Revista do Instituto de Medicina Tropical de São Paulo
To publish articles dealing with research on tropical diseases and related sciences.
Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo
HTLV-1-associated diseases: a systematic review
Human T-cell lymphotropic virus type 1 (HTLV-1) is a human retrovirus associated with a broad spectrum of clinical manifestations. While most people living with HTLV-1 remain asymptomatic, a proportion develops severe conditions such as adult T-cell leukemia/lymphoma or HTLV-1-associated myelopathy/tropical spastic paraparesis. Increasing evidence also indicates that HTLV-1 infection is related to multiple systemic complications involving different organ systems (including neurological, pulmonary, dermatological, rheumatological, and ophthalmological disorders) and opportunistic infections. Given the growing recognition of these diverse manifestations, this review aims to compile and synthesize the scientific evidence regarding clinical manifestations, co-infections, opportunistic diseases, and complications related to HTLV-1 infection.
Copyright (c) 2026 Rosa Maria Nascimento Marcusso, Víctor Ângelo Folgosi, Augusto César Penalva de Oliveira, Jorge Casseb https://creativecommons.org/licenses/by-nc/4.0
Occurrence of Culex (Microculex) Theobald, 1907 in a polyvinyl chloride trap container indicates an ongoing adaptation process to anthropized environment
Microculex mosquitoes are widespread in Central and South America and typically oviposit in phytotelmata breeding sites. However, some species also tend to oviposit in artificial containers. Artificial containers made of polyvinyl chloride (PVC traps) were installed and monitored in Pariquera-Acu and Cananeia, São Paulo State, Brazil for six months (December 2024 to August 2025) to test their efficiencies in collecting mosquitoes. Of the four collected species, three are considered sylvatic species: Toxorhynchites (Megarhina) theobaldi, Culex (Microculex) imitator, and Limatus durhamii. Culex (Microculex) imitator specimens were collected for the first time in an artificial breeding site. This finding indicates that Cx. imitator tend to use artificial containers for reproduction. Continuous monitoring and research on the ecology and epidemiological relevance of Cx. imitator is essential given the limited information on its potential role as an arbovirus vector.
Copyright (c) 2026 Rafael Oliveira-Christe, Luiz Carlos de Oliveira, Jair Donizete da Silva, Mauro Toledo Marrelli https://creativecommons.org/licenses/by-nc/4.0
Chest pain and eosinophilia in a middle-aged female caused by hookworm infection: a case report
Hookworm infection, while often asymptomatic, may rarely cause Löffler syndrome. We report the case of a 45-year-old female farmer who presented with a 10-year history of recurrent chest pain. Laboratory tests revealed marked eosinophilia (33.4%) and microcytic anemia. Cardiac and abdominal imaging findings were normal. Stool microscopy confirmed hookworm infection. Treatment of oral mebendazole (400 mg twice daily) for three days resulted in complete resolution of symptoms, normalization of eosinophil count, and clearance of parasites on follow-up. This case highlights hookworm infection as a potential cause of eosinophilia and chest pain in endemic regions.
Copyright (c) 2026 Bo Jiang, Xiaoyan Zhu https://creativecommons.org/licenses/by-nc/4.0
Coinfection by Mycobacterium tuberculosis and Rhodococcus equi in advanced HIV
A 28-year-old man with HIV (diagnosed eight years prior, last CD4 count 23 cells/mm3) and prior tuberculosis (cured, then confirmedly reinfected with treatment default) presented with cachexia, diarrhea, chest pain, and tachypnea with increased work of breathing that required orotracheal intubation. Admission chest CT showed extensive bilateral consolidations with air bronchograms, suggestive of previous mycobacterial infection and/or possible new bacterial infection. Initially managed as sepsis, blood cultures grew Rhodococcus equi (four samples). Molecular testing confirmed Mycobacterium tuberculosis in sputum and tracheal aspirate, establishing coinfection and exceeding the similarities in acid-fast staining, clinical, and radiological findings between the two organisms. Treatment included antituberculosis therapy associated with clarithromycin and vancomycin (14 days). The patient achieved complete clinical improvement with partial radiological resolution (residual cavitations). He was discharged after 25 days, but was lost to follow-up and died three months later from probable septic shock. This report highlights a rare M. tuberculosis/R. equi coinfection in an immunosuppressed patient, emphasizing diagnostic challenges and the importance of therapeutic adherence in advanced HIV.
Copyright (c) 2026 Mariana Soares Kajita, Erika Yuki Mogami Bomfim, Gabriella Cecilia Vanin, João Vitor Matachon Viana, Guilherme Kenzo Shimizu Saito, Ceila Maria Sant’Ana Malaque, Jaques Sztajnbok https://creativecommons.org/licenses/by-nc/4.0
Case series on Zika virus genome detection in cerebrospinal fluid samples from newborns at a Brazilian tertiary hospital
Detection of ribonucleic acid (RNA) Zika virus in cerebrospinal fluid (CSF) by molecular methods serves as a marker of the involvement of congenital infection in newborns’ central nervous system. This study aims to describe the detection of Zika virus genome in CSF samples from newborns (aged from one to 28 days) using molecular biology and its clinical consequences following the Zika virus epidemic from October 2015 to May 2017, in Brazil. This prospective descriptive study molecularly analyzed 151 CSF samples from neonates at Professor Doutor Jose Aristodemo Pinotti Hospital, collected for cytological and biochemical diagnosis from June 2017 to June 2021. After the consent of legal guardians, signing of free and informed consent forms, and the issuance of these results, the remaining CSF was sent to the Virology Laboratory of School of Medical Sciences in the State University of Campinas (Unicamp) and was subjected to RNA extraction and real-time polymerase chain reaction (RT-PCR). A review of patients’ medical records and descriptive statistics were also performed. This study obtained 151 CSF samples, four of which were PCR positive for Zika virus (2.6%, with two presenting congenital malformations). These results suggest the clinical relevance of etiological diagnosis of congenital Zika syndrome by molecular biology in newborns’ CSF samples even after the Zika virus epidemic (which occurred from October 2015 to May 2017) in Brazil.
Copyright (c) 2026 Suzana Ferreira Zimmerman, Jamil Pedro de Siqueira Caldas, Rodrigo Gonçalves de Lima, Sandra Helena Alves Bonon, Plínio Trabasso, Sergio Tadeu Martins Marba https://creativecommons.org/licenses/by-nc/4.0
Zoonotic potential of bovine Sarcocystis species: a challenge for public health and meat inspection
Foodborne parasitic diseases remain a neglected public health issue worldwide. Sarcocystosis, caused by the ingestion of tissue cysts of Sarcocystis species, represents a growing challenge for food safety and public health. Cattle serve as intermediate hosts for several Sarcocystis species, including those with confirmed zoonotic potential such as S. hominis, S. heydorni, and the recently described S. sigmoideus (2024/2025). In humans, intestinal sarcocystosis often presents with gastrointestinal distress, whereas extraintestinal (muscular) infections can lead to severe clinical manifestations, including acute eosinophilic myositis and, rarely, neurosarcocystosis. Despite these risks and the high epidemiological prevalence in beef herds worldwide, current sanitary inspection methods in abattoirs are primarily based on macroscopic visual examination. Said approach frequently fails to detect microscopic cysts, allowing the latent transmission of these pathogens. This review addresses the biology, clinical manifestations across different hosts (humans, bovines, and equines), and epidemiology of bovine sarcocystosis. We discuss the limitations of conventional morphological diagnosis and the critical need for molecular tools to accurately differentiate zoonotic from non-zoonotic species. Finally, we highlight the need for adopting a One Health approach, integrating sensitive diagnostic methods into the meat production chain to mitigate the risk of human infection and ensure global food safety.
Copyright (c) 2026 Cayuan Tadeu Brandão Pinto, Luciana Regina Meireles https://creativecommons.org/licenses/by-nc/4.0
Phase-dependent dynamics of circulating cell-free mitochondrial DNA reflect distinct immunometabolic states
Circulating cell-free mitochondrial DNA (ccf-mtDNA) has emerged as a potential biomarker of tissue injury and systemic inflammation, acting as a mitochondrial damage-associated molecular pattern (DAMP) capable of activating innate immune pathways. However, most studies have focused on acute inflammatory conditions, and the behavior of ccf-mtDNA across distinct immunological and metabolic disease states remains poorly characterized, particularly in pediatric populations. This study investigated whether circulating ccf-mtDNA levels vary according to the clinical and immunometabolic context rather than simply reflecting the presence of inflammation. Serum ccf-mtDNA copy number was quantified by quantitative polymerase chain reaction (qPCR) targeting the mitochondrial ND2 gene in 181 clinical samples obtained from five groups: adults with chronic-active and/or treatment-refractory pulmonary tuberculosis (n = 47); asymptomatic children with latent tuberculosis infection confirmed by interferon-gamma release assay (IGRA) without clinical, radiological or microbiological evidence of active disease (n = 11); children with severe chronic underlying diseases in clinically stable condition (n = 41); children undergoing cardiac surgery with cardiopulmonary bypass (CPB), with perioperative serial sampling (n = 52); and healthy young adult blood donors as controls (n = 30). Non-parametric statistical tests were applied due to non normal data distribution. Median ccf-mtDNA levels in controls were 649.3 copies/μL. Adults with chronic-active pulmonary and/or treatment-refractory tuberculosis and children undergoing cardiac surgery with CPB did not exhibit significantly elevated ccf-mtDNA levels compared with controls. In contrast, significantly higher levels were observed in IGRA-positive children with latent tuberculosis infection (median: 1,648.5 copies/μL; p = 0.0004) and in children with severe chronic underlying diseases despite the absence of overt infection or inflammation (median: 2,663.9 copies/μL; p = 0.0001). These findings suggest that circulating ccf-mtDNA does not behave as a simple linear marker of inflammatory intensity. Instead, its levels appear to reflect the interaction between mitochondrial injury, immune activation, metabolic competence, and clearance mechanisms. We propose a phase-dependent model in which mitochondrial DAMP signaling is amplified during sustained but metabolically competent immune engagement, and is attenuated during advanced immunometabolic exhaustion. These findings suggest that ccf-mtDNA levels are shaped by the host's underlying immunometabolic context, rather than simply mirroring the intensity of systemic inflammation.
Copyright (c) 2026 Karen Alessandra Rodrigues, Emilly Henrique dos Santos, Gabriel Acca Barreira, Maria Carolina Pires Cruz; Kelly Aparecida Kanunfre; Thelma Suely Okay https://creativecommons.org/licenses/by-nc/4.0
Congenital toxoplasmosis in a newborn of a chronically infected mother
Congenital toxoplasmosis rarely occurs in infants born to mothers with evidence of prior immunity. We report the case of a preterm infant with severe ocular and neurological manifestations of congenital toxoplasmosis, despite maternal seropositivity (IgG+/IgM–) during pregnancy. This case highlights the potential for reactivation or reinfection with virulent strains and reinforces the need for vigilance and preventive strategies throughout pregnancy.
Copyright (c) 2026 Vitória Schneider Müller, Júlia Sales Machado, Wilson Hoshino, Aida de Fátima Tomé Barbosa Gouvêa, Fabiana Bononi do Carmo, Kelly Simone Almeida Cunegundes, Maria Aparecida Ferrarini, Annelise Pereira Barreto Monteiro, Daisy Maria Machado, Ana Isabel Melo Pereira Monteiro https://creativecommons.org/licenses/by-nc/4.0
Disseminated sporotrichosis with orbital osteomyelitis in a child: a case report
Sporotrichosis is an infection caused by fungi of the Sporothrix complex that can affect both humans and animals. In most cases, it is a benign infection limited to the skin and subcutaneous tissue, rarely disseminating to other organs with systemic involvement. Diagnosis is based on clinical data, epidemiological data, and laboratory tests, with culture being considered the gold standard. The disease generally has a good prognosis and is usually resolved with appropriate antifungal treatment. This case report describes an atypical presentation of sporotrichosis with suppurative nodules and orbital bone involvement in an adolescent followed at the pediatric infectious diseases outpatient clinic of our institution. The patient was followed longitudinally for 12 months due to a lesion on the left upper back with lymphocutaneous involvement, which progressed to osteomyelitis of the left orbit. Deep lesion culture identified Sporothrix spp. The sporotrichosis was considered disseminated, and treatment with oral itraconazole for 12 months was initiated. Complete remission of both cutaneous and bone lesions occurred after five months of treatment. The patient was discharged from outpatient follow-up after one year.
Copyright (c) 2026 Fabiana Bononi do Carmo, Kimberly Souza Rocha, Caio Vinícius Luís, Aída de Fátima Thomé Barbosa Gouvea, Daisy Maria Machado, Ana Isabel Melo Pereira Monteiro, Érica Regina Cruz Paulino, Marina Gomes Pereira Sardinha, Kelly Simone Almeida Cunegundes, Paulo Gois Manso, Anderson Messias Rodrigues, Pedro Fiorini Pucchini, Marcelo Luiz Abramczyk, Maria Aparecida Gadiani Ferrarini, Carolina Sanchez Aranda Lago, Regina Célia de Menezes Succi https://creativecommons.org/licenses/by-nc/4.0
Association between atmospheric SO2 exposure and severity of respiratory infections in infants: a systematic review
Environmental factors may influence the severity of lower respiratory infections, a major cause of morbidity and mortality in infants. Sulfur dioxide (SO2) has biologically plausible pro-inflammatory and epithelial effects. This PRISMA 2020–compliant systematic review synthesized observational studies published between 2015 and 2025, selected to ensure methodological comparability and contemporary relevance, examining the association between atmospheric SO2 exposure and severity-related respiratory outcomes in infants. Thirteen studies met eligibility criteria. Most evaluated short-term exposure using daily lag structures (lag01 to lag03) or 1–2 week averages, whereas one birth cohort assessed annual exposure during the first year of life. All studies adjusted for meteorological variables, and most incorporated multipollutant regression models. Owing to substantial heterogeneity in exposure metrics, increments, lag structures, and effect scales, a meta-analysis was not performed. Across studies, short-term SO2 exposure was most consistently associated with increased hospitalization for ALRIs, longer length of stay, and progression to severe disease. Effect estimates per 10 µg/m3 were modest but statistically significant in specific lag windows. In one cohort, higher annual exposure was associated with severe ALRI (IRR 2.81; 95% CI 1.35–5.83), and one hospital-based study reported increased mortality (OR 2.04; 95% CI 1.33–3.13). Associations were less consistent in low-exposure settings or in models with strong multipollutant collinearity. Overall, the evidence suggests context-dependent associations between short-term SO2 exposure and increased severity of respiratory infections in infants, particularly hospitalization, longer length of stay, and progression to severe disease. Given the observational and heterogeneous nature of the data, findings should be interpreted cautiously.
Copyright (c) 2026 Sandra Elisabete Vieira, Alexandre Archanjo Ferraro https://creativecommons.org/licenses/by-nc/4.0
Temporal trends and spatial distribution of leishmaniasis based on biomes in Brazil, 2007 to 2020
<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;">Analyses based on biomes provide a less fragmented view than usual studies and help the understanding of epidemiological characteristics from different perspectives. We describe the temporal trends and spatial distribution of American cutaneous leishmaniasis (ACL) and visceral leishmaniasis (VL) in Brazilian biomes, from 2007 to 2020. This ecological survey used data from the Brazilian Notifiable Diseases Information System. The Prais–Winsten method was used for temporal analyses. ACL and VL incidences were calculated based on sex and age groups, relative risk considering these two variables, and mortality, lethality, cure, and treatment abandonment rates per biome. The Amazon, Atlantic Forest, Cerrado, and Caatinga biomes showed a decreasing temporal trend, varying from −1% to −3% for ACL and VL, respectively. Other biomes showed a stationary temporal trend for both diseases. VL had a similar transmission profile in all biomes, affecting children aged 0–4 years regardless of sex. In contrast, ACL mainly affected older adults, except in the Amazon and Pampa, where working-age males were most commonly affected. In all biomes, being a man constituted a risk factor for acquiring these diseases, abandoning treatment, and dying, whereas being a woman configured a factor that favored cure and protected against lethality. Our findings showed a decrease in ACL and VL incidence in most biomes and a stable incidence in other biomes. The results of our study showed that the distinct transmission profiles of ACL and VL have persisted across different biomes with minute differences.
Copyright (c) 2026 Geisa Bezerra Ferreira, Leonardo Augusto Kohara Melchior, Andreia Fernandes Brilhante https://creativecommons.org/licenses/by-nc/4.0
Disseminated tuberculosis with Poncet's disease mimicking childhood-onset systemic lupus erythematosus: a unique case report
Disseminated tuberculosis in children may present with systemic and immunologic features that overlap with autoimmune diseases, complicating diagnosis and treatment. We report the first pediatric case of microbiologically confirmed disseminated tuberculosis involving multiple sites associated with Poncet's disease, mimicking childhood-onset systemic lupus erythematosus (cSLE). A previously healthy five-year-old boy presented with a four-month history of persistent fever, weight loss, and symmetrical oligoarthritis involving both knees and wrists, resulting in loss of mobility. Laboratory tests revealed severe non-hemolytic anemia, leukopenia, elevated inflammatory markers, hypoalbuminemia, hematuria, positive antinuclear antibodies, low complement levels, and lupus anticoagulant positivity. Chest imaging showed bilateral pleural effusion, pulmonary opacities, and lymphadenopathy, fulfilling the Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for cSLE. Despite initially negative tuberculin skin test and gastric lavage analysis, lymph node biopsy confirmed Mycobacterium tuberculosis by histology, molecular assay, and culture. Subsequent urine and gastric samples were also positive. The patient had received BCG vaccination at birth. He was treated with rifampicin, isoniazid, pyrazinamide, and pyridoxine, with rapid clinical improvement, complete resolution of arthritis, and full recovery of mobility without sequelae in one month. No immunosuppressive therapy was administered. This case reinforces the diagnostic complexity of distinguishing tuberculosis from childhood-onset systemic autoimmune rheumatic diseases, particularly in endemic regions. To our knowledge, this is the first reported pediatric case of disseminated tuberculosis with Poncet's disease mimicking cSLE. Recognizing this specific condition is crucial to prevent misdiagnosis and unnecessary immunosuppression, while ensuring timely treatment of the underlying infection.
Childhood-onset systemic lupus erythematosus
Copyright (c) 2026 Matheus Santos França, Fernanda Lima Gomes, Marina de Azambuja Nogueira, Maria Fernanda Bádue Pereira, Heloisa Helena de Sousa Marques, Katia Tomie Kozu, Lucia Maria Arruda Campos, Clovis Artur Silva https://creativecommons.org/licenses/by-nc/4.0
Post-treatment paradoxical reaction in tuberculous flexor tenosynovitis with rice bodies after a cat bite
Tuberculous tenosynovitis is a rare form of extrapulmonary tuberculosis characterized by an indolent course and nonspecific clinical findings, frequently leading to delayed diagnosis. Paradoxical inflammatory reactions during or after anti-tuberculosis therapy may further complicate clinical management and mimic disease relapse. This is a case study regarding a 54-year-old female veterinarian presented with a four-year history of progressive swelling and induration of the right index finger extending to the palm, accompanied by gradually worsening limitation of finger flexion and hand grasp. Magnetic resonance imaging demonstrated extensive flexor tenosynovitis with synovial proliferation. Tenosynovectomy revealed multiple rice bodies surrounding the flexor tendon. Histopathology showed well-formed granulomas without central necrosis, accompanied by focal stromal coagulative necrosis, while microbiological tests were negative. Tuberculous tenosynovitis was diagnosed based on clinical, radiological, and histopathological findings, and anti-tuberculosis therapy was initiated. The patient showed gradual clinical improvement over the nine-month course of treatment. However, one month after therapy completion, recurrent finger swelling with axillary and new epitrochlear lymphadenopathy developed. In the absence of evidence of relapse, a post-treatment paradoxical inflammatory reaction was suspected. Corticosteroid therapy resulted in rapid clinical improvement. This case highlights the diagnostic challenges of tuberculous tenosynovitis, particularly in patients with delayed presentation and negative microbiological findings, and underscores that paradoxical inflammatory reactions may occur even after completion of anti-tuberculosis therapy, potentially mimicking disease relapse.
Copyright (c) 2026 Zehra Çağla Karakoç, Sait Ada, Önder Pekel, Arzu Avcı, Kubilay Erol, Mahir Kapmaz, Ali Mert https://creativecommons.org/licenses/by-nc/4.0
Emergence of difficult-to-treat lymphocutaneous sporotrichosis? Analysis based on three cases with high and low MIC Sporothrix brasiliensis isolates
Sporotrichosis, caused by a Sporothrix schenckii complex species, is historically viewed as an easily manageable mycosis. However, the current zoonotic epidemic in Brazil due to the more virulent Sporothrix brasiliensis poses some challenges. We describe three cases of lymphocutaneous sporotrichosis (LC) in non-immunocompromised patients, which proved refractory to standard treatment, and suggest that closer epidemic surveillance would be advisable to detect whether more difficult-to-treat cases are ­­emerging. All cases required prolonged treatment, escalating doses, and therapeutic changes for resolution. Patients’ isolates were molecularly identified as S. brasiliensis. Antifungal susceptibility testing (AST) revealed high itraconazole MICs in two of the three isolates. Management required high-dose itraconazole (400 mg/day) in two cases and Amphotericin B in one. These cases challenge the perception of sporotrichosis as an always easily treatable disease. The difficulties observed may be linked to the increased S. brasiliensis virulence, the emergence of drug-resistant strains, and/or the rise in severe and atypical presentations. Lack of standardized protocols for refractory cases complicates effective management. These findings underscore the urgent need for enhanced epidemiological surveillance, efforts to isolate and perform AST on clinical strains, and standardization of treatment guidelines for patients failing initial therapy.
Copyright (c) 2026 Juliana Carreiro Avila, Ana Paula Carvalho Reis, Kaique Arriel, Amanda Azevedo Bittencourt, Livia Vieira Almeida, Rita de Cassia Soler, Giovanna Azevedo Celestrino, Ana Paula Cordeiro Lima, Maria Gloria Teixeira Sousa, José Angelo Lauletta Lindoso, Gil Benard https://creativecommons.org/licenses/by-nc/4.0
The potential of molecular testing and mutation analysis for detecting isoniazid and rifampicin-resistant Mycobacterium tuberculosis in Thailand
<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;">Drug-resistant tuberculosis (TB) poses a significant threat, and drug-susceptibility testing (DST) is essential for effective TB treatment and control. Genotypic DST has been used for the early detection of drug-resistant TB, and the detection of isoniazid (INH) resistance is increasingly important. This study aims to determine the potential of genotypic DST using the Anyplex<sup style="box-sizing: border-box; position: relative; font-size: 0.75em; line-height: 0; vertical-align: baseline; top: -0.5em; color: #393939; font-family: 'Noto Sans', sans-serif; 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;">TM<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;"> II MTB/MDR real-time polymerase chain reaction (PCR) kit and analyze the mutations associated with INH and rifampicin (RIF) resistance in <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;">Mycobacterium tuberculosis<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;"> (MTB). DST and DNA sequencing of the <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;">katG, inhA<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;">, and <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;">rpoB<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;"> genes were performed in 146 MTB isolates. Compared with phenotypic DST, the Anyplex real-time PCR assay showed the sensitivity of 84.0%, 83.3%, 85.7%, and 94.6%; and the specificity of 96.9%, 96.4%, 98.2%, and 92.3% for the detection of INH resistance, RIF resistance, multidrug-resistant TB (MDR-TB), and drug-susceptible MTB, respectively. Substantial agreement with DNA sequencing was observed. For INH resistance, 91.8% had mutations in the <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;">katG<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;"> or <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;">inhA<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;">; the <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;">katG<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;"> gene accounted for 71.8%, and the <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;">inhA<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;"> promoter region accounted for 20.0%. S315T was predominant in the <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;">katG<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;"> mutation, and only C(-15)T was present in the <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;">inhA<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;"> mutation. For RIF resistance, 95.1% harbored the <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;">rpoB<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;"> mutation, with S531L and D516V being the two most common. The association of mutations with INH and RIF resistance was high. The study highlighted the significance of data on the genetic determinants of INH and RIF resistance, and suggested the potential of using genotypic DST, such as the Anyplex II MTB/MDR assay, in the country and similar settings.
Copyright (c) 2026 Janisara Rudeeaneksin, Benjawan Phetsuksiri, Sopa Srisungngam, Supranee Bunchoo, Payu Bhakdeenuan, Wiphat Klayut https://creativecommons.org/licenses/by-nc/4.0
The potential of essential oils as mosquito (Diptera: Culicidae) bio-repellents: a systematic review
<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;">Controlling culicid-borne diseases remains a global public health challenge. While public health actions are vital, individual protection via repellents is essential. Concerns regarding synthetic compounds such as DEET have intensified the search for sustainable plant-derived alternatives. This systematic review analyzed 33 experimental studies that were published from 2020 to 2024. A comprehensive search was performed on SciELO, PubMed, Scopus, Web of Science, ScienceDirect, and LILACS using the keywords "Repellency," "Essential Oils," and "Mosquitoes." Data were independently selected and extracted to evaluate protection time and repellency percentages. The included studies showed low risk of methodological bias according to SYRCLE. Results showed that most of the tested essential oils possess high protective potential. Species such as <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;">Perilla frutescens, Leucas stachydiformis<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;">, <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;">Cymbopogon nardus<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;">, and <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;">Eucalyptus camaldulensis<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;"> achieved up to 100% repellency, with protection exceeding eight hours. The cage test was the predominant laboratory method. Essential oils are promising, effective alternatives to synthetic repellents, offering reduced environmental and toxicological impacts. However, this evidence is based on controlled laboratory conditions rather than field trials. This limitation may affect real-world effectiveness, and further research in natural environments is recommended to validate these results for commercial application.
Copyright (c) 2026 Adeilson Pimentel Rabelo, Rodrigo Alves Soares Cruz, Everson dos Santos David, Erique da Costa Fonseca, Karen Carmo dos Santos, Raimundo Nonato Picanço Souto https://creativecommons.org/licenses/by-nc/4.0
Strain-dependent duodenal structural alterations in hamsters infected with Leishmania (Viannia) braziliensis
Leishmania (Viannia) braziliensis (LVB), the main etiological agent of cutaneous and mucocutaneous leishmaniasis, may cause atypical manifestations in immunosuppressed hosts, affecting organs beyond the skin, including the intestine. This study investigated whether the duodenum is involved during experimental LVB infection in hamsters. Overall, 48 female golden hamsters were divided into a control and infected group with five LVB strains. They were euthanized after 90 or 120 days of infection. Duodenal samples were subjected to histological and morphometric analyses, including evaluation of the duodenal wall, villi dimensions, intraepithelial lymphocytes, goblet cells, mast cells, collagen fiber composition (types I and III), and myenteric ganglia. Biochemical assays were performed to assess myeloperoxidase activity and nitrite levels. LVB infection reduced Alcian Blue pH 1.0–positive goblet cells and myenteric ganglia area at 90 days and increased type III collagen fibers at 120 days. Infected animals showed increased villus width at 90 days and greater villus height at 120 days. Overall, LVB infection induces significant and time-dependent alterations in the duodenal histoarchitecture, including epithelial, neuronal, and extracellular matrix changes, indicating that the duodenum undergoes dynamic structural remodeling during the infection.
Copyright (c) 2026 Maria Gabriela Lima da Silva- Zussa, Amanda Gubert Alves dos Santos, Thaís Gomes Verzignassi Silveira, Andrea Claudia Bekner Silva Fernandes, Lainy Leiny de Lima, Roberto Keiji Nakamura Cuman, Débora de Mello Gonçales Sant’Ana, Gessilda de Alcantara Nogueira-Melo https://creativecommons.org/licenses/by-nc/4.0
Infective endocarditis in the real world: Diagnostic challenges and predictors of in-hospital mortality in a 10-year retrospective cohort from a Brazilian tertiary center
Infective endocarditis (IE) remains a life-threatening condition with high mortality, particularly in middle-income countries where access to advanced diagnostics and timely surgery is unequal. Real-world data from such settings remain limited. This study describes the clinical and microbiological characteristics of patients with suspected IE and identifies independent predictors of in-hospital mortality at a Brazilian tertiary referral center. We conducted a retrospective cohort including adults hospitalized with suspected IE between 2012 and 2022. Cases were classified according to modified Duke criteria. Demographic, clinical, laboratory, microbiological, and echocardiographic data were collected, and independent predictors of in-hospital mortality were identified using multivariable logistic regression. Of the 112 patients evaluated, 66 met the criteria for definite or possible IE. Median age was 55 years, 59.1% were male, and 34.8% were ≥60 years. Structural heart disease was present in 87.8%, predominantly involving the mitral valve. Blood cultures were positive in 57.1%, with Staphylococcus aureus as the leading pathogen (25%), whereas 42.9% were culture-negative. Echocardiographic evidence of IE was documented in 80.9%, and valve surgery was performed in 51.5%. In-hospital mortality was 36.6%. Independent predictors of death included age ≥60 years (OR 7.0), hypertension (OR 3.9), new valvular regurgitation (OR 6.3), thrombocytopenia ≤150×10³/mm³ (OR 3.5), total bilirubin ≥1.2 mg/dL (OR 15.4), and arterial lactate >1.6 mmol/L (OR 5.2). In this real-world cohort, IE was characterized by diagnostic limitations, a high proportion of culture-negative cases, and high in-hospital mortality. Readily available clinical and laboratory parameters showed prognostic value and may support early risk stratification in resource-limited settings.
Copyright (c) 2026 Raquel Couto e Silva, Danilo Bortolotto Gurian, Guilherme Barbosa Pinto, Murilo Freua Sequeira, Erika Yukie Ishigaki, Eloisa Basile Siqueira Ayub, Nicoly Caroline de Andrade Delmondes, Gabriel Fialkovitz, Rinaldo Focaccia Siciliano, Olavo Henrique Munhoz Leite, Marcello Mihailenko Chaves Magri https://creativecommons.org/licenses/by-nc/4.0
Open-access Between insects and birds: molecular evidence of Bartonella henselae DNA in Rhodnius prolixus (Stål, 1859) from an insectary and Cairina moschata (Linnaeus, 1758) ducks used as triatomine blood meal source
Bartonella henselae is the primary human pathogen species of this Gram-negative bacterial genus, associated with several clinical manifestations including cat scratch disease, bacillary angiomatosis, endocarditis, and myocarditis. This pathogen was recently detected in Triatoma sordida, a vector of Chagas disease in Brazil. Here, we investigated the presence of B. henselae DNA in Rhodnius prolixus, another triatomine vector of Trypanosoma cruzi maintained in an insectary and in ducks (Cairina moschata) used as a blood source for their colony. A total of 84 triatomines and blood samples from 10 ducks were analyzed by nested PCR targeting the ftsZ gene of B. henselae. Bacterial DNA was detected in four (4.76%) triatomines and in nine (90%) ducks. Sequencing of amplicons from three triatomines and two ducks revealed 100% identity, full query coverage, and highly significant E-values, indicating complete sequence identity to Bartonella henselae strain Houston-1. To the best of the authors’ knowledge, this study provides novel evidence of B. henselae DNA in R. prolixus and C. moschata. However, the vector competence of triatomines for transmitting this bacterium to humans and/or ducks remains unclear.
Copyright (c) 2026 Luciene Silva dos Santos, Paulo Eduardo Neves Ferreira Velho, Jader de Oliveira, João Aristeu da Rosa, Osvaldo Campos dos Santos Nonato, Francine Ramos Scheffer, Marina Rovani Drummond https://creativecommons.org/licenses/by-nc/4.0
Weil's disease: rapid recovery following corticosteroid treatment: a case report
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.
Copyright (c) 2026 Ahmet Melih Şahin, İrem Atçı-Koç, Sinan Çetin https://creativecommons.org/licenses/by-nc/4.0
Rare fungal bloodstream infections in pediatric patients: a case series
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.
Copyright (c) 2026 Nicole Feitosa Ximenes Ferreira, Giovana Fernandes Zorzan, André Ricardo Araújo da Silva https://creativecommons.org/licenses/by-nc/4.0
Open-access The diagnostic value of fine-needle aspiration cytology in the early diagnosis of pulmonary cryptococcosis
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.
Copyright (c) 2026 Dongxia Wang, Ning Wang, Jiejing Liu, Chengyan Zhao, Xue Xing https://creativecommons.org/licenses/by-nc/4.0
Treatment of brucellosis in pregnant women: a systematic review and analysis of current gaps and future perspectives
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.
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
Clostridioides difficile infections in seven Brazilian hospitals during the COVID-19 pandemic: hand hygiene and antimicrobial consumption
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.
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
Molecular biomarkers associated with ATLL and HAM progression in HTLV-1 infection: a systematic review
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.
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
Mycobacterium kansasii in cancer patients: a 13-case series
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.
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
Epidemiological study of hantavirus in Southern Brazil, 2009-2019
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.
Copyright (c) 2026 Felipe Manoel Gimenez de Oliveira, Paulo Augusto Esteves, Ricardo Evandro Mendes https://creativecommons.org/licenses/by-nc/4.0
Candidemia in a tertiary hospital in Southern Brazil
<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 (26 adults, 15 neonates, and three pediatric individuals) were diagnosed with candidemia at our hospital and included in this study. <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;"> species accounted for 4.5% of all sepsis-causing agents (44/971). The overall incidence was 2.2 cases per 1,000 hospitalizations; however, when stratified by hospitalization unit, this rate reached 26 per 1,000 hospitalizations in the neonatal intensive care unit (NICU), followed by 13 per 1,000 hospitalizations in the intensive care unit (ICU). The mortality rate reached 92% among ICU patients and 40% among NICU patients. <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;">C. albicans<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;"> was the most prevalent species (57%), while <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;">C. parapsilosis<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;"> was the most common non-<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;">albicans<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;"> species (∼30%). Resistance to at least one of the three antifungal classes tested was detected in 13% of the isolates. This study underscores the substantial impact of candidemia in ICU settings in a tertiary hospital in Southern Brazil, emphasizing the importance of improved awareness and surveillance to enhance diagnosis, control, prevention, and monitoring of antifungal resistance, aiming to reduce incidence and mortality rates.
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
A rare case of oral myiasis in a non-tropical region: the role of systemic vulnerability
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.
Copyright (c) 2026 Gökçe Kızılkale Kayıkcı, Ayşe Yılmaz, Furkan Arabacı, Hale Ahsen Yardibi Demir, Mesut Özsoy https://creativecommons.org/licenses/by-nc/4.0
Genotypic virulence profiles and mobile genetic elements related to invasiveness in Neisseria gonorrhoeae strains
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.
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