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

Estimates suggest that over 50% of the global population suffer from Helicobacter pylori infections. Nowadays, first-line quadruple therapy is recommended to eradicate the bacteria due to the increasing failures of the standard triple therapy. Thus, antibiotics such as furazolidone have emerged as a new treatment due to their success rate (>90%) in rescue therapies. Nevertheless, furazolidone is not routinely used for treatment of H. pylori in Colombia. Still, some Asian countries commonly prescribe it. This study aimed to determine the susceptibility of H. pylori to furazolidone in isolates from patients with gastroduodenal diseases in Colombia that were extracted from 2019-2022. A descriptive study was carried out with 179 patients with gastroduodenal diseases. Susceptibility was determined by the agar dilution method. The gene oorD from resistant isolates was amplified by polymerase chain reaction, and their PCR products were sequenced. The frequency of H. pylori equaled 23.5% (42/179); the bacterium was isolated in 84 gastric biopsies. Moreover, 1.7% (3/179) of patients had one resistant isolate to furazolidone in at least one of the two gastric biopsies, corresponding to 5.95% (5/84) of the isolates resisting furazolidone. Overall, three new mutations in the oorD gene occurred in one isolate, and two of the mutations in the five isolates had been reported in Iran, Brazil, and China. This research found low in vitro resistance of H. pylori isolates to furazolidone in Colombia. Finally, all five isolates showed mutations in the oorD gene.

Urogenital tuberculosis (UGT) constitutes a significant extrapulmonary form of tuberculosis, often presenting non-specific symptoms and a prolonged indolent course that leads to delayed diagnosis and treatment, which can result in severe and irreversible complications such as urinary strictures, renal failure, and infertility. This report describes a case of a 38-year-old man with a five-month history of low back pain, hematuria, dysuria, and altered urinary frequency. Initial treatment for a presumed urinary tract infection failed, and subsequent diagnostic investigations showed stones, nodules, and cysts in his left kidney. A positive tuberculin skin test confirmed the diagnosis of UGT and identification of Mycobacterium tuberculosis in urine samples. The patient underwent standard six-month antituberculosis therapy and subsequent retreatment due to persistent symptoms. Despite significant symptom amelioration, irreversible urological sequelae, including infundibular stenosis, polyuria, and nocturia, remained. This case underscores the importance of early suspicion, accurate diagnosis, and timely treatment of UGT to minimize long-term complications. It also highlights the potential need for extended treatment length in complex cases to improve outcomes and reduce sequelae, warranting further research in this area.

In Honduras, Leishmania (Leishmania) infantum chagasi, the etiological agent of visceral leishmaniasis (VL), is responsible for non-ulcerated cutaneous leishmaniasis (NUCL). We characterized NUCL and VL Honduran strains to understand intraspecies infectivity. Based on in-vitro assays, we aimed to elucidate certain host-parasite interactions in VL and NUCL isolates through a hamster model. To assess the capacity of these strains to infect peritoneal macrophages, we exposed them to promastigotes from NUCL and VL patients at varying temperatures and time intervals (32, 34, and 36 °C; 24 and 48 h) and infection-index (II) was determined. No significant differences were observed over time for dermotropic strains; however, a higher II was noted at lower temperatures (32 and 34 °C). Interestingly, only the VL strain exhibited a higher II at elevated temperatures (34 and 36 °C) at 48 h. Low levels of oxygen and nitrogen-derived metabolites were detected in both NUCL and VL strains. For in-vivo assays, hamsters were infected subcutaneously (SC) and intraperitoneally (IP) with 107-promastigotes from NUCL and VL patients. After 90 days of infection, parasite-load and histopathological changes were assessed from spleen samples. Regardless of the administration route, no substantial differences were observed in the histopathological features between NUCL and VL strains. In conclusion, lower temperatures may favor parasite infection for NUCL strains, mirroring conditions found in the skin. This contrasts with the VL strain, which demonstrated a superior II at higher temperatures, a condition normally found in the viscera. Our data also indicate that M. auratus is susceptible to Honduran L. (L.) infantum chagasi strains, circumventing the skin barrier by IP or SC injection.

[This corrects the article doi: 10.1590/S1678-9946202567002].

[This corrects the article doi: 10.1590/S1678-9946202567013].

Early diagnosis plays a pivotal role in breaking the epidemiological chain of Mycobacterium leprae transmission. Currently, diagnosis relies on clinical, dermato-neurological features, and histological/microbiological assessments. This prospective cross-sectional study investigated whether IgA, IgM, and IgG anti-lipid antibodies can be used to improve the diagnostic performance for leprosy-affected patients in a high-burden municipality in Brazil. Serum samples from 91 volunteers, including patients with leprosy (n=62), household contacts (n=21), and endemic controls (n=8) were screened by enzyme-linked immunosorbent assays (ELISA) for IgA, IgM, and total IgG against four lipids-namely, cardiolipin (CL), phosphatidylcholine (PTC), phosphatidylethanolamine (PE), and phosphatidylinositol (PI)-and a glycosphingolipid-sulfatide (SL)-found in the bacterial cell wall. Antibodies against all lipids were detected in the sera of patients with leprosy. Significantly higher levels of IgA anti-CL, anti-PE, and anti-PTC, IgM anti-CL, and total IgG anti-PTC were observed in these patients compared to household contacts and endemic controls (p < 0.0001). ROC curve analyses demonstrated high accuracy in discriminating patients with leprosy from the contacts, with moderate to high sensitivity and specificity, even in paucibacillary patients. Despite the small study population and the absence of patients with other dermatological lesions for differential diagnosis, these findings suggest the potential of anti-lipid antibodies as biomarkers for leprosy detection. This approach offers a promising method to improve early diagnosis in high-burden areas, such as the studied municipality in Brazil.

Cutaneous leishmaniasis (CL) has substantial epidemiological and clinical differences depending on host characteristics, Leishmania species and geographic areas. CL in Rio de Janeiro State was evaluated. Mandatory notifications of confirmed cases from 2001-2020 were analyzed considering sociodemographic and clinical variables, temporal trends, the Cutaneous Leishmaniasis Composite Indicator (CLCI) for each affected city in relation to the total of affected cities in the state, and each triennium from the beginning to the end of the time series (2001-2003, 2002-2004 until 2018-2020, sequentially). The number of cases decreased over time. High average incidence rates occurred in contiguous cities from the Southernmost to the Northernmost regions of Rio de Janeiro State, following areas where the Atlantic Forest persists. The CLCI showed temporal variations in the intensity of the risk of CL in the affected cities. Rio de Janeiro city was the only one with intense or very intense risk of CL throughout the studied period. The disease predominantly affected people residing in urban areas and in the middle age groups (20-59 years). CL also predominated in males, regardless of age. The mucosal clinical form was also significantly associated with men, with an 80% chance of them being more affected than women. Regarding diagnostic tests, the Leishmanin Skin Test showed higher positivity than the direct parasitological exam and the histopathological exam. No differences regarding cure between sexes were found. This study may guide control actions in areas where they are most needed in Rio de Janeiro State.

Adverse reactions to antituberculosis drugs can lead to treatment abandonment, prolonging the burden of the disease. The role of sex in pyrazinamide exposure and uric acid metabolism raises questions about its influence on the rates of arthralgia and hyperuricemia in patients with tuberculosis. Given the limited evidence in the literature regarding sex-related differences in adverse reaction rates, this study compares serum levels of pyrazinamide and uric acid, as well as the rates of hyperuricemia and arthralgia, between male and female patients with pulmonary tuberculosis. Uric acid levels were measured using the spectrophotometric uricase method, and serum pyrazinamide levels were determined by high-performance liquid chromatography. A total of 88 patients were enrolled in the study. The mean weight, pyrazinamide dosage, and median uric acid levels were similar between sexes. However, the proportion of males with hyperuricemia was higher than that of females. Pyrazinamide maximum concentrations ranged from 10 to 98 µg/mL and were higher in females than in males. The overall rate of arthralgia was 25%, occurring primarily in male patients with hyperuricemia. Serum pyrazinamide levels were higher in patients with arthralgia compared to those without it. No significant correlations were found between drug levels and uric acid in either sex. In conclusion, sex influences pyrazinamide exposure and arthralgia and hyperuricemia rates. Close monitoring of uric acid levels may help improve adherence to tuberculosis therapy.

[This corrects the article doi: 10.1590/S1678-9946202567003].

Nocardia keratitis is a rare cause of microbial keratitis, primarily affecting patients in tropical and subtropical regions. Its diagnostic challenge arises from this keratitis uncommon presentation, which often mimics other infectious keratitis types, leading to delays in appropriate treatment. This case report aims to elucidate the complexities of diagnosing and managing Nocardia keratitis of a 41-year-old male who had a chronic, progressively worsening wreath-pattern corneal infiltrate and hypopyon following ocular trauma. Initial empirical treatments were ineffective. Diagnostic confirmation via corneal scraping culture enabled targeted antimicrobial therapy. Subconjunctival amikacin and topical tobramycin led to gradual improvement, though complications such as corneal scarring and neovascularization remained, indicating potential need for surgical intervention. This case emphasizes the importance of high clinical suspicion and precise laboratory diagnostics in managing rare cases of Nocardia keratitis. Establishing standardized treatment guidelines for rare ocular infections could improve clinical outcomes.