Revista da Sociedade Brasileira de Medicina Tropical最新文献

Background: The genetic diversity of Trypanosoma cruzi and the epidemiological characteristics of the environments in which the parasite occurs are essential for understanding infection dynamics and controlling Chagas disease. This systematic review aimed to: (i) identify and analyze studies that evaluated the genetic variability and epidemiological aspects of T. cruzi infection in the state of Rio Grande do Norte, Brazil; (ii) summarize the information reported in the literature; and (iii) suggest new control strategies tailored to the region's epidemiological profile.

Methods: Following the application of inclusion and exclusion criteria, 13 studies catalogued in PubMed, the Brazilian Virtual Health Library, Scopus, and the Web of Science were selected.

Results: T. cruzi isolates were primarily obtained from triatomine species Triatoma brasiliensis, Panstrongylus lutzi, and Triatoma pseudomaculata, as well as from wild mammals such as Euphractus sexcinctus, Galea spixii, and humans. A total of 295 T. cruzi isolates were genotyped: 46.5% (137) were identified as Discrete Typing Unit (DTU) I, 29.1% (86) as DTU II, and 20% (59) as DTU III. Mixed infections were detected in 4.4% (13/295) of hosts. Triatomine species were found in both peridomestic and intradomestic environments and were occasionally infected with T. cruzi.

Conclusions: This review provides a comprehensive overview of the circulation of distinct Trypanosoma cruzi genotypes (I, II, and III) in both wild and human-modified environments in Rio Grande do Norte.

Background: Long COVID, which refers to persistent symptoms following acute COVID-19, is being increasingly reported. However, available data regarding its prevalence and characteristics are limited. This study was conducted to evaluate the occurrence and presentation of long COVID in patients with COVID-19 who were followed up in outpatient, ward, or intensive care settings.

Methods: This study included patients who were diagnosed with COVID-19 at least four weeks prior to the start of the study. The patients underwent symptom assessment at baseline and 1, 3, 6, and 12 months post-infection. Functional status was evaluated using the Post-COVID-19 Functional Status (PCFS) Scale, and quality of life was assessed using the SF-36 Health Survey questionnaire.

Results: A total of 134 patients (71 males [54.2%]), with a mean age of 43.7 (15.3) years, participated in this study. The distribution of patients across care settings was as follows: 51.1% outpatients, 35.9% in wards, and 13% in intensive care units (ICUs). Fatigue during exertion was the most frequently reported long COVID symptom. Patients treated in ICUs experienced a higher burden of long COVID symptoms than those treated in outpatient or ward settings. Furthermore, patients treated in ICUs and wards had a significantly poorer quality of life and functional status than the outpatients.

Conclusions: Long COVID poses a significant ongoing health concern, particularly for patients who require intensive care during acute COVID-19. Vigilant monitoring of long-term sequelae, particularly those that affect quality of life and functional status, is crucial for individuals recovering from COVID-19.

Background: In the western region of Pará (Brazil), the clinical manifestations of scorpionism exhibit unique characteristics, and there is currently no proposal for a quantitative assessment of this condition. This manuscript proposes and applies a classification system for assessing the severity of scorpionism, comparing it with the system used by the Ministry of Health.

Methods: This quantitative, descriptive, observational, cross-sectional study evaluated victims of scorpionism treated at the Municipal Hospital of Rurópolis in Pará, Brazil. Clinical and therapeutic data were collected using instruments and scales, particularly the International Cooperative Scale for the Evaluation of Ataxias.

Results: Thirty-four patients were assessed between January and July 2023. The majority were young males. All presented with pain, an 'electric shock sensation' and myoclonus. Muscle spasms were observed in 65% of patients, postural changes in 64%, dysmetria in 55%, altered eye movements in 50%, and dysarthria in 44%. While these manifestations are transitory, they cause significant discomfort to the patient. The classification proposed in this study was compared to the Ministry of Health's Severity Classification, and low agreement between the two classifications was shown (only in 50% of cases). The proposed classification raised the severity of 17 patients by one degree: fifteen from mild to moderate and two from moderate to severe, one of whom developed rhabdomyolysis and acute kidney injury.

Conclusions: The proposed classification was beneficial and could be used in the future to assess the effectiveness of therapeutic interventions for this frequent and neglected condition in the Amazon.

Background: Rabies poses a serious public health challenge in Brazil, and its epidemiology has undergone significant changes over the past two decades. Although canine transmission of rabies has been controlled through national vaccination programs, new risks have emerged, particularly from wildlife reservoirs.

Methods: We performed a retrospective analysis of human rabies cases reported in Brazil between 2001 and 2025 using epidemiological surveillance data, scientific literature, and public health reports. We focused on trends in transmission sources, changes in affected populations, and challenges in prevention and treatment, particularly regarding the availability of post-exposure prophylaxis (PEP).

Results: A total of 188 human rabies cases were reported in Brazil between 2001 and 2025 (average: 7.52 cases per year). Most of the cases occurred in the northern and northeastern regions of the country. Bats were the most common source of transmission, followed by dogs and non-human primates. Although rabies is preventable, most of the cases reported within the study period resulted in death. PEP was administered in most cases; however, the treatment may have been delayed, incomplete, or initiated after the onset of symptoms, which limited its effectiveness. Only two patients survived, and both of them received intensive care and were treated using modified therapeutic protocols.

Conclusion: The transition from canine- to bat-mediated rabies highlights the need for enhanced surveillance and targeted prevention strategies. Despite advances in canine rabies control, ensuring PEP accessibility and strengthening public health interventions in high-risk areas remain critical for reducing the incidence of human rabies in Brazil.

Cutaneous cryptococcosis is a manifestation of systemic cryptococcal infection, characterized by polymorphic skin lesions that can make diagnosis challenging. We report an HIV-positive patient with a solitary facial nodule, initially diagnosed as keratoacanthoma. Histopathology, fungal culture, and cerebrospinal fluid analysis confirmed disseminated cryptococcosis with central nervous system involvement caused by Cryptococcus neoformans genotype VNI. He was treated with amphotericin B followed by fluconazole, resulting in complete clinical resolution. This case underscores the need to consider disseminated cryptococcosis in the differential diagnosis of tumorlike skin lesions, particularly in HIV-positive patients.

Streptococcus constellatus, a member of the Streptococcus anginosus group, is a commensal bacterium that causes pyogenic infections, particularly abscesses. This report describes the case of a 28-year-old immunocompetent man who developed a brain abscess and epidural empyema after pneumonia. MRI suggested an abscess, which was confirmed by culture, revealing S. constellatus. Treatment included abscess drainage and ceftriaxone administration, which led to a full recovery. Diagnosis is challenging because of overlapping features with other bacteria. Imaging and culturing are crucial for identification. This case highlights the importance of considering S. constellatus in central nervous system infections, even in immunocompetent individuals.