The Burden of Chagas Disease in the Contemporary World: The RAISE Study.

Chagas disease (ChD), a Neglected Tropical Disease, has witnessed a transformative epidemiological landscape characterized by a trend of reduction in prevalence, shifting modes of transmission, urbanization, and globalization. Historically a vector-borne disease in rural areas of Latin America, effective control measures have reduced the incidence in many countries, leading to a demographic shift where most affected individuals are now adults. However, challenges persist in regions like the Gran Chaco, and emerging oral transmission in the Amazon basin adds complexity. Urbanization and migration from rural to urban areas and to non-endemic countries, especially in Europe and the US, have redefined the disease's reach. These changing patterns contribute to uncertainties in estimating ChD prevalence, exacerbated by the lack of recent data, scarcity of surveys, and reliance on outdated models. Besides, ChD's lifelong natural history, marked by acute and chronic phases, introduces complexities in diagnosis, particularly in non-endemic regions where healthcare provider awareness is low. The temporal dissociation of infection and clinical manifestations, coupled with underreporting, has rendered ChD invisible in health statistics. Deaths attributed to ChD cardiomyopathy often go unrecognized, camouflaged under alternative causes. Understanding these challenges, the RAISE project aims to reassess the burden of ChD and ChD cardiomyopathy. The project is a collaborative effort of the World Heart Federation, Novartis Global Health, the University of Washington's Institute for Health Metrics and Evaluation, and a team of specialists coordinated by Brazil's Federal University of Minas Gerais. Employing a multidimensional strategy, the project seeks to refine estimates of ChD-related deaths, conduct systematic reviews on seroprevalence and prevalence of clinical forms, enhance existing modeling frameworks, and calculate the global economic burden, considering healthcare expenditures and service access. The RAISE project aspires to bridge knowledge gaps, raise awareness, and inform evidence-based health policies and research initiatives, positioning ChD prominently on the global health agenda.

Clinical-epidemiological aspects and prognostic factors associated with death from visceral leishmaniasis between the years 2010 to 2019 in the Central-West region of Brazil.

In Brazil, the fatality rate for visceral leishmaniasis is high, and it is important to investigate its associated factors. The aim of this study was to analyze the clinical-epidemiological profile and prognostic factors associated with death from visceral leishmaniasis (VL) in the Central-West region of Brazil, between 2010 and 2019. A study of series of VL cases was carried out using data obtained from the Sistema de Informação de Agravos de Notificação (SINAN). Multivariate logistic regression was performed to identify variables associated with deaths. Male (64.96%); age group ≤5 years (28.51%); mixed race/color (59.20%); and level of education incomplete primary education (45.16%) were the most affected. The most frequent symptoms were fever (87.65%), weakness (77.56%), enlarged spleen (70.22%) and liver (67.33%), weight loss (67.22%) and pallor (63.41%). Co-infection with HIV was observed in 15.84% of patients. The parasitological diagnosis was positive in 74.17% and the Indirect Immunofluorescence (IIF) in 82.80%. The drug most used for treatment was pentavalent antimony (41.96%). Regarding the evolution of VL, cure was recorded for 82.90% of patients and death from VL in 8.30%. Factors associated with death from VL were: age group ≥20 and <60 (OR 2.95; 95% CI 1.98-4.38) and ≥60 (OR 5.84; 95% CI 3.63-9.38), edema (OR 2.27; 95% CI 1.64-3.13), pallor (OR 1.53; 95% CI 1.06-2.20), infectious condition (OR 1.56; 95% CI 1.12-2.15) and hemorrhagic phenomena (OR 2.87; 95% CI 2.02-4.08). New studies are needed in order to better manage VL control, monitoring, prevention and primary care strategies.

Evaluation of isotype-based serology for diagnosis of Schistosoma mansoni infection in individuals living in endemic areas with low parasite burden.

Intestinal schistosomiasis is a chronic and debilitating disease that affects public health systems worldwide. Control interventions to reduce morbidity primarily involve the diagnosis and treatment of infected individuals. However, the recommended Kato-Katz (KK) parasitological method shows low sensitivity in individuals with low parasite loads and is not useful for monitoring elimination of parasite transmission at later stages. In the current study, we evaluated the accuracy of serum reactivity levels of different immunoglobulin isotypes in an enzyme-linked immunosorbent assay (ELISA), utilizing Schistosoma mansoni crude extracts, with the aim to improve the diagnosis of infected individuals with low parasite loads. The serum reactivity of IgM and IgG subclass antibodies (IgG1, IgG3, and IgG4) against soluble adult worm and egg antigen preparations was evaluated in residents from a schistosomiasis-endemic area in northern Minas Gerais, Brazil. The parasitological status of the study population was determined through fecal examination with multiple parasitological tests to create a consolidated reference standard (CRS) plus a fecal DNA detection test (q-PCR). Twelve months after praziquantel treatment, a second serum sample was obtained from the population for reexamination. A two-graph receiver operating characteristic curve (TG-ROC) analysis was performed using the serum reactivity of non-infected endemic controls and egg-positive individuals, and the cut-off value was established based on the intersection point of the sensibility and specificity curves in TG-ROC analyses. The diagnostic accuracy of each serological test was evaluated in relation to the parasitological CRS and to the combination of CRS plus qPCR results. The data revealed that serum reactivity of IgM and IgG3 against S. mansoni antigens did not allow identification of infected individuals from the endemic area. In contrast, serum IgG1 and IgG4-reactivity against schistosome antigens could distinguish between infected and non-infected individuals, with AUC values ranging between 0.728-0.925. The reactivity of IgG4 anti-soluble egg antigen - SEA (sensitivity 79 %, specificity 69 %, kappa = 0.49) had the best diagnostic accuracy, showing positive reactivity in more than 75 % of the infected individuals who eliminated less than 12 eggs per gram of feces. Moreover, serum IgG4 reactivity against SEA and against soluble worm antigen preparation (SWAP) was significantly reduced in the serum of infected individuals after 12 months of confirmed parasitological cure and in the absence of re-infection. These results reinforce that the described IgG4 anti-SEA ELISA assay is a sensitive alternative for the diagnosis of active intestinal schistosomiasis in individuals from endemic areas, including in those with a very low parasite load.

Epidemiological profile, spatial patterns and priority areas for surveillance and control of leishmaniasis in Brazilian border strip, 2009-2017.

Leishmaniasis represents a major neglected public health problem and the control measures have not been successful in Brazil. Recent studies have shown leishmaniasis importance to Brazilian border zones which reinforces the need to investigate its spread in those regions. This study aimed to analyze epidemiologic profile and its spatial distribution or aggregation process in both tegumentary and visceral leishmaniasis in the Brazilian border strip from 2009 to 2017. This is an ecological study of the epidemiological profile and spatial patterns encompassing municipalities in the Brazilian border strip. The presence of spatial autocorrelation and determination of priority areas for disease control were performed using global (Moran I) and local (LISA) Moran spatial techniques. The annual mean coefficients of tegumentary and visceral leishmaniasis were 29.8 and 0.6 by 100,000 inhabitants in the border strip, respectively. The indigenous population rates of leishmaniasis in the border zone appears to be higher than in the rest of the country (cutaneous changed from 33.2% to 6.6% and visceral rising from 1.0% to 17.5%) in the period. The most affected municipalities were located in the North and Central arches of the border zone. The results can subsidize the development of more targeted and effective strategies that can contribute to the surveillance and control of leishmaniasis in border zones, as the provision of epidemiological and spatial data on the disease. For better control of the disease, we recommend and emphasize the need to integrate public health policies of neighboring countries.

Epidemiological aspects of pediculosis by Pediculus humanus capitis (Phthiraptera: Pediculidae) in Minas Gerais: a systematic review / Aspectos epidemiológicos da pediculose por Pediculus humanus capitis (Phthiraptera: Pediculidae) em Minas Gerais: uma revisão sistemática

Abstract Background Head lice, or head pediculosis, is a parasitosis considered a serious public health problem that affects mainly resource-limited countries. Objective To describe epidemiological aspects of the pediculosis capitis in Minas Gerais, in Brazil. Method This systematic review was conducted through the standards established by the Preferred Reporting Items in Systematic Reviews and Metanalyses (PRISMA). PubMed, LILACS, and SciELO databases, as well as the gray literature, were searched. Results Nine of 1,167 studies were included, published between 1988 and 2019. These studies reported a total prevalence of parasitosis that ranged from 1.4% to 57.4%. The prevalence of head lice ranged from 0.0% to 66.7% for males and 2.3% to 57.4% for females, thus being higher in black-skinned people (1.4% to 40.3%). Regarding age, the highest prevalence was 10-12 years old (45.3%). As for the characteristics of the hair, there was a greater infestation in people with long (16.0% to 79.5%), wavy (0.0% to 44.7%), dark (0.0% to 36.6%), with low capillary density (35.4%), and thick hair (39.2%). Conclusion Head pediculosis affects both sexes, different ages, and races, representing an important health problem in Minas Gerais, not only due to the presence of ectoparasite but also to the secondary complications that can be generated from this parasitism.

Resumo Introdução A pediculose de cabeça é uma parasitose considerada um sério problema de saúde pública, afetando principalmente países com recursos limitados. Objetivo Descrever os aspectos epidemiológicos da pediculose de cabeça em Minas Gerais, Brasil. Método Revisão sistemática conduzida por meio dos padrões estabelecidos pelo Preferred Reporting Items in Systematic Reviews and Metanalyses (PRISMA). Foram pesquisadas as bases de dados PubMed, LILACS e SciELO, bem como a literatura cinza. Resultados Nove de 1.167 estudos foram incluídos, publicados entre 1988 e 2019. Relatou-se uma prevalência total da parasitose que variou de 1,4% a 57,4%. Ela variou de 0,0% a 66,7% para homens e 2,3% a 57,4% para mulheres, sendo maior em pessoas de cor negra (1,4% a 40,3%). Em relação à idade, a maior prevalência foi de 10 a 12 anos (45,3%). Quanto às características dos cabelos, houve maior infestação em pessoas com cabelos longos (16,0% a 79,5%), ondulados (0,0% a 44,7%), escuros (0,0% a 36,6%), com baixa densidade capilar (35,4%) e fios grossos (39,2%). Conclusão A pediculose atinge ambos os sexos, diferentes idades e raças, representando um importante problema de saúde em Minas Gerais, não só pela presença do ectoparasita, mas também pelas complicações secundárias que podem ser geradas desse parasitismo.

The role of mucosal-associated invariant T cells in visceral leishmaniasis.

Mucosal-associated invariant T (MAIT) cells are restricted by MR1 and are known to protect against bacterial and viral infections. Our understanding of the role of MAIT cells in parasitic infections, such as visceral leishmaniasis (VL) caused by protozoan parasites of Leishmania donovani, is limited. This study showed that in response to L. infantum, human peripheral blood MAIT cells from children with leishmaniasis produced TNF and IFN-γ in an MR1-dependent manner. The overall frequency of MAIT cells was inversely correlated with alanine aminotransferase levels, a specific marker of liver damage strongly associated with severe hepatic involvement in VL. In addition, there was a positive correlation between total protein levels and the frequency of IL-17A+ CD8+ MAIT cells, whereby reduced total protein levels are a marker of liver and kidney damage. Furthermore, the frequencies of IFN-γ+ and IL-10+ MAIT cells were inversely correlated with hemoglobin levels, a marker of severe anemia. In asymptomatic individuals and VL patients after treatment, MAIT cells also produced IL-17A, a cytokine signature associated with resistance to visceral leishmaniasis, suggesting that MAIT cells play important role in protecting against VL. In summary, these results broaden our understanding of MAIT-cell immunity to include protection against parasitic infections, with implications for MAIT-cell-based therapeutics and vaccines. At last, this study paves the way for the investigation of putative MAIT cell antigens that could exist in the context of Leishmania infection.

Factors associated with deaths from dengue in a city in a metropolitan region in Southeastern Brazil: a case-control study.

BACKGROUND: Dengue is a public health problem in Brazil. Therefore, this study aimed to analyze factors associated with deaths from dengue in residents of the municipality of Contagem, Metropolitan Region of Belo Horizonte, state of Minas Gerais, Brazil, during the 2016 epidemic. METHODS: To determine the factors associated with deaths due to dengue, we used a logistic regression model (univariate and multivariable) in which the response variable (outcome) was death due to dengue. Independent variables analyzed included demographic variables and those related to symptoms, treatment, hospitalization, testing, comorbidities, and case history. RESULTS: The factors associated with dengue deaths in the final multivariable model [p < 0.05; 95% confidence interval (CI)] were age (OR = 1.07; 95%CI 1.03-1.11) and presence of bleeding (OR = 8.55; 95%CI 1.21-59.92). CONCLUSIONS: The results showed that age and the presence of bleeding factors increased the risk of dengue death. These findings indicate that warning signs of dengue should be routinely monitored, and patients should be instructed to seek medical attention when they occur. It is also emphasized that the parameters and epidemiological conditions of dengue patients need to be continuously investigated to avoid a fatal outcome.

Burden of syphilis in Brazil and federated units, 1990-2016: estimates from the Global Burden of Disease Study 2019.

BACKGROUND: Syphilis is a chronic infectious disease that has created challenging situations for humanity for centuries. Transmission can occur sexually or vertically, with great repercussions on populations, particularly among women and children. The present study presents information on the main burden imposed by syphilis generated by the Global Burden of Disease (GBD) Study 2019 for Brazil and its 27 federated units. METHODS: We described the metrics of incidence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), standardized by age and per 100,000 inhabitants, from 1990 to 2019, and we compared the disease burden between the years 1990 and 2019. RESULTS: In Brazil, the disease burden increased between 2005 and 2019 for all metrics. Although a higher incidence of syphilis was found among women in 2019, DALYs [YLLs (males: 15.9%; females: 21.8%), YLDs (males: 25.0%; females: 50.0%), and DALYs (males: 16.2%; females: 22.4%)] were higher among men. In 2019, the highest DALY rate per 100,000 inhabitants was observed in individuals aged above 50 years. The State of Maranhão presented the highest values of DALYs {1990: 165.2 [95% uncertainty interval (UI) 96.2-264.4]; 2005: 43.8 [95% UI 30.3-62.4]; 2019: 29.1 [95% UI 19.8-41.1]} per 100,000 inhabitants in the three years analyzed. CONCLUSIONS: The burden of syphilis has increased in recent years. Men presented higher DALYs, although the incidence of the disease was higher in women. Syphilis affects a large number of people across all age groups, causing different degrees of disability and premature death (DALYs).

Spatial and spatiotemporal patterns of human visceral leishmaniasis in an endemic southeastern area in countryside Brazil.

Visceral leishmaniasis (VL) has shown endemic pattern and epidemic episodes in urban and rural areas, however, there are still gaps in knowledge with regards to disease transmission. This study aimed to analyze the spatiotemporal dispersion of VL cases in the municipality of Araçuaí, Minas Gerais. A study of confirmed VL cases was conducted considering the endemic and epidemic periods between 2012 and 2017. The incidence rate was calculated, and for spatial analysis, the kernel map, directional distribution ellipse, and space-time scanning techniques were used. The correlations between VL cases and exposure variables (precipitation, humidity, and temperature) were calculated. The mean incidence of VL in the endemic period was 18.5 (95% confidence interval (CI) 5.9-32.5) and 44.4 in the epidemic period (95%CI, 12.0-28.6) by 100,000 inhabitants. The relative risk for the epidemic period was 2.4 (95% CI 1.4-4.1) when compared to the endemic period. A higher incidence of the disease was observed in rural areas of the municipality. Kernel mapping analysis revealed hotspots in the urban area of the municipality. The directional distribution ellipse encompasses the urban perimeter and part of the rural area of the municipality, expanding eastward during the epidemic period. Spatial analysis revealed a high-risk cluster for VL in rural areas. A positive correlation was observed between VL cases and temperature during the endemic period. Spatial analysis allowed us to outline the epidemiological scenario of human VL cases. These findings may be useful in case surveillance and in the work of health professionals and managers in Brazil.

Factors associated with deaths from dengue in a city in a metropolitan region in Southeastern Brazil: a case-control study

ABSTRACT Background: Dengue is a public health problem in Brazil. Therefore, this study aimed to analyze factors associated with deaths from dengue in residents of the municipality of Contagem, Metropolitan Region of Belo Horizonte, state of Minas Gerais, Brazil, during the 2016 epidemic. Methods: To determine the factors associated with deaths due to dengue, we used a logistic regression model (univariate and multivariable) in which the response variable (outcome) was death due to dengue. Independent variables analyzed included demographic variables and those related to symptoms, treatment, hospitalization, testing, comorbidities, and case history. Results: The factors associated with dengue deaths in the final multivariable model [p < 0.05; 95% confidence interval (CI)] were age (OR = 1.07; 95%CI 1.03-1.11) and presence of bleeding (OR = 8.55; 95%CI 1.21-59.92). Conclusions: The results showed that age and the presence of bleeding factors increased the risk of dengue death. These findings indicate that warning signs of dengue should be routinely monitored, and patients should be instructed to seek medical attention when they occur. It is also emphasized that the parameters and epidemiological conditions of dengue patients need to be continuously investigated to avoid a fatal outcome.

Spatial and spatiotemporal patterns of human visceral leishmaniasis in an endemic southeastern area in countryside Brazil

ABSTRACT Visceral leishmaniasis (VL) has shown endemic pattern and epidemic episodes in urban and rural areas, however, there are still gaps in knowledge with regards to disease transmission. This study aimed to analyze the spatiotemporal dispersion of VL cases in the municipality of Araçuaí, Minas Gerais. A study of confirmed VL cases was conducted considering the endemic and epidemic periods between 2012 and 2017. The incidence rate was calculated, and for spatial analysis, the kernel map, directional distribution ellipse, and space-time scanning techniques were used. The correlations between VL cases and exposure variables (precipitation, humidity, and temperature) were calculated. The mean incidence of VL in the endemic period was 18.5 (95% confidence interval (CI) 5.9-32.5) and 44.4 in the epidemic period (95%CI, 12.0-28.6) by 100,000 inhabitants. The relative risk for the epidemic period was 2.4 (95% CI 1.4-4.1) when compared to the endemic period. A higher incidence of the disease was observed in rural areas of the municipality. Kernel mapping analysis revealed hotspots in the urban area of the municipality. The directional distribution ellipse encompasses the urban perimeter and part of the rural area of the municipality, expanding eastward during the epidemic period. Spatial analysis revealed a high-risk cluster for VL in rural areas. A positive correlation was observed between VL cases and temperature during the endemic period. Spatial analysis allowed us to outline the epidemiological scenario of human VL cases. These findings may be useful in case surveillance and in the work of health professionals and managers in Brazil.

Burden of syphilis in Brazil and federated units, 1990-2016: estimates from the Global Burden of Disease Study 2019

ABSTRACT Background: Syphilis is a chronic infectious disease that has created challenging situations for humanity for centuries. Transmission can occur sexually or vertically, with great repercussions on populations, particularly among women and children. The present study presents information on the main burden imposed by syphilis generated by the Global Burden of Disease (GBD) Study 2019 for Brazil and its 27 federated units. Methods: We described the metrics of incidence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), standardized by age and per 100,000 inhabitants, from 1990 to 2019, and we compared the disease burden between the years 1990 and 2019. Results: In Brazil, the disease burden increased between 2005 and 2019 for all metrics. Although a higher incidence of syphilis was found among women in 2019, DALYs [YLLs (males: 15.9%; females: 21.8%), YLDs (males: 25.0%; females: 50.0%), and DALYs (males: 16.2%; females: 22.4%)] were higher among men. In 2019, the highest DALY rate per 100,000 inhabitants was observed in individuals aged above 50 years. The State of Maranhão presented the highest values of DALYs {1990: 165.2 [95% uncertainty interval (UI) 96.2-264.4]; 2005: 43.8 [95% UI 30.3-62.4]; 2019: 29.1 [95% UI 19.8-41.1]} per 100,000 inhabitants in the three years analyzed. Conclusions: The burden of syphilis has increased in recent years. Men presented higher DALYs, although the incidence of the disease was higher in women. Syphilis affects a large number of people across all age groups, causing different degrees of disability and premature death (DALYs).

Factors associated with the occurrence of dengue epidemics in Brazil: a systematic review.

OBJECTIVE: To identify and describe broadly the factors related to the occurrence of dengue epidemics in Brazil. METHODS: Systematic review of studies published in Medline, Lilacs, PubMed, Cochrane, BVS, Web of Science, Scopus, and thesis and dissertations databases using descriptors cataloged in DeCs and MeSH on dengue and factors associated with the occurrence of epidemics, published from 2008 to 2018. RESULTS: Thirty-five studies carried out in the country were selected. The epidemics recorded in Brazil were associated and/or correlated with multiple factors such as environment, socioeconomic conditions, climate, and aspects related to the vector, among others. CONCLUSIONS: Dengue epidemics are complex and multifactorial. The continuity of the vector control actions was found to be relevant to the reduction of Aedes aegypti and for disease control. To contain the spread of the disease, effective measures are needed in all sectors, including health, education, economy, population, business, and government. Actions for the early detection of cases of the disease can prevent new outbreaks of epidemics.

Factors associated with the occurrence of dengue epidemics in Brazil: a systematic review

[ABSTRACT]. Objective. To identify and describe broadly the factors related to the occurrence of dengue epidemics in Brazil.Methods. Systematic review of studies published in Medline, Lilacs, PubMed, Cochrane, BVS, Web of Sci-ence, Scopus, and thesis and dissertations databases using descriptors cataloged in DeCs and MeSH on dengue and factors associated with the occurrence of epidemics, published from 2008 to 2018.Results. Thirty-five studies carried out in the country were selected. The epidemics recorded in Brazil were associated and/or correlated with multiple factors such as environment, socioeconomic conditions, climate, and aspects related to the vector, among others.Conclusions. Dengue epidemics are complex and multifactorial. The continuity of the vector control actions was found to be relevant to the reduction of Aedes aegypti and for disease control. To contain the spread of the disease, effective measures are needed in all sectors, including health, education, economy, population, business, and government. Actions for the early detection of cases of the disease can prevent new outbreaks of epidemics.

[RESUMEN]. Objetivo. Determinar y describir de manera amplia los factores relacionados con la aparición de epidemias de dengue en Brasil.Métodos. Se llevó a cabo una revisión sistemática de los estudios publicados en MEDLINE, LILACS, PubMed, Cochrane, BVS, Web of Science, Scopus y en bases de datos de tesis y trabajos de final de grado con los descriptores catalogados en DeCS y MeSH sobre dengue y factores asociados con la aparición de epidemias publicados entre 2008 y 2018.Resultados. Se seleccionaron 35 estudios llevados a cabo en Brasil. Las epidemias registradas en el país se asociaron o se relacionaron con diversos factores, como el medioambiente, las condiciones socioeconómi-cas, el clima y aspectos relacionados con el vector, entre otros.Conclusiones. Las epidemias de dengue son complejas y multifactoriales. Se constató que la continuidad de las medidas de control de vectores es pertinente para la reducción de Aedes aegypti, así como para el control de la enfermedad. Para contener la propagación de la enfermedad son necesarias medidas eficaces en todos los sectores, como la salud, la educación, la economía, la población, las empresas y el gobierno. Las medidas de detección temprana de casos de la enfermedad pueden prevenir nuevos brotes de epidemias.

[RESUMO]. Objetivo. Identificar e descrever, de forma geral, os fatores relacionados à ocorrência de epidemias de den-gue no Brasil.Métodos. Revisão sistemática de estudos publicados entre 2008 e 2018 nas bases de dados MEDLINE, LILACS, PubMed, Cochrane, BVS, Web of Science e Scopus e em bancos de teses e dissertações, com o uso de descritores de dengue e de fatores associados à ocorrência de epidemias catalogados no portal DeCS/MeSH.Resultados. Trinta e cinco estudos realizados no Brasil foram selecionados. As epidemias registradas no país foram associadas e/ou correlacionadas a vários fatores como meio ambiente, condições socioeconômicas e climáticas, e aspectos relacionados ao vetor, entre outros.Conclusões. As epidemias de dengue são complexas e multifatoriais. Observou-se que ações contínuas de controle vetorial são essenciais para a redução da população de Aedes aegypti e o controle da doença. Para conter a propagação da dengue são necessárias medidas multissetoriais eficazes, abrangendo saúde, educação, economia, população, negócios e governo. As ações visando à detecção precoce de casos da doença contribuem para prevenir novos surtos epidêmicos.

Association between ocular toxoplasmosis and APEX1 and MYD88 polymorphism.

Ocular toxoplasmosis (OT) is the most common form of posterior uveitis, and in some countries, it is the most frequent cause of visual impairment. Studies demonstrate that the polymorphism in genes involved with the immune response can be related both to the occurrence and to the recurrence of OT. Thus, the present study aimed to analyze the association between OT and the polymorphism of the APEX1 (rs1130409) and MyD88 (rs7744) genes. The studied sample consisted of 48 volunteers with OT and 96 asymptomatic volunteers, but positive for anti - T. gondii IgG (control group). Blood collection was performed for serological analysis (ELISA) and DNA extraction. Genotyping of the polymorphism was performed using real-time PCR. To analyze the association between gene polymorphism and OT, logistic regression was performed. The results showed no association between the MYD88 gene polymorphism and the development of OT. However, a significant association was found between OT and APEX1 gene polymorphism, indicating that individuals expressing polymorphic (GG) or heterozygous (GT) alleles are more likely to develop the disease (P-value = 0.02 and 0.03 respectively). These results suggest that APEX1 (rs1130409) polymorphism is a risk factor for the occurrence of ocular toxoplasmosis in the studied population.

Entry of dengue virus serotypes and their geographic distribution in Brazilian federative units: a systematic review.

OBJECTIVE: To describe the entry of Dengue virus (DENV) serotypes in Brazil and its federative units. METHODS: A systematic review of studies published between 1980 and 2018 in databases and in the gray literature was performed using descriptors related to the years of entry of the DENV serotypes. Additionally, experts and official sources of information (Brazilian Ministry of Health) were consulted. RESULTS: From 100 publications selected for the systematic review, 26 addressed the entry of DENV serotypes in the North region of the country, 33 in the Northeast, 24 in the Southeast, 14 in the Central-West, and five in the South. DENV-1 and DENV-4 were introduced in the North region in 1981. DENV-2 was introduced in the Southeast in 1990. DENV-3 was introduced in the North in 1999. CONCLUSION: The rapid expansion of dengue throughout the Brazilian territory was verified from the second half of the 1980s, with the gradual entry of the four serotypes, which resulted in the emergence of epidemics of arbovirus, which are currently verified in the country. Considering the epidemiology of the disease, more information should be disseminated and published in the wide-ranging scientific literature for a better understanding of the spread and circulation of DENV serotypes.

Previous History of American Tegumentary Leishmaniasis Alters Susceptibility and Immune Response Against Schistosoma mansoni Infection in Humans.

Schistosomiasis and Leishmaniasis are chronic parasitic diseases with high prevalence in some tropical regions and, due to their wide distribution, a risk of co-infections is present in some areas. Nevertheless, the impact of this interaction on human populations is still poorly understood. Thus, the current study evaluated the effect of previous American Tegumentary Leishmaniasis (ATL) on the susceptibility and immune response to Schistosoma mansoni infection in residents from a rural community in Northern of Minas Gerais state, Brazil, an area endemic for both parasitic infections. The participants answered a socioeconomic questionnaire and provided stool and blood samples for parasitological and immunological evaluations. Stool samples were examined by a combination of parasitological techniques to identify helminth infections, especially S. mansoni eggs. Blood samples were used for hemograms and to measure the serum levels of cytokines and chemokines. Reports on previous ATL were obtained through interviews, clinical evaluation forms, and medical records. S. mansoni infection was the most prevalent parasitic infection in the study population (46%), and the majority of the infected individuals had a very low parasite burden. In the same population, 93 individuals (36.2%) reported previous ATL, and the prevalence of S. mansoni infection among these individuals was significantly higher than among individuals with no ATL history. A multiple logistic regression model revealed that S. mansoni infection was positively associated with higher levels of CCL3 and CCL17, and a higher frequency of IL-17 responders. Moreover, this model demonstrated that individuals with an ATL history had a 2-fold higher probability to be infected with S. mansoni (OR = 2.0; 95% CI 1.04-3.68). Among S. mansoni-infected individuals, the logistic regression demonstrated that a previous ATL history was negatively associated with the frequency of IL-17 responders and CXCL10 higher responders, but positively associated with higher IL-27 responders. Altogether, our data suggest that previous ATL may alter the susceptibility and the immune response in S. mansoni-infected individuals, which may likely affect the outcome of schistosomiasis and the severity of the disease in humans.