C-reactive protein for the diagnosis and prognosis of visceral leishmaniasis caused by Leishmania infantum

Acute-phase reaction (APR) and its marker C-reactive protein (CRP) are heightened in some infectious diseases. APR may contribute to clinical manifestations of systemic inflammation such as hemorrhages, anemia and edema. These symptoms are shared by visceral leishmaniasis (VL), a disease caused by the protozoa Leishmania infantum and L. donovani. The former is zoonotic, hitting mostly children and the immunosuppressed, with higher mortality. As APR and CRP have not been studied in VL caused by L. infantum, we decided to investigate their role as diagnostic and prognostic tools in Brazil. We measured CRP in 136 patients before the treatment of VL and 128 who survived and returned 30 days later and compared it to the clinical presentation, HIV status, and disease severity. Sensitivity for the disease was 97.8% (95%CI: 93.7 - 99.5) and specificity was 85.9% (95%CI: 78.7 - 91.0) with the cut-off of 10mg/L. There was no association of CRP concentration with demographic, clinical and laboratory data. The correlation between pre-and post-treatment levels existed but was poor. Marginal association with the presence of parasites in the bone marrow and death was noticed. The role of APR in the pathogenesis of VL and disease severity remains to be explored. However, the study reveals the significant role of CRP for VL caused by L. infantum and should be routinely required for the diagnosis and follow-up.

Occurrence of potentially highly pathogenic free-living amoebae in ready made salads from restaurants in Jatai, Goias, Brazil

Free-living amoebae (FLA) are part of a group of protozoa found worldwide and in the most diverse environments. They resist various temperatures and disinfection methods, and are a risk to human health. Pathogenic strains grow at high temperatures and under hyperosmolarity conditions. Some FLA genera are mainly related to primary amoebic meningoencephalitis (PAM), skin ulcerations, corneal lesions, kidney and lung infections and keratitis. Therefore, studies that assess the pathogenic potential of FLA are public health issues of great concern. We aimed to evaluate the pathogenic potential of FLA isolated in salads from restaurants in vitro, using osmotolerance and thermotolerance tests. Forty-five isolates were used from ready-made salads purchased in restaurants in Jatai, Goias. Twelve isolates subjected to the osmotolerance test (26.6%) showed growth in 0.5 M mannitol, 18 (40.0%) in 1.0 M mannitol and 16 (35.5%) in 1.5 M mannitol, 13 (28.8%) isolates did not show growth. Four isolates that underwent the thermotolerance test (8.9%) showed growth at 25°C, 8 (17.8%) showed growth at 30°C, 3 (6.7%) showed growth at 37°C and 30 (66.7%) did not show growth. With the indices obtained in the present study, we concluded that 15.6% of the isolates were osmotolerant and thermotolerant. Our findings highlight a public health problem once these FLA are associated with harboring or being harbored by microorganisms responsible for diseases such as diarrhea and meningitis. Measures are required to improve food hygiene and so avoid FLA-related health problems.

Spiders in Brazil: from arachnidism to potential therapeutic use of their venom part 1 of 2

Spider envenomation, generically known as arachnidism, is described in many places around the world. In terms of medical importance, the following genera of animals stand out as the main origin of the morbid condition: Atrax (Sidney funnel web spider), Steatoda (false black widow), Latrodectus (black widow), Loxosceles (brown spider) and Phoneutria (armed spider), the last three causing accidents involving spiders in Brazil. This article, part 1 of 2, aims to present the main aspects of arachnidism in the country, with an emphasis on the biology and geographical distribution of spiders, biochemistry of the venom, pathogenesis and epidemiology of arachnidism, as well as prevention of the morbid condition.

Spiders in Brazil: from arachnidism to potential therapeutic use of their venom part 2 of 2

Arachnidism, spider envenomation, is an important public health issue in different parts of the world. Its clinical evolution depends on the genus involved. Symptoms and signs range from skin alterations to systemic manifestations. The success of treatment, consisting of serotherapy and other measures, depends on the patient's immediate care. In addition to the potential injury to human hosts, spider venom has been investigated for the therapy of various diseases. Based on these considerations, this article, part 2 of 2, aims to present the main aspects of spider accidents, focusing on clinical findings, diagnosis, differential diagnosis and treatment, as well as highlighting the potential of the venom of these arachnids.

Prevalence of tungiasis in humans in Brazil and in its federative units: a systematic review

Tungiasis is a neglected parasitic disease caused by penetration of female Tunga penetrans under the skin, causing important health outcomes in humans. Therefore, the aim of this study was to describe the prevalence of tungiasis in Brazil and in its federative units. In November 2019, an investigation was carried out to find studies published from 1980 onwards in MEDLINE, LILACS, Cochrane, CINAHL, Scopus, Web of Science and Embase databases, and in the gray literature, using descriptors related to the prevalence of tungiasis caused by T. penetrans in Brazil. Of the 542 studies found, only 16 published between 2002 and 2010 met the eligibility criteria to be included in this systematic review. Of the 16 selected publications, 14 addressed the prevalence of tungiasis in communities in the Northeast region of the country, one in the South and one in the Southeast. The general prevalence of the parasitosis in the studies ranged from 1.6% to 54.8%, predominantly in the five to nine age group. Eight studies considered the prevalence by gender, ranging from 2.2% to 62.2% for females and 1.1% to 62.5% for males. This systematic review presents an unprecedented survey of the prevalence of tungiasis, a parasitic disease whose dissemination is facilitated by several factors, occuring mainly in low-income communities. Considering the regionalization of the findings, the scarcity of publications, as well as disease neglect, more studies are required.

Diseases caused by pathogens in the urban water system in the metropolitan region of Belém, Pará, Brazil, and their relationship with the socio-economic context of the population

The metropolitan region of Belém-PA suffers human fecal pollution in the local water supply system favoring the increase in cases of water circulating diseases in the population, especially the most socioeconomically vulnerable. Therefore, it is necessary to compile information on cases of these diseases over the years in this region, in order to better define public health policies. Thus, this work aims to contribute to the gathering of this information through a literature review selecting articles found in the SciELO, Pubmed and Google Academic databases with publications between 2005 and 2021 in Portuguese and English. The neighborhoods most affected by water circulation diseases proved were Guamá, Marco, Jurunas, Tapanã, Telegrafo and Terra Firme, located close to hydrographic basins, rivers and canals and are subject to flooding due to high tides and overflowing canals. In addition, the population in these neighborhoods is considered underprivileged. The most cited diseases and symptoms were leptospirosis, worms and diarrhea, which are easily prevented. Total and thermotolerant coliforms were also widely described, being the main indicators of fecal water contamination. The importance of sanitary measures is evidenced, as these reduce cases of water supply diseases in urban centers and improve population health. The quality of the water in the supply network is also important to mitigate the prevalence of these diseases.

Educational level and positive serology for dengue. a knowledge, attitudes and practices study in Huánuco, Peru

Dengue is a worldwide spread arboviral disease. Huánuco region is an endemic area for dengue. Understanding the influence of Knowledge, Attitudes and Practices (KAP) in dengue endemic areas can provide important insight for improving public health policies. The purpose of this study was to understand the KAP about dengue in the marginal urban city of Tingo Maria, district of Rupa-Rupa, a rain forest area in Huánuco region and its association with positive serology for dengue. An analytical, retrospective, cross-sectional study was carried out in which a randomized sample of 112 people were evaluated using a semi structured questionnaire and tested for IgG against dengue virus. Most participants recruited were from marginal urban settlements. The median age was 38 years and 64% were female. A bivariate analysis showed an association between educational level and serological positivity. Over 95% of participants with only primary school education had a positive serological test for dengue. No statistical significances were found between attitudes towards dengue control initiatives (p=0.221), preventive practices against dengue (p=0.773), and the level of knowledge about dengue (p=0.073). Although attitudes, preventive practices and level of knowledge were not related to positive serology in dengue cases, educational level showed an association with serological positivity for dengue.

Clinical-epidemiological profile of COVID-19 patients during the first wave of the disease in the state of Pará, Brazil

December 2019 saw several cases of pneumonia of unknown origin reported in Wuhan, China; the cause of this unknown disease was later identified as the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The purpose of the present study was to evaluate the epidemiological profile of coronavirus disease 2019 (COVID-19) in the North Region of Brazil to assess possible correlations between demographic, social and health factors as well as adherence to safety protocols and the epidemiological profile of COVID-19. Information was obtained via a socio epidemiological survey carried out using Google Forms shared on various social media platforms from May 13 to 20, 2020. 6,781 people, living in the State of Pará, participated in the study of which only 682 (10.1%) had been diagnosed with COVID-19. Of these, 43 (6.3%) required hospitalization. 155 (23.5%) tested positive by RT-PCR associated with computed tomography. The RT-PCR test, with no association with other methods, was performed in 77 (11.6%) cases and serology performed in 360 cases (54.6%). There was a higher prevalence of confirmed cases (457, 67.0%) in females than in males, and the predominant age group was 30 to 40 years of age (214 participants, 31.4%). Considering the relatively homogeneous demographic profile of the sample, continued research is vital, preferably multi-centric studies, to obtain relevant data regarding the epidemiological dynamics of COVID-19; this data will allow the development of pandemic-prevention strategies that consider the social, cultural and political aspects of specific locations

Diagnosis of chromoblastomycosis: an historical review

Chromoblastomycosis is a skin infection caused by dematiaceous fungi, characterized by a verrucous plaque on the limbs. It mainly affects rural workers in tropical countries. The purpose of this review is to identify how the diagnostic methods used in the propaedeutic of chromoblastomycosis emerged and were developed. The MeSH terms "chromoblastomycosis" or "chromomycosis" or "verrucous dermatitis" and "diagnosis" were used to search articles indexed in MEDLINE and LILACS databases. The description of a first-time-used method in diagnosing chromoblastomycosis or modifications and innovations in an existing technique was the criteria used to deem the article eligible. The first methods described in diagnosing chromoblastomycosis were histopathological examination and culture, which characterizes and defines the disease in the early 20th century. Subsequently, they were described as direct microscopic examination, fine needle aspiration for cytology, electron microscopy, serology, molecular tests, scintigraphy, nuclear magnetic resonance and dermoscopy. Tests based on the direct identification of the fungus through biopsy, culture, or direct microscopy are the oldest and more employed methods for diagnosing chromoblastomycosis. The polymerase chain reaction was introduced in the last few decades and is a promising technique. Dermoscopy of chromoblastomycosis shows blackish red dots and white and pink areas along with scaling. Other techniques, such as serology and skin testing for delayed-type hypersensitivity, have not been incorporated into clinical practice

Epidemiological aspects and spatial analysis of chikungunya fever cases from 2017 to 2021, in a state in the northeast region of Brazil

This study aimed to characterize the epidemiological aspects and perform a spatial analysis of Chikungunya fever cases from 2017 to 2021, in the State of Maranhão, Brazil. This is an ecological, descriptive, observational, and retrospective study, conducted by collecting data on Chikungunya fever's confirmed cases in the State of Maranhão, available on the platform of the Department of Informatics of the Unified Health System. Most cases of Chikungunya fever occurred in the year 2017 (p<0.0001), in females (p=0.54), in people between 20 and 39 years old (p=0.04), and with a high school degree (p=0.25). Regarding the evolution of the disease, most cases were cured (p=0.006). The municipalities that obtained a High/High pattern of spatial correlation for the incidence rates of Chikungunya fever per 100,000 inhabitants in the State of Maranhão were located in the West and South Mesoregions in 2017; North and East in 2018; Central, North and East in 2019; North in 2020; and North, East and South in 2021. The epidemiological situation of Chikungunya fever in the State of Maranhão needs attention from public health agencies. Greater efforts towards vector and outbreaks prevention, as well as the improvement on health education programs that educate the population about the disease are necessary. Mainly in the most affected municipalities in order to effectively involve the population in reducing domestic mosquito breeder sites

Molecular detection of anaplasmataceae agents on dogs from the departament of Piura, Peru

This study aimed to study the prevalence of Anaplasmataceae organisms through the nested-PCR and phylogenetic analysis on domestic dogs in the Department of Piura, Peru. Two hundred and twelve canine blood samples were randomly collected on dogs from the central urban areas at the Piura Department in Peru. The extracted DNAs were tested, by nested-PCR based on 16SrRNA gene, to identify agents from Anaplasmataceae family. These results show that there was a prevalence of 18.5% (40/216) of positive dogs, 13.8% (30/216) for Ehrlichia canis, 7.4% (16/216) for Anaplasma platys and 0.1% (2/216) for Ehrlichia sp. confirmed by sequencing analysis. Co-positivity among Anaplasmataceae family species was present in 25% (10/40) of positive samples. There was a significant association among Anaplasmataceae family infection in dogs and the following variables: sex (p=0.034), presence of ticks (p=0.0001), and socio-economic status (p=0.001). There was no statistical association on the variables "living with other animals" and "age group" (p=0.1074). The partial sequences on the portion of the 16S rRNA gene, from positive samples for agents of Anaplasmataceae family demonstrated an identity of 97-100% with the isolated E. canis and A. platys obtained from the GenBank. This is the first study on infection by agents of Anaplasmataceae family in dogs in the Department of Piura, through molecular analysis

Fasciola hepatica prevalence in cattle from the Abancay, Curahuasi and Tamburco districts, Abancay province-Apurímac, Peru during the 2018 rainy season

This study aims to determine the prevalence of Fasciola hepatica in cattle from the Abancay, Curahuasi, and Tamburco districts in the Abancay province, Apurímac, Peru, during the 2018 rainy season, and the association between prevalence and age, breed, and district of origin. In total, 295 stool samples were collected, namely 34 from Tamburco, 193 from Curahuasi and 68 from Abancay. For coproparasitological evaluation, the four-sieve sedimentation technique described by Girão and Ueno was used. The total prevalence of F. hepatica in the cattle sampled in this study was 50.8% (150/295), and the prevalence by district was 42.6% (29/68) in Abancay, 53.8% (104/193) in Curahuasi, and 50% (17/34) in Tamburco. No significant association was found with the variable district of origin (p<0.05). However, using a bivariate logistic regression analysis, a significant association was found between F. hepatica prevalence and the breed variable (p=0.008). A similar significant association with the breed variable (p=0.007) was also found using a multiple logistic regression analysis. The high prevalence of F. hepatica identified in this study is consistent with previous reports made in the Apurímac Region, an area considered hyperendemic for the parasite, thus highlighting the need for effective health programs to control disease distribution, which may have an economic and, because of its zoonotic character, public health impact.

Mosquitoes (diptera: culicidae) in bamboo internodes in the northwestern region of the state of Rio Grande do Sul, Brazil

Bamboo internodes can serve as a breeding ground for a diverse mosquito fauna, some with relative epidemiological importance. The goal of this study is to determine the mosquitoes´ species found in the bamboo internodes at the northwestern region of Rio Grande do Sul, Brazil. From September 2016 to August, 2017 immature forms of mosquitoes were collected from bamboos (Bambusa sp.), in the quarterly intervals (ten plants per collection) through 0.5 cm in diameter perforations on 40 internodes sides. After 30 days, the perforated internodes were cut out and their contents were taken to the laboratory where the immature forms of mosquitoes developed to adult stage were identified. A total of 367 immature forms of Culicidae were collected, however only 158 (43.1%) have developed to adult stage and were identified at a specific level. Eight species were identified: Onirium personatum (Lutz, 1904), Sabethes aurescens (Lutz, 1905), Sa. intermedius (Lutz, 1904), Sa. purpureus (Theobald, 1907), Shannoniana fluviatilis (Theobald, 1903), Trichoprosopon pallidiventer (Lutz, 1905), Wyeomyia limai (Lane & Cerqueira, 1942) and Wyeomyia serratoria (Dyar & Nuñez Tovar, 1927). Thus, the study showed the importance of this type of breeding in order to maintain the mosquito fauna in the wild areas in the studied region. The finding of the species On. personatum and Sh. fluviatilis was also reported for the first time in the State.

Erythematous papular rash after international travel

Bed bugs are hematophagous ectoparasites usually found in bedsteads mattresses, and sheets. The bed bug infestations have been increasing dramatically, but only a few cases have been reported in Brazil. We presented a case of a 49-year-old woman with diffuse, extremely itchy skin lesions, after she returned from an international travel.

Pre-oviposition behavior of Aedes aegypti in the field: first report of eggs laying on water surface in an artificial breeding site in the city of Rio de Janeiro

This study presents the first report of Aedes aegypti laying eggs on the water surface of an artificial breeding site in the field. This report occurred in the city of Rio de Janeiro inside a white bucket containing 11 liters of rainwater. Conspecific larvae had previously been found in this bucket. From the 219 eggs obtained, 135 (61.6%) were laid on the water and 84 (38.3%) on the border of the bucket. Larvae (4th instar) and adults obtained from the eggs were identified as A. aegypti. This behavior may influence the population dynamics of A. aegypti and expands the knowledge about the species adaptation. This report confirms the species' ability to lay eggs on the water surface of artificial breeding sites in the field and suggests the hypothesis that pheromones in the water may influence the females to lay eggs on water.

Parasitological analysis of vegetables sold in supermarkets and free markets in the city of Taguatinga, Federal District, Brazil

Parasitosis are the most common diseases in the world, they are responsible for relevant negative consequences in the individuals´ health. The consumption of vegetables in Brazil and in the world is common due to their high nutritional value and they are recommended to be included in the population´s diet. Contaminations in vegetables are most often caused by irrigation water which is contaminated by feces, other forms of contamination are through organic manure containing fecal waste and the contact of vegetables with animals where they are grown. This research evaluated the contamination in vegetables with the purpose of warning the community about hygiene and the correct approach of food handling in order to prevent parasitic infections, contributing to people´s health. Samples were collected from supermarkets and farmers´ markets, where we obtained a total of 30 samples that were analyzed using Hoffman, centrifugation and slide reading´s techniques. In all samples, parasites were found. In six samples non-pathogenic amoebas were found, however this finding means that there was contamination from human or animal feces. And, in the other 24 samples, parasitic structures that cause damage to health were found. This work showed a high level of contamination of the vegetables that are consumed daily by the population and the diseases caused by food which are a concern for the public health. Contaminated vegetables are dangerous considering the transport of parasites that may generate human infections, therefore the importance to create public policies in order to avoid parasitic infections.

Microbiological and parasitological quality of fruit pulps and juices used for detoxifying purposes

The juice consumption with detoxifying properties has increased in the last few years, but inadequately produced food may transport pathogens. This study aimed to investigate the occurrence of parasitological and microbiological contamination in fruit juices and fruit pulp used for detoxifying purposes. Twenty samples were analyzed, 10 of fruit pulp and 10 juices from July to August 2018. Thermotolerant coliform, mold, and yeast were counted. Parasitological analysis was performed by spontaneous sedimentation method and sedimentation by centrifugation techniques. Results showed that 20% and 60% of the fruit pulp and juice samples exhibited thermotolerant coliform counts above 1 log CFU/mL, respectively. The results showed that 60% of the pulp samples presented mold and yeast counts above 3 log CFU/mL. The protozoa found in the samples were Endolimax nana, Entamoeba coli, and E. histolytica/E. dispar cysts. The presence of thermotolerant coliforms in juices is an indicator of the presence of enteropathogens, mainly Escherichia coli. The high mold and yeast populations and the presence of protozoa in the fruit pulp and juices indicate hygienic and sanitary failures in the food processing. It may be concluded that there is a need for supervision and training in Good Manufacturing Practices by health agencies, aiming at the food safe production.

Evolution of the prevalence and antimicrobial resistance among Escherichia coli isolated as a cause of infection in patients admitted to a iv-level hospital in Lima, Peru

The levels and evolution of antimicrobial resistance of Escherichia coli during 01/2009-06/2010 (Period 1), 01/2012-06-2013 (Period 2) and 07/2013-12/2014 (Period 3) were analyzed. Identification, susceptibility levels to 13 antibiotics and the presence of extendedspectrum ß-lactamases (ESBLs) were determined. Overall, 9,918 microorganisms were isolated as a cause of infection. Of these 3,016 (30.4%) were E. coli, with 1,770 (59%), 992 (33%) and 254 (8%), from the Medicine and the Surgery Departments and the Intensive Care Unit (ICU), respectively. There was a significant increase (p=0.0002) of E. coli throughout considered periods. The isolates presented high levels of resistance (>60%) to cephalosporins, ciprofloxacin and cotrimoxazole, being only susceptible to imipenem (0.3% of resistance) and tigecycline. Overall the analysis of evolution of antimicrobial resistance showed that resistance to cephalosporins and amikacin significantly increased, while, the ones of piperacillintazobactam, cotrimoxazole and gentamicin had significantly decreased. Nevertheless, the ICU isolates showed an inverse scenario for cephalosporins. These findings agree with an increase of ESBLs on the Medicine (56% to 66%; p<0.0001) and on the Surgery (54% to 62%; p=0.0197) departments, with a parallel decrease in the ICU (76% to 68%). In summary, high levels of antimicrobial resistance have been reported among E. coli, with worrisome levels of ESBL. A continuous surveillance of antimicrobial resistance levels in the area is needed.

Respiratory and functional tests in the assessment and prognosis of patients with chagas disease

Chagas disease causes an important impact on cardiorespiratory system, functional and working capacity of the patient. Performing a functional assessment on these individuals becomes essential, since the impact of physical limitation is an important factor that is related with other life domains, such as risk of cardiovascular events in a brief period and risk of death. The goal of this work was to perform a literature review to present the evaluative and prognostic value of main valid respiratory and functional tests in patients with Chagas disease, as well as their applicability and reproducibility. A literature search was performed from 1981 to 2020 in Scielo, Pubmed/Medline, Science Direct, Scopus and Web of Science databases. Only complete studies published in English, Portuguese or Spanish were analyzed which specifically discussed the respiratory and functional tests used in patients with Chagas disease. In total, 544 articles were retrieved of which 35 were eligible. The main functional tests approached were Cardiopulmonary Exercise Testing, Incremental Exercise Testing and Six-Minute Walk Test. Several studies show themselves as useful markers for predicting quality of life, mortality and functional impairment, in addition to other patients' characteristics. Several tests can be used to assess the respiratory and functional impact to patients' health, as well as its relationship with important domains of their lives

The ecology of herd immunity

The COVID-19 pandemic that began in early 2020 is currently the subject of thousands of articles on the various aspects of its epidemiology. One recurrent theme is the phenomenon of herd immunity or herd effect. In this article, I present a short history of the concept, the arguments around its nomenclature, and the ecologist's view of the herd effect, using the case history of the sleeping sickness control in Africa.