Abstract in English:

Abstract Introduction Community-Acquired Pneumonia (CAP) caused by pneumococcus and Invasive Pneumococcal Disease (IPD) pose a substantial economic burden on health systems. The objective of the present study is to explore hospitalization costs of pneumococcal disease in the public health system in Brazil, the Unified Health System. Methods Retrospective analysis of administrative data on hospitalized cases of pneumococcal disease from January 2019 to July 2023. Hospitalization cases recorded with ICD-10 codes of CAP due to S. pneumoniae and IPD were retrieved from DATASUS, the inpatient information system of the Unified Health System in Brazil. Costs were converted to US dollars by Using Purchasing Power Parity (USD-PPP). Absolute number of hospitalizations, costs of hospitalizations and healthcare resource utilization were presented descriptively. The annual cost estimate was calculated. Differences in costs by type of clinical presentation and age group were assessed. Factors associated with higher costs were explored by multiple linear regression models. Results A total of 22,498 hospitalization episodes were analyzed. Total cost of hospitalizations was USD-PPP 13,958,959 (BRL 34,659,578) with an annual mean estimate of USD-PPP 3,045,591 (BRL 7,562,090). Cost per hospitalization episode was significantly higher for meningitis, followed by septicemia, CAP and arthritis, with median values ranging from USD-PPP 190.93 to 615.14 (BRL 476.20 to 1529.02). (Kruskal-Wallis χ2 = 6473, df = 3, p-value < 0.0001). Costs were significantly higher among individuals aged 60-years and older. (Kruskal-Wallis test; χ2 = 773.53; df = 2, p-value < 0.0001). There were differences in age at hospitalization, length of stay, and ICU utilization among types of clinical presentations. Conclusions Our findings reveal the economic burden associated with pneumococcal disease in the Unified Health System in Brazil. Hospitalization costs were higher for cases of meningitis and among individuals aged 60-years and above.

Abstract in English:

Abstract Specific Pathogen-Free (SPF) animals are bred and maintained to exclude pathogens associated with significant morbidity or mortality, which may pose a risk to research replicability. The BALB/c strain is distributed globally and is among the most commonly used inbred strains in immunology and infectious disease research. Despite being a widely distributed bacterium that causes chronic infection, Bartonella henselae infection has not been investigated in any protocol that characterizes SPF animals. The objective of this study was to investigate the potential natural infection of laboratory animals of the BALB/c lineage by B. henselae. To achieve this, ten immunocompetent BALB/c mice were obtained directly from the bioterium and euthanized for collection of samples, including blood, skin, spleen, liver, heart, eye, kidney, intestine, esophagus, and brain. DNA was extracted using a commercial kit and tested via nested PCR for the ftsZ gene, as well as conventional PCR and qualitative real-time PCR using Sybr® Green for the citrate synthase gene (gltA), all specific reactions for B. henselae. All animals showed detection of B. henselae DNA in at least two different reactions in different tissues. The sequenced amplicons showed 100 % similarity to B. henselae. The use of mice infected by B. henselae in experiments is undesirable, as the bacteria can affect several aspects of the animal's physiology and consequently influence the results of the project, especially when subjected to immunosuppression. More studies are needed to understand and confirm the natural infection in experimental animals by Bartonella spp.. To date, no additional published reports of contamination of experimental animals by these bacteria have been identified.

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Abstract Increased spread of antimicrobial resistance by Gram-Negative Bacilli (GNB) poses a global challenge, with exacerbated burden post-pandemic. The aim of this study was to investigate the in vitro activity of ceftolozane/tazobactam and its comparators against the frequently identified GNB isolated from patients admitted to Brazilian medical sites between the year 2018‒2019 and 2020‒2021. The impact of pandemic on antimicrobial resistance and presence of β-lactamase genes were also evaluated. Antimicrobial susceptibility testing and molecular characterization of ß-lactamase encoding genes using Polymerase Chain Reaction (PCR) and DNA sequencing were carried out from GNB isolated mostly from intra-abdominal, respiratory, and urinary tract infections and interpreted following BrCAST/EUCAST guidelines. A total of 3994 GNB isolates were evaluated which mostly included E. coli, K. pneumoniae and P. aeruginosa. Ceftolozane/tazobactam remained highly active against E. coli isolates during both 2018‒2019 (96.0 %) and 2020‒2021 (98.5 %). Among K. pneumoniae, ceftolozane/tazobactam (47.6 % and 43.0 % susceptible during 2018‒2019 and 2020‒2021, respectively) showed poor activity due to blaKPC-2. Colistin and ceftolozane/tazobactam were the most active β-lactam agents tested against P. aeruginosa in 2018‒2019 (99.3 % and 88.8 %) and 2020‒2021 (100 % and 92.8 %), including ceftazidime and meropenem resistant isolates. β-lactamase encoding gene characterization was carried out and both carbapenemases and Extended-Spectrum β-Lactamase (ESBL) producers were found in E. coli, K. pneumoniae and P. aeruginosa isolates. Ceftolozane/tazobactam documented remarkable in vitro activity against E. coli and P. aeruginosa isolates in Brazil, both pre- and post-pandemic periods and could constitute an effective therapeutic option for the treatment of urinary tract infections, intra-abdominal infections, and respiratory tract infections.

Abstract in English:

Abstract Candidemia is the predominant form of invasive candidiasis and the most frequently occurring serious fungal infection in critically ill patients in Intensive Care Units (ICU). Studies carried out in Latin America reveal a higher incidence of candidemia and higher mortality rates when compared to North America or Europe. This highlights the need to develop guidelines for correctly diagnosing and treating candidemia in critically ill patients in the ICU. These guidelines are part of the efforts to implement antifungal optimization programs in the region to obtain better clinical outcomes and promote rational antifungal use. This evidence-based clinical standard, established through expert consensus for the Latin American context, contains recommendations and algorithms for diagnosing and treating candidemia in critically ill ICU patients.

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Abstract Objective To outline the features of COVID-19 in Brazil through a countrywide telephone survey. Methods Data from the Telephone Survey of Risk Factors for Chronic Noncommunicable Diseases During the Pandemic (Covitel), a telephone survey of individuals aged 18 years or older from all macro-regions of Brazil, were used. The questionnaire included sociodemographic characteristics and outcomes related to COVID-19 infection, severity, vaccination, and use of masks. Results Data revealed that 34.7 % (95 %CI 32.4 - 37.1) of the population had been diagnosed with COVID-19, and 10.1 % (95 %CI 7.9 - 12.7) of those required hospital admission. The prevalence of COVID-19 diagnosis increased with education level: <8 years (26.6 % [95 %CI 23.1 - 30.7]), 9-11 years (33.4 % [95 %CI 29.4 - 37.7]), and >11 years (53.2 % [95 % CI 49.7 - 56.8]). Nevertheless, the hospitalization rate of Brazilians with more than eleven years of education was lower (5.8 % [95 %CI 4.3 - 7.6]). In 2023, 92.9 % (95 %CI 90.9 - 94.4) of the Brazilian population was fully vaccinated against COVID-19, but only 37.2 % (95 %CI 33.5 - 40.9) have received the updated vaccinal scheme (two doses and two boosters). During the pandemic outbreak, 81.9 % (95 %CI 79.4 - 84.2) reported always using face masks. However, only 16.1 % (95 %CI 13.5 - 19.0) maintained this practice in 2023. Conclusion There were inequalities in COVID-19 testing in Brazil. Testing and vaccination policies implemented in the COVID-19 pandemic must be reevaluated by the Brazilian government.

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Abstract Background Human Cytomegalovirus (HCMV) remains a significant cause of morbidity and mortality among pregnant women and immunocompromised patients. HCMV transmission can occur through blood transfusions and typically results in asymptomatic infections in newborns and young individuals or causes symptoms like infectious mononucleosis when symptomatic infections arise. HCMV infection poses a notable risk to transfusion recipients, particularly in vulnerable groups such as premature newborns and immunosuppressed patients. The risk persists even after prophylaxis ends, especially in patients who undergo organ transplantation and receive blood or blood products from a seropositive donor while being seronegative themselves (D+/R-). Materials and methods Here, we investigated the serological and molecular prevalence of HCMV among 980 blood donors from the main blood bank in Rio de Janeiro, Brazil, using chemiluminescence and real-time PCR (TaqMan). The data underwent univariate, bivariate, and multivariate statistical analyses using the SPSS program, version 20.0. Results The average age of donors was 38.53 years, with a majority being male (53.9 %). The prevalence of cytomegalovirus was 88.5 %, and HCMV DNA was detected in 1.2 % of the samples. Discussion Given that there are approximately 100,000 blood donations per year, this prevalence rate is considerably high compared to that in developed countries. These findings underscore the critical need for ongoing surveillance and molecular testing to ensure the safety of blood supplies.

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Abstract Introduction Post-COVID Syndrome (PCS), occurs several weeks after Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2 infection), has a frequency of 10 %‒35 % of cases, presents a wide range of symptoms that can persist for months or years and markedly reduces the quality of life of patients. Objective To describe clinical, epidemiological and evolutionary aspects of a cohort of patients diagnosed with PCS followed on an outpatient basis. Methodology Individuals of both sexes, > 18-years old who presented symptoms suggestive of PCS and had previously confirmed SARS-CoV-2 infection were included. Clinical evaluation was carried out monthly by a multidisciplinary team, and if necessary laboratorial exams were performed. Results From June 2021 to June 2022, 92 cases of PCS were diagnosed, of which 60 (65.2 %) were female and the average age was 49.1 years. In 61 (66.3 %) of the cases, SARS-CoV-2 infection occurred between January and November 2021. In 55 (59.7 %) of the cases the symptoms were mild, while 31 (36.0 %) were moderate or severe cases. Most cases of PCS occurred in individuals with the mild form of COVID-19. The predominant symptoms were chronic fatigue in 59 (68.6 %) cases, brain fog in 68 (73.4 %), myalgias and arthralgias in 44 (47.8 %), cramps and paresthesia's in 40 (46.5 %). The main comorbidities observed were high blood pressure, obesity and diabetes mellitus. The persistence of symptoms was greater in those cases who presented severe forms of COVID-19. Most patients experienced gradual and progressive improvement over the months. Discussion The profile of patients with PCS in this cohort is similar to other reports. A great number of symptoms is remarkable with variable presentation and evolution and their frequency exceeds that previously described in a large meta-analysis. Inflammatory phenomena mediated by the virus, autoimmunity and direct organic damage have been implicated in the genesis of this syndrome.

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Abstract Introduction We aimed to create and validate the 30-day prognostic score for mortality in patients with surgical wound infection (SWICS-30) after cardiothoracic surgery. Methods This retrospective study enrolled patients with surgical wound infection following cardiothoracic surgery admitted to a Cardiologic Reference Center Hospital between January 2006 and January 2023. Clinical data and commonly used blood tests were analyzed at the time of diagnosis. An independent scoring system was developed through logistic regression analysis and validated using Artificial intelligence. Results From 1713 patients evaluated (mean age of 60 years (18-89), 55 % female), 143 (8.4 %) experienced 30-day mortality. The SWICS-30 logistic regression score comprised the following variables: age over 65 years, undergoing valve heart surgery, combined coronary and valve heart surgery, heart transplantation, time from surgery to infection diagnosis exceeding 21 days, leukocyte count over 13,000/mm3, lymphocyte count below 1000/mm3, platelet count below 150,000/mm3, and creatinine level exceeding 1.5 mg/dL. These patients were stratified into low (2.7 %), moderate (14.2 %), and high (47.1 %) in-hospital mortality risk categories. Artificial intelligence confirmed accuracy at 90 %.

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Abstract Background Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) share the same routes of transmission, therefore, co-infection by both viruses represents a challenge to the goal of eliminating viral hepatitis as a public health threat. There are an estimated 2.3 million people living with HIV/HCV worldwide. Most of these cases affect vulnerable populations located in places with low infrastructure. Because of this, the use of alternative samples such as Dried Blood on Spot (DBS) would facilitate access to diagnosis and HCV treatment. The aim of this study is to evaluate the HCV genetic variability in HIV/HCV individuals by correlating paired serum and DBS samples. Methods A total of 14 HIV/HCV individuals, recruited from reference outpatient clinics in the city of Rio de Janeiro/Brazil, were included. From them, 64 % were man, mean of age 54±7. HCV RNA from both serum and DBS samples was RT-PCR amplified and sequenced with HCV NS5B-specific oligonucleotides. All positive samples were submitted to phylogenetic analysis. Results Serum mean HCV load was 6.2 ± 0.5 log IU/mL. All patients presented undetectable HIV RNA. The distribution of HCV genotypes/subgenotypes was 1a (4/14); 1b (5/14); 3a (4/14); and 4d (1/14). Most paired serum and DBS samples showed concordant results (genetic distance: 0.0 to 0.16). One individual showed discordance in the subtypes between serum and DBS. Three individuals presented the 316 N Resistance Associated Mutation (RAS) in both serum and DBS. Conclusion Our results demonstrate the applicability of DBS for HCV molecular tracking in HIV/HCV coinfected patients for viral genomic surveillance in key and vulnerable populations.

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Abstract Background Dolutegravir (DTG) is widely used as a first-line Antiretroviral Therapy (ART) due to its high efficacy and safety. However, concerns about DTG resistance persist. This study investigated the prevalence and factors associated with transmitted DTG resistance in treatment-naive HIV-1-infected individuals in Brazil. Methods The study followed 150 treatment-naive HIV-1 individuals from May 2019 to May 2022 at a reference center for HIV/AIDS in Rio de Janeiro, Brazil. Baseline characteristics, viral load, and CD4 + cell counts were assessed. Genotypic resistance testing was conducted on plasma samples at baseline, and viral load was monitored during follow-up visits. Results One hundred and thirty-one patients completed the study. The mean age was 37.73-years; 107 were male, and 24 were female. The median baseline of viral load was 4.33 log (21,193 copies/mm3), and CD4 + count was 342 cells/mm3, with the lowest count being 8 cells/mm3. The mean CD4 + count increase was 112 cells/mm3 (p < 0.01). One hundred and nine patients achieved an undetectable viral load three months after starting ART, with only eight patients not reaching undetectable levels by six months (42‒106 copies/mm3). The most common early adverse effect was nausea (12.9 %), and the most common later effect was increased creatinine levels (9.1 %), leading to the suspension or substitution of Tenofovir Disoproxil Fumarate (TDF). Genotyping was successfully performed on 85 patients: 66 were subtype B, 9 subtype C, 8 subtype F, and two CRF47_BF, with no resistance mutations and one accessory mutation (T97A). Conclusion This study did not demonstrate transmitted DTG resistance among treatment-naive HIV-1-infected individuals. The findings suggest that DTG remains a safe and effective first-line ART option. However, close monitoring of viral load is recommended for all patients on DTG-containing ART regimens. Additionally, genotypic resistance testing should be performed on individuals who experience virological failure or a significant decline in CD4 + cell counts, with close attention to ART adherence.

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Abstract This study describes and estimates the social and economic impact of Invasive Meningococcal Disease (IMD) sequelae globally and in Brazil. An integrative review was conducted to identify IMD sequelae costs estimates worldwide. The evidence identified supported the development of a Delphi survey to estimate medical Resource Use (RU) and caregiver productivity loss during the first Year (Y1) of IMD and the Subsequent Year (SY) in Brazil. Treatment costs of long-term IMD sequelae were estimated through microcosting approach using Brazilian cost reference tables and taking into account the Delphi survey estimates. The review included eight studies from high-income countries. Mean costs of IMD sequelae in high-income countries varied substantially by type of sequelae in Y1 (hearing loss $14,511; amputation $144,087), type of care over a lifetime horizon (outpatient $28,498; inpatient $67,038), and medical procedure over a lifetime horizon (shunt revision $22,794; prosthesis $508,735). The Delphi survey indicated that medical RU was significantly higher in Y1 versus SY. Resource use was highest for patients with multiple limb amputations. In addition, the highest number of outpatient visits (32) were required for patients with skin scars; speech therapy (72) for hearing loss; and the most psychologist sessions (116) for mental health disorders in Y1. Similarly, estimated treatment costs were highest for patients with multiple limb amputations ($4,139.70 in Y1 and $1,874.39 for SY), followed by single limb amputation ($2,803.24 in Y1 and $902.73 for SY) and skin scarring ($2,307.69 in Y1 and $816.19 for SY). All sequelae resulted in multiple workdays lost for caregivers, ranging from 33 (skin scarring) to 85 (multiple limbs amputation) during the first year of treatment. This study informs decision-makers on the healthcare, social and educational services, and social protection needs of patients with long-term sequelae in Brazil and globally.

Abstract in English:

Abstract Background Ceftazidime-Avibactam (CAZ-AVI) plays a key role in the treatment of Multidrug Resistant Gram-Negative Bacilli (MDR-GNB) infections. In pediatrics, CAZ-AVI is clinically approved for treatment of urinary tract or intra-abdominal infection. However, there is limited data available about its use in children with cancer who have complicated infections caused by MDR-GNB. Objective This study aims to describe our experience in using CAZ-AVI for the treatment of MDR GNB infections in children with cancer. Methods This retrospective observational study was conducted at the Pediatric Oncology Institute (IOP/GRAACC/UNIFESP), including pediatric oncologic patients who received CAZ-AVI for the treatment of infections caused by GNB. Results From Jan/2021 to Jun/2022, 11 patients with 13 episodes were included in the analysis. Among them, 45 % were female, with a median age of 7 years. Three patients had Acute lymphoblastic Leukemia (ALL), three had Acute Myeloid Leukemia (AML), two had Non-Hodgkin Lymphoma (NHL). Additionally, there was one case each of medulloblastoma, fibrosarcoma, and craniopharyngioma. All patients presented significant risk factors for MDR-GNB, such as neutropenia and two were submitted to Hematopoietic Stem Cell Transplantation (HSCT). The infection episodes included six Bloodstream Infections (BSI), two Urinary Tract Infections (UTI), two tracheobronchitis cases, along with one case each of necrotizing pneumonia, ventriculitis, and endocarditis. The identified pathogens included Klebsiella pneumoniae, Pseudomonas spp., Enterobacter cloacae, and Stenotrophomonas maltophilia. The primary reason for prescribing CAZ-AVI was either Multidrug-Resistant Gram-Negative Bacteria (MDR-GNB) infection or clinical worsening after initial therapy. Combination therapy was prescribed in eight episodes with a median prescription length of nine days. Microbiological sterilization was achieved in 92 % of episodes, and the 30-day survival rate was 84 %. Notably, no deaths were associated with treatment failure, and no adverse events associated with CAZ-AVI use were observed. Conclusion CAZ-AVI could be used for treating GNB infections in oncologic pediatric patients.

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Abstract Crimean-Congo Hemorrhagic Fever (CCHF) is a viral hemorrhagic fever common in many regions of the world. There are many diseases in the differential diagnosis of CCHF. In our study, we aimed to predict the diagnosis of CCHF at the time of initial presentation by using clinical and laboratory findings in patients with a preliminary diagnosis of CCHF. In our study, 74 patients with a definitive diagnosis of CCHF and 43 patients with a preliminary diagnosis of CCHF but not diagnosed with CCHF were compared in terms of demographic, clinical and laboratory findings. Multivariate logistic regression analysis and Receiver Operating Characteristics (ROC) curve were used to determine variables to predict the diagnosis of CCHF. Living in an endemic area, tick bite, fever, CRP below 48 mg/L and PCT below 0.52 ng/mL were determined as independent risk factors for CCHF diagnosis. The specificity for cut off values of 2485 mm3 for WBC and 970 mm3 for neutrophil count were 86 % and 93 %, respectively. The sensitivity for cut off values of 48 mg/L for CRP and 0.52 ng/mL for PCT were 90.5 % and 82.4 %, respectively. In-hospital and 28-day mortality were higher in the non-CCHF group. The differential diagnosis of CCHF is important for planning appropriate isolation procedures and treatments for patients. Additionally, by excluding CCHF, it allows for the early consideration of other diseases in the non-CCHF group that show high mortality. In patients living in endemic areas with tick bites and clinical findings compatible with CCHF, easily accessible tests such as WBC, neutrophil count, CRP and PCT, within the cut-off values identified in our study, will assist in diagnosing CCHF at the initial presentation.

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Abstract Aspergillosis is a disease caused by the filamentous fungus Aspergillus spp. with a spectrum of clinical presentation that includes invasive and noninvasive forms. The invasive clinical presentation of aspergillosis most frequently affects people with compromised immune systems. In patients with oncohematologic pathology, invasive lung aspergillosis is a significant opportunistic mycosis, because it occurs frequently and has a major impact on morbidity, mortality, and high costs. The global problem of antimicrobial resistance, to which improper use of antifungals contributes, has put Aspergilus spp. in the spotlight, so it is important to generate guidelines for guidance in the proper use of antifungals in the management of invasive lung aspergillosis, to obtain better clinical outcomes and promote rational use of antifungals. This guideline contains recommendations for diagnosing and treating invasive lung aspergillosis in patients with oncohematologic disease, based on evidence and defined through a participatory process of expert consensus, for the Latin American context.

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Abstract Methicillin-Resistant Staphylococcus Aureus (MRSA) is commonly transmitted among hospitalized patients through direct contact or contaminated objects. However, the dynamics of household transmission of MRSA remain unclear, posing challenges for effective prevention. This study evaluates the persistence of MRSA colonization in asymptomatic carriers over a period of at least 17-months and examines the potential for intra-household transmission. We conducted home visits to seven families, each with at least one MRSA-colonized member, to collect nasal swabs from all household members. Phenotypic and genotypic profiles of the isolates were determined through culture, antimicrobial susceptibility testing, and PCR. We compared these new samples with previous samples from a recent study involving the same individuals to assess spontaneous clearance of MRSA. A total of 25 samples were collected, with 56 % (14) identified as S. aureus and 44 % (11) as non-S. aureus; among the S. aureus isolates, four were MRSA. We observed spontaneous clearance of MRSA in six of the original cases. Unexpectedly, there was limited intra-household transmission of MRSA, although all families with MRSA colonization had at least one member with a history of skin disease. In the family where colonization persisted, one individual had recurrent cutaneous abscesses, suggesting a possible link to sustained colonization.

Abstract in English:

Abstract Influenza viruses cause 3-5 million severe cases and 300,000-600,000 deaths worldwide. Most of the disease burden is in Low- and Middle-Income Countries (LMICs) owing to factors such as high population density, infrastructure challenges, poor quality healthcare, lack of consistent recommendations, less prioritization of all high-risk groups, and prevalent use of trivalent influenza vaccines. Although influenza vaccines are effective in reducing the annual influenza disease burden, existing vaccines have several limitations. In this narrative review, we address the unmet needs of existing influenza vaccines in LMICs in Africa, Asia Pacific, Latin America and the Middle East and discuss the characteristics of novel vaccines in clinical development. We also describe features of a successful vaccination program that LMICs could emulate to improve their current vaccination coverage and reduce the public health burden of influenza.

Abstract in English:

Abstract Viral hepatitis is a public health problem, about 1 million people die due to complications of this viral disease, the etiological agents responsible for inducing cirrhosis and cellular hepatocarcinoma are HBV and HCV, both hepatotropic viruses that cause asymptomatic infection in most cases. The regulation of the microbiota performs many physiological functions, which can induce normal intestinal function and produce essential nutrients for the human body. Metabolites derived from gut microbiota or direct regulation of host immunity and metabolism have been reported to profoundly affect tumorigenesis in liver disease. If the microbiota is unbalanced, both exogenous and symbiotic microorganisms can affect a pathological process. It is well understood that the microbiota plays a role in viral diseases and infections, specifically the hepatic portal pathway has been linked to the gut-liver axis. In HBV and HCV infections, the altered bacterial representatives undergo a state of dysbiosis, with subsequent establishment of the pathobiome with overexpression of taxons such as Bacteroides, Clostridium, Lactobacillus, Enterobacter, and Enterococcus. This dysregulated microbiome induces a microenvironment conducive to the development of hepatic complications in patients with acute and chronic HBV and HCV infection, with subsequent dysregulation of cytokines IFN-α/β, TNF-α, IL-1β, TGF-β, IL-6 and IL-10, which alter the dysfunction and damage of the hepatic portal system. In view of the above, this review aimed to correlate the pathophysiological mechanisms in HBV and HCV infection, the dysregulation of the microbiome in patients infected with HBV and HCV, the most altered cytokines in the microbiome, and the most altered bacterial representatives in the pathobiome of infection.

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Abstract A 22-year-old woman presented with an ulcer on her right earlobe 2 months ago, with inflammation and enlarged ipsilateral lymph nodes in her neck. She was treated with antibiotics without success and then was referred to an infectious disease specialist. She has a cat at home with sporotrichosis, but without direct contact with the lesion, she did not remember any scratching by the cat. She also mentioned wearing a semi-jewel earring. This is a rare and unusual case of sporotrichosis in the earlobe, probably caused by wearing an earring contaminated by the cat's fungus that was present in the home environment. The delay in diagnosis and treatment led to the worsening of the injury and loss of the earlobe.

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Abstract A retrospective and cross-sectional study was carried out on blood donors from Piauí State located at Northeastern Brazil to evaluate the prevalence of Hepatitis E Virus (HEV) infection. Serum samples were tested for anti-HEV IgG and IgM using electrochemiluminescence and HEV RNA was tested using real time PCR. A total of 890 individuals were included with median age of 33.4 years and most of them were male and lived at Mid-Northern region of the State. Prevalences of anti-HEV IgG and IgM were 1.35 % and 0.11 %, respectively. None HEV-RNA was detected. This study demonstrated low prevalence of HEV infection in blood donors in this region.

Abstract in English:

Abstract Background Treating NDM-producing bacteria poses a significant challenge, especially for those bacteria inherently resistant to polymyxin, such as Serratia marcescens, necessitating combined therapies. Objective To assess in vitro the synergistic effect of different antimicrobial combinations against NDM-producing S. marcescens. Methods Four clinical isolates were tested with various antibiotic combinations: polymyxin, amikacin, meropenem, and aztreonam. Concentrations used were those maximized by pharmacokinetic and pharmacodynamic assessments. Synergy evaluation involved a static macrodilution test followed by a time-kill curve assay. Results All four isolates demonstrated resistance according to CLSI and EUCAST standards for the tested antibiotics (polymyxin, amikacin, meropenem, and aztreonam). In the macrodilution synergy test, the combination of aztreonam and amikacin was active in 2 out of 4 isolates within 24 h, and polymyxin with meropenem in only one isolate, despite of intrinsic resistance to polymyxin. However, time-kill curve analysis revealed no synergism or additive effect for combinations with the tested antimicrobials. Conclusion Combinations of polymyxin, meropenem, aztreonam, and amikacin at doses optimized by pharmacokinetic/pharmacodynamic were insufficient to demonstrate any synergism in NDM-producing S. marcescens isolates in time-kill curves.

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Abstract Introduction Dengue cases in the Americas in 2024 have reached record highs, especially in Brazil. However, surveillance remains suboptimal and new methods are needed to monitor Dengue Virus (DENV) spread. To assess whether wastewater-based epidemiology would be a useful tool, we investigated the presence of DENV RNA in dengue patients’ urine and oral fluid from an endemic area to inform how shedding in these fluids occurs and provide insight for wastewater surveillance. Methods We examined how often DENV RNA is detected in urine and oral fluid from dengue patients confirmed by serum RT-qPCR, NS1 ELISA or IgM seroconversion in Salvador, Brazil. Results Of 88 confirmed cases, 9.1 % were positive for DENV RNA in urine (7/88) or oral fluid (1/88). Of 53 serum RT-qPCR-positive patients, 6 (11.3 %) showed detectable DENV RNA in acute- or convalescent-phase urine. Patients with RT-qPCR-positive urine had a lower frequency of DENV IgG in acute-phase serum (a proxy for secondary infection) (57 % vs. 74 %) and a lower median serum RT-qPCR cycle threshold than those with negative urine (21.8 vs. 23.9). Conclusion The low presence of DENV RNA in urine suggests that additional research is needed to evaluate whether using wastewater-based epidemiology to monitor DENV transmission is possible.

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Abstract Background The incidence of Late-Onset Sepsis (LOS) increases as gestational age decreases in newborns. The clinical signs of neonatal sepsis are not specific for diagnosis in preterm infants. The gold standard for its diagnosis is the blood culture test, which requires more than 24 h to obtain results, with positive results obtained in 10-3 % of cases analysed. As the molecular markers on the lymphocyte surface CD64 and CD69 are involved in early innate immune activation, they may be helpful for faster diagnosis. Aim Measure the expression of CD64 and CD69 on lymphocytes in clinical and confirmed sepsis patients and compared to that in infants without sepsis. Methodology We used peripheral blood samples from three groups of preterm babies with suspected sepsis (n = 31), confirmed sepsis (n = 10) and without sepsis (n = 47). Using flow cytometry, we measure the expression of CD64 on neutrophils and CD69 on NK cells. Results Expression of CD64 on neutrophils and CD69 on NK cells did not increase in the clinical or confirmed sepsis groups compared to the without sepsis group. Conclusions Leukocytes from infants born prematurely may have tightly regulated mechanisms that control their activation phenotype, rendering them unsuitable for diagnosing sepsis.