces from diverse geographic regions, but the G. duodenalis assemblages are unknown, which is a key point for the One Health view. Here, we successfully amplified the BG/GDH/DIS3/HCMP2/HCMP3 targets of G. duodenalis from five bat species captured in the Brazilian Amazon biome revealing the presence of zoonotic G. duodenalis assemblages A and B in the feces of these flying mammals. Our study reveals that bats may play a role in transmission of zoonotic G. duodenalis, at least in this biome.

Wastewater surveillance for viral pathogens: A tool for public health.

A focus on water quality has intensified globally, considering its critical role in sustaining life and ecosystems. Wastewater, reflecting societal development, profoundly impacts public health. Wastewater-based epidemiology (WBE) has emerged as a surveillance tool for detecting outbreaks early, monitoring infectious disease trends, and providing real-time insights, particularly in vulnerable communities. WBE aids in tracking pathogens, including viruses, in sewage, offering a comprehensive understanding of community health and lifestyle habits. With the rise in global COVID-19 cases, WBE has gained prominence, aiding in monitoring SARS-CoV-2 levels worldwide. Despite advancements in water treatment, poorly treated wastewater discharge remains a threat, amplifying the spread of water-, sanitation-, and hygiene (WaSH)-related diseases. WBE, serving as complementary surveillance, is pivotal for monitoring community-level viral infections. However, there is untapped potential for WBE to expand its role in public health surveillance. This review emphasizes the importance of WBE in understanding the link between viral surveillance in wastewater and public health, highlighting the need for its further integration into public health management.

High Uptake of Respiratory Syncitial Virus Prevention for Neonates in a Military Treatment Facility.

We investigated the uptake of nirsevimab for infants and the bivalent respiratory syncytial virus prefusion F (RSVPreF) vaccine for pregnant persons as measures for RSV prevention during an infant's birth hospitalization in a military treatment facility. We found >85% uptake between October 2023 to February 2024. These data may aid health systems plan for future RSV seasons.

Histoplasmosis in Non-HIV Infected Patients: Another Neglected Infection in French Guiana.

(1) Background: Only a few studies on histoplasmosis in immunocompetent patients have been reported in French Guiana. Therefore, we conducted a detailed clinical description of hospitalized patients suffering with histoplasmosis among non-HIV patients. (2) Methods: This is a single-center, retrospective study conducted at Cayenne Hospital Center between 2008 and 2022. (3) Results: Our cohort was composed of 31 (91%) adults (>18 years of age) and 3 (9%) children, with a sex ratio, M:F, of 1:2. The median age was higher among the women than among the men (70 versus 54 years). The collection of respiratory samples constituted the majority of the performed examinations (38%). Fever (>37 °C) was found in 56% of patients. Surprisingly, the histoplasmosis was disseminated in 82% of patients with an overall case fatality rate of 14.7%. However, immunosuppressive conditions were found in 52% (16/31) of the adult patients, including lymphoid hemopathies, diabetes and immunosuppressive drugs. Conclusions: This disease, though rare and usually considered a mostly benign disease in non-HIV patients, presented a relatively high mortality rate in our cohort. Thus, histoplasmosis should be suspected, screened and investigated as a first line of defense in highly endemic areas, even in immunocompetent and non-HIV patients, especially those with fever or chronic respiratory symptoms.

Isolation and molecular identification of Leptospira santarosai and Leptospira interrogans in equines from eastern Mexico.

Leptospirosis is an infectious disease with a worldwide distribution, which represents a major challenge in animal production across developing countries, mainly in tropical areas. Horses are particularly susceptible to the disease, presenting manifestations ranging from subclinical to the development of uveitis that compromises the visual health of the animals. In recent years, serological studies have been carried out in equid populations from America, demonstrating high exposure. For this reason, the aim of this study was to demonstrate microbiologically and molecularly the presence of the members of the genus Leptospira in urine samples from equids in an endemic state of leptospirosis in Mexico, and to detect the serological presence of anti-Leptospira antibodies in the sampled animals. For this reason, blood and urine samples were collected from 28 horses and one mule from three localities in the state of Veracruz, Mexico. Urine samples were inoculated in Ellinghausen-McCullough-Johnson-Harris (EMJH) medium, and the recovered isolates were typed using a short Multi Locus Sequence Typing scheme. Amplifications of the expected size were subjected to sequencing, and the recovered sequences were compared with those of reference deposited in GenBank using the BLAST tool. To identify their phylogenetic position, we performed a phylogenetic reconstruction using the maximum likelihood method. Additionally, Microscopic Agglutination test was performed on the serum samples to identify anti-Leptospira antibodies. We recovered 16 urine isolates which tested positive for the presence of Leptospira DNA. The phylogenetic reconstruction and the MLST analysis confirmed the presence of several genotypes of Leptospira interrogans and Leptospira santarosai. An overall serological frequency of 97.1 % was detected. Our results represent the first record of the presence of Leptospira through bacteriological isolates in equids from Mexico.

Characterizing the blood microbiota in healthy and febrile domestic cats via 16s rRNA sequencing.

This study aimed to evaluate the blood bacterial microbiota in healthy and febrile cats. High-quality sequencing reads from the 16S rRNA gene variable region V3-V4 were obtained from genomic blood DNA belonging to 145 healthy cats, and 140 febrile cats. Comparisons between the blood microbiota of healthy and febrile cats revealed dominant presence of Actinobacteria, followed by Firmicutes and Proteobacteria, and a lower relative abundance of Bacteroidetes. Upon lower taxonomic levels, the bacterial composition was significantly different between healthy and febrile cats. The families Faecalibacterium and Kineothrix (Firmicutes), and Phyllobacterium (Proteobacteria) experienced increased abundance in febrile samples. Whereas Thioprofundum (Proteobacteria) demonstrated a significant decrease in abundance in febrile. The bacterial composition and beta diversity within febrile cats was different according to the affected body system (Oral/GI, systemic, skin, and respiratory) at both family and genus levels. Sex and age were not significant factors affecting the blood microbiota of febrile cats nor healthy ones. Age was different between young adult and mature adult healthy cats. Alpha diversity was unaffected by any factors. Overall, the findings suggest that age, health status and nature of disease are significant factors affecting blood microbiota diversity and composition in cats, but sex is not.

Persistent Food Insecurity and Material Hardships: A Latent Class Analysis of Experiences among Venezuelan Refugees and Migrants in Urban Colombia.

The causes and conditions of displacement often increase the vulnerability of migrant and refugee populations to food insecurity, alongside other material hardships. We aimed to examine the multidimensional aspects and patterns of food insecurity and other material hardships in a cross-sectional sample of 6221 Venezuelan refugees and migrants in urban Colombia using a latent class analysis. Using multinomial and logistic regression models, we investigated the demographic and migratory experiences associated with identified classes and how class membership is associated with multiple health outcomes among Venezuelan refugees and migrants, respectively. Approximately two thirds of the sample was comprised cisgender women, and the participants had a median age of 32 years (IQR: 26-41). Four heterogeneous classes of food insecurity and material hardships emerged: Class 1-low food insecurity and material hardship; Class 2-high food insecurity and material hardship; Class 3-high income hardship with insufficient food intake; and Class 4-income hardship with food affordability challenges. Class 2 reflected the most severe food insecurity and material hardships and had the highest class membership; Venezuelans with an irregular migration status were almost 1.5 times more likely to belong to this class. Food insecurity and material hardship class membership was independently associated with self-rated health, mental health symptoms, and recent violence victimization and marginally associated with infectious disease outcomes (laboratory-confirmed HIV and/or syphilis infection). Social safety nets, social protection, and other interventions that reduce and prevent material hardships and food insecurity among refugees and migrants, alongside the host community, may improve public health, support development, and reduce healthcare costs. In the long term, regularization and social policies for migrants aimed at enhancing refugees' and migrants' social and economic inclusion may contribute to improving food security in this population.

Cognitive impairment increases in older people living with HIV: a systematic review of cohort studies / Aumento do comprometimento cognitivo em idosos que vive m com HIV: revisão sistemática de estudos de corte

The progressive increase in HIV infection among older adults requires constant research and monitoring, given that geriatric syndromes associated with HIV comorbidities have become an important public health problem. We reported this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and it has a central question: Is the incidence of cognitive impairment higher in older patients living with HIV than in their seronegative peers? The following databases were searched for this review: MEDLINE/PubMed, EMBASE, LILACS, Web of Science, and Scopus. The inclusion criteria were studies whose samples were ≥ 50% patients aged ≥ 50 years, with and without HIV, and a main outcome related to the incidence of cognitive impairment. Only cohort studies with follow-up lasting ≥ 24 months were considered. Three reviewers independently screened the documents for eligibility criteria, extracted the data, assessed the risk of bias (Newcastle-Ottawa Scale), and evaluated the quality of evidence. A narrative synthesis was prepared. In total, 10 798 trials were screened, 8884 were excluded, 14 were analyzed, and 5 were included in this review. Only 1 applied cognitive assessment tests; the rest used secondary data from the medical records. Most found that the incidence of cognitive disorders was higher among older people living with HIV, which highlights the need for public policies aimed at primary and secondary prevention strategies. Further research from other countries is still required. PROSPERO register (CRD42022321914). (AU)

Integrated plasma proteomics identifies tuberculosis-specific diagnostic biomarkers.

BACKGROUNDNovel biomarkers to identify infectious patients transmitting Mycobacterium tuberculosis are urgently needed to control the global tuberculosis (TB) pandemic. We hypothesized that proteins released into the plasma in active pulmonary TB are clinically useful biomarkers to distinguish TB cases from healthy individuals and patients with other respiratory infections.METHODSWe applied a highly sensitive non-depletion tandem mass spectrometry discovery approach to investigate plasma protein expression in pulmonary TB cases compared to healthy controls in South African and Peruvian cohorts. Bioinformatic analysis using linear modeling and network correlation analyses identified 118 differentially expressed proteins, significant through 3 complementary analytical pipelines. Candidate biomarkers were subsequently analyzed in 2 validation cohorts of differing ethnicity using antibody-based proximity extension assays.RESULTSTB-specific host biomarkers were confirmed. A 6-protein diagnostic panel, comprising FETUB, FCGR3B, LRG1, SELL, CD14, and ADA2, differentiated patients with pulmonary TB from healthy controls and patients with other respiratory infections with high sensitivity and specificity in both cohorts.CONCLUSIONThis biomarker panel exceeds the World Health Organization Target Product Profile specificity criteria for a triage test for TB. The new biomarkers have potential for further development as near-patient TB screening assays, thereby helping to close the case-detection gap that fuels the global pandemic.FUNDINGMedical Research Council (MRC) (MR/R001065/1, MR/S024220/1, MR/P023754/1, and MR/W025728/1); the MRC and the UK Foreign Commonwealth and Development Office; the UK National Institute for Health Research (NIHR); the Wellcome Trust (094000, 203135, and CC2112); Starter Grant for Clinical Lecturers (Academy of Medical Sciences UK); the British Infection Association; the Program for Advanced Research Capacities for AIDS in Peru at Universidad Peruana Cayetano Heredia (D43TW00976301) from the Fogarty International Center at the US NIH; the UK Technology Strategy Board/Innovate UK (101556); the Francis Crick Institute, which receives funding from UKRI-MRC (CC2112); Cancer Research UK (CC2112); and the NIHR Biomedical Research Centre of Imperial College NHS.

Epidemiological profile of individuals with HIV/Aids in a municipality in Maranhão State, Brazil, from 2017 to 2020 / Perfil epidemiológico de individuos con VIH/SIDA en municipio en Maranhão, Brasil, de 2017 a 2020 / Perfil epidemiológico de indivíduos com HIV/Aids em município no Maranhão, Brasil, de 2017 a 2020

Background and Objective: To understand the main forms of transmission of HIV in order to foster the containment of the transmission chain, early diagnosis and the epidemiological profile of patients. In this sense, it will enable the analysis of the epidemiological profile and the transmissibility variables of patients with HIV/Aids from the municipality of Imperatriz-MA.. Method: This is an observational cross-sectional study. Data collection was performed from the analysis of patients' records registered in the Center for Testing and Counseling (CTA) from 2017 to 2020. For data collection, a questionnaire with transmission variables and epidemiological characteristics of patients was used. Results: From January 2017 to December 2020, 211 medical records were filed. Of these, 71.6% were male, 55.5% of the participants were between 21 and 40 years, and 66.4% from Imperatriz-MA. The most prevalent type of exposure was sexual intercourse without a condom. Among the participants, 83.9% (n=177) were positive only for HIV. About 140 people with HIV had an undetectable viral load (VL) (< 50 copies/ml) after 6 months of using antiretroviral therapy, making it low transmissibility. Conclusion: The study was able to characterize the epidemiological profile of patients from the Specialized Assistance Service (SAE) in Imperatriz between 2017 and 2020. Despite the increase in the number of cases among women, the most affected public remains young men, from 21 to 40 years of age, with 8 to 11 years of education, single and brown. Sexual intercourse without a condom is the main type of exposure.(AU)

Justificación y Objetivo: Buscando proporcionar a la contención de la cadena de transmisión del VIH, el diagnóstico precoz y el perfil epidemiológico de los pacientes para conocer las principales formas de transmisión del VIH. En este sentido, el estudio tiene como objetivo analizar el perfil epidemiológico y las variables de transmisibilidad de los usuarios con VIH/sida del municipio de Imperatriz-MA. Método: Se trata de un estudio observacional de carácter transversal, la recolección de datos fue realizada a partir del análisis de registros de usuarios registrados en el CTA en el período de 2017 a 2020. Para la recolección de datos, se utilizó un cuestionario con variables de transmisión y características epidemiológicas de los pacientes. Resultados: Se registraron 211 registros y enero de 2017 a diciembre de 2020. De estos, 71,6% del sexo masculino, 55,5% de los participantes tenían entre 21 y 40 años y 66,4% de Imperatriz - MA. El tipo de exposición más prevalente fue la relación sexual sin condón. Entre los participantes, 83,9% (n=177) fueron positivos solo para el VIH. Cerca de 140 personas con VIH tenían carga viral indetectable (< 50 copias/ml) después de 6 meses usando terapia antirretroviral, haciéndola de baja transmisibilidad. Conclusión: El público más afectado sigue siendo hombres jóvenes, de 21 a 40 años, con 8 a 11 años de educación, solteros y de piel morena. Las relaciones sexuales sin preservativo son el principal tipo de exposición.(AU)

Justificativa e Objetivo: Conhecer as principais formas de transmissão do HIV para proporcionar a contenção da cadeia de transmissão do HIV, o diagnóstico precoce e o perfil epidemiológico dos pacientes. Nesse sentido, será possível analisar o perfil epidemiológico e as variáveis de transmissibilidade dos usuários com HIV/Aids do município de Imperatriz-MA. Métodos: Trata-se de um estudo observacional de caráter transversal. A coleta de dados foi realizada a partir da análise de registros de usuários cadastrados no CTA no período de 2017 a 2020. Para a coleta de dados, utilizou-se um questionário com variáveis de transmissão e características epidemiológicas dos pacientes. Resultados: Foram registrados 211 prontuários de janeiro de 2017 a dezembro de 2020. Destes, 71,6% do sexo masculino, 55,5% dos participantes tinham entre 21 e 40 anos e 66,4% de Imperatriz-MA. O tipo de exposição mais prevalente foi a relação sexual sem preservativo. Entre os participantes, 83,9% (n=177) foram positivos apenas para HIV. Cerca de 140 pessoas com HIV tinham carga viral indetectável (< 50 cópias/ml) após 6 meses usando terapia antirretroviral, tornando-a de baixa transmissibilidade. Conclusões: O estudo conseguiu caracterizar o perfil epidemiológico dos usuários de SAE em Imperatriz entre 2017 e 2020. Apesar do aumento no número de casos em mulheres, o público mais afetado continua sendo homens jovens, de 21 a 40 anos, com 8 a 11 anos de educação, solteiros e pardos. A relação sexual sem preservativo é o principal tipo de exposição.(AU)

Bacterial Meningitis in Buffaloes in Brazil.

Meningitis is the inflammation of the membranes surrounding the central nervous system and is poorly described in water buffaloes. Five cases of meningitis in adults buffaloes of the Murrah and Mediterranean breads were studied. All buffaloes came from a farm located in the municipality of Castanhal, Pará, Brazil at different times. Clinical examination showed neurological clinical signs, such as apathy, reluctance to move, spastic paresis especially of the pelvic limbs, hypermetria, difficulty getting up, pressing of the head into obstacles and convulsion. In three buffaloes, a large part of the horn had been lost, exposing the corresponding frontal sinus, through which a bloody to purulent exudate flowed. The hemogram revealed neutrophilic leukocytosis. At necropsy, adherence of the dura mater to the periosteum and a purulent to fibrinopurulent exudate were observed in the sulci of the cerebral cortex and on the pia mater over almost the entire surface of the brain and throughout the spinal cord. The cerebrospinal fluid had a cloudy aspect with fibrin filaments. The histopathology of buffaloes confirmed the diagnosis of bacterial fibrinopurulent meningitis. Buffaloes are susceptible to bacterial inflammation of the meninges due to fractures of the base of the horn and mostly present with neurological manifestations.

Neurodevelopmental Outcomes of Normocephalic Colombian Children with Antenatal Zika Virus Exposure at School Entry.

The long-term neurodevelopmental effects of antenatal Zika virus (ZIKV) exposure in children without congenital Zika syndrome (CZS) remain unclear, as few children have been examined to the age of school entry level. A total of 51 Colombian children with antenatal ZIKV exposure without CZS and 70 unexposed controls were evaluated at 4-5 years of age using the Behavior Rating Inventory of Executive Function (BRIEF), the Pediatric Evaluation of Disability Inventory (PEDI-CAT), the Bracken School Readiness Assessment (BSRA), and the Movement Assessment Battery for Children (MABC). The mean ages at evaluation were 5.3 and 5.2 years for cases and controls, respectively. Elevated BRIEF scores in Shift and Emotional Control may suggest lower emotional regulation in cases. A greater number of cases were reported by parents to have behavior and mood problems. BSRA and PEDI-CAT activity scores were unexpectedly higher in cases, most likely related to the COVID-19 pandemic and a delayed school entry among the controls. Although PEDI-CAT mobility scores were lower in cases, there were no differences in motor scores on the MABC. Of 40 cases with neonatal neuroimaging, neurodevelopment in 17 with mild non-specific findings was no different from 23 cases with normal neuroimaging. Normocephalic children with ZIKV exposure have positive developmental trajectories at 4-5 years of age but differ from controls in measures of emotional regulation and adaptive mobility, necessitating continued follow-up.

The emergence of Rocky Mountain spotted fever in the southwestern United States and northern Mexico requires a binational One Health approach.

Rocky Mountain spotted fever (RMSF) is an international and quintessential One Health problem. This paper synthesizes recent knowledge in One Health, binational RMSF concerns, and veterinary and human medical perspectives to this fatal, reemerging problem. RMSF, a life-threatening tick-borne disease caused by the bacterium Rickettsia rickettsii, emerged during the first decade of the 21st century in impoverished communities in the southwestern US and northern Mexico. Lack of an index of suspicion, delay in diagnosis, and delayed initiation of antibiotic treatment contribute to fatality. Campaigns targeting dog neutering, restraint to residents' properties, and on-dog and on-premises treatment with acaricides temporarily reduce prevalence but are often untenable economically. Contemporary Mexican RMSF is hyperendemic in small communities and cities, whereas epidemics occur in the western US primarily in small tribal communities. In in both locations, the epidemics are fueled by free-roaming dogs and massive brown dog tick populations. In the US, RMSF has a case fatality rate of 5% to 7%; among thousands of annual cases in Mexico, case fatality often exceeds 30%.1,2 Numerous case patients in US border states have recent travel histories to northern Mexico. Veterinarians and physicians should alert the public to RMSF risk, methods of prevention, and the importance of urgent treatment with doxycycline if symptomatic. One Health professionals contribute ideas to manage ticks and rickettsial disease and provide broad education for the public and medical professionals. Novel management approaches include vaccine development and deployment, acaricide resistance monitoring, and modeling to guide targeted dog population management and other interventions.

Spatial and temporal trends of dengue infections in Curaçao: A 21-year analysis.

Dengue viruses are a significant global health concern, causing millions of infections annually and putting approximately half of the world's population at risk, as reported by the World Health Organization (WHO). Understanding the spatial and temporal patterns of dengue virus spread is crucial for effective prevention of future outbreaks. By investigating these patterns, targeted dengue surveillance and control measures can be improved, aiding in the management of outbreaks in dengue-affected regions. Curaçao, where dengue is endemic, has experienced frequent outbreaks over the past 25 years. To examine the spatial and temporal trends of dengue outbreaks in Curaçao, this study employs an interdisciplinary and multi-method approach. Data on >6500 cases of dengue infections in Curaçao between the years 1995 and 2016 were used. Temporal and spatial statistics were applied. The Moran's I index identified the presence of spatial autocorrelation for incident locations, allowing us to reject the null hypothesis of spatial randomness. The majority of cases were recorded in highly populated areas and a relationship was observed between population density and dengue cases. Temporal analysis demonstrated that cases mostly occurred from October to January, during the rainy season. Lower average temperatures, higher precipitation and a lower sea surface temperature appear to be related to an increase in dengue cases. This effect has a direct link to La Niña episodes, which is the cooling phase of El Niño Southern Oscillation. The spatial and temporal analyses conducted in this study are fundamental to understanding the timing and locations of outbreaks, and ultimately improving dengue outbreak management.

Oral and oropharyngeal mucosal lesions: clinical-epidemiological study of patients attended at a reference center for infectious diseases.

OBJECTIVE: To determine the prevalence, epidemiological profile, and clinical characteristics of Oral or Oropharyngeal Mucosal Lesions (OOPML) in patients attended at the Otorhinolaryngology Service of the Evandro Chagas National Institute of Infectious Diseases (INI-FIOCRUZ) from 2005 to 2017. METHODS: Statistical analysis of descriptive data from medical records (gender, age, education level, skin color, origin, smoking, alcoholism, HIV co-infection, time of disease evolution, first symptom, and OOPML location) was performed. RESULTS: Of 7551 patients attended at the service, 620 (8.2%) were included in the study. OOPML were classified into developmental anomalies (n = 3), infectious diseases (non-granulomatous n = 220; granulomatous n = 155), autoimmune diseases (n = 24), neoplasms (benign n = 13; malignant, n = 103), and unclassified epithelial/soft tissue diseases (n = 102). OOPML of infectious diseases (60.5%) and neoplasms (18.7%) were the most frequent. The predominant demographics of patients with OOPML were: males (63.5%), white (53.5%), and those in the fifth to sixth decades of life (43.3%). Local pain (18.1%) and odynophagia (15%) were the most reported first symptoms, and the most frequent OOPML sites were the palatine tonsil (28.5%), hard palate (22.7%), and tongue (20.3%). The median evolution time was three months. CONCLUSIONS: Infectious OOPML were the most frequent, as expected in a reference center for infectious diseases, and thus, they are likely to be less frequent in general care and/or dental services. Underreporting of OOPML is possible, as oral/oropharyngeal examination is often not included in the routine medical examination. Oral cavity/oropharynx examination should be performed by specialists, such as dentists and otorhinolaryngologists, who have the expertise in identifying OOPML, even in incipient/asymptomatic cases. Given the numerous diseases in which OOPML can present, diagnosis could be facilitated by multidisciplinary teams, potentially enabling the early treatment of diseases, and thus, reduce morbidity and improve prognosis. The use of standardized medical records for oral/oropharyngeal systematic examination could provide relevant tools for differential diagnoses and information for new clinical-epidemiological studies. LEVEL OF EVIDENCE: Level 3.

Combining Digital and Molecular Approaches Using Health and Alternate Data Sources in a Next-Generation Surveillance System for Anticipating Outbreaks of Pandemic Potential.

Globally, millions of lives are impacted every year by infectious diseases outbreaks. Comprehensive and innovative surveillance strategies aiming at early alert and timely containment of emerging and reemerging pathogens are a pressing priority. Shortcomings and delays in current pathogen surveillance practices further disturbed informing responses, interventions, and mitigation of recent pandemics, including H1N1 influenza and SARS-CoV-2. We present the design principles of the architecture for an early-alert surveillance system that leverages the vast available data landscape, including syndromic data from primary health care, drug sales, and rumors from the lay media and social media to identify areas with an increased number of cases of respiratory disease. In these potentially affected areas, an intensive and fast sample collection and advanced high-throughput genome sequencing analyses would inform on circulating known or novel pathogens by metagenomics-enabled pathogen characterization. Concurrently, the integration of bioclimatic and socioeconomic data, as well as transportation and mobility network data, into a data analytics platform, coupled with advanced mathematical modeling using artificial intelligence or machine learning, will enable more accurate estimation of outbreak spread risk. Such an approach aims to readily identify and characterize regions in the early stages of an outbreak development, as well as model risk and patterns of spread, informing targeted mitigation and control measures. A fully operational system must integrate diverse and robust data streams to translate data into actionable intelligence and actions, ultimately paving the way toward constructing next-generation surveillance systems.

Hemotropic Mycoplasmas (Hemoplasmas) in Free-Ranging Azara's Agoutis (Dasyprocta azarae) from an Urban Area of Southern Brazil.

Hemotropic mycoplasmas (hemoplasmas) are opportunistic bacteria that attach to the erythrocyte surface, causing infectious anemia in several mammalian species, including rodents. Studies surveying native Azara's agoutis (Dasyprocta azarae) in Brazil are lacking. Accordingly, the present study aimed to assess hemoplasmas infection in free-ranging agoutis from an urban environmental conservation area in Curitiba, southern Brazil. Overall, 11/35 (31.43%) agoutis were positive to hemoplasmas by quantitative PCR (cycle threshold≤34.4). Sequencing of the 16S ribosomal RNA gene indicated Mycoplasma haemomuris infection, closely related to M. haemomuris subsp. ratti, suggesting hemoplasma transmission from urban rats to agoutis. Because the main route of M. haemomuris transmission has been direct rodent-to-rodent infection, the relatively lower positivity that we detected may be the result of low intraspecies contact due to the smaller social units of agoutis, generally consisting of two to four individuals, and low interspecies contact due to only sporadic agouti-rat interactions in urban settings, compared with other rodent species interactions. Further studies should be conducted to determine whether the hemoplasma infection that we found can cause clinical onset and life-threatening anemia in agoutis.