Revista do Instituto de Medicina Tropical de São Paulo
type: channel
description: To publish articles dealing with research on tropical diseases and related sciences.
publisher: Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo
language: en
publication name: Revista do Instituto de Medicina Tropical de São Paulo
issn: 0036-4665
items: Weil's disease: rapid recovery following corticosteroid treatment: a case report
items: Rare fungal bloodstream infections in pediatric patients: a case series
items: Open-access The diagnostic value of fine-needle aspiration cytology in the early diagnosis of pulmonary cryptococcosis
items: Treatment of brucellosis in pregnant women: a systematic review and analysis of current gaps and future perspectives
items: Clostridioides difficile infections in seven Brazilian hospitals during the COVID-19 pandemic: hand hygiene and antimicrobial consumption
items: Molecular biomarkers associated with ATLL and HAM progression in HTLV-1 infection: a systematic review
items: Mycobacterium kansasii in cancer patients: a 13-case series
items: Epidemiological study of hantavirus in Southern Brazil, 2009-2019
items: Candidemia in a tertiary hospital in Southern Brazil
items: A rare case of oral myiasis in a non-tropical region: the role of systemic vulnerability
items: Genotypic virulence profiles and mobile genetic elements related to invasiveness in Neisseria gonorrhoeae strains
items: The COVID-19 pandemic in the hotel industry: the application of hygiene and safety protocols by hotel employees
items: Plasmidial virulence of Rhodococcus equi and its implications of livestock infections for human health: a possible foodborne pathogen?
items: A fatal case report of sepsis caused by Robinsoniella sp.
items: Dengue haemorrhagic fever: an evaluation of host innates immune factors in hepatic lesions and their correlation with immunopathogenesis
items: Rezafungin in fluconazole-resistant and refractory candidiasis: the first Brazilian experience
items: Streptococcus suis infection as an emerging zoonotic threat in Brazil: a One Health-based review
items: Molecular identification of Bartonella henselae in dogs with clinical suspicion of visceral leishmaniasis
items: Eosinophilic meningitis caused by Angiostrongylus cantonensis: case report in a patient with false-positive immunological test result for Neisseria meningitides
items: Non-feline transmission of sporotrichosis: a systematic review of published cases
items: Fulminant hepatitis secondary to dengue in pediatric patients: a series of four cases
items: Comparative performance of Filamentous Fungi 4.0 and Mass Spectrometry Identification 2.0 databases for Aspergillus spp.: identification using a simplified protein extraction method
items: Yellow fever virus resurgence in Sao Paulo State, Brazil, 2024–2025
items: https://revistas.usp.br/rimtsp/en/article/view/245852
items: Reflections on the study "Central sterile supply department management on hospital-associated infections: a systematic review and meta-analysis" by Shuai et al
items: Fatal cerebral myiasis secondary to squamous cell carcinoma: case report and scoping review
items: Leptospirosis-associated pulmonary hemorrhagic syndrome: immune mechanisms, clinical manifestations, and experimental models
items: SARS-CoV-2 lineage-specific disease symptoms and disease severity in a city in southeastern Brazil
items: HIV-associated neurological infections in a Brazilian tertiary care center: clinical-epidemiological features and predictors of in-hospital mortality
items: Circulating cell-free mitochondrial DNA as a candidate marker of hyperinflammation and immune activation in pre-adolescents, adolescents and young adults with COVID-19 and comorbidities

Weil's disease: rapid recovery following corticosteroid treatment: a case report
type: item
description: Leptospirosis is a zoonotic infection with a range of clinical findings, ranging from a mild, self-limited illness to a severe, life-threatening disease known as Weil's disease. The role of adjunctive corticosteroid therapy in severe leptospirosis remains controversial. We report a 41-year-old male with a history of intravenous drug use, regular alcohol consumption, and exposure to contaminated freshwater, who presented with fever, myalgia, vomiting, jaundice, thrombocytopenia, and acute kidney injury. Serological testing via the microagglutination test (MAT) was negative at admission, and empirical antibiotic therapy with ceftriaxone was initiated. Despite appropriate antimicrobial treatment and supportive care, including hemodialysis, the patient developed progressive hyperbilirubinemia and persistent thrombocytopenia. A repeat MAT performed one week later confirmed infection with Leptospira interrogans serovar Pomona. Due to ongoing clinical deterioration, methylprednisolone (1 mg/kg/day) was initiated, resulting in a dramatic clinical and laboratory improvement within 24 h. This rapid response suggests a potential role for corticosteroid therapy in selected patients with severe leptospirosis; however, further studies are required to establish its efficacy and safety.
subject: Case Report
  topic: section
subject: Leptospirosis
  topic: keywords
subject: Weil's disease
  topic: keywords
subject: Corticosteroid therapy
  topic: keywords
subject: Hyperbilirubinemia
  topic: keywords
subject: Thrombocytopenia
  topic: keywords
creator: Ahmet Melih Şahin
creator: İrem Atçı-Koç
creator: Sinan Çetin
rights: Copyright (c) 2026 Ahmet Melih Şahin, İrem Atçı-Koç, Sinan Çetin https://creativecommons.org/licenses/by-nc/4.0
date: 2026-06-01
publication date: 2026-06-01
starting page: e35
ending page: e35
doi: 10.1590/S1678-9946202668035

Rare fungal bloodstream infections in pediatric patients: a case series
type: item
description: Fungemia caused by rare fungal species has been increasingly recognized in both immunocompromised and immunocompetent children. Our aim is to characterize the clinical and microbiological features of rare fungal bloodstream infections in hospitalized pediatric patients. A retrospective, descriptive study was conducted including all cases of fungemia due to rare yeasts in patients admitted to two tertiary pediatric hospitals between 2021 and 2025. Fungal species identification, anatomical sites of infection, antifungal therapeutic regimens, and clinical outcomes were systematically analyzed. In total, 13 cases of rare fungal bloodstream infections were identified among 13 patients from 2,555 blood cultures obtained during the study period, representing an incidence of 0.5%. The predominant species isolated were Saccharomyces cerevisiae (n=5), Wickerhamomyces anomalus (n=3), Candid orthopsilosis (n=2), Yarrowia lipolytica (n=1), Meyerozyma guilliermondii (n=1), and Trichosporon asahii (n=1). The median age at infection was 31 months (range: 0–178 months), with 92.3% (12/13) of patients presenting underlying medical conditions. The median interval from hospital admission to fungemia onset was 19 days (range: 0–73 days). Amphotericin B deoxycholate was the most frequently employed initial antifungal agent (n=5), followed by liposomal amphotericin B (n=4). Modification of antifungal therapy was required in five cases (38.5%). Microbiological clearance was achieved in all patients on subsequent blood cultures. The 30-day all-cause mortality rate was 15.4% (2/13). We concluded that rare fungal bloodstream infections occurred predominantly in patients with underlying comorbidities and prolonged hospital stays; nevertheless, the majority showed favorable clinical responses with appropriate antifungal therapy and achieved fungal eradication from the bloodstream.
subject: Original Article
  topic: section
subject: Rare fungi
  topic: keywords
subject: Invasive fungal infections
  topic: keywords
subject: Pediatric patients
  topic: keywords
subject: Fungemia
  topic: keywords
subject: Hospitalization
  topic: keywords
creator: Nicole Feitosa Ximenes Ferreira
creator: Giovana Fernandes Zorzan
creator: André Ricardo Araújo da Silva
rights: Copyright (c) 2026 Nicole Feitosa Ximenes Ferreira, Giovana Fernandes Zorzan, André Ricardo Araújo da Silva https://creativecommons.org/licenses/by-nc/4.0
date: 2026-06-01
publication date: 2026-06-01
starting page: e34
ending page: e34
doi: 10.1590/S1678-9946202668034

Open-access The diagnostic value of fine-needle aspiration cytology in the early diagnosis of pulmonary cryptococcosis
type: item
description: Pulmonary cryptococcosis, an invasive fungal infection caused by Cryptococcus spp., is often misdiagnosed as tuberculosis or lung cancer due to overlapping clinical and radiological features, leading to treatment delays. In this descriptive study, we aim to characterize the diagnostic findings and clinical utility of fine-needle aspiration cytology (FNAC) in a series of patients with pulmonary cryptococcosis, within the context of other available diagnostic modalities. We retrospectively analyzed 10 patients with pulmonary cryptococcosis who underwent imaging-guided percutaneous lung aspiration. Wright-Giemsa-stained cytology smears were examined under oil immersion, enabling clear visualization of the characteristic morphological features of Cryptococcus. In this case series, FNAC provided a rapid cytological diagnosis within two hours in all 10 cases, consistent with the results obtained by metagenomic next-generation sequencing (mNGS) and serological testing. In contrast, conventional smear microscopy showed lower detection rates, and histopathology required longer processing times. The use of FNAC facilitated early diagnosis, enabling timely initiation of antifungal therapy and helping to avoid unnecessary surgical interventions. Our findings suggest that cytomorphological evaluation by FNAC is a rapid and valuable diagnostic tool in the early clinical management of pulmonary cryptococcosis, effectively complementing existing diagnostic methods.
subject: Original Article
  topic: section
subject: Pulmonary cryptococcosis
  topic: keywords
subject: Fine-needle aspiration cytology
  topic: keywords
subject: Early diagnosis
  topic: keywords
subject: Diagnostic methods
  topic: keywords
creator: Dongxia Wang
creator: Ning Wang
creator: Jiejing Liu
creator: Chengyan Zhao
creator: Xue Xing
rights: Copyright (c) 2026 Dongxia Wang, Ning Wang, Jiejing Liu, Chengyan Zhao, Xue Xing https://creativecommons.org/licenses/by-nc/4.0
date: 2026-06-01
publication date: 2026-06-01
starting page: e33
ending page: e33
doi: 10.1590/S1678-9946202668033

Treatment of brucellosis in pregnant women: a systematic review and analysis of current gaps and future perspectives
type: item
description: Human brucellosis is a globally prevalent bacterial disease with significant implications during pregnancy due to obstetric complications. Despite the importance of early diagnosis and treatment, the lack of therapeutic consensus and robust evidence underscores the need for systematic evaluation to guide clinical practice. This study systematically reviewed the literature to identify and summarize available drug therapy options for brucellosis in pregnant women, focusing on efficacy, safety, and obstetric outcomes. The review followed PRISMA and Cochrane Handbook guidelines. Searches were conducted in MEDLINE, Embase, Cochrane Library, LILACS, and gray literature for references indexed up to September 15, 2025. Eligible studies reported therapeutic interventions in pregnant women with brucellosis. Risk of bias was assessed using the JBI Critical Appraisal tool, and data on participants, interventions, and outcomes were extracted. Of 737 records screened, six studies met the inclusion criteria, comprising retrospective and prospective reports published between 1991 and 2020, totaling 403 pregnant women. Therapeutic regimens varied, with sulfamethoxazole–trimethoprim (SMX–TMP) plus rifampicin being the most frequently used combination. Adverse obstetric outcomes associated with this regimen occurred in 16% (95%CI: 8%–30%) of cases. Overall, abortion occurred in 94 (23.3%) women, 20 preterm births were reported, and 10 newborns had low birth weight. Recurrence was observed in only 3% of cases. Heterogeneity in outcomes and definitions limited comparability. In conclusion, there is no standardized treatment for brucellosis during pregnancy. Adverse obstetric outcomes remain frequent, highlighting the need for controlled studies to establish safe and effective therapeutic protocols.
subject: Review
  topic: section
subject: Brucellosis
  topic: keywords
subject: Pregnancy
  topic: keywords
subject: Systematic review
  topic: keywords
subject: Therapeutics
  topic: keywords
creator: Endi Lanza Galvão
creator: Diêgo Mendes Xavier
creator: Glaciele Maria de Souza
creator: Gláucia Cota
creator: Sarah Nascimento Silva
rights: Copyright (c) 2026 Endi Lanza Galvão, Diêgo Mendes Xavier, Glaciele Maria de Souza, Gláucia Cota, Sarah Nascimento Silva https://creativecommons.org/licenses/by-nc/4.0
date: 2026-05-19
publication date: 2026-05-19
starting page: e32
ending page: e32
doi: 10.1590/S1678-9946202668032

Clostridioides difficile infections in seven Brazilian hospitals during the COVID-19 pandemic: hand hygiene and antimicrobial consumption
type: item
description: This study aimed to evaluate the incidence density of Clostridioides difficile infections (CDIs), hand hygiene adherence, and antimicrobial consumption across Brazilian hospitals during the COVID-19 pandemic. An ecological study was conducted in seven Brazilian hospitals from June 2018 to December 2019 (pre-pandemic) and from June 2020 to December 2021(pandemic). Data on CDI incidence density, hand hygiene adherence, and antimicrobial consumption were collected. CDI incidence was assessed based on the number of monthly cases and the incidence density rate per 10,000 patient-days. This study involved hospitals from four states and included three public and four private institutions. Statistical analyses were performed using the Mann-Whitney U test in R (p < 0.05). Time series analysis used joinpoint regression to determine monthly percent change, average monthly percent change, and 95% confidence intervals. Although statistically insignificant, an upward trend occurred in CDI incidence (p = 0.081) from the pre-pandemic to the pandemic periods. Consumption of azithromycin (p < 0.01) and levofloxacin (p < 0.01) increased significantly, whereas ceftriaxone use decreased (p = 0.0038). The joinpoint regression analysis of antimicrobial consumption trends during the pandemic showed trend changes for vancomycin and meropenem defined daily dose, with higher consumption during the second wave of COVID-19 in Brazil. Hand hygiene adherence failed to differ significantly but showed a downward trend in 2020 and 2021. The dynamics of the COVID-19 pandemic and changes in protective measures may have influenced CDI incidence and antimicrobial consumption patterns across the study period.
subject: Original Article
  topic: section
subject: Clostridioides difficile
  topic: keywords
subject: COVID-19
  topic: keywords
subject: Antibiotic consumption
  topic: keywords
creator: Luiza Arcas Gonçalves
creator: Ivan Lira dos Santos
creator: Ana Paula Matos Porto
creator: Antônio Brazil Viana Junior
creator: Julia Herkenhoff Carijo
creator: Claudia Dantas de Maio Carillho
creator: Brunno Cesar Batista Cocentino
creator: Luciana Neves Passos
creator: Glaucia Fernanda Varkulja
creator: Thais Guimarães
creator: Silvia Figueiredo Costa
rights: Copyright (c) 2026 Luiza Arcas Gonçalves, Ivan Lira dos Santos, Ana Paula Matos Porto, Antônio Brazil Viana Junior, Julia Herkenhoff Carijo, Claudia Dantas de Maio Carillho, Brunno Cesar Batista Cocentino, Luciana Neves Passos, Glaucia Fernanda Varkulja, Thais Guimarães, Silvia Figueiredo Costa https://creativecommons.org/licenses/by-nc/4.0
date: 2026-05-19
publication date: 2026-05-19
starting page: e31
ending page: e31
doi: 10.1590/S1678-9946202668031

Molecular biomarkers associated with ATLL and HAM progression in HTLV-1 infection: a systematic review
type: item
description: Human T-lymphotropic virus type 1 (HTLV-1) infects approximately five to 10 million individuals worldwide, although only a minority develop severe outcomes such as adult T-cell leukemia/lymphoma (ATLL) or HTLV-1-associated myelopathy (HAM). Proviral load (PVL), while widely used, shows limited sensitivity and specificity, reinforcing the need for complementary biomarkers. Omics-based approaches have emerged as promising tools to improve risk prediction. We conducted a systematic review following PRISMA guidelines, searching PubMed, Web of Science, Virtual Health Library (BVS), and CAPES Periodicals databases for studies published between May 2020 and May 2025. Eligible studies included original observational designs investigating genomic, proteomic, and metabolic biomarkers associated with progression to ATLL or HAM. Methodological quality was assessed using tools from the National Heart, Lung, and Blood Institute (NHLBI). In total, 35 studies met the inclusion criteria, most conducted in Brazil, Japan, and Iran. A total of 67 biomarkers were identified: 37 genomic, 27 proteomic, and three metabolic with potential clinical applications in risk stratification, prognosis, and therapeutic monitoring of HTLV-1 infection. PVL remained the most frequently investigated marker but lacked predictive power in isolation. Additional candidates with strong potential included IFN-γ, CXCL10, Neopterin, AnxA1, and sTNFR2. This review highlights the potential of integrated multiparametric panels—combining PVL with omics-derived biomarkers—as a promising strategy to improve risk stratification, prognosis, and therapeutic monitoring in people living with HTLV-1 (PLHTLV-1). However, further longitudinal and clinically validated studies are needed to confirm their applicability and support their translation into early intervention strategies, particularly during the asymptomatic phase.
subject: Review
  topic: section
subject: HTLV-1
  topic: keywords
subject: Surrogate markers
  topic: keywords
subject: Myelopathy associated disease (HAM)
  topic: keywords
subject: Adult T-cell leukemia/lymphoma (ATLL)
  topic: keywords
subject: Disease progression
  topic: keywords
creator: Theo Leite
creator: Marcos Eduardo Souza Abreu
creator: Alex Ap. Rosini Silva
creator: Rubens de Assis Santos Sebastião
creator: Lucas Araujo Romão
creator: Jorge Casseb
creator: Tatiane Assone
creator: Fabio Eudes Leal
creator: Sheila de Oliveira Garcia Mateos
rights: Copyright (c) 2026 Theo Leite, Marcos Eduardo Souza Abreu, Alex Ap. Rosini Silva, Rubens de Assis Santos Sebastião, Lucas Araujo Romão, Jorge Casseb, Tatiane Assone, Fabio Eudes Leal, Sheila de Oliveira Garcia Mateos https://creativecommons.org/licenses/by-nc/4.0
date: 2026-05-18
publication date: 2026-05-18
starting page: e30
ending page: e30
doi: 10.1590/S1678-9946202668030

Mycobacterium kansasii in cancer patients: a 13-case series
type: item
description: Mycobacterium kansasii comprises one of the most common and most pathogenic nontuberculous mycobacteria, particularly in immunocompromised individuals. This retrospective observational study aimed to describe the epidemiology, clinical characteristics, and outcomes of M. kansasii infections in 13 cancer patients from Instituto do Cancer do Estado de Sao Paulo, Brazil, from January 2011 to September 2023. Of the 19 initial positive cultures, 13 fully met diagnostic criteria for M. kansasii infections. Solid tumors occurred the most (69.2%), and only 38.4% of patients were undergoing chemotherapy at diagnosis. Smoking was the most frequent previous characteristic in these cases (76.9%). Fever (53.4%), cough (46.1%) and dyspnea (30.7%) were the most common symptoms. Multiple nodules (46.1%) and cavities (46.1%) were the most common radiological findings. Overall, seven patients (53.8%) received at least 12 months of therapy. One-year overall mortality totaled 38.4-22.2% in patients with solid tumors and 75% in patients with hematologic malignancies. In conclusion, M. kansasii infections were predominantly pulmonary in this series of cancer patients, which showed a high frequency of other respiratory comorbidities, especially smoking. Mortality occurred in several patients, particularly among those with hematological malignancies.
subject: Original Article
  topic: section
subject: Mycobacterium kansasii
  topic: keywords
subject: Cancer
  topic: keywords
subject: Oncology
  topic: keywords
subject: Nontuberculous mycobacterium
  topic: keywords
creator: Patrícia Rodrigues Bonazzi
creator: Giovanni Mollo Baia
creator: William Kazunori Sekiguchi
creator: Adriana Satie Gonçalves Kono Magri
creator: Raquel Keiko de Luca Ito
creator: Karim Yaqub Ibrahim
creator: Odeli Nicole Encinas Sejas
creator: Edson Abdala
rights: Copyright (c) 2026 Patrícia Rodrigues Bonazzi, Giovanni Mollo Baia, William Kazunori Sekiguchi, Adriana Satie Gonçalves Kono Magri, Raquel Keiko de Luca Ito, Karim Yaqub Ibrahim, Odeli Nicole Encinas Sejas, Edson Abdala https://creativecommons.org/licenses/by-nc/4.0
date: 2026-05-18
publication date: 2026-05-18
starting page: e29
ending page: e29
doi: 10.1590/S1678-9946202668029

Epidemiological study of hantavirus in Southern Brazil, 2009-2019
type: item
description: Brazil has the highest number of hantavirus cardiopulmonary syndrome cases on the American continent, with Santa Catarina being the state with the most notifications. This retrospective longitudinal study aimed to describe the epidemiological profile of 177 hantavirus cases reported in Santa Catarina from 2009 to 2019, using data from the Notifiable Diseases Information System (SINAN). Statistical analyses of socio-demographic, clinical, and epidemiological data revealed that the typical patient was a male of working age with low educational attainment, living in a rural area. The highest incidence occurred in the Santa Catarina West, Midwest, and Mountain regions, strongly associated with agricultural activities. The case fatality rate (CFR) was highest among the 15-19-year age group. Clinical risk factors for death included respiratory signs, increased hematocrit, and the need for mechanical ventilation. Patients who sought early care had a higher CFR, possibly due to the initial difficulty of differentiating hantavirus from other viral diseases. Conversely, regions with higher notification rates showed lower CFRs, suggesting better surveillance. This study highlights critical areas for public health intervention and the key characteristics of hantavirus patients (males in rural areas and adolescents aged 15-19 years in regions with low notification rates) and areas for public health intervention. Training for medical professionals in regions with low notification rates should aim to reduce lethality, especially in regions with low reported cases (Itajai river delta and South), where underreporting may be occurring. Furthermore, the high lethality in adolescents and in patients with non-specific initial symptoms requires greater awareness. This study shows the utility of a governmental database in identifying epidemiological patterns and creating public health strategies tailored to regional specificities.
subject: Original Article
  topic: section
subject: Public-health
  topic: keywords
subject: Risk-based surveillance
  topic: keywords
subject: Hantavirus infections
  topic: keywords
subject: Viral zoonoses
  topic: keywords
creator: Felipe Manoel Gimenez de Oliveira
creator: Paulo Augusto Esteves
creator: Ricardo Evandro Mendes
rights: Copyright (c) 2026 Felipe Manoel Gimenez de Oliveira, Paulo Augusto Esteves, Ricardo Evandro Mendes https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-22
publication date: 2026-04-22
starting page: e28
ending page: e28
doi: 10.1590/S1678-9946202668028

Candidemia in a tertiary hospital in Southern Brazil
type: item
description: <span style="color: #393939; font-family: 'Noto Sans', sans-serif; font-size: 18px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">Invasive bloodstream infections caused by <em style="box-sizing: border-box; color: #393939; font-family: 'Noto Sans', sans-serif; font-size: 18px; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">Candida<span style="color: #393939; font-family: 'Noto Sans', sans-serif; font-size: 18px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;"> spp. significantly impact global health and are associated with high mortality rates. This study describes a five-year retrospective analysis conducted in a tertiary hospital with 213 beds in Rio Grande, Rio Grande do Sul State, Brazil, aiming to provide clinical-epidemiological data on candidemia and the susceptibility profile of isolates in this region. From January 2019 to December 2023, 44 patients…
subject: Original Article
  topic: section
subject: Candida spp
  topic: keywords
subject: Epidemiology
  topic: keywords
subject: Fungemia
  topic: keywords
subject: Blood culture
  topic: keywords
subject: Antifungal resistance
  topic: keywords
creator: Leandre Carmem Wilot
creator: Bianca dos Santos Blan
creator: Vanice Rodrigues Poester
creator: Cecília Bittencourt Severo
creator: Karine Ortiz Sanchotene
creator: Mônica Campos dos Santos
creator: Mariana Rodrigues Trápaga
creator: Melissa Orzechowski Xavier
rights: Copyright (c) 2026 Leandre Carmem Wilot, Bianca dos Santos Blan, Vanice Rodrigues Poester, Cecília Bittencourt Severo, Karine Ortiz Sanchotene, Mônica Campos dos Santos, Mariana Rodrigues Trápaga, Melissa Orzechowski Xavier https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-22
publication date: 2026-04-22
starting page: e27
ending page: e27
doi: 10.1590/S1678-9946202668027

A rare case of oral myiasis in a non-tropical region: the role of systemic vulnerability
type: item
description: Myiasis is a rare parasitic infection caused by the larvae of Diptera flies, which infest the tissues of humans or animals and are typically found in warm, humid climates. Oral myiasis is uncommon in healthy individuals and typically occurs when adult flies lay eggs or larvae near the mouth or on open wounds. Malnutrition, immunodeficiency, poor oral hygiene, dental problems, neurological or psychiatric conditions, and alcoholism are the main risk factors. In this report, we present a case of oral myiasis that occurred in a patient with multiple comorbidities, including malnutrition, immunological and neurological dysfunction (lung carcinoma, cirrhosis, cachexia, Parkinson's disease). The patient was admitted to our intensive care unit while intubated because of confusion, respiratory failure, and sepsis, in which oral myiasis was identified. Due to the patient's comorbid conditions, ivermectin could not be administered. A conservative approach was used, including daily cleaning with diluted hydrogen peroxide and povidone–iodine, together with mechanical removal of the larvae. The infestation was completely resolved within three days. This case shows that oral myiasis may develop in non-tropical settings when systemic vulnerability exists. It highlights the importance of regular oral exams and mouth care for high-risk patients.
subject: Original Article
  topic: section
subject: Oral myiasis
  topic: keywords
subject: Cirrhosis
  topic: keywords
subject: Malnutrition
  topic: keywords
subject: Intensive care unit
  topic: keywords
creator: Gökçe Kızılkale Kayıkcı
creator: Ayşe Yılmaz
creator: Furkan Arabacı
creator: Hale Ahsen Yardibi Demir
creator: Mesut Özsoy
rights: Copyright (c) 2026 Gökçe Kızılkale Kayıkcı, Ayşe Yılmaz, Furkan Arabacı, Hale Ahsen Yardibi Demir, Mesut Özsoy https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-17
publication date: 2026-03-17
starting page: e26
ending page: e26
doi: 10.1590/S1678-9946202668026

Genotypic virulence profiles and mobile genetic elements related to invasiveness in Neisseria gonorrhoeae strains
type: item
description: Neisseria gonorrhoeae (NG) has become an increasing global health threat due to drug resistance and potentially invasive disease. In this study, we assessed the genotypic profile in both invasive and non-invasive NG strains from patients at University of Sao Paulo Faculty of Medicine Clinics Hospital, Brazil. We analyzed the NG genotypic profiles and clinical data from 25 patients hospitalized at Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC-FMUSP) from January 2017 to March 2020. A total of 25 isolates underwent whole genome sequencing, of which 10 (40%) were collected from sterile sites like blood and classified as invasive. Invasive and noninvasive specimens were clustered in 5 STs and 11 STs, respectively, sharing 3 STs in common. We identified resistance markers for macrolides (mtrR) in 40% of isolates and 92% exhibited at least one resistance marker for beta-lactams (penA, blaTEM-1B, or blaTEM-135), predominantly PBP1 and PBP2 alterations. Resistance genes blaTEM-1B (7%vs.50%, p=0.023) and tetM (13%vs.80%, p=0.002) were more frequently found in invasive disease isolates, always accompanied by the mobile genetic elements pJD4 and pEP5289, respectively. Associated with these elements were two toxin encoding genes (vapD and zeta1/2) previously described as possible virulence factors and resistance genes for beta-lactams and tetracyclines. Results revealed that invasive strains of NG are genotypically clustered and frequently harbor two plasmids which may be associated with invasive disease. Resistance markers for beta-lactam as PBP1 and PBP2 alterations warn against a future potential resistance to this class.
subject: Original Article
  topic: section
subject: Neisseria gonorrhoeae
  topic: keywords
subject: Invasive
  topic: keywords
subject: Non-invasive
  topic: keywords
subject: Virulence
  topic: keywords
subject: Whole genome sequencing
  topic: keywords
creator: José Victor Bortolotto Bampi
creator: Saidy Vásconez Noguera
creator: Sania Alves dos Santos
creator: Ana Paula Marchi
creator: Marina Farrel Côrtes
creator: Joyce Vanessa da Silva Fonseca
creator: Ivan Lira dos Santos
creator: Flávia Rossi
creator: Maria Luiza Bazzo
creator: Gwenda Hughes
creator: Igor Borges
creator: Silvia Figueiredo Costa
rights: Copyright (c) 2026 José Victor Bortolotto Bampi, Saidy Vásconez Noguera, Sania Alves dos Santos, Ana Paula Marchi, Marina Farrel Côrtes, Joyce Vanessa da Silva Fonseca, Ivan Lira dos Santos, Flávia Rossi, Maria Luiza Bazzo, Gwenda Hughes, Igor Borges, Silvia Figueiredo Costa https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-16
publication date: 2026-03-16
starting page: e25
ending page: e25
doi: 10.1590/S1678-9946202668025

The COVID-19 pandemic in the hotel industry: the application of hygiene and safety protocols by hotel employees
type: item
description: This study sought to understand how the application of hygiene and safety protocols by hotel companies in Sao Paulo city, Brazil, occurred during the COVID-19 pandemic. The first objective of the study was to find, based on the information provided by employees who worked in certain hotels via questionnaires from March 2020 to December 2022, which protocols were applied in the studied period and which measures were definitively incorporated into the hygiene schemes of these hotels. Secondly, this study aimed to assess how the interaction and adaptations to the implemented hygiene protocols took place to find the measures that have become hygiene habits in everyday life. The literature on the applied health protocols during the pandemic was reviewed. A cross-sectional descriptive study was conducted with 421 respondents. This study found a significant association between sex and the adoption of protective measures during the pandemic. Women adhered more to protective measures than men, and this association remained after the pandemic. Employees who worked in the food and beverage area contracted COVID-19 more often than employees in other hotel areas. Those with higher education levels received more doses of COVID-19 vaccines than those with lower levels of education. Finally, this study found a direct relationship between the quality standard of the hotels and the frequency of training received by employees and a high adherence to vaccination against COVID-19 that was lower at higher educational levels.
subject: Original Article
  topic: section
subject: Pandemic
  topic: keywords
subject: COVID-19
  topic: keywords
subject: Travel medicine
  topic: keywords
subject: Hygiene protocol
  topic: keywords
subject: Hotels
  topic: keywords
subject: Employees
  topic: keywords
subject: Brazil
  topic: keywords
creator: Cláudia Regina Rodrigues Sarralheiro Butuhy
creator: Expedito José de Albuquerque Luna
rights: Copyright (c) 2026 Cláudia Regina Rodrigues Sarralheiro Butuhy, Expedito José de Albuquerque Luna https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-16
publication date: 2026-03-16
starting page: e24
ending page: e24
doi: 10.1590/S1678-9946202668024

Plasmidial virulence of Rhodococcus equi and its implications of livestock infections for human health: a possible foodborne pathogen?
type: item
description: Rhodococcus equi, a versatile and adapted opportunistic in nature bacterium, infects animals and humans. This soil-borne microorganism widely occurs in farms. Its dissemination occurs by feces from domestic animals (particularly horses, cattle, and pigs). In the last decades, bacterial virulence has been strongly attributed to plasmid-encoded virulence-associated proteins (VAPs). To date, three virulence plasmid types have been recognized: pVAPA, pVAPB, and pVAPN, which are considered host- or livestock-adapted. The pVAPA type is related to equine isolates (horse-type), the pVAPB type is associated with pig isolates (porcine-type), whereas the pVAPN type occurs in domestic ruminants (bovine and caprine) (ruminant-type). Nonetheless, pathogenic R. equi possessing the three virulent plasmid types can infect humans. Inhaling aerosol particles from the environment of equids represents the first route traditionally considered for the transmission of R. equi to humans, although an epidemiological lack of transmission remains in human infections because some patients with rhodococcosis have no history of contact with livestock or their environment on farms. However, all pVAPs types have been found in humans infected by R. equi (predominantly living with HIV), which could be presumably transmitted to patients by the ingestion of contaminated undercooked or raw meat from slaughtered pigs, cattle and, occasionally, horses, representing a probably route of the transmission of the pathogen from livestock-to-humans that could partially explain infections in humans without a history of contact with cattle, pigs, horses, or their farm environments.
subject: Review
  topic: section
subject: pVAP types
  topic: keywords
subject: Rhodococcosis
  topic: keywords
subject: Epidemiology
  topic: keywords
subject: One Health
  topic: keywords
subject: Overview
  topic: keywords
creator: Márcio Garcia Ribeiro
creator: Alexandre Naime Barbosa
creator: Juliano Gonçalves Pereira
creator: Fábio Sossai Possebon
creator: José Paes de Almeida Nogueira Pinto
creator: Fábio Vinícius Ramos Portilho
creator: Thaís Spessotto Bello
creator: Patrik Júnior de Lima Paz
creator: Marcelo Fagali Arabe Filho
creator: Letícia Colin Panegossi
creator: Alec Utida Reznik
creator: Larissa Onuki Zeferino
creator: Maria Clara Trindade
creator: Nícolas Garcia Ribeiro
creator: Shinji Takai
rights: Copyright (c) 2026 Márcio Garcia Ribeiro, Alexandre Naime Barbosa, Juliano Gonçalves Pereira, Fábio Sossai Possebon, José Paes de Almeida Nogueira Pinto, Fábio Vinícius Ramos Portilho, Thaís Spessotto Bello, Patrik Júnior de Lima Paz, Marcelo Fagali Arabe Filho, Letícia Colin Panegossi, Alec Utida Reznik, Larissa Onuki Zeferino, Maria Clara Trindade, Nícolas Garcia Ribeiro, Shinji Takai https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-16
publication date: 2026-03-16
starting page: e23
ending page: e23
doi: 10.1590/S1678-9946202668023

A fatal case report of sepsis caused by Robinsoniella sp.
type: item
description: Robinsoniella species are anaerobic, spore-forming, Gram-positive bacilli that are rarely associated with human infections because of their slow growth and the limitations of conventional identification methods. We describe a fatal case of sepsis in an 84-year-old woman with hypertension, diabetes, and chronic renal insufficiency. During hospitalization, she developed impaired consciousness, polymicrobial infections, and multiple organ failure. Despite aggressive antimicrobial and supportive treatment, her condition deteriorated, leading to death. This study identified a Robinsoniella isolate (designated Rp5645) by 16S rRNA gene sequencing, showing 98.35% similarity to R. peoriensis PPC31. As this value falls below the accepted species-level threshold, Rp5645 may represent a novel Robinsoniella species. Unfortunately, the isolate lost viability before further genomic or phenotypic studies could be performed. This outcome illustrates the technical challenges in recovering and preserving fastidious anaerobes and underscores the crucial role of rapid molecular identification in confirming rare pathogens. This case broadens the clinical spectrum of Robinsoniella infections and highlights its potential pathogenic capacity, particularly in older or immunocompromised patients. It also emphasizes the need for timely molecular characterization to prevent the loss of valuable data from uncommon clinical isolates.
subject: Case Report
  topic: section
subject: Robinsoniella species
  topic: keywords
subject: Sepsis
  topic: keywords
subject: Anaerobic bacteria
  topic: keywords
subject: 16S rRNA
  topic: keywords
creator: Meijia Huang
creator: Hongjuan Zhang
creator: Xinyue Li
creator: Xiangchentao Zhang
creator: Yunmin Xu
rights: Copyright (c) 2026 Meijia Huang, Hongjuan Zhang, Xinyue Li, Xiangchentao Zhang, Yunmin Xu https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-05
publication date: 2026-03-05
starting page: e22
ending page: e22
doi: 10.1590/S1678-9946202668022

Dengue haemorrhagic fever: an evaluation of host innates immune factors in hepatic lesions and their correlation with immunopathogenesis
type: item
description: Dengue fever challenges public health worldwide. The numerous factors associated with dengue fever severity and mortality risk include host characteristics such as patient age, comorbid conditions, previous dengue virus (DENV) infections, and biochemical biomarkers. Type I IFNs are essential cytokines in orchestrating innate and adaptive immune responses against viral invasion, and their regulation is mediated by IRF-2, which prevents excessive IFN expression. In vitro studies have shown DENV evasion strategies that affect IFN-I production but few have considered the in-situ interrelationship between IFN-I and the virus. This study aims to find elements of innate immunity that induce the anti-viral response and their correlation with the detected alterations in liver lesions. Liver specimens from individuals who died due to dengue were selected according to clinical and laboratory data and serological diagnosis. The specimens were subjected to histological and immunohistochemical evaluation of cells expressing IFN-I, RIG-1, IRF-2, and STING. Viral antigens were detected by an anti-DENV. A high number of cells expressed RIG-1 and IRF-2 when compared to IFN-I and STING. In severe cases of dengue, DENV may play a role in its pathogenesis with properties that induce non-effective immune responses. The virus can evade effective immune responses by impairing the early activation of innate immunity. This immune dysregulation may contribute to the progression of more severe manifestations and seems to play a role in the pathogenesis of hepatic involvement.
subject: Original Article
  topic: section
subject: Dengue
  topic: keywords
subject: Liver
  topic: keywords
subject: Innate immune response
  topic: keywords
subject: IFN-I
  topic: keywords
creator: Carla Pagliari
creator: Geovanna Menezes Marcoli
creator: Luciane Kanashiro-Galo
creator: Evandro Sobroza de Mello
creator: Leda Viegas de Carvalho
creator: Ricardo Penny
creator: Juarez Simões Quaresma
creator: Pedro Fernando da Costa Vasconcelos
creator: Mirian Nacagami Sotto
rights: Copyright (c) 2026 Carla Pagliari, Geovanna Menezes Marcoli, Luciane Kanashiro-Galo, Evandro Sobroza de Mello, Leda Viegas de Carvalho, Ricardo Penny, Juarez Simões Quaresma, Pedro Fernando da Costa Vasconcelos, Mirian Nacagami Sotto https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-05
publication date: 2026-03-05
starting page: e21
ending page: e21
doi: 10.1590/S1678-9946202668021

Rezafungin in fluconazole-resistant and refractory candidiasis: the first Brazilian experience
type: item
description: Invasive candidiasis is associated with high morbidity and mortality, and the rising of antifungal resistance underscores the need for new therapies. Rezafungin, a second-generation echinocandin, enables once-weekly dosing, achieves high plasma concentrations, and shows potent in vitro activity. We report two Brazilian cases showing its clinical utility: (i) fluconazole-resistant Candida tropicalis bloodstream infection in a patient with colorectal cancer and chronic kidney disease and (ii) azole-refractory C. albicans esophagitis in a patient with autoimmune polyglandular syndrome type 1. Both achieved rapid clinical response and microbiological clearance. These are the first documented cases of rezafungin use for invasive candidiasis in Brazil.
subject: Case Report
  topic: section
subject: Rezafungin
  topic: keywords
subject: Echinocandins
  topic: keywords
subject: Invasive candidiasis
  topic: keywords
subject: Esophageal candidiasis
  topic: keywords
subject: Antifungal resistance
  topic: keywords
creator: Wdson Luis Lima Kruschewsky
creator: Jeanne Aiko de Souza Nakagawa
creator: Lumena Pereira Machado Siqueira
creator: Mariane Taborda
creator: Vítor Falcão de Oliveira
creator: Edson Abdala
creator: Adriana Satie Gonçalves Kono Magri
creator: Marcello Mihailenko Chaves Magri
rights: Copyright (c) 2026 Wdson Luis Lima Kruschewsky, Jeanne Aiko de Souza Nakagawa, Lumena Pereira Machado Siqueira, Mariane Taborda, Vítor Falcão de Oliveira, Edson Abdala, Adriana Satie Gonçalves Kono Magri, Marcello Mihailenko Chaves Magri https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-05
publication date: 2026-03-05
starting page: e20
ending page: e20
doi: 10.1590/S1678-9946202668020

Streptococcus suis infection as an emerging zoonotic threat in Brazil: a One Health-based review
type: item
description: Streptococcus suis infection is an emerging zoonotic pathogen of growing concern in Brazil, particularly in the Northeast—a region lacking swine-focused surveillance. Although human contamination remains rare, they have been increasingly reported among individuals exposed to pigs or pork products, and most commonly present as central nervous system infections. Diagnostic challenges persist, especially related to culture-based methods, highlighting the need for advanced molecular tools like polymerase chain reaction and metagenomic Next-Generation Sequencing. Veterinary data reveal a high diversity of serotypes and concerning rates of antimicrobial resistance. These studies remain scarce in regions with reports of human infection. This review highlights the clinical, epidemiological, and microbiological aspects of S. suis in Brazil and underscores the importance of One Health approaches to enhance detection and prevention.
subject: Review
  topic: section
subject: Streptococcus suis
  topic: keywords
subject: Zoonosis
  topic: keywords
subject: Emerging diseases
  topic: keywords
subject: One Health
  topic: keywords
creator: Luís Arthur Brasil Gadelha Farias
creator: Osvaldo Mariano Viana Neto
creator: Ednaldo Pereira Lima Sobrinho
creator: Antonio Gutierry Neves Dantas de Melo
creator: Isabela Melo Pontes
creator: Bruna Batista Schmid Gonçalves
creator: Helena Pinheiro Benevides
creator: Susana Pereira de Oliveira Maia
creator: Jorge Luiz Nobre Rodrigues
creator: Lauro Vieira Perdigão Neto
rights: Copyright (c) 2026 Luís Arthur Brasil Gadelha Farias, Osvaldo Mariano Viana Neto, Ednaldo Pereira Lima Sobrinho, Antonio Gutierry Neves Dantas de Melo, Isabela Melo Pontes, Bruna Batista Schmid Gonçalves, Helena Pinheiro Benevides, Susana Pereira de Oliveira Maia, Jorge Luiz Nobre Rodrigues, Lauro Vieira Perdigão Neto https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-05
publication date: 2026-03-05
starting page: e19
ending page: e19
doi: 10.1590/S1678-9946202668019

Molecular identification of Bartonella henselae in dogs with clinical suspicion of visceral leishmaniasis
type: item
description: The genus Bartonella includes species responsible for severe infections. Bartonella henselae, commonly linked to human disease, also infects dogs with or without symptoms. In Brazil, visceral leishmaniasis (VL) caused by Leishmania infantum is prevalent in Mato Grosso State, Brazil, particularly in Rondonopolis city, affecting both humans and dogs. Although reports of co-infection with Bartonella spp. and L. infantum exist in other countries, Brazilian studies are scarce. This study investigates the presence of B. henselae using culture and molecular methods in dogs suspected of having VL in Rondonopolis, while also assessing potential co-infections and evaluating diagnostic limitations of VL. Results showed B. henselae DNA in 53.75% (43/80) of these dogs, with Leishmania spp. DNA found in 65.11% (28/43) of them. Of the 80 dogs, 43.75% (35) lacked VL serological confirmation, yet 48.57% (17/35) were positive for B. henselae. This is the first report of B. henselae bacteremia in dogs from Rondonopolis. The high occurrence of dogs with clinical VL suggests a need for further research to understand the bacterium's role in VL-suspected cases, regardless of diagnostic confirmation. The study highlights a significant finding: approximately half of the dogs suspected of zoonotic parasitosis, with or without serological confirmation, were infected with B. henselae. Additionally, the detection of Leishmania sp. DNA in dogs not confirmed by Brazil's Health Department serological criteria suggests that these diagnostic standards may need reevaluation by health authorities, though caution is warranted due to the limitations of blood-based PCR for Leishmania sp. detection.
subject: Original Article
  topic: section
subject: Bartonella
  topic: keywords
subject: Dogs
  topic: keywords
subject: Leishmania infantum
  topic: keywords
creator: Verônica Domingos Miranda
creator: Luciene Silva dos Santos
creator: Mariana Medeiros Torres
creator: Osvaldo Campos dos Santos Nonato
creator: Adriano Cappellazzo Coelho
creator: Paulo Eduardo Neves Ferreira Velho
creator: Marina Rovani Drummond
rights: Copyright (c) 2026 Verônica Domingos Miranda, Luciene Silva dos Santos, Mariana Medeiros Torres, Osvaldo Campos dos Santos Nonato, Adriano Cappellazzo Coelho, Paulo Eduardo Neves Ferreira Velho, Marina Rovani Drummond https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-04
publication date: 2026-03-04
starting page: e18
ending page: e18
doi: 10.1590/S1678-9946202668018

Eosinophilic meningitis caused by Angiostrongylus cantonensis: case report in a patient with false-positive immunological test result for Neisseria meningitides
type: item
description: Eosinophilic meningitis caused by Angiostrongylus cantonensis is an uncommon disease in Brazil that occurs by ingesting slugs, water or food contaminated with the parasite. Here we report a case of a 64-year-old patient with neck stiffness, headache, fever, and peripheral and cerebrospinal fluid (CSF) eosinophilia, compatible with eosinophilic meningitis. He had a false-positive result for Neisseria meningitides and received unsuccessful treatment with antibiotics. After extensive investigation, DNA and anti-A.cantonensis antibodies were detected and the patient was successfully treated with prednisone and albendazole. Diagnosis of neuroangiostrongyliasis relies on epidemiological data, as well as clinical and laboratory examinations such as detection of antibodies and DNA of the parasite in CSF. Its timely treatment with corticosteroid therapy reduces damage to neural tissues and manages headache.
subject: Case Report
  topic: section
subject: Eosinophilic meningitis
  topic: keywords
subject: Angiostrongylus cantonensis
  topic: keywords
subject: Food-borne diseases
  topic: keywords
creator: Marcela Nataly Parra Alvarez
creator: Juan Sebastián Sánchez León
creator: Tassiane Moreira da Silva
creator: Renato Dumba Monteiro de Castro
creator: Arlete Hilbig
creator: Leyva Cecilia Vieira de Melo
creator: Carlos Graeff-Teixeira
creator: Alessandro Comarú Pasqualotto
rights: Copyright (c) 2026 Marcela Nataly Parra Alvarez, Juan Sebastián Sánchez León, Tassiane Moreira da Silva, Renato Dumba Monteiro de Castro, Arlete Hilbig, Leyva Cecilia Vieira de Melo, Carlos Graeff-Teixeira, Alessandro Comarú Pasqualotto https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-04
publication date: 2026-03-04
starting page: e17
ending page: e17
doi: 10.1590/S1678-9946202668017

Non-feline transmission of sporotrichosis: a systematic review of published cases
type: item
description: Sporotrichosis is a subcutaneous mycosis caused by species belonging to the genus Sporothrix. While zoonotic transmission has been primarily associated with cats, reports have pointed to sporotrichosis transmission by various non-feline animals, albeit infrequently compared with the aforementioned. These reports suggest the potential for zoonotic or environmentally mediated transmission routes with clinical and epidemiological relevance that have yet to be extensively explored. This systematic review organizes the current knowledge on sporotrichosis acquired by non-feline zoonotic transmission. A comprehensive literature review was conducted from January 1980 to March 2025, leveraging prominent databases like PubMed, SciELO, Web of Science, and EBSCO to identify cases of sporotrichosis transmitted by non-feline animals. A total of 78 cases of sporotrichosis transmitted by non-feline animals were identified in 26 articles. Most cases (76%) were transmitted by vertebrate animals, primarily dogs, whereas 24% were transmitted by invertebrates, such as mosquitoes. Lymphocutaneous presentation predominated among clinical manifestation in 80.7% of cases. Most frequently isolated species was Sporothrix schenckii, whereas Sporothrix brasiliensis was isolated only in infections caused by vertebrate animals. Most patients were young adult males, mainly related with hunting activities. Itraconazole was the most frequently used treatment. Sporotrichosis transmission route via non-feline animals is significant and frequently underestimated. Further research is needed to improve our understanding of the transmission mechanisms, focusing on distinguishing between direct zoonotic transmission and environmental exposure mediated by animal contact. Such enhanced understanding is crucial for improving diagnostic procedures in hyperendemic regions and strengthening epidemiological surveillance.
subject: Original Article
  topic: section
subject: Sporotrichosis
  topic: keywords
subject: Zoonotic diseases
  topic: keywords
subject: Zoonotic transmission
  topic: keywords
subject: Non-feline
  topic: keywords
subject: Sporothrix sp. Sporothrix schenckii
  topic: keywords
creator: Pamela Rodríguez-Salgado
creator: Andrés Tirado-Sánchez
creator: Valeria Lyzzete Diaz-Molina
creator: Max Carlos Ramírez-Soto
creator: Flavio Queiroz-Telles
creator: Alexandro Bonifaz
rights: Copyright (c) 2026 Pamela Rodríguez-Salgado, Andrés Tirado-Sánchez, Valeria Lyzzete Diaz-Molina, Max Carlos Ramírez-Soto, Flavio Queiroz-Telles, Alexandro Bonifaz https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-04
publication date: 2026-03-04
starting page: e16
ending page: e16
doi: 10.1590/S1678-9946202668016

Fulminant hepatitis secondary to dengue in pediatric patients: a series of four cases
type: item
description: This study reports a case series of four pediatric patients with dengue who developed fulminant hepatitis and acute liver failure requiring transplantation. This study aims to enhance early recognition of dengue-related complications, particularly fulminant hepatitis. The series includes two previously healthy girls, aged one and six years; and two boys, aged 12 and 15 years, with pre-existing hemoglobinopathies. A review was conducted to contextualize these cases with prior reports of dengue-associated fulminant hepatitis in children, focusing on diagnosis and management. All four patients underwent liver transplantation, yet their clinical courses and outcomes were varied. Patient 1, a six-year-old girl, had early warning signs and underwent cadaveric liver transplantation nine days after onset. Patient 2, a one--year-old girl, developed severe disease and received living-donor transplantation 20 days after onset. Both had favorable postoperative outcomes. Patient 3, a 12-year-old boy with SC hemoglobinopathy, underwent transplantation on day seven of illness but died on the fifth postoperative day. Patient 4, a 15-year-old boy with sickle cell anemia, underwent transplantation on day four of symptoms but suffered multiple cardiorespiratory arrests during recovery and died on postoperative day 24. Although rare, dengue can lead to fulminant hepatitis in previously healthy children, with worse outcomes in those with comorbidities. Early recognition of severe manifestations is critical for appropriate management. Larger studies are warranted to identify prognostic factors and optimize decision-making for pediatric patients requiring liver transplantation.
subject: Original Article
  topic: section
subject: Acute liver failure
  topic: keywords
subject: Dengue
  topic: keywords
subject: Liver transplantation
  topic: keywords
subject: Severe dengue
  topic: keywords
subject: Pediatrics
  topic: keywords
creator: Isabelly Victoria Simões Melchiori
creator: Mariana Favero Elias
creator: Jhonny Richard de Sousa
creator: Leonardo Labbate Kalil
creator: João Pedro de Mattos Anacleto
creator: Victor Fernandes Rosa
creator: Ana Cristina Aoun Tannuri
rights: Copyright (c) 2026 Isabelly Victoria Simões Melchiori, Mariana Favero Elias, Jhonny Richard de Sousa, Leonardo Labbate Kalil, João Pedro de Mattos Anacleto, Victor Fernandes Rosa, Ana Cristina Aoun Tannuri https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-02
publication date: 2026-03-02
starting page: e15
ending page: e15
doi: 10.1590/S1678-9946202668015

Comparative performance of Filamentous Fungi 4.0 and Mass Spectrometry Identification 2.0 databases for Aspergillus spp.: identification using a simplified protein extraction method
type: item
description: Aspergillus spp. are major agents of pulmonary aspergillosis, posing diagnostic challenges in clinical laboratories due to morphological similarity among species. This study compared the performance of two spectral databases, Filamentous Fungi v4.0 (Bruker Daltonics) and Mass Spectrometry Identification v2.0 (MSI 2.0), for Aspergillus species identification by MALDI-TOF MS, and evaluated the applicability of the simplified protein extraction method from solid culture medium for routine use in hospital laboratories. Overall, 46 clinical isolates from patients with pulmonary aspergillosis were cultured on Sabouraud Dextrose Agar (SDA) at 37 °C for 48 h. Proteins were extracted directly from colonies and analysed using the Bruker MALDI Biotyper system. Spectra were compared against FF_4.0 and MSI_2.0 databases, and results were correlated with molecular identification by benA, cmd5, and ITS gene sequencing. The extraction method yielded high-quality spectra with peaks between 2–15 kDa. The FF_4.0 database identified 52.17% of isolates at the section level and none at the species level, reflecting limited spectral compatibility and taxonomic coverage. Conversely, MSI_2.0 correctly identified 82.6% of isolates at the species level, 15.23% at the section level, and only 2.17% were not identified. Concordance between MSI_2.0 and sequencing reached 44.7%, without statistical significance (p = 0.627). The simplified solid-medium extraction method combined with MSI 2.0 proved efficient, reproducible, and suitable for clinical routine, offering faster identification of Aspergillus species compared to conventional methods. In contrast, FF_4.0 showed limited applicability for hospital workflows.
subject: Brief Communication
  topic: section
subject: Aspergillus identification
  topic: keywords
subject: MALDI-TOF MS
  topic: keywords
subject: Spectral databases
  topic: keywords
subject: Medical mycology
  topic: keywords
creator: Gustavo Giacon Damiani
creator: Vivian Caso Coelho
creator: Juliana Possato Fernandes Takahashi
creator: Ingrid Gonçalves Costa Leite
creator: Marcia Regina von Zeska Kress
creator: Marcello Mihailenko Chaves Magri
creator: Valdes Roberto Bollela
creator: Roberto Martínez
creator: Gil Benard
creator: Tiago Alexandre Cocio
rights: Copyright (c) 2026 Gustavo Giacon Damiani, Vivian Caso Coelho, Juliana Possato Fernandes Takahashi, Ingrid Gonçalves Costa Leite, Marcia Regina von Zeska Kress, Marcello Mihailenko Chaves Magri, Valdes Roberto Bollela, Roberto Martínez, Gil Benard, Tiago Alexandre Cocio https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-02
publication date: 2026-03-02
starting page: e14
ending page: e14
doi: 10.1590/S1678-9946202668014

Yellow fever virus resurgence in Sao Paulo State, Brazil, 2024–2025
type: item
description: We report the detection of yellow fever virus in Campinas and Ribeirao Preto city areas (two geographic areas within Sao Paulo State, Brazil) from September 2024 to February 2025. Phylogenetic analysis of six new genomes showed a re-introduction in 2022 from Midwest Brazil followed by persistence in Sao Paulo State. Continued surveillance in neotropical primates is required to prevent cases in humans.
subject: Brief Communication
  topic: section
subject: Yellow fever virus
  topic: keywords
subject: Phylogenetics
  topic: keywords
subject: Surveillance
  topic: keywords
creator: Mariana Sequetin Cunha
creator: Juliana Mariotti Guerra
creator: Márcio Junio Lima Siconelli
creator: Benedito Antonio Lopes da Fonseca
creator: Jessica Caroline de Almeida Dias
creator: Gisele Dias de Freitas
creator: Ester Cerdeira Sabino
creator: Erika Regina Manuli
creator: Geovana Maria Pereira
creator: Ian Nunes Valença
creator: Patrícia Sayuri Silvestre Matsumoto
creator: Nuno Rodrigues Faria
creator: Natália Coelho Couto de Azevedo Fernandes
rights: Copyright (c) 2026 Mariana Sequetin Cunha, Juliana Mariotti Guerra, Márcio Junio Lima Siconelli, Benedito Antonio Lopes da Fonseca, Jessica Caroline de Almeida Dias, Gisele Dias de Freitas, Ester Cerdeira Sabino, Erika Regina Manuli, Geovana Maria Pereira, Ian Nunes Valença, Patrícia Sayuri Silvestre Matsumoto, Nuno Rodrigues Faria, Natália Coelho Couto de Azevedo Fernandes https://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-02
publication date: 2026-03-02
starting page: e13
ending page: e13
doi: 10.1590/S1678-9946202668013

https://revistas.usp.br/rimtsp/en/article/view/245852
type: item
title: Occlusion body-incorporated SARS-CoV-2 S-RBD via cypovirus polyhedrin-derived peptide: a novel insect cell-expressed antigen for high-accuracy COVID-19 diagnosis, and humoral immune response and hybrid immunity evaluation
description: Accurate serological assays are critical for monitoring antibody responses to SARS-CoV-2 and for assessing vaccine efficacy. In this study, we engineered a recombinant baculovirus to express the SARS-CoV-2 spike receptor-binding domain (RBD) fused to an N-terminal peptide of cypovirus polyhedrin (S-RBD-POLH), thereby enabling its potential encapsulation within occlusion bodies. The construct was expressed in insect cells and employed to establish an in-house enzyme-linked immunosorbent assay (ELISA-S) for COVID-19 diagnosis and evaluation of the humoral immune response to SARS-CoV-2. We compared the performance of ELISA-S with a commercial lateral flow immunoassay (LFIA), a chemiluminescence immunoassay (CLIA), and an in-house ELISA targeting Escherichia coli-produced nucleocapsid (N) protein (ELISA-N). Both in-house ELISAs had excellent diagnostic performance (overall accuracy = 0.90), with ELISA-S achieving 98.9% sensitivity and 100% specificity. Inter-assay concordance was high (kappa coefficient > 0.92), with near-perfect agreement between ELISA-S and LFIA (kappa = 0.99). Longitudinal analysis revealed increasing anti-RBD IgG titers over time, in contrast to declining anti-N IgG levels, consistent with expected post-infection kinetics. Moreover, ELISA-S reliably detected antibodies in individuals with hybrid immunity across different periods of the pandemic. These findings establish a scalable platform for antigen encapsulation and production in insect cells to enhance antibody detection. The ELISA-S system represents a robust and adaptable approach for evaluating humoral immunity following infection, vaccination, or hybrid immunity, and can be used for all variants.
subject: Original Article
  topic: section
subject: Serological assay
  topic: keywords
subject: ELISA
  topic: keywords
subject: Pandemic
  topic: keywords
subject: S-RBD-POLH
  topic: keywords
subject: Vaccine
  topic: keywords
creator: Murilo Barros-Silveira
creator: Fabricio da Silva Morgado
creator: Laurine Lacerda Pigosso
creator: Fernanda Cortez Roriz Pontes
creator: Ethiane Rozo dos Santos
creator: Rosana Pereira Morais
creator: Yves Mauro Fernandes Ternes
creator: Célia Maria de Almeida Soares
creator: Bergmann Morais Ribeiro
creator: Fátima Ribeiro-Dias
rights: Copyright (c) 2026 Murilo Barros-Silveira, Fabricio da Silva Morgado, Laurine Lacerda Pigosso, Fernanda Cortez Roriz Pontes, Ethiane Rozo dos Santos, Rosana Pereira Morais, Yves Mauro Fernandes Ternes, Célia Maria de Almeida Soares, Bergmann Morais Ribeiro, Fátima Ribeiro-Dias https://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-26
publication date: 2026-02-26
starting page: e12
ending page: e12
doi: 10.1590/S1678-9946202668012

Reflections on the study "Central sterile supply department management on hospital-associated infections: a systematic review and meta-analysis" by Shuai et al
type: item
description: no applicable
subject: Letter to the Editor
  topic: section
creator: Eliane Molina Psaltikidis
rights: Copyright (c) 2026 Eliane Molina Psaltikidis https://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-26
publication date: 2026-02-26
starting page: e11
ending page: e11
doi: 10.1590/S1678-9946202668011

Fatal cerebral myiasis secondary to squamous cell carcinoma: case report and scoping review
type: item
description: 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.
subject: Original Article
  topic: section
subject: Myiasis
  topic: keywords
subject: Infection
  topic: keywords
subject: Brain
  topic: keywords
subject: Osteomyelitis
  topic: keywords
subject: Abscess
  topic: keywords
creator: Paulo Henrique Alves Togni Filho
creator: Ernani Alves de Oliveira
creator: Roscicler Pereira de Sousa
creator: André Luís Santos Vaz Leite
creator: Lucas Eiji Adachi Oliveira
creator: Guilherme Augusto Paro
creator: Julia de Campos Preto
rights: Copyright (c) 2026 Paulo Henrique Alves Togni Filho, Ernani Alves de Oliveira, Roscicler Pereira de Sousa, André Luís Santos Vaz Leite, Lucas Eiji Adachi Oliveira, Guilherme Augusto Paro, Julia de Campos Preto https://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-26
publication date: 2026-02-26
starting page: e10
ending page: e10
doi: 10.1590/S1678-9946202668010

Leptospirosis-associated pulmonary hemorrhagic syndrome: immune mechanisms, clinical manifestations, and experimental models
type: item
description: <span style="color: #393939; font-family: 'Noto Sans', sans-serif; font-size: 18px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">Leptospirosis is a neglected zoonotic disease caused by bacteria of the genus <em style="box-sizing: border-box; color: #393939; font-family: 'Noto Sans', sans-serif; font-size: 18px; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">Leptospira<span style="color: #393939; font-family: 'Noto Sans', sans-serif; font-size: 18px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">, mainly acquired via direct contact with water and soil contaminated by the urine of infected animals. This is most observed in tropical and subtropical regions, and it is strongly associated with urban population growth in areas lacking adequate sanitation conditions. <em style="box-sizing: border-box; color: #393939; font-family: 'Noto Sans', sans-serif; font-si…
subject: Review
  topic: section
subject: Leptospirosis
  topic: keywords
subject: Complement system
  topic: keywords
subject: Hemorrhagic pulmonary syndrome
  topic: keywords
subject: Immunity
  topic: keywords
subject: Leptospira
  topic: keywords
creator: Lara Rodrigues da Silva
creator: Milena Carvalho Carneiro
creator: Ana Carolina Mikejevs Lorga
creator: Luana Barbosa Rodrigues dos Santos
creator: Leonardo Moura Midon
creator: Amaro Nunes Duarte Neto
creator: Thais Akemi Amamura
creator: Lourdes Isaac
rights: Copyright (c) 2026 Lara Rodrigues da Silva, Milena Carvalho Carneiro, Ana Carolina Mikejevs Lorga, Luana Barbosa Rodrigues dos Santos, Leonardo Moura Midon, Amaro Nunes Duarte Neto, Thais Akemi Amamura, Lourdes Isaac https://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-26
publication date: 2026-02-26
starting page: e09
ending page: e09
doi: 10.1590/S1678-9946202668009

SARS-CoV-2 lineage-specific disease symptoms and disease severity in a city in southeastern Brazil
type: item
description: In 2020, Sao Caetano do Sul city, located in the metropolitan region of Sao Paulo State, Brazil, established a web-based platform to provide primary care to suspected COVID-19 patients, integrating clinical and demographic data and sample metadata. Here we describe lineage-specific spatiotemporal dynamics of infections, clinical symptoms, and disease severity during the first year of the epidemic, which included circulation of the poorly characterised Gamma variant of concern. From April 6, 2020, to April 30, 2021, we gathered clinical, demographic, spatial and epidemiological data from the city's platform. We selected and sequenced 879 PCR+ swab samples (8% of all reported cases), obtaining a spatially and temporally representative set of sequences. Daily lineage-specific prevalence was estimated with a moving-window approach, allowing inference of cumulative cases and symptom probability stratified by lineage using integrated data from the platform. Most infections were caused by B.1.1.28 (41.3%), followed by Gamma (31.7%), Zeta (9.6%), and B1.1.33 (9.0%). Gamma and Zeta correlated with larger prevalence of dyspnoea (respectively, 81.3% and 78.5%) and persistent fever (84.7% and 61.1%) compared with B.1.1.28 and B.1.1.33. Ageusia, anosmia, and coryza were respectively 18.9%, 20.3%, and 17.8% less commonly caused by Gamma, whereas altered mental status was 108.9% more common in Zeta. Case incidence was spatially heterogeneous and larger in poorer and younger districts. Our study reveals that Gamma was associated with more severe presentation of the disease, emphasising its role in the heightened mortality levels in Brazil.
subject: Original Article
  topic: section
subject: SARS-CoV-2
  topic: keywords
subject: COVID-19
  topic: keywords
subject: Epidemiology
  topic: keywords
subject: Genomic surveillance
  topic: keywords
subject: Gamma VOC
  topic: keywords
creator: Flavia Cristina da Silva Sales
creator: Carlos Augusto Prete Junior
creator: Leandro Abade
creator: Lewis Fletcher Buss
creator: Darlan da Silva Candido
creator: Ingra Morales Claro
creator: Filipe Romero Rebello Moreira
creator: Erika Regina Manuli
creator: Ligia Capuani
creator: Camila Alves da Silva Maia
creator: Thais Coletti
creator: Heuder Gustavo Oliveira Paião
creator: Silvia Figueiredo Costa
creator: Maria Cassia Mendes Correa
creator: Fabio Eudes Leal
creator: Kris Varun Parag
creator: Vítor Heloiz Nascimento
creator: Nuno Rodrigues Faria
creator: Ester Cerdeira Sabino
rights: Copyright (c) 2026 Flavia Cristina da Silva Sales, Carlos Augusto Prete Junior, Leandro Abade, Lewis Fletcher Buss, Darlan da Silva Candido, Ingra Morales Claro, Filipe Romero Rebello Moreira, Erika Regina Manuli, Ligia Capuani, Camila Alves da Silva Maia, Thais Coletti, Heuder Gustavo Oliveira Paião, Silvia Figueiredo Costa, Maria Cassia Mendes Correa, Fabio Eudes Leal, Kris Varun Parag, Vítor Heloiz Nascimento, Nuno Rodrigues Faria, Ester Cerdeira Sabino https://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-25
publication date: 2026-02-25
starting page: e07
ending page: e07
doi: 10.1590/S1678-9946202668007

HIV-associated neurological infections in a Brazilian tertiary care center: clinical-epidemiological features and predictors of in-hospital mortality
type: item
description: Neurological manifestations remain a significant cause of hospitalization and in-hospital mortality among people living with HIV (PLWH), even in the era of antiretroviral therapy (ART). This study aims to describe the clinical and epidemiological profile of PLWH with neurological opportunistic infections (nOIs) and to identify factors associated with in-hospital mortality. We conducted a retrospective cohort study with PLWH aged >18 years hospitalized due to nOIs between November 2017 and December 2021 at a tertiary hospital in Brazil. Demographic, clinical, and laboratory data were extracted from electronic medical records. Logistic regression was used to evaluate associations between patient characteristics and in-hospital mortality. Among 237 hospitalized PLWH, 89 (37.6%) had nOIs. The median CD4 count at admission was 55 cells/mm³ (IQR 22.5–149), and 91.7% had previously used ART (only 22.7% used it regularly). The most frequent infections were cerebral toxoplasmosis (50.6%), cryptococcal meningitis (10.1%), and progressive multifocal leukoencephalopathy (9%). A total of 19 in-hospital deaths occurred. In the multivariate analysis, undefined neurological infections (aOR: 8.67; 95%CI: 1.23–61.17) and ICU admission (aOR: 58.61; 95% CI: 10.24–335.49) were independently associated with mortality. In conclusion, severe immunosuppression and low ART adherence were common in this cohort. Cerebral toxoplasmosis was the most prevalent neurological infection. ICU admission and undefined neurological syndromes were strong predictors of in-hospital mortality. Early diagnosis, prompt treatment, and strategies to improve ART adherence are essential to reduce fatal outcomes in this population.
subject: Original Article
  topic: section
subject: HIV
  topic: keywords
subject: Opportunistic infections
  topic: keywords
subject: Antiretroviral therapy
  topic: keywords
subject: In-hospital mortality
  topic: keywords
subject: CNS infections
  topic: keywords
creator: Laísa Rivas Dapousa Ramos
creator: Daniel Ayabe Ninomiya
creator: Murilo Freua Sequeira
creator: Olavo Henrique Munhoz Leite
creator: Marcello Mihailenko Chaves Magri
rights: Copyright (c) 2026 Laísa Rivas Dapousa Ramos, Daniel Ayabe Ninomiya, Murilo Freua Sequeira, Olavo Henrique Munhoz Leite, Marcello Mihailenko Chaves Magri https://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-25
publication date: 2026-02-25
starting page: e08
ending page: e08
doi: 10.1590/S1678-9946202668008

Circulating cell-free mitochondrial DNA as a candidate marker of hyperinflammation and immune activation in pre-adolescents, adolescents and young adults with COVID-19 and comorbidities
type: item
description: Youth encompasses pre-adolescence (10-14 years), adolescence (15-17 years), and young adulthood (18-24 years). Adolescents in general, particularly those with comorbidities, appear more susceptible to severe COVID-19, a vulnerability also observed in newborns and young infants. The mechanisms underlying this increased risk remain unclear, highlighting the need for early disease biomarkers. Circulating cell-free mitochondrial DNA (ccf-mtDNA), a damage-associated molecular pattern (DAMP), has been linked to systemic inflammation and immune activation during viral infections. This study evaluated plasma ccf-mtDNA levels in pre-adolescents, adolescents, and young adults with and without COVID-19, all presenting respiratory symptoms and predominantly harboring comorbidities, some with coinfections by other respiratory viruses. In this prospective study of 88 participants aged 12-21 years, half tested positive and half negative for SARS-CoV-2 by Reverse-Transcribed Polymerase Chain Reaction (RT-PCR). Comorbidities were present in 75% of COVID-19-positive and 54.5% of COVID-19-negative participants. Coinfections were detected in 52.3% and 25% of tested participants, respectively. Plasma ccf-mtDNA was quantified by a quantitative Real Time PCR (qPCR) targeting the mitochondrial NADH dehydrogenase 2 (ND2) gene or MT-ND2. COVID-19-positive participants exhibited significantly higher ccf-mtDNA levels than both symptomatic COVID-19-negative individuals and healthy controls (p<0.001). Although median levels were numerically higher in severe/critical compared with mild/moderate cases (7,769 vs. 4,649 ccf-mtDNA/mL), the difference was not statistically significant, likely due to limited sample size. In conclusion, elevated ccf-mtDNA distinguishes young individuals with COVID-19 and comorbidities from non-COVID-19 symptomatic participants and healthy controls. Although not linked to disease severity in this preliminary study, ccf-mtDNA may serve as an early biomarker of SARS-CoV-2-…
subject: Original Article
  topic: section
subject: COVID-19
  topic: keywords
subject: DAMP
  topic: keywords
subject: Adolescence
  topic: keywords
subject: Comorbidities
  topic: keywords
subject: Cell-free mitochondrial DNA
  topic: keywords
subject: Biomarker
  topic: keywords
creator: Gabriella Bayler Novo
creator: Emilly Henrique dos Santos
creator: Karen Alessandra Rodrigues
creator: Gabriel Acca Barreira
creator: Mariana Okay Saippa
creator: Maria Carolina Pires Cruz
creator: Maria Fernanda Baduê Pereira
creator: Heloisa Helena de Sousa Marques
creator: Thelma Suely Okay
rights: Copyright (c) 2026 Gabriella Bayler Novo, Emilly Henrique dos Santos, Karen Alessandra Rodrigues, Gabriel Acca Barreira, Mariana Okay Saippa, Maria Carolina Pires Cruz, Maria Fernanda Baduê Pereira, Heloisa Helena de Sousa Marques, Thelma Suely Okay https://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-24
publication date: 2026-02-24
starting page: e06
ending page: e06
doi: 10.1590/1678-9946202668006