Revista Do Instituto De Medicina Tropical De Sao Paulo最新文献

Immune thrombocytopenia (ITP) is an autoimmune hematological condition characterized by a markedly isolated decrease in platelets without any apparent associated clinical conditions, resulting in bleeding and bruising of the skin, mucous membranes, and major organs. It is often triggered by preceding illness or several immune stimulants such as immunizations, infections, allergic reactions, among others. While uncommon, arthropod bites can trigger acute ITP. Four cases have been reported due to bee stings and insect bites, as well as a case of ITP following honeybee-venom therapy. Here, we report a case of acute ITP possibly triggered by multiple tick bites.

Immunocompromised individuals were considered high-risk for severe disease due to SARS COV-2 infection. This study aimed to describe the safety of two doses of COVID-19 adsorbed inactivated vaccine (CoronaVac; Sinovac/Butantan), followed by additional doses of mRNA BNT162b2 (Pfizer/BioNTech) in immunocompromised (IC) adults, compared to immunocompetent/healthy (H) individuals. This phase 4, multicenter, open label study included solid organ transplant and hematopoietic stem cell transplant recipients, cancer patients and people with inborn errors of immunity with defects in antibody production, rheumatic, end-stage chronic kidney or liver disease, who were enrolled in the IC group. Participants received two doses of CoronaVac and additional doses of mRNA BNT162b2. Adverse reactions (AR) data were collected within seven days after each vaccination. Serious adverse events and of special interest (AESI) were monitored throughout the study. We included 241 immunocompromised and 100 immunocompetent subjects. Arthralgia, fatigue, myalgia, and nausea were more frequent in the IC group after CoronaVac. Following the first additional dose of mRNA BNT162, pain, induration, and tenderness at injection site, fatigue and myalgia were more frequent in the H group. A heart transplant recipient had a graft rejection temporally associated with the second CoronaVac dose, but there was no literature evidence of causal association. Four cases of AESI were considered related to the vaccine: three erythema multiforme after CoronaVac, all in IC participants, and one paresthesia after mRNA, in a H participant. Our findings were comparable to other studies that evaluated the safety of COVID-19 vaccines in different immunocompromised populations. Both vaccines were safe for immunocompromised participants.

COVID-19 and hepatitis B disease are significant global pandemics, both of which can lead to liver damage. This study aims to report the clinical course of liver function and disease prognosis of COVID-19 patients with hepatitis B virus (HBV) super-infections. A total of 249 outpatients with COVID-19 were enrolled in this study from December 1, 2023 to February 28, 2024. Clinical characteristics, laboratory data, chest CT findings, and patients' treatment and outcomes were collected and analyzed retrospectively. Of the 249 outpatients, 37 (14.9%) were super-infected with HBV, whereas 212 (85.1%) showed no such outcome. This study found no significant differences between the two groups regarding age, gender, symptoms, complications, or chest CT findings. However, COVID-19 patients super-infected with HBV showed lower white blood cell, neutrophil, and platelet counts (p < 0.05). Additionally, total bilirubin levels were significantly higher in the SARS-CoV-2/HBV super-infected group compared to the COVID-19-only group (p = 0.022). After the first week of similar treatment, both groups showed almost identical outcomes, including hospitalization, severity, and mortality rates. Thus, SARS-CoV-2/HBV super-infection slightly affected liver function but did not worsen COVID-19 outcomes. Routine HBV monitoring and liver function tests are recommended to manage COVID-19 patients with HBV super-infections. This study found no clear indications of the need to change the therapeutic prescription for COVID-19 in cases of HBV super-infections.

Strongyloides stercoralis infections, human T-lymphotropic virus (HTLV) infections, and Chagas diseases occur throughout many regions of Central and South America, including Peru. This study aimed to evaluate the seroprevalence of S. stercoralis, HTLV, and Chagas disease in Iquitos (Peruvian Amazon) and the associated epidemiological conditions for S. stercoralis seroprevalence in Iquitos. A population-based cross-sectional study was conducted from May 1 to June 15, 2020, to assess the seroprevalence of S. stercoralis [lysate antigen ELISA (enzyme linked immunosorbent assay)], HTLV (recombinant antigen ELISA), and Chagas disease (crude and recombinant antigen ELISAs). Of the 396 included individuals, 257 were seropositive for S. stercoralis (a 64.9% prevalence, 95% confidence interval [CI] 60.0% to 69.4%). In the multivariable analysis, seropositivity for S. stercoralis was higher in women (odds ratio [OR] 1.60, 95% CI 1.03 to 2.66) and residents of Punchana (OR 3.47, 95% CI 1.51 to 7.93), whereas residence in Iquitos was associated with lower positivity (OR 0.52, 95% CI 0.32 to 0.85). In total, four individuals were positive for HTLV (1.0% seroprevalence, 95% CI 0.3% to 2.7%), and none were positive for Chagas disease (0.0% seroprevalence, 95% CI 0.0% to 1.2%). The seroprevalence of S. stercoralis in Iquitos is high, particularly among women and residents of Punchana. The presence of HTLV infection indicates that the virus is circulating in Iquitos. This study found no cases of Chagas disease.

Innate immune cells are important players during an infection. The frequency of monocytes, myeloid-derived suppressor cells (MDSCs), natural killer (NK), and NKT cells were assessed in blood samples of children and adolescents living with HIV (CALHIV) and HIV-uninfected (HU) children. Blood samples from 10 CALHIV (treated or not) and six HU individuals were collected for approximately one year. Flow cytometry was employed to phenotypically characterize cell populations. We found a lower frequency of classical monocytes in CALHIV patients compared to the HU group (35.75% vs. 62.60%, respectively) but a higher frequency of CD56-CD16+ NK cells in CALHIV patients compared to the HU group (1.45% vs. 0.44%, respectively). At baseline, the frequency of monocytic-MDSCs inversely correlated with CD56dimCD16+ NK cells (r= -0.73, p=0.020), CD56-CD16+ NK cells (r= -0.78, p=0.010), and with intermediate monocytes (r= -0.71, p=0.027) in the CALHIV group. We also found a negative correlation between CD56++CD16+- and CD56dimCD16+ NK cells with CD4 T cells frequency at baseline. The results suggest an alteration in the innate compartment of the CALHIV cohort, which may contribute to their susceptibility to infections.

The Zika virus (ZIKV) has been associated with several complications, including acute transverse myelitis (ATM), an acute inflammation of the spinal cord, with rapid development of motor, sensory and dysautonomic symptoms. It is a rare disease, and its clinical features, as well as differences in relation to idiopathic ATMs, are still not completely known. The objective of this paper is to review the literature in search of clinical features and complementary exams of ATM post-ZIKV infection, alone or in association with other neurological conditions (mixed diseases), as well as its treatments and prognoses. The search was made on 5 databases, using the PRISMA methodology (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Nine articles were selected (total of 20 subjects), which were divided between isolated ATM and mixed neurological syndromes with ATM. The study found a predominance of individuals aged 20 to 30. Among the six subjects in the mixed group, three were over 50 years old. The median prodromal period was 2 days for the mixed diseases group and 7 days for the isolated ATM group. Some individuals in the isolated ATM group exhibited signs of dysautonomia, such as syncope, postural lability, and arrhythmia. The mixed group had a higher incidence of coinfections, with 4 cases compared to 1 case in the isolated ATM group. Over 50% of the individuals had moderate to moderately severe disability. These findings suggest that severe conditions may progress to significant sequelae, highlighting the need for prompt diagnosis and treatment, particularly during endemic periods.

The infodemic and the spread of disinformation have fostered mistrust in vaccines, health institutions, and governments, contributing to a global decline in vaccination coverage and the resurgence of vaccine-preventable diseases like measles. In recent years, the use of digital platforms to access health information, including vaccines, has increased significantly. However, the rapid dissemination of disinformation on these under-regulated platforms can greatly influence vaccination behavior. This study aimed to identify and analyze the main arguments used on Facebook® regarding measles vaccination. Posts and comments in Brazilian Portuguese were extracted using keywords such as "Measles Vaccines," "Triple Viral," and "Tetra Viral" from general and anti-vaccine pages from January 2017 to December 31, 2020. A sample from both datasets was selected and analyzed using deductive content analysis. Of the posts, 213 (84.5%) were classified as pro-vaccine, primarily promoting vaccination campaigns, with limited discussions on vaccine risk-benefit and collective responsibility. Notably, anti-vaccine pages, though fewer in number and followers, were more active in posting than pro-vaccine pages. Of the anti-vaccine posts, 118 (59.3%) focused on undermining vaccine safety and efficacy, spreading disinformation to downplay disease risks. Although pro-vaccine messages showed the highest engagement on the platform, more effective communication strategies are needed to complement traditional health systems, as anti-vaccine posts appear to influence vaccination behavior, particularly among hesitant communities.

Diagnostic networks ensure efficiency in disease diagnosis. A descriptive study evaluated the network of public health laboratories (NPHL) in Minas Gerais State, Brazil, using diagnostic results for tegumentary leishmaniasis (TL) from the laboratory management system in 2017-2020. Out of 1,369 individuals analyzed, 704 (51.4%) cases of TL were confirmed, with 610 (86.7%) by direct parasitological examination (DPE) and 94 (13.4%) by polymerase chain reaction (PCR). Notably, 25.3% of cases with DPE-negative results were PCR-positive. Consecutive diagnostic tests enhanced diagnosis of TL. NPHL-MG is a promising model for expanding similar networks and improving disease control.

An immunocompromised patient was infected by the SARS-CoV-2 variant of interest named Zeta (P.2) in February 2021. More than one year later, he suffered from symptomatic COVID-19 and sequencing revealed the same variant, which accumulated 23 substitutions. This case illustrates intra-host evolution of a particular SARS-CoV-2 variant, highlighting the importance of genomic surveillance of immunocompromised patients.

Candida glabrata is a yeast which incidence has increased in recent years and usually causes urogenital and bloodstream infections. Its resistance to fluconazole hinders C. glabrata infections treatment. This case report presents a case of candidemia and scrotal abscess caused by C. glabrata, which was successfully treated with liposomal amphotericin B. The primary treatment options for C. glabrata candidemia are echinocandins and amphotericin B formulations. However, echinocandins and lipid-based amphotericin B formulations do not properly pass through the urinary system. Amphotericin B deoxycholate has a high risk of side effects and is difficult to obtain. The treatment option for candidemia caused by fluconazole-resistant C. glabrata secondary to urinary tract infection is unclear and there are no sufficient studies. For treatment, liposomal amphotericin B may be considered, especially for scrotal and prostatic fluconazole-resistant fungal abscesses. More studies comparing the penetration of antifungals into scrotal and prostatic tissue and the success of antifungal treatment in these tissue infections are needed.