Revista da Sociedade Brasileira de Medicina Tropical最新文献

The reactivation of Chagas disease (RCD) by human immunodeficiency virus (HIV) is associated with high mortality and is a relevant public health problem in areas endemic for the causative agent of CD, Trypanosoma cruzi (T. cruzi). Here, we report a fatal case of meningoencephalitis caused by RCD involving the discrete typing unit (DTU) of T. cruzi I (TcI) in an HIV-coinfected patient from Paraná, Brazil. Based on computed tomography findings, a 55-year-old man initially underwent empirical treatment for neurotoxoplasmosis. However, Giemsa-stained cerebrospinal fluid and blood smears revealed T. cruzi trypomastigotes on direct microscopic examination. Protozoa were detected by fresh blood examination and blood culture. Additionally, anti-T. cruzi immunoglobulin G antibodies were detected in serum using a chemiluminescent immunoassay. Blood culture sequencing of cytochrome oxidase II confirmed the DTU TcI infection. Benznidazole therapy was administered for 76 d; however, the patient showed no clinical improvement and died nearly 7 months after hospital admission. The fatal outcome was likely related to delayed diagnosis and treatment, severe immunosuppression (CD4 = 39 cells/mm³), high viral load (94,638 copies/mL), and the involvement of TcI, which has been consistently associated with fatal RCD-related meningoencephalitis.

Background: To study the unfavorable outcomes of tuberculosis treatment, presenting individual, social, and program vulnerabilities in homeless, HIV-infected individuals and individuals living in areas of high social vulnerability in the city of São Paulo.

Methods: Cases were reported, confirmed, and monitored using the tuberculosis control program in the city of São Paulo. Social vulnerability was assessed using the São Paulo Social Vulnerability Index (SVI). Individuals analyzed in the study with more than one vulnerability condition were allocated to more than one vulnerability group, and the outcomes were analyzed separately. The reference category included the remaining cases. The following outcomes were examined: death, treatment abandonment, tuberculosis recurrence, and drug resistance.

Results: A total of 14,221 cases reported in 2019 and 2021 were studied; 11,322 lived in areas of high social vulnerability, 2,753 were HIV-infected, and 1,388 were homeless (the total exceeded 14,221, given that there were individuals with more than one vulnerability). All groups had higher incidence, prevalence, and mortality rates, as well as a higher risk of unfavorable outcomes. The risks were highest for homeless individuals, followed by HIV-infected individuals and those living in areas of high social vulnerability.

Conclusions: Compared to individuals without the analyzed vulnerabilities, we found that unfavorable tuberculosis treatment outcomes were associated with different types of vulnerabilities, reflecting individual, social, and program vulnerabilities. Although the individuals studied had access to treatment, several vulnerabilities impacted the likelihood of successful treatment and challenged the tuberculosis control.

We examined the recent surge in misinformation surrounding giant hammerhead flatworms (Bipaliinae, primarily Bipalium kewense), which has generated widespread confusion across multiple countries regarding their risks to human health. Prompted by a routine taxonomic identification, this study aims to restore scientific accuracy and address the growing disconnect between science and the public concerning these worms, which have become an Internet sensation. In late 2023, we were asked to identify specimens collected in Pedro Leopoldo, Minas Gerais, Brazil, that had already attracted considerable online and regional media attention, warning of a "new, invasive, and dangerous worm" and its supposed threats. After confirming the species was B. kewense, we reviewed the literature, constructed a timeline of scientific and media reports, and compared information retrieved from Google News and Google Scholar. Our findings indicate that while academic research on invasive species has steadily increased, sensationalized and often inaccurate content on hammerhead worms proliferated in the general media, particularly between 2017 and 2018. Notably, claims (2023-2024) regarding the toxicity of Bipalium spp. lack scientific support. This case illustrates the broader challenges of health misinformation in the digital age, where misleading narratives rapidly transcend countries and languages. We discuss potential drivers, including communication gaps between academia and the public, the influence of media and social networks, and behavioral factors underlying misinformation. Finally, we highlight the urgent need for innovative strategies and coordinated efforts to strengthen online science communication and ensure the dissemination of accurate information.

Background: Human visceral leishmaniasis (HVL) is a neglected tropical disease that remains highly lethal if left untreated and continues to affect public health. In Brazil, Leishmania infantum is the main etiological agent, and domestic dogs are considered the primary reservoir. Considering the historic importance of leishmaniasis in Brazil, we aimed to gather information on the epidemiology of HVL in Brazil over 20 years.

Methods: We conducted an integrative review through a bibliographic survey of articles published between 2002 and 2022.

Results: The process resulted in the inclusion of 75 studies. Most of these studies reported data from the northeastern region, which continues to present the highest incidence rates nationwide. Most cases were concentrated in men and children under 10 years of age, particularly in urban and peri-urban areas. Although national case numbers have recently declined in Brazil, the persistence of endemic areas, driven by poverty, inadequate sanitation, deforestation, and unplanned urban growth, underscores the ongoing public health relevance of HVL.

Conclusions: The ongoing spread of HVL and variation in its occurrence across regions underscore the unequal impact of the disease. HVL is not only a parasitic infection but also a manifestation of broader structural inequalities.

Paracoccidioidomycosis (PCM), the most prevalent systemic mycosis in Brazil, is caused by dimorphic fungi of the genus Paracoccidioides and is acquired primarily through inhalation. PCM is associated with a high mortality, particularly among men living in rural areas. This case report describes a 47-year-old man with osteocutaneous involvement diagnosed by biopsy and direct fungal examination. The osseous form of PCM is rare and should be differentiated from other infections and neoplasms. Management involves prolonged antifungal therapy and follow-up for at least two years. This case highlights the diagnostic value of dermatological assessments in atypical presentations of PCM.

Background: Piranhas are carnivorous fish that inhabit rivers in Central and South America, and they are popularly recognized as relentless hunters of continental waters. Their reputation as killers is fueled by folklore and cinematographic works, which contribute to the creation of myths, generation of fear among people, and the vilification of fish.

Methods: We analyzed several media reports on piranha bites that occurred in Brazil, seeking to demystify these attacks as they are described in the lay press, using the injuries and circumstances observed as a basis. In addition, we highlighted human actions that directly affect piranha behavior.

Results: Of the 711 cases reported in humans in the last 10 years, 82.27% were classified as mild, with single "punch-out"-shaped injuries associated with the behavior of males to protect nests and larvae in dams and lakes. Seasonal analysis revealed that 29.62% of attacks occurred during the breeding season and 25.92% were associated with improper disposal of food in rivers.

Conclusions: Media coverage of piranha attacks tends to negatively reinforce popular perceptions of the behavior of these species toward humans, diverting attention from human responsibility for the environmental impacts that directly influence the occurrence of these injuries.

Background: Aedes aegypti var. queenslandensis, a pale form of Aedes aegypti, is widespread in Asia and adapted to urbanized and warm environments.

Methods: Two BG-Sentinel traps with BG-Lure were deployed in an urban forest fragment between December 19 and 24, 2024, to monitor mosquito vectors.

Results: A total of 191 specimens of Ae. aegypti var. queenslandensis were collected, marking the first record of this variety in Macapá, Amapá.

Conclusions: This finding suggests that the population was introduced via maritime transport and highlights the need to strengthen entomological surveillance and assess potential insecticide resistance in vector control efforts in Macapá.

Background: Chagas disease is caused by Trypanosoma cruzi and transmitted by kissing bugs.

Methods: We investigated the presence of Panstrongylus megistus in Ilha Grande, RJ. The insects was analyzed for T. cruzi infection and blood meal sources (BMSs).

Results: Morphological identification confirmed P. megistus. Molecular analysis revealed Gallus gallus as the BMS, with no T. cruzi infection.

Conclusions: These findings represent the first record of P. megistus in the region, expanding its distribution, highlighting the need for continuous monitoring and implementation of physical barriers to reduce transmission risk. Strengthening health education and surveillance is crucial for preventing the disease.

Cutaneous leishmaniasis is endemic in Minas Gerais, Brazil; however, data on the circulating species remain limited. This study identified Leishmania species in he skin samples of patients in Montes Claros using molecular methods. Leishmania (Viannia) braziliensis was found in ten samples, and Leishmania (Leishmania) infantum in one, representing an unusual case of cutaneous leishmaniasis caused by L. infantum in an immunocompetent patient in the state. The patient, a 62-year-old woman presented with four atypical papular lesions on the arm, forearm, and back, with no systemic symptoms. These results highlighted the need for enhanced epidemiological surveillance.

Background: Erythema nodosum leprosum (ENL) is an immunological inflammatory reaction requiring precise management. Recalcitrant cases, their refractoriness to conventional therapy, and the adverse effects of standard treatments underline the need to explore alternative therapeutic options.

Methods: We conducted a retrospective study of five patients treated with secukinumab between January 2023 and January 2025.

Results: Patients showed clinical improvement with a reduced ENL frequency, neuritis relief, and corticosteroid sparing.

Conclusions: Secukinumab appears to be a promising corticosteroid-sparing option for ENL, with a favorable safety profile. Further studies are required to confirm the efficacy and long-term safety of this treatment regimen.