Revista da Sociedade Brasileira de Medicina Tropical最新文献

Background: This study aimed to present historical trends and key epidemiological indicators of congenital syphilis in São Paulo, Brazil, from 1986 to 2023.

Methods: This retrospective cross-sectional study used secondary data.

Results: A total of 56,547 cases and 690 deaths from congenital syphilis were reported. The incidence rate steadily increased over time. The number of stillbirths and miscarriages also rose. Most cases of maternal syphilis infection were identified during prenatal care, and the rate of inadequate maternal treatment remained high. Partner treatment led to modest improvements.

Conclusion: Despite improvements in prenatal care coverage and earlier diagnosis, the persistent rise in congenital syphilis incidence and mortality highlights ongoing gaps in maternal and partner treatment.

Background: Leishmaniasis undergoes geographic expansion in the Neotropical regions, driven by ecological and socioeconomic factors that contribute to urban and peri-urban outbreaks. Roadkilled wild mammals represent a potential source of eco-epidemiological data, and polymerase chain reaction (PCR)-based detection provides a sensitive tool for the surveillance of Leishmania spp.

Methods: This study investigated the occurrence of Leishmania spp. in 40 roadkilled wild mammals collected along highways in the central-western and northern coastal regions of São Paulo State, Brazil between 2020 and 2022. Necropsies were performed on all specimens, and ear skin samples were collected for molecular detection of Leishmania spp. using primers targeting kinetoplast DNA (kDNA). Positive samples were further analyzed for species identification by PCR-restriction fragment length polymorphism (RFLP) targeting the hsp70 gene. Restriction patterns were compared with reference strains to confirm Leishmania species identity.

Results: Leishmania spp. kDNA was detected by molecular diagnosis in skin tissue samples from several roadkilled wild mammals collected in the state of São Paulo. Subsequent species-level identification using hsp70 PCR-RFLP detected Leishmania infantum chagasi in a maned wolf (Chrysocyon brachyurus) and Leishmania amazonensis in a raccoon (Procyon cancrivorus).

Conclusions: Wild mammals could be exposed to distinct Leishmania species across diverse ecological contexts, and examining roadkilled animals, combined with the molecular detection of parasites, proved to be an effective tool for passive Leishmania surveillance, highlighting the need for integrated investigations within a One Health framework.

Sporotrichosis is a fungal infection caused by species belonging to the genus Sporothrix. It primarily affects domestic cats, which are considered definitive hosts, and can be transmitted to humans and other animals in various regions worldwide. We compiled information on the clinical aspects, diagnoses, clinical manifestations, prevention, and therapeutic management of cases reported in the literature between 2018 and 2022. The databases used were BVS-Bireme, PubMed, Scopus, and Web of Science. In total, 121 studies were included. S. brasiliensis emerged as the most prevalent species, although S. schenckii and S. globosa were also reported. This analysis highlights the global increase in zoonotic sporotrichosis and reinforces the importance of collaborative public health strategies based on the One-Health concept.

Background: Arboviruses, including dengue (DENV), Zika (ZIKV), and chikungunya (CHIKV), pose serious threats to neonatal health; however, the consequences of maternal peripartum infections, particularly those that are asymptomatic, remain poorly characterized.

Methods: This hospital-based cross-sectional study investigated the adverse neonatal outcomes associated with maternal arbovirus infection among pregnant women hospitalized for obstetric complications in Northeast Brazil (October 2018 to May 2019). Maternal and neonatal data were collected through interviews and reviewing medical records. Acute/recent maternal infections were confirmed by molecular or serological assays. Associations between maternal infection (categorized as any arbovirus, ZIKV-only, or CHIKV-only) and neonatal outcomes were assessed using Poisson's regression with robust variance, yielding adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs), controlled for maternal covariates.

Results: Among 806 neonates, 131 (16.3%) were born to arbovirus-infected mothers and had a higher prevalence of prematurity (aPR=1.25, 95% CI: 1.00-1.56) and sepsis (aPR=1.74, 95% CI: 1.07-2.83) compared with those born to non-infected mothers. Neonates of ZIKV-infected mothers had a two-fold higher prevalence of sepsis (aPR=2.02, 95% CI: 1.00-4.11) than neonates of non-infected mothers, and a trend was observed for CHIKV (aPR=1.76, 95% CI: 0.97-3.20).

Conclusions: In this hyperendemic region, a high frequency of newborns were exposed to maternal arbovirus infection during the inter-epidemic period, which was associated with increased premature births and neonatal sepsis. These findings underscore the need for increased clinical vigilance and routine screening in endemic areas, necessitating further longitudinal studies to confirm causality and guide management.

Background: Scorpion stings are a major public health concern in Turkey. This study aims to examine the demographic characteristics, clinical features, and treatment processes of scorpion sting cases in Şanlıurfa Province, located in the Southeastern Anatolia region of Turkey.

Methods: This retrospective study analyzed patient data, including demographic profiles, clinical presentations, and treatment details of scorpion envenomation cases over a 5-year period (June 2019-June 2024), obtained from the Şanlıurfa Harran University Hospital Information Management System.

Results: A total of 1,041 scorpion envenomation cases were analyzed. The mean age was 25.61 ± 18.50 years (mean ± standard deviation), and women (61.47%) comprised the majority of the patients. The age group of 1-17 years (39.38%) was the most affected. Most envenomation cases (63.4%) occurred during summer, and the extremities (29.5%) were the most commonly affected body regions. Most patients (94.1%) received outpatient treatment and were discharged within 24 h. Antivenom was administered to 12.0% of patients, and 15% were subjected to forensic evaluation. One patient (0.1%) developed cardiac arrest during follow-up and died.

Conclusion: This study investigated the clinical and demographic characteristics of scorpion envenomation to highlight the importance of raising public awareness and implementing preventive measures in high-risk regions. It also emphasizes the critical medical and legal importance of examining the forensic aspects of scorpion stings and ensuring that physicians conduct appropriate evaluation in such cases.

Background: Imported malaria is regularly detected in Pernambuco, a nonendemic area, highlighting the need for surveillance by healthcare professionals.

Methods: We performed a descriptive observational study of malaria cases reported in Pernambuco during 2001-2022.

Results: Most of the 350 patients were men (75.1%) and Mixed-race individuals (51.1%), with a median age of 32 years. Most patients resided in urban areas (81.1%), and 32% had primary education. Travel- and construction-related activities were the primary sources of exposure, with most infections originating in Brazil (52%) or Angola (33%). The median interval from symptom onset to testing was 10 days for Indigenous individuals, 5 days for Black individuals, and 4 days for Mixed race and White individuals. The delay was also longer for those with lower educational levels (6.5 days for primary education vs. 3 days for higher education). However, multivariate analysis showed that ethnicity, educational level, and geographic displacement were not statistically significant predictors of diagnostic delay. The cases showed a significant seasonal pattern, with a higher incidence during the first half of the year (p=0.0382). Although the annual incidence showed a slightly declining trend, this was not statistically significant (p=0.138). Plasmodium vivax and P. falciparum were the predominant species, accounting for 49.7% and 47.5% of cases, respectively.

Conclusions: Although disparities in median diagnostic times exist, multivariate analysis indicated that other complex factors are responsible for delayed diagnosis. Strengthening awareness among clinicians in nonendemic settings and ensuring timely testing are crucial for preventing severe outcomes and reducing malaria-related morbidity and mortality.

Background: We investigated the clinical profiles of patients with multibacillary leprosy treated with at least 12 doses of multidrug therapy (MDT), in whom intact Mycobacterium leprae bacilli were identified in skin biopsies.

Methods: Clinical and therapeutic characteristics of 30 patients were analyzed, and their association with bacillary integrity was assessed.

Results: Leprosy reactions were commonly observed. Two-thirds of patients completed treatment within 5 years. A strong association was observed between the 12-dose regimen and the presence of intact bacilli.

Conclusions: Clinical and laboratory aspects should be considered when deciding to discontinue MDT, particularly if leprosy reactions occur.

Background: The collection of immature Sabethines from natural habitats is challenging. Objective: To develop a low-cost and effective trap using widely available materials.

Methods: A perforated coconut endocarp filled with water was installed in the Atlantic Forest of Sergipe.

Results: Sabethes albiprivus, Sa. batesi, Toxorhynchites theobaldi, and Wyeomyia nigritubus were identified after collection and rearing.

Conclusion: The traps proved effective in collecting immature Sabethines and contributed to expanding the geographic range of Sa. batesi and Wyeomyia nigritubus. This method offers a new alternative for collecting sylvatic yellow fever vectors.