Revista da Sociedade Brasileira de Medicina Tropical最新文献

Background: Schistosomiasis, caused by Schistosoma haematobium, is a neglected disease that affects millions of people, primarily in developing countries.

Methods: We describe cases of urogenital schistosomiasis that occurred in Cabo Verde between 2022 and 2023 along with their possible associated risk factors. This analytical, cross-sectional study included 229 suspected cases.

Results: Of 229 cases, 53 (23.1%) were confirmed. The most affected age group was 15-24 years, with an incidence rate of 12 cases per 1,000 inhabitants. Male patients were more affected, with a male-to-female ratio of 12:1. The most common symptoms were hematuria (58.7%) and dysuria (17.3%). The incidence of the disease was 6.8 times higher among individuals who had contact with water from tanks.

Conclusion: This study revealed the emergence of urogenital schistosomiasis in Cabo Verde, highlighting the need to strengthen surveillance, prevention, and control measures.

Background: The rapid detection of drug resistance in Mycobacterium tuberculosis is essential for managing drug-resistant tuberculosis (DR-TB). This study evaluated the performance of molecular assays compared to phenotypic drug susceptibility testing (pDST) and targeted next-generation sequencing (T-NGS).

Methods: We retrospectively analyzed 40 presumptive pulmonary DR-TB cases in Rio de Janeiro from 2018 to 2022. Xpert MTB/RIF Ultra (Xpert Ultra) and Line Probe Assay (LPA; MTBDRplus = LPA-1, MTBDRsl = LPA-2) were performed directly on clinical respiratory specimens, with pDST serving as the reference standard. T-NGS was used to identify resistance mutations and clarify discordant results.

Results: Most samples (92.5%) were smear-positive. Xpert Ultra and LPA-1 demonstrated high sensitivity for detecting resistance to rifampicin (91.7% and 89.3%, respectively). However, LPA-1 exhibited lower sensitivity for isoniazid (81.5%). The performance of LPA-1 decreased in samples with cycle threshold (Ct) values ≥16, indicating low bacterial load (p = 0.001). T-NGS detected resistance to fluoroquinolones (22.5%) and injectables (15-20%) that was missed by LPA-2 and MGIT. Mixed infections were identified in 17.5% of samples and accounted for 27.8% of discordant results. Isoniazid heteroresistance was detected in 32.5% of samples by LPA-1 and in 7.5% by T-NGS.

Conclusions: Xpert Ultra and LPA-1 are effective for the rapid detection of rifampicin resistance but have limitations for isoniazid and second-line drugs. T-NGS improved the detection of low-level resistance, heteroresistance, and mixed infections, supporting its implementation in reference laboratories for comprehensive DR-TB diagnosis.

Background: Delayed diagnosis remains a primary challenge in leprosy control, often resulting in severe physical impairment and significant psychological distress among those affected. The factors contributing to this delay are complex and multifactorial, encompassing both patient-related and healthcare system-related elements. To investigate the patient- and health system-related factors contributing to delayed diagnosis of leprosy in an endemic area of Northeast Brazil.

Methods: This cross-sectional study included 247 leprosy patients. Demographic and clinical characteristics, along with data on patient- and health system-related determinants associated with delays in diagnosis, were collected. Univariate and multivariate Poisson regression analyses were performed to examine associations between the outcome (delay in months) and the independent variables.

Results: The median time from the first healthcare visit to leprosy diagnosis was 15.0 months (interquartile range: 6.0-36.0). Approximately 17% of participants had grade 2 disability (G2D) at diagnosis. In the multivariate Poisson regression analysis, female sex, residence in rural areas, delayed healthcare seeking after symptom onset, lack of initial suspicion of leprosy, multiple referrals requiring four or more consultations before diagnostic confirmation, and prior misdiagnosis with treatment for another condition were independently associated with prolonged diagnostic delay.

Conclusion: This study identified significant delays in leprosy diagnosis in Sergipe, Brazil, which may contribute to the persistently high proportion of new cases with G2D. Both patient- and health system-related factors were associated with longer diagnostic delays. Urgent interventions are warranted to increase disease awareness among the general population and strengthen the capacity of primary healthcare services.

Background: Chikungunya (CHIK) is an acute febrile arthritic illness caused by Aedes aegypti and Aedes albopictus mosquitoes. Understanding the pathophysiology of CHIK is crucial because of the wide distribution of cases and the lack of specific treatments or validated biomarkers. This study aimed to describe the cytokine profiles of female patients with laboratory-confirmed CHIK across the three clinical phases of the disease, monitored at an outpatient clinic in Northeastern Brazil. Additionally, this study evaluated whether cytokine levels were associated with persistent arthralgia and the presence of comorbidities.

Methods: This was a prospective cohort study conducted from 2021 to 2024, including 40 female patients and 10 heathy controls (women aged ≥18 years, without comorbidities, not taking medications and non-reactive serologies for CHIK). Blood samples were collected at five time points (0, 21, 90, 180, and 360 days after the symptom onset).

Results: More than half of the patients reported persistent pain. Among CHIK-infected women, interleukin (IL)-10 levels remained elevated from day 21, with statistically significant differences between D0 and D180 and D0 and D360 (p = 0.027). IL-18 levels increased significantly between D0 and D21 (p = 0.020).

Conclusions: Dynamic cytokine behavior throughout the CHIK phase has been described in other studies and may be influenced by host immunogenetics and other factors.

Background: Chikungunya is an emerging disease that significantly impacts global public health and is associated with various environmental and social factors. This study aimed to identify the spatial and spatiotemporal clusters of chikungunya in the state of Brazilian Bahia, as well as their relationships with environmental and socioeconomic variables.

Methods: High- and low-risk clusters were analyzed for 2014-2023 using SatScan. Associations among socioeconomic, climatic, and vegetation characteristics were established using geostatistical estimates.

Results: Many high-risk clusters were observed at high densities in the southern, north-central, and south-central mesoregions. The months with the highest risk were February and March. A decreasing chikungunya trend of -0.6% per year was identified in the Bahian territory when the spatial variation of the temporal trends was analyzed. High-risk municipalities within the spatial chikungunya clusters generally had higher minimum annual and summer temperatures, lower thermal amplitudes, higher monthly and average summer precipitation levels, and higher socioeconomic indicators. The lowest vegetation cover was observed in the Caatinga biome, and the highest in the Atlantic Forest.

Conclusions: Bahia has many high-risk clusters for chikungunya, underscoring the need to strengthen preventive and control measures through coordinated epidemiological surveillance services across the state.

Background: Malaria remains a major public health concern, and sub-Saharan Africa accounts for a significant proportion of global cases. A key challenge in malaria control is the increasing resistance of malaria vectors to commonly used insecticides, particularly pyrethroids. This study assessed the susceptibility of Anopheles gambiae s.l. to permethrin and deltamethrin in Zuba, located in the Gwagwalada Area Council of Abuja, Nigeria.

Methods: Mosquito larvae were collected in June 2024 and reared under controlled insectary conditions until adulthood. Adult mosquitoes were then tested using the Centers for Disease Control and Prevention bottle bioassays, and exposed to both standard World Health Organization recommended doses (21.5 µg/bottle for permethrin and 12.5 µg/bottle for deltamethrin) and lower, sub-lethal concentrations. Mortality rates were monitored up to 24 h post-exposure, and the results were analyzed using one-way analysis of variance at a significance level of P < 0.05.

Results: At the standard dose, permethrin induced a mortality rate of 84.4% (21.10 ± 0.50) after 30 min, significantly higher (P = 0.031) than that observed at 15.0 µg/bottle (18.00 ± 0.00, 72%). Complete mortality was achieved only after 35 min. Deltamethrin caused a mortality rate of 76% at 30 min (19.00 ± 0.30), with 100% mortality observed after 40 min (P = 0.04). No mortality was recorded for sub-lethal doses (≤0.8 µg/bottle) after 24 h (P = 0.061).

Conclusions: These findings highlight the resistance levels of permethrin and deltamethrin in An. gambiae s.l. population in Zuba. Routine resistance surveillance and tailored mosquito control strategies are essential for sustaining mosquito control efforts in this region.

Acinetobacter baumannii is a gram-negative opportunistic pathogen associated with high morbidity and mortality in nosocomial infections, particularly in intensive care units. Multidrug resistance (MDR) is mediated by efflux pumps, lipopolysaccharide modifications, aminoglycoside adenylyltransferases, FosA, structural alterations, and production of enzymes that inactivate antibiotics, such as carbapenemases. These factors limit the therapeutic options and increase clinical challenges, as there are currently few drugs or combinations with therapeutic success against A. baumannii infections. Some strategies and new drugs, such as cefiderocol, eravacycline, sulbactam-darlobactam, tigecycline, and their combinations with colistin, are being tested and have shown apparent advances. This integrative review discusses the current resistance mechanisms and emerging therapeutic strategies aimed at overcoming the growing threat posed by MDR A. baumannii.

Tuberculosis (TB) is among the oldest and deadliest infectious diseases, particularly when associated with human immunodeficiency virus (HIV) and antimicrobial resistance. Despite the progress in prevention, diagnosis, and treatment, global elimination remains elusive and is driven largely by socioeconomic inequalities and systemic challenges. Although scientific research is a cornerstone of the WHO End TB Strategy, it has been chronically underfunded and undervalued in Brazil's health agenda. One critical consequence is the weakening of pipelines for future TB research. Funding shortages, lack of incentives, and the shifting attention toward s other emerging diseases have made it increasingly difficult to recruit and retain scientists in the field of TB. This opinion paper aimed to explore the historical role of Brazilian science in advancing TB control while addressing the emerging crisis of renewing the country's TB scientific workforce. We conducted a narrative synthesis of the available literature, reviewing impactful peer-reviewed articles produced by Brazilian scientists in the field of TB science, alongside official documents from the Brazilian Ministry of Health. This was complemented by a bibliometric analysis of the output of TB-related PhD theses (2016-2024) and PubMed-indexed publications (2001-2024) from Brazilian institutions. Finally, we discuss the systemic barriers affecting early career researchers and outline strategies for revitalizing interest and sustaining scientific progress. These include targeted TB research funds through public-private partnerships, structured mentorship programs, and competitive early career fellowships. Such interventions are essential for reversing the current decline in TB research engagement and ensuring that Brazil continues to contribute to global TB elimination efforts while preserving its scientific legacy.

Digital technologies and artificial intelligence (AI) have become integral in many fields, including medicine. Neglected tropical diseases transmitted by vectors, such as arboviral diseases, spotted fever, Chagas disease, and leishmaniasis, pose a significant impact on public health, particularly in the Americas. Strengthening surveillance and control requires the use of digital technology to identify vectors. In this study, we explored how AI can aid in identifying vectors in the Americas and strengthen disease surveillance and control efforts. We reviewed the literature on the automated identification of triatomines, mosquitoes, sand flies, and ticks, focusing on advances in the Americas over the last 10 years, and provided a critical analysis of the automated identification systems for each group. Moreover, we analyzed the development stages of each study: image acquisition, image processing, algorithm training, algorithm testing, app development, app availability, and AI-based devices for vector identification and surveillance. Most studies have applied AI to identify mosquito species. The vector species databases were not diverse, and the most representative group was Triatominae, comprising 65 species (41% of all described species). Currently, approximately 30 algorithms are used for automated vector identification, with the most common being AlexNet, MobileNet, and ResNet. Most studies are in the algorithm training stage, and in the Americas, only one study has progressed to the development of applications or devices. These results highlight the potential of AI for identifying vectors in the Americas, supporting the use of automated visual identification systems as a promising approach to improve vector surveillance, while also promoting citizen science.

This article reviews the trypanocidal therapy for chronic Chagas disease, emphasizing its indications, efficacy, limitations, and future perspectives. The etiological treatment is based on the use of benznidazole and nifurtimox, both of which were developed over five decades ago. These drugs are most effective in the acute phase, but are also recommended for children, adolescents, and adults aged <50 years without severe organ damage, and women of childbearing age to prevent congenital transmission. Adherence to treatment is limited by adverse drug reactions, which affect approximately half of the patients, leading to treatment discontinuation in approximately 30% of cases. The cure criteria included parasitological, serological, and clinical responses that required long-term follow-up. Clinical trials and systematic reviews have shown heterogeneous results that are influenced by age, clinical stage, and geographical region. Recent public policies supported by non-governmental organizations and academic networks have expanded access to diagnosis and treatment, although structural and informational barriers persist. New therapeutic strategies include shortened benznidazole regimens, drug repositioning, and combination therapies aimed at reducing adverse drug reactions and improving efficacy. Novel molecules with distinct mechanisms and vaccines with therapeutic and preventive potentials are under investigation. Despite these advances, the challenge remains in translating these innovations into concrete benefits for affected populations, particularly in the most vulnerable regions.