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

Cerebral myiasis is an exceptionally rare condition caused by infestation with dipteran larvae, with only 20 cases reported in the literature to date. A 78-year-old man presented with anorexia, vomiting, and fever. Physical examination revealed a 7 × 8 cm ulcerated scalp lesion with a necrotic base, purulent discharge, a foul odor, and numerous larvae. Computed tomography demonstrated an osteolytic frontal bone defect accompanied by pneumocephalus and subcutaneous emphysema. The larvae were manually removed, an iodoform dressing was applied, and intravenous ceftriaxone therapy was initiated. Progressive neurological decline prompted repeat imaging, which revealed frontal and parietal cerebritis with abscess formation. Surgical debridement was performed to remove necrotic tissue. Histopathological analysis showed moderately differentiated squamous cell carcinoma with acute osteomyelitis, and cultures yielded multidrug-resistant Pseudomonas aeruginosa. Despite targeted antibiotic therapy and intensive supportive care, the patient died. This case highlights the significant morbidity and mortality associated with cerebral myiasis, particularly when complicated by underlying malignancy and multidrug-resistant infection. Early recognition, prompt surgical intervention, and pathogen-directed antimicrobial therapy are crucial, while comprehensive multidisciplinary management remains essential to optimize outcomes in this life-threatening condition.

Panstrongylus megistus is the most important autochthonous vector of Trypanosom cruzi, the etiological agent of Chagas disease, in the midwest region of the Minas Gerais State, Brazil. This study investigates the vectorial roles of Triatoma infestans and P. megistus in Chagas disease in this geographical area during the late 1970s. A retrospective analysis of entomological and serological surveys from 1975-1983 was conducted, comparing the presence of T. infestans and P. megistus with the seroprevalence of T. cruzi infection in the human population within the Divinopolis Regional Health Superintendency. Panstrongylus megistus was recorded in all surveyed municipalities (52/52), whereas T. infestans co-occurrence with P. megistus was recorded in only 19.2% (10/52) of them. In the 41 municipalities where only P. megistus was found and relevant data were available, the mean seroprevalence of human T. cruzi infection was 17.8% ranging from 1.0% to 41.9%. In the municipalities where T. infestans occurred, the mean seroprevalence was higher, at 25.8%, ranging from 9.8% to 40.8%. Among the municipalities where only P. megistus was present, 19.5% had a low, 29.3% an intermediate, and 51.2% a high seroprevalence of human T. cruzi infection. In the ten municipalities where both T. infestans and P. megitus were found, 80% showed high seroprevalence, whereas only one municipality each showed low or intermediate levels. The findings highlight the significant role of P. megistus in T. cruzi transmission, even in the absence of T. infestans. The wide distribution of P. megistus increased the risk of transmission. P. megistus was the main household vector in the region in the 1970s. Nowadays, continuous surveillance remains essential for monitoring triatomine infestations and evaluating the current risk of T. cruzi transmission.

Chronic hepatitis C virus (HCV) infection is a major cause of liver cirrhosis and hepatocellular carcinoma, which may lead to liver transplantation. Co-infection with HIV may accelerate liver disease and impact treatment response. Monitoring liver fibrosis involves non-invasive methods such as transient hepatic elastography (THE), AST to Platelet Ratio Index (APRI), and Fibrosis-4 (FIB-4). This study compared changes in THE, APRI, and FIB-4 among patients with HCV alone and those with HIV-HCV co-infection before and after direct-acting antiviral (DAA) therapy. We conducted a retrospective cohort study using medical records from patients treated at a reference clinic in Sao Paulo, Brazil, between January 2015 and February 2019. Fibrosis assessments (THE, APRI, FIB-4) were performed pre-treatment and six months post-treatment. APRI and FIB-4 were also evaluated at 12 months. Among 148 participants, 105 (70%) had HCV mono-infection and 43 (30%) had HIV-HCV co-infection. Genotype 1 was most prevalent (86%). At six months post-treatment, greater reductions in THE, APRI, and FIB-4 were observed in the HCV mono-infection group. Pre-treatment THE values positively correlated with subsequent reductions. However, multivariable analysis showed no significant differences between groups in THE reductions, and no significant group differences in APRI or FIB-4 at six and 12 months. DAA treatment led to fibrosis regression in most participants. HIV co-infection did not significantly alter fibrosis outcomes following successful HCV treatment.

Paracoccidioidomycosis (PCM) is a neglected fungal disease with a rising incidence in Brazil, including increasing hospitalizations in previously non-endemic regions outside the Amazon. This study analyzed the spatiotemporal patterns of acute PCM hospitalizations and their relationship with deforestation. We carried out a retrospective ecological analysis of all PCM-related hospitalizations that were registered in the Brazilian Hospital Information System from 2014 to 2023. Acute and subacute cases were defined using ICD-10 codes (B40.0, B40.7, B40.8, B40.9, B41.0, B41.7, B41.8, and B41.9), whereas chronic forms were excluded. Rates were calculated with census population data and stabilized by Spatial Empirical Bayes smoothing. Space-time cube analysis was applied to detect clusters, which were then compared with deforestation alerts from the DETER-B satellite monitoring system. This study found 4,232 acute PCM hospitalizations, predominantly in men (80%), with a median age of 49 years. Cases were reported in 1,292 municipalities (23%), of which 78% were outside the Amazon. This study also found four significant hotspot clusters, including a newly emergent area in the Cerrado region along the Tocantins-Goias border near Brasilia. Hotspot municipalities showed the largest deforested areas (1,178 km2) when compared to coldspots (24 km2), suggesting a strong spatial association. The spatiotemporal dynamics of acute PCM indicate expansion into deforested areas of the Cerrado, highlighting the role of environmental disruption in shaping disease risk. Mitigating PCM spread in Brazil urgently requires strengthened surveillance and integrated health-environmental policies.

Dengue fever is an acute, systemic, and debilitating febrile illness that poses a significant global public health threat. Vaccination is important in combating the virus in highly prevalent countries, as it reduces the risk of symptomatic infection, hospitalizations, morbidity, and mortality. We report a unique case of atypical dengue fever in a previously healthy 42-year-old Brazilian woman. She developed dengue without the characteristic fever or elevated inflammatory markers 15 days after her initial TAK-003 (Q-denga) vaccine dose, setting her case apart from typical manifestations. 'Whether the mildness of the case was due to the vaccine's protective effect or if it was caused by the vaccine virus itself, as genetic sequencing of DENV-2 was not possible, is unclear. In regions where the vaccine is being introduced, atypical cases, particularly those without fever, require thorough investigation, so dengue can be excluded.

We report a rare case of disseminated Cryptococcus gattii species complex (CGSC) infection in a 51-year-old immunocompetent man who initially had extensive ulcerated skin nodules, an uncommon cutaneous manifestation of cryptococcosis. Positron emission tomography/computed tomography (PET/CT) revealed hypermetabolic lesions in the skin and lungs, while brain magnetic resonance imaging (MRI) demonstrated multiple cryptococcomas with mass effect. The diagnosis was confirmed by skin and lung biopsies and a positive serum cryptococcal antigen test. Induction therapy with lipid complex amphotericin B, flucytosine, and corticosteroids was initiated. This case highlights the importance of recognizing atypical cutaneous lesions as potential indicators of disseminated CGSC infection in immunocompetent individuals, and underscores the need for early antifungal management.

Leprosy remains a significant public health challenge, with approximately 182,815 new cases annually. This review synthesizes current knowledge on pathogenesis, diagnosis, and treatment, emphasizing recent advances. We discuss the immunological spectrum, ranging from Th1-dominant tuberculoid forms to Th2/regulatory-dominant lepromatous forms, and highlight the roles of B-lymphocyte, inflammasome activation, and Schwann cell antigen presentation in granuloma formation and neural damage. Leprosy reactions-type 1 and 2-arise from distinct immunopathological mechanisms triggered by various factors, with emerging evidence pointing to the involvement of Th17 and regulatory B cells. Diagnostic advances include molecular techniques, nerve ultrasonography, monofilament testing, and serological assays that complement traditional approaches. Treatment is based on multidrug therapy, with country-specific adaptations such as Brazil's PQT-U, although challenges with adherence and resistance persist. Alternative regimens may include minocycline, clarithromycin, and fluoroquinolones, with bedaquiline showing promising results. Prophylactic strategies include BCG vaccination and the debated use of single-dose rifampicin for contacts. Management of reactional states employs corticosteroids, thalidomide, with biologics and JAK inhibitors reserved for refractory cases. Genetic and epigenetic factors, including TLR polymorphisms and HLA variants, influence susceptibility and outcomes. Despite recent progress, delayed detection, stigma, and inadequate follow-up remain barriers. Comprehensive approaches integrating early diagnosis, active case finding, chemoprophylaxis, stigma reduction, and rehabilitation are essential. The elimination of leprosy requires sustained commitment, improved resource access, and ongoing research into host-pathogen interactions. This review offers clinicians and researchers an updated understanding to support global control strategies.

Sarocladium spp. are filamentous fungi commonly associated with plant diseases and only rarely cause hyalohyphomycosis in humans. Immunosuppressed patients are at risk for this infection, which typically presents with skin and subcutaneous lesions that may eventually disseminate to internal organs. This study reports a case of a man in intensive care following SARS-CoV-2 infection. During hospitalization, he developed neutropenia, persistent fever, and a cavitary lung lesion. Sarocladium spp. was isolated from blood cultures, and the patient was treated with voriconazole, leading to a successful cure. To our knowledge, this is the first reported case of Sarocladium implicatum infection in a COVID-19 patient, underscoring the importance of monitoring opportunistic fungal infections in immunocompromised individuals, particularly during epidemics and pandemics.

Secondary syphilis can compromise many organs and is widely known for manifesting with classic signs, such as a rash that involves palms and soles along with mucosal lesions. The absence of these manifestations, along with false negative serological tests, as seen with the prozone phenomenon, poses a difficult challenge for the clinician. When skin lesions are visible, a biopsy for pathological description and immunohistochemistry for Treponema pallidum may help aid in the confirmation and certainty of the diagnosis. Here, we report a case of secondary syphilis with atypical manifestations.

This study aims to find evidence of the effectiveness of molecular biology techniques in detecting Plasmodium in Anopheles spp mosquitoes. This systematic review was based on the PRISMA 2020 protocol. It was carried out in five electronic databases (LILACS, PubMed, SciELO, Scopus, and Web of Science, with published studies in health and interdisciplinary areas) in addition to complementary research on Google Scholar. Studies that used molecular biology techniques to detect and evaluate Plasmodium in anopheles (the results of which determined the type of Plasmodium in the samples) were included in this review. In total, 484 recent studies were retrieved from the electronic databases. According to the inclusion/exclusion criteria, only 12 studies met the objectives of this systematic review. Molecular biology was used in mosquitoes to determine parasitic species in all studies. Despite the difficulties and challenges in using molecular biology in mosquitoes, the obtained scientific advances show the accuracy and reliability of the results, contributing to an effective epidemiological response and monitoring of the spread of Plasmodium in endemic areas.