Influence of microbiota-driven natural antibodies on dengue transmission.

Dengue has had a significant global health impact, with a dramatic increase in incidence over the past 50 years, affecting more than 100 countries. The absence of a specific treatment or widely applicable vaccine emphasizes the urgent need for innovative strategies. This perspective reevaluates current evidence supporting the concept of dual protection against the dengue virus (DENV) through natural antibodies (NAbs), particularly anti-α-Gal antibodies induced by the host's gut microbiome (GM). These anti-α-Gal antibodies serve a dual purpose. Firstly, they can directly identify DENV, as mosquito-derived viral particles have been observed to carry α-Gal, thereby providing a safeguard against human infections. Secondly, they possess the potential to impede virus development in the vector by interacting with the vector's microbiome and triggering infection-refractory states. The intricate interplay between human GM and NAbs on one side and DENV and vector microbiome on the other suggests a novel approach, using NAbs to directly target DENV and simultaneously disrupt vector microbiome to decrease pathogen transmission and vector competence, thereby blocking DENV transmission cycles.

Characterization of Dengue Virus 4 Cases in Paraguay, 2019-2020.

In 2019-2020, dengue virus (DENV) type 4 emerged to cause the largest DENV outbreak in Paraguay's history. This study sought to characterize dengue relative to other acute illness cases and use phylogenetic analysis to understand the outbreak's origin. Individuals with an acute illness (≤7 days) were enrolled and tested for DENV nonstructural protein 1 (NS1) and viral RNA by real-time RT-PCR. Near-complete genome sequences were obtained from 62 DENV-4 positive samples. From January 2019 to March 2020, 799 participants were enrolled: 253 dengue (14 severe dengue, 5.5%) and 546 other acute illness cases. DENV-4 was detected in 238 dengue cases (94.1%). NS1 detection by rapid test was 52.5% sensitive (53/101) and 96.5% specific (387/401) for dengue compared to rRT-PCR. DENV-4 sequences were grouped into two clades within genotype II. No clustering was observed based on dengue severity, location, or date. Sequences obtained here were most closely related to 2018 DENV-4 sequences from Paraguay, followed by a 2013 sequence from southern Brazil. DENV-4 can result in large outbreaks, including severe cases, and is poorly detected with available rapid diagnostics. Outbreak strains seem to have been circulating in Paraguay and Brazil prior to 2018, highlighting the importance of sustained DENV genomic surveillance.

Linear epitope mapping in the E and NS1 proteins of dengue and Zika viruses: Prospection of peptides for vaccines and diagnostics.

The arrival of the Zika virus (ZIKV) in dengue virus (DENV)-endemic areas has posed challenges for both differential diagnosis and vaccine development. Peptides have shown promise in addressing these issues. The aim of this study was to identify the linear epitope profile recognized by serum samples from dengue and Zika patients in the E and NS1 proteins of DENV and ZIKV. This cross-sectional study included individuals of all ages with laboratory-confirmed DENV and ZIKV infections, who were selected through convenience sampling. The serum samples from dengue and Zika patients detected epitopes evenly distributed across the viral proteins in a peptide microarray platform. However, several epitopes were located within "epitope hotspots", characterized by clusters of peptides recognized in more than 30% of the sub-arrays analyzed using individual or pooled serum samples. The serum samples from dengue and Zika patients showed a high level of cross-reactivity with peptides in the DENV and ZIKV proteins. Analysis using an additional peptide microarray platform, which contained peptides selected based on the results of the initial screening, revealed that two DENV and one ZIKV peptide, highly specific to their related viruses, were located within the epitope hotspots; however, they presented low detection rates (32.5, 35.0, and 28.6%, respectively). In addition, two DENV peptides detected at similarly high rates by both dengue and Zika patients were also found within the epitope hotspots. These hotspots contain several immunodominant epitopes that are recognized by a larger number of individuals when compared to 15-amino acid (aa) sequence peptides. Thus, epitope hotspots may have greater potential to serve as antigens in diagnostic tests and vaccine development than peptides composed of only 15 amino acids.

Serum biomarkers and anti-flavivirus antibodies at presentation as indicators of severe dengue.

BACKGROUND: Dengue is the most common vector-borne viral disease worldwide. Most cases are mild, but some evolve into severe dengue (SD), with high lethality. Therefore, it is important to identify biomarkers of severe disease to improve outcomes and judiciously utilize resources. METHODS/PRINCIPAL FINDINGS: One hundred forty-five confirmed dengue cases (median age, 42; range <1-91 years), enrolled from February 2018 to March 2020, were selected from an ongoing study of suspected arboviral infections in metropolitan Asunción, Paraguay. Cases included dengue virus types 1, 2, and 4, and severity was categorized according to the 2009 World Health Organization guidelines. Testing for anti-dengue virus IgM and IgG and serum biomarkers (lipopolysaccharide binding protein and chymase) was performed on acute-phase sera in plate-based ELISAs; in addition, a multiplex ELISA platform was used to measure anti-dengue virus and anti-Zika virus IgM and IgG. Complete blood counts and chemistries were performed at the discretion of the care team. Age, gender, and pre-existing comorbidities were associated with SD vs. dengue with/without warning signs in logistic regression with odds ratios (ORs) of 1.07 (per year; 95% confidence interval, 1.03, 1.11), 0.20 (female; 0.05,0.77), and 2.09 (presence; 1.26, 3.48) respectively. In binary logistic regression, for every unit increase in anti-DENV IgG in the multiplex platform, odds of SD increased by 2.54 (1.19-5.42). Platelet count, lymphocyte percent, and elevated chymase were associated with SD in a combined logistic regression model with ORs of 0.99 (1,000/µL; 0.98,0.999), 0.92 (%; 0.86,0.98), and 1.17 (mg/mL; 1.03,1.33) respectively. CONCLUSIONS: Multiple, readily available factors were associated with SD in this population. These findings will aid in the early detection of potentially severe dengue cases and inform the development of new prognostics for use in acute-phase and serial samples from dengue cases.

Detection of neutralizing antibodies against flaviviruses in free-ranging birds, Paraguay (2016-2018).

Saint Louis encephalitis virus (SLEV), West Nile virus (WNV) and Ilheus virus (ILHV) are flaviviruses maintained by enzootic transmission networks between mosquitoes and birds. They have been detected in South America, with no records for Paraguay. We detected the presence of neutralizing antibodies for SLEV, WNV and ILHV in free-ranging birds collected in Paraguay (2016-2018). Four positive samples were detected in resident birds: one SLEV (rufous-bellied thrush), one WNV (barred antshrike) and two ILHV (white-tipped dove and shiny cowbird). These results bring new information about enzootic activity of flaviviruses in Paraguay.

Consejo técnico escolar: participación virtual de los docentes de educación física de una zona escolar de Chihuahua durante la pandemia / School technical council: virtual participation of physical education teachers in a school zone in Chihuahua during the pandemic

Este estudio se enfocó en los trabajos del Consejo Técnico Escolar para explorar e identificar las temáticas, organización e interacción de los docentes de Educación Física y el posible regreso a clases. Se realizó un estudio descriptivo exploratorio con una iniciativa didáctica de micro investigación, participando 15 maestros de una zona escolar, respondiendo una encuesta de opinión. En cuanto a las formas de intervención en la educación a distancia entre los docentes mujeres y hombres, se encontraron diferencias con relación a los recursos tecnológicos y materiales apropiados (p < .025). En el manejo de las emociones de los docentes se observaron diferencias significativas en las mujeres (p < 0.028). La educación a distancia y los programas de mejora son los principales temas abordados, seguidos de la educación socioemocional y evaluación, para lo cual han tenido que desarrollar estrategias de enseñanza aprendizaje de forma remota. Se concluye que se han logrado pocos aprendizajes en la educación virtual.

This study focused on the works carried out by the School Technical Council to explore and identify the themes, organization and interaction of Physical Education teachers and their possible return to classes. An exploratory descriptive study was performed, with didactic micro-research initiative. An opinion survey was answered by 15 teachers from a school district. Regarding the forms of intervention in remote education among female and male teachers, differences were found relating to technological resources and appropriate equipment (p < .025). In regard to teachers' emotional management, there were significant differences observed in women (p < 0.028). The main topics addressed were remote education and improvement programs, followed by socioemotional education and evaluation, for which they had to develop specific strategies for remote teaching and accomplish some learning goals in remote and virtual learning.

Rendimiento del Kit de Chagas V2.0 IICS-UNA para el tamizaje de la enfermedad

En Paraguay la enfermedad de Chagas es endémica, siendo el número de personas infectadas de aproximadamente 165.000 y la población expuesta del 30% según registros del 2012. El objetivo del trabajo fue evaluar el ELISA Chagas test IICS V2.0 para tamizaje de la enfermedad en muestras de donantes de sangre. Se realizó un estudio transversal de pruebas diagnósticas, para lo que se incluyeron 775 muestras de suero provenientes de dos bancos de sangre, a partir de cuyos resultados se calculó la sensibilidad, valores predictivos positivo, negativo y la curva ROC. También se determinó la concordancia y correlación entre el ELISA Chagas test IICS V2.0 y un ELISA comercial. De las 775 muestras de bancos de sangre analizadas se obtuvo una sensibilidad del 99%, especificidad de 96%, VPP 96%, VPN 99% y un índice kappa igual a 0,95 (0,93-0,97) Error Estándar (EE) 0.01 y p>00001 y el área ROC igual a 0,9835. Con respecto a la concordancia con el test comercial, el índice kappa fue de 0,926 IC95% (0,888-0,976), p=0,00001 y el coeficiente de correlación r=0,971 IC95% (0,962-0.978) p=0,0001. Las concordancias obtenidas fueron muy buenas con respecto a la serología de las muestras de banco de sangre como la comparada con el test comercial, pudiendo utilizarse el kit de Chagas IICS V2 para el tamizaje de la enfermedad.

In Paraguay, Chagas disease is endemic, with approximately 165,000 infected people and 30% of the exposed population according to 2012 records. The objective of this study was to evaluate the ELISA Chagas test IICS V2.0 for screening of the disease in blood donor samples. We carried out a cross-sectional study of diagnostic tests, including 775 serum samples from two blood banks, and then calculating sensitivity, positive and negative values and the ROC curve. We also determined the concordance and correlation between the ELISA Chagas test IICS V2.0 and commercial ELISA. In the 775 blood bank samples analyzed, the Chagas ELISA test IICS V2.0 obtained a sensitivity of 99%, specificity of 96%, PPV 96%, NPV 99% and a kappa index equal to 0.95 (0.93-0.97) Standard Error (SE) 0.01 and p>0.0001 and the ROC area equal to 0.9835. Regarding the concordance with the commercial test, the kappa index was 0.926 CI95% (0.888-0.976), p=0.00001 and the correlation coefficient r=0.971 CI95%(0.962-0.978) p=0.0001.The concordances obtained were very good with respect to the serology of the blood bank samples as compared to the commercial test, allowing the use of the Chagas IICS V2 kit for the disease screening.

Adquisición de competencias pedagógicas en educación física durante el confinamiento por covid-19 en México / Aquisição de habilidades pedagógicas em educação física durante o confinamento por covid-19 no México / Acquisition of pedagogical skills in physical education during the covid-19 confinement in Mexico

La pandemia por COVID-19 afectó diferentes estructuras sociales, una de las estructuras internas que puso a prueba fue la educativa. El propósito de este estudio fue analizar la experiencia pedagógica del profesorado en Educación Física antes y durante la pandemia, además de las perspectivas futuras en relación con el confinamiento por COVID-19 en México. Este estudio tuvo un diseño fenomenológico y participaron siete asesores técnico pedagógicos y supervisores de Educación Física. Como resultados destaca que previo a la pandemia el profesorado no se había apropiado del programaeducativo; durante el confinamiento, la intervención didáctica fue un reto, sobre todo la evaluación; y se visualiza que el profesorado será más competente en el regreso a clases presenciales. Por lo que se puede concluir que se observó la necesidad de reformas estructurales que contemplen la implementación de herramientas pedagógicas que usen la virtualidad como valioso recurso dentro de la Educación Física.(AU)

A pandemia de covid-19 afetou diferentes estruturas sociais. Dentre as estruturas internas que colocou à prova estava a educacional. O objetivo deste estudo foi analisar a experiência pedagógica de professores de Educação Física antes, durante e perspectivas futuras em relação ao confinamento por covid-19 no México. Este estudo teve um desenho fenomenológico, participaram sete orientadores técnico-pedagógicos e supervisores de Educação Física. Como resultados, destaca-se que antes da pandemia, os professores não se apropriavam do programa educacional. Durante o confinamento, a intervenção didática foi um desafio, especialmente a avaliação; e visualiza-se que o corpo docente será mais competente no retorno às aulas presenciais. Portanto, pode-se concluir que se observou a necessidade de reformas estruturais que contemplem a implantação de ferramentas pedagógicas que utilizem a virtualidade como um recurso valioso dentro da Educação Física.(AU)

The COVID-19 pandemic affected different social structures, among the internal structures that it put to the test was the educational one. The purpose of this study was to analyze the pedagogical experience of Physical Education teachers before, during and future perspectives in relation to the confinement by COVID-19 in Mexico. This study had a phenomenological design, seven technical-pedagogical advisors and Physical Education supervisors participated. As results, it stands out that, prior to the pandemic, teachers did not appropriate the educational program. During confinement, the didactic intervention was a challenge, especially the evaluation; and it is visualized that the teaching personal will be more competent in the return to face-to-face classes. Therefore, it can be concluded the need for structural reforms that contemplate the implementation of pedagogical tools that use the online environment as a valuable resource within Physical Education.(AU)

Inclusión del modelo emergente de educación aventura en la educación física en México / Inclusion of the emerging adventure education model in physical education in Mexico

RESUMEN La Educación Física ha estado en constante evolución, en las últimas décadas se ha transitado por diversos planteamientos educativos, en México se ha pasado de un enfoque militar, a uno deportivo, psicomotriz, orgánico-funcional, hasta llegar al actual que contempla la adquisición de aprendizajes claves. En este sentido, la adaptación de actividades físicas en el medio natural al contexto escolar surge como una posibilidad innovadora. En otros países, los programas basados en el modelo de Educación Aventura han demostrado favorecer el desarrollo integral de los escolares, teniendo beneficios psicológicos sociales y motrices. Por tal motivo, se propone la aplicación de actividades lúdicas con cuerdas como actividades pedagógicas en la Educación Física. Se concluye que el modelo de Educación Aventura representa posibilidades pedagógicas y didácticas que son pertinentes en las sesiones de Educación Física. Así mismo, las instituciones de educación superior deben replantear sus currículos incluyendo nuevos modelos pedagógicos para la práctica en el contexto educativo.

ABSTRACT Physical Education has been in constant evolution, in the past decades it has passed through various educational approaches, in Mexico it has gone from a military approach, to sports-based, to psychomotor-based, to organic-functional approach, to the current one that contemplates the acquisition of key learnings aspects. In this way, the adaptation of physical activities in the natural environment to the school context emerges as an innovative possibility. In other countries, programs based on the Adventure Education model have shown to favor the integral development of school children, having psychological, social and motor benefits. For this reason, the implementation of playful activities with ropes is proposed as pedagogical activities in Physical Education. It is concluded that the Adventure Education model represents pedagogical and didactic possibilities that are relevant in Physical Education sessions. Likewise, higher education institutions must rethink their curricula including emerging models for practice in the educational context.

Implementación de un sistema de detección de flavivirus en mosquitos / Implementation of a flavivirus detection system in mosquitoes

Los Flavivirus constituyen virus transmitidos por artrópodos, principalmente mosquitos. Pueden producir enfermedades en humanos y animales, también incluyen virus específicos de insectos que solo infectan y se replican en los insectos, no así en vertebrados. En Paraguay los virus dengue, fiebre amarilla y Zika fueron detectados en infecciones humanas, pero los estudios de flavivirus en mosquitos son aún escasos. Por ello, el objetivo del presente estudio fue implementar un sistema de detección de flavivirus en mosquitos en el IICS-UNA. Primero, se organizaron capacitaciones en colecta, preparación de pools y procesamiento por técnicas de RT-PCRs convencionales realizadas por expertos internacionales a profesionales locales (bioquímicos y biólogos). Además, se implementaron planillas de registro de datos y de control de transporte de muestras de los lugares de colectas hasta el IICS-UNA. Se prepararon en total 201 pools de 1 a 35 mosquitos cada uno agrupados por especie, localidad, entre otros criterios. Para asegurar la integridad del RNA extraído se realizó la detección de un control interno (Actina-1), siendo todos los pools positivos para el mismo, 91/201 pools fueron positivos para flavivirus. Se realizó la secuenciación de 19/91 pools positivos para flavivirus identificándose flavivirus de insectos (detectándose principalmente Culex Flavivirus, cell fusing agents Flavivirus y Kamiti river virus), evidenciando la elevada distribución de estos virus. Estos resultados demuestran que fue factible implementar el sistema de detección de flavivirus en mosquitos, lo cual podría contribuir a fortalecer la vigilancia y control de estas virosis, así como el conocimiento sobre la importancia ecológica de flavivirus de insectos

Flaviviruses are viruses transmitted by arthropods, mainly mosquitoes. They can cause diseases in humans and animals, they also include specific insect viruses that only infect and replicate in insects, not in vertebrates. In Paraguay, dengue, yellow fever, and Zika viruses were detected in human infections, but studies of flaviviruses in mosquitoes are still scarce. Therefore, the objective of the present study was the implementation of a flavivirus detection system in mosquitoes at IICS-UNA. First, trainings on collection, pool preparation and processing by conventional RT-PCR techniques were organized by international experts for local professionals (biochemists and biologists). In addition, data log sheets and sample transport control forms from the collection sites to the IICS were implemented. A total of 201 pools of 1 to 35 mosquitoes were prepared, each grouped by species, locality, among others. To ensure the integrity of the extracted RNA, an internal control (Actin-1) detection was performed, all pools being positive for it; 91/201 pools were positive for flaviviruses. The sequencing of 19/91 pools positive for flavivirus was carried out, identifying flavivirus in all cases of insects (mainly detecting Culex Flavivirus, cell fusing agents Flavivirus and Kamiti river virus), evidencing the high distribution of these viruses. These results demonstrate that it was feasible to implement the flavivirus detection system in mosquitoes, which could contribute to strengthen the detection, surveillance and control of these viruses, as well as, the knowledge about the ecological importance of insect flaviviruses

Comparison of Anti-Dengue and Anti-Zika IgG on a Plasmonic Gold Platform with Neutralization Testing.

Antibody cross-reactivity confounds testing for dengue virus (DENV) and Zika virus (ZIKV). We evaluated anti-DENV and anti-ZIKV IgG detection using a multiplex serological platform (the pGOLD assay, Nirmidas, Palo Alto, CA) in patients from the Asunción metropolitan area in Paraguay, which experiences annual DENV outbreaks but has reported few autochthonous ZIKV infections. Acute-phase sera were tested from 77 patients who presented with a suspected arboviral illness from January to May 2018. Samples were tested for DENV and ZIKV RNA by real-time reverse transcription-PCR, and for DENV nonstructural protein 1 with a lateral-flow immunochromatographic test. Forty-one patients (51.2%) had acute dengue; no acute ZIKV infections were detected. Sixty-five patients (84.4%) had anti-DENV-neutralizing antibodies by focus reduction neutralization testing (FRNT50). Qualitative detection with the pGOLD assay demonstrated good agreement with FRNT50 (kappa = 0.74), and quantitative results were highly correlated between methods (P < 0.001). Only three patients had anti-ZIKV-neutralizing antibodies at titers of 1:55-1:80, and all three had corresponding DENV-neutralizing titers > 1:4,000. Hospitalized dengue cases had significantly higher anti-DENV IgG levels (P < 0.001). Anti-DENV IgG results from the pGOLD assay correlate well with FRNT, and quantitative results may inform patient risk stratification.

Real-time RT-PCR for the detection and quantitation of Oropouche virus.

Oropouche virus (OROV) causes an acute, systemic febrile illness, and in certain regions of South America, this represents the second most common human arboviral infection after dengue virus. A new real-time RT-PCR was developed for OROV and reassortant species. The new OROV rRT-PCR proved linear across 6-7 orders of magnitude with a lower limit of 95% detection of 5.6-10.8 copies/µL. Upon testing dilutions of OROV and Iquitos virus reference genomic RNA, all dilutions with >10 copies/µL were detected in both the OROV rRT-PCR and a comparator molecular assay, but the OROV rRT-PCR detected more samples with ≤10 copies/µL (8/14 vs 0/13, respectively, P = 0.002). In a set of 100 acute-phase clinical samples from Paraguay patients with a suspected arboviral illness, no patients tested positive for OROV RNA using either assay. The OROV rRT-PCR provides a sensitive molecular assay for the study of this important yet neglected tropical arboviral infection.

Characterization of dengue cases among patients with an acute illness, Central Department, Paraguay.

BACKGROUND: In 2018, Paraguay experienced a large dengue virus (DENV) outbreak. The primary objective of this study was to characterize dengue cases in the Central Department, where the majority of cases occur, and identify factors associated with DENV infection. METHODS: Patients were enrolled from January-May 2018 if they presented with a suspected arboviral illness. Acute-phase specimens (≤8 days after symptom onset) were tested using rRT-PCR, a rapid diagnostic test for DENV nonstructural protein 1 (NS1) and anti-DENV IgM and IgG, and ELISA for IgG against NS1 from Zika virus (ZIKV). RESULTS: A total of 231 patients were enrolled (95.2% adults) at two sites: emergency care and an outpatient clinical site. Patients included 119 (51.5%) dengue cases confirmed by rRT-PCR (n = 115, 96.6%) and/or the detection of NS1 and anti-DENV IgM (n = 4, 3.4%). DENV-1 was the predominant serotype (109/115, 94.8%). Epidemiologically, dengue cases and non-dengue cases were similar, though dengue cases were less likely to reside in a house/apartment or report a previous dengue case. Clinical and laboratory findings associated with dengue included red eyes, absence of sore throat, leucopenia and thrombocytopenia. At an emergency care site, 26% of dengue cases (26/100) required hospitalization. In univariate analysis, hospitalization was associated with increased viral load, anti-DENV IgG, and thrombocytopenia. Among dengue cases that tested positive for IgG against ZIKV NS1, the odds of DENV NS1 detection in the acute phase were decreased 10-fold (OR 0.1, 0.0-0.3). CONCLUSIONS: Findings from a predominantly adult population demonstrate clinical and laboratory factors associated with DENV infections and the potential severity of dengue in this group. The combination of viral load and specific IgG antibodies warrant further study as a prognostic to identify patients at risk for severe disease.

[Disseminated juvenile paracoccidioidomycosis diagnosed in a girl in an urban area]. / Paracoccidioidomicosis juvenil diseminada diagnosticada en una niña en área urbana.

INTRODUCTION: Paracoccidioidomycosis is one of the most prevalent systemic fungal infections in Latin American countries. The incidence rate has been increasing and its detection has gotten increasingly common in travelers or immigrants from endemic areas. It is characterized by respiratory symptoms, lymphadenopathies and skin lesions, which gradually progress and subsequently lead to death in some untreated chronic disease cases. OBJECTIVE: To describe the clinical approach and diagnosis of an exotic tropical pathology in an urban area. CASE DESCRIPTION: Case description and extended literature review. We made a case report of urban paracoccidioidomycosis in a young patient, with a clinical syndrome of fever for a month, widespread nodal involvement, cutaneous manifestations and weight loss. During the physical examination, hepatosplenomegaly and a febrile episode were evidenced, whose diagnosis was difficult. Management started with itraconazole and trimethoprim sulfamethoxazole, with subsequent cessation of spiking fevers and significant improvement of the skin lesions. We performed a comprehensive literature review, with search criteria performed in PubMed and adapted for different databases. The review was conducted based on the studies found in Medline, LILACS, SciELO and Cochrane Library, from 1966 up to this moment. Studies were selected by the authors based on their relevance and scientific contribution to the discussion of this case. CONCLUSIONS: There are few cases of paracoccidiomycosis in the pediatric population despite the endemicity of this entity in Latin America. An increasing population influx from endemic areas makes suspecting of this disease a must.

Paracoccidioidomicosis juvenil diseminada diagnosticada en una niña en área urbana / Disseminated juvenile paracoccidioidomycosis diagnosed in a girl in an urban area

Introducción. La paracoccidioidomicosis es una de las infecciones micóticas sistémicas más prevalente en los países latinoamericanos. La tasa de incidencia ha ido en incremento y su detección es cada vez más común en viajeros o inmigrantes de las zonas endémicas. Se caracteriza por un cuadro de síntomas respiratorios, linfadenopatías y lesiones cutáneas que progresan paulatinamente, por lo que la enfermedad crónica no tratada puede llevar a la muerte. Objetivo. Describir el enfoque clínico y diagnóstico de una enfermedad tropical exótica en una zona urbana. Caso clínico. Se describe un caso de paracoccidioidomicosis juvenil en área urbana con un cuadro clínico de síndrome febril de un mes de evolución, compromiso ganglionar generalizado, manifestaciones cutáneas y pérdida de peso; el examen físico evidenció episodio febril y hepatoesplenomegalia, cuyo diagnóstico fue difícil. Se inició manejo con itraconazol y trimetoprim-sulfametozaxol con posterior cese de los picos febriles y mejoría significativa de las lesiones en la piel. Se hizo una revisión extensa de la literatura científica con los criterios de búsqueda de Pubmed adaptados para las diferentes bases de datos; la revisión se basó en los estudios hallados en Medline, LILACS, SciELO y Cochrane Library desde 1966 hasta la fecha. Los estudios fueron seleccionados por los autores con base en su relevancia y aporte científico a la discusión del caso en mención. Conclusiones. Son pocos los casos de paracoccidioidomicosis en la población pediátrica a pesar de ser endémica en América Latina. Las crecientes corrientes de urbanización de las zonas endémicas hacen que este cuadro deba sospecharse.

Introduction: Paracoccidioidomycosis is one of the most prevalent systemic fungal infections in Latin American countries. The incidence rate has been increasing and its detection has gotten increasingly common in travelers or immigrants from endemic areas. It is characterized by respiratory symptoms, lymphadenopathies and skin lesions, which gradually progress and subsequently lead to death in some untreated chronic disease cases. Objective: To describe the clinical approach and diagnosis of an exotic tropical pathology in an urban area. Case description: Case description and extended literature review. We made a case report of urban paracoccidioidomycosis in a young patient, with a clinical syndrome of fever for a month, widespread nodal involvement, cutaneous manifestations and weight loss. During the physical examination, hepatosplenomegaly and a febrile episode were evidenced, whose diagnosis was difficult. Management started with itraconazole and trimethoprim sulfamethoxazole, with subsequent cessation of spiking fevers and significant improvement of the skin lesions. We performed a comprehensive literature review, with search criteria performed in PubMed and adapted for different databases. The review was conducted based on the studies found in Medline, LILACS, SciELO and Cochrane Library, from 1966 up to this moment. Studies were selected by the authors based on their relevance and scientific contribution to the discussion of this case. Conclusions: There are few cases of paracoccidiomycosis in the pediatric population despite the endemicity of this entity in Latin America. An increasing population influx from endemic areas makes suspecting of this disease a must.