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

Toxoplasmosis is a widespread zoonotic disease that poses significant public health concern globally, with neurotoxoplasmosis being a severe complication associated with high mortality rates. The standard therapy for neurotoxoplasmosis involves a combination of sulfadiazine and pyrimethamine, which, despite its efficacy, is often limited by adverse effects leading to treatment discontinuation. This study aimed to evaluate the in vivo efficacy of nitazoxanide in treating neurotoxoplasmosis in mice infected with the Me49 strain. The study comprised two groups: Group I, including subgroups of uninfected, infected and treated with saline, and infected and untreated mice; and Group II, comprising infected mice treated with nitazoxanide at 100 mg/kg/day, nitazoxanide at 150 mg/kg/day, and pyrimethamine combined with sulfadiazine. After 14 days of treatment, the mice were euthanized for organ collection. Histopathological examination of the brains revealed that the highest dose of nitazoxanide reduced parasitic load and cerebral hemorrhages. Biochemical and histopathological analyses of liver and kidney tissues demonstrated toxicological profiles comparable to pyrimethamine and sulfadiazine. However, despite showing efficacy and similar toxicity levels, nitazoxanide treatment was less effective regimen in controlling neurotoxoplasmosis in this experimental model compared to the pyrimethamine and sulfadiazine. Thus, while nitazoxanide presents potential in neurotoxoplasmosis treatment, pyrimethamine combined with sulfadiazine remains the preferred therapeutic choice based on better efficacy observed in this study.

Cutaneous leishmaniasis represents 99% of all reported leishmaniasis cases in Mexico and typically occurs in agricultural or sylvatic areas. Campeche State is endemic for leishmaniasis; however, there are no previous records of urban Leishmania transmission. This report presents a case of cutaneous leishmaniasis in a 75-year-old man residing in an urban area. The patient presented with a three-month-old lesion on the right ear following an initial misdiagnosis of a bacterial infection. Given the suspicion of leishmaniasis, a tissue imprint was collected, revealing the presence of Leishmania amastigotes. Subsequently, amplification and sequencing of the Alanine aminotransferase and Internal transcribed spacer subunit 1 genes confirmed the presence of Leishmania mexicana. The patient was then treated with intralesional meglumine antimoniate. This case is significant as it marks the first confirmed human transmission of L. mexicana in an urban environment in Campeche State, demonstrating the importance of considering this pathology in patients with skin lesions originating from non-endemic areas in Mexico.

Piedras are small nodules found on the hair shafts. White piedra was initially described as caused by Trichosporon beigelii, which was later reclassified in several species. We describe the first case of white piedra caused by Cutaneotrichosporon debeurmannianum. Affected hairs were examined in natura with scanning electron microscopy, after gold metallization. The typical whitish cerebriform creamy colony was obtained in Sabouraud medium. Fungal genomic DNA extracted from cultures and locus was amplified with the NL1/NL4 primer pair from the D1/D2 region of the large ribosomal subunit (LSU) of 28S rRNA. With scanning electron microscopy, nodules are easily identified surrounding the hair shaft; with high magnifications, rounded structures adhered to each other were identified. Comparison of the nucleotide sequences of IMT-1703 Cutaneotrichosporon debeurmannianum revealed 99.6% similarity with the 28S large ribosomal unit rDNA sequence. This case of white piedra was caused by Cutaneotrichosporon debeurmannianum.

Acute respiratory distress syndrome is a significant complication in critical care patients. COVID-19 (C19)-associated severe respiratory failure is related to it, and d-dimer rise predicts a worse outcome. To investigate the association between d-dimer and the severity of this respiratory syndrome, we conducted a study in C19 intubated patients. A retrospective, single-center observational study was conducted with 64 C19 adult intubated patients. Strata of d-dimer results between patients was evaluated using survival analysis. Survival was higher in mild respiratory distress patients. D-dimer showed poor sensitivity and specificity in predicting respiratory failure severity. Risk assessment for death showed a higher prevalence of admission d-dimer results (HR 1.335; 95% CI 0.695-2.564). Our sample confidently represented the medical profile of C19 severe patients. Sepsis development in C19 is associated with the inflammatory storm in respiratory distress syndrome. As the receiver operating curves show, the increase in d-dimer results is consistent with inflammation rather than a prognostic biomarker. As expected, severe respiratory distress patients presented higher mortality. In summary, d-dimer results are not associated with the prognosis of C19 respiratory distress syndrome patients.

The genus Flavivirus (Family: Flaviviridae) comprises arboviruses with the capacity to infect humans and animals. It also integrates insect-specific viruses. This study aimed to identify Flavivirus in mosquitoes captured in 17 municipalities in Yucatan State, Mexico. The mosquitoes were caught in households from November 2021 to May 2022. A total of 4,321 adult mosquitoes from five species were caught. The most abundant were Culex quinquefasciatus (n = 3,563) and Aedes aegypti (n = 734). For molecular investigations, 600 female mosquitoes were split into groups of 10, mostly for species and site location. Reverse transcriptase polymerase chain reaction (RT-PCR) amplified a region of the NS5 gene to find the Flavivirus ribonucleic acids (RNA). A total of 24 pools that were positive for Flavivirus were detected in Ae. aegypti specimens and subsequently subjected to sequencing using the Sanger method. A total of 12 sequences matched the established quality criteria and were subsequently employed for sequence homology analysis. We found that one sequence corresponded to the Zika virus (ZIKV), and 11 sequences had sequence similarity with Phlebotomus-associated flavivirus (PAFV), an insect-specific virus (ISF). In conclusion, we found ZIKV in the Merida municipality, Yucatan State, which suggests that the virus is silently circulating. Phlebotomus-associated flavivirus is distributed in five municipalities in Yucatan State, Mexico. Future studies could focus on isolating this virus and studying its biological role within Ae. aegypti.

Haff disease was first described at the beginning of the twentieth century in Europe. Almost a century later, thousands of cases have now been reported in different countries. In Brazil, most cases are observed in the Amazon region, and its associated factors remain to be fully understood. This disease is an uncommon syndrome characterized by intense myalgia and rhabdomyolysis, which manifests within 24 h after consuming some types of freshwater or saltwater fish and crustaceans. A possible heat-stable toxin contained in seafood may be the cause of Haff disease, but this hypothesis is not yet completely proven. This review will describe the clinical and epidemiological aspects of Haff disease with updated literature.

The relationship between the environment and animal life began to be seen as an important tool to help control zoonoses. Climate variations lead to changes in the environment, which can influence the spatial distribution of species and, consequently, the spread of diseases to humans. Considered the main non-human definitive host species of Schistosoma mansoni in Brazil, the wild rodent Nectomys squamipes plays an important role as a reservoir in maintaining the schistosomiasis cycle in the absence of humans. This study demonstrates the results of ecological niche modeling of intermediate and definitive wild hosts of S. mansoni in the Regional Health Superintendence of Barbacena (Minas Gerais State), which has registered 31 municipalities, 80% of which are classified as endemic for parasitosis. Environmental variables associated with the distribution of each species were used based on information from the scientific collections of Global Biodiversity Information Facility (GBIF) and Species Link to project the ecological niche model in the geographic space. Abiotic variables such as the mean annual temperature, isothermality, and precipitation seasonality were obtained from World Clim. Ecological niche modeling of the wild host, N. squamipes, revealed the occurrence of the species in geographic overlap with the Biomphalaria species. Knowing the influence of bioclimatic variables and identifying favorable conditions for the establishment, occurrence, and distribution of species are important information for developing strategic actions for the surveillance and control of this endemic species. The presence of the definitive wild host needs to be considered by control programs of schistosomiasis.

Rotavirus, a dsRNA virus in the Reoviridae family, shows a segmented genome. The VP1 gene encodes the RNA-dependent RNA polymerase (RdRp). This study aims to develop a multiepitope-based vaccine targeting RdRp using immunoinformatic approaches. In this study, 100 available nucleotide sequences of VP1-Rotavirus belonging to different strains across the world were retrieved from NCBI database. The selected sequences were aligned, and a global consensus sequence was developed by using CLC work bench. The study involved immunoinformatic approaches and molecular docking studies to reveal the promiscuous epitopes that can be eventually used as active vaccine candidates for Rotavirus. In total, 27 highly immunogenic, antigenic, and non-allergenic T-cell and B-cell epitopes were predicted for the Multiepitope vaccine (MEV) against rotavirus. It was also observed that MEV can prove to be effective worldwide due to its high population coverage, demonstrating the consistency of this vaccine. Moreover, there is a high docking interaction and immunological response with a binding score of -50.2 kcal/mol, suggesting the vaccine's efficacy. Toll-like receptors (TLRs) also suggest that the vaccine is physiologically and immunologically effective. Collectively, our data point to an effective MEV against rotavirus that can effectively reduce viral infections and improve the health status worldwide.

This systematic review and meta-analysis assessed the association between urinary tract infections (UTIs) during pregnancy and the risk of preterm birth (PTB). We searched multiple databases for relevant observational studies, categorizing them as UTI-based (comparing PTB incidence in women with and without UTIs) or PTB-based (comparing UTI prevalence in women with and without PTB). Using a random-effects model in Stata software version 17.0, we estimated pooled and adjusted odds ratios (ORs) with 95% confidence intervals (CIs), and performed subgroup, sensitivity, and cumulative analyses to explore heterogeneity. In total, 30 studies comprising 32 datasets were included, involving a total of 249,810 cases and 2,626,985 healthy controls. The meta-analysis revealed a significant positive association between UTIs during pregnancy and PTB occurrence (OR, 1.92; 95% CI, 1.62-2.27). A sub-group analysis based on studies, the participants showed significant association in both PTB-based (OR, 2.01; 95% CI, 1.58-2.56) and UTI-based studies (OR, 1.79; 95% CI, 1.42-2.26). However, Egger's test indicated the presence of publication bias (p=0.020), and substantial heterogeneity was observed across the included studies (I2=96.6; p< 0.001). These findings emphasize the critical importance of early detection and effective management of UTIs in pregnant women to reduce the risk of PTB and its associated adverse outcomes. While the results highlight a robust link between UTIs during pregnancy and PTB risk, the potential influence of publication bias and substantial heterogeneity should be considered to interpret these findings. Further research is needed to better understand the underlying mechanisms and to develop targeted interventions for high-risk pregnant women.

This study aimed to assess the prevalence of anemia in children of two Guarani communities in Misiones, Argentina, and to analyze its association with socioenvironmental and parasitic factors. This cross-sectional study took place in two villages, Koen Ju and Kaa Poty, and included Mbya Guarani children aged 6 months to 14 years. A multivariable analysis was performed to evaluate the association of anemia with the presence of intestinal parasites. Altogether, 162 children were included in the study: 53.1% were boys, 32.7% had low weight-for-age, and 22.2% low height-for-age. Nearly half (46.9%, n=76) had anemia, which was mainly mild (92.1%), with a few moderate cases (7.9%). Of the 109 children who underwent testing for intestinal parasites, 89 (81.7%) had at least one, and 53 (59.5%) had more than one. The main parasite was Blastocystis hominis (49.5%), followed by Entamoeba coli (47.7%), hookworms (36.7%), and Ascaris lumbricoides (31.5%). In the multivariable analysis, anemia was associated with intestinal parasitosis (adjusted odds ratio [OR] 4.24, 95% confidence interval [CI] 1.08-16.5; p=0.038) and male sex (adjusted OR 2.66; 95% CI 1.08-6.47; p= 0.01). Overall, we found that both anemia and intestinal parasites are common in the pediatric population of the Guarani ethnic group. Intestinal parasites and male sex were associated with the presence of anemia.