Revista do Instituto de Medicina Tropical de São Paulo
type: channel
description: Publicar artículos que tratan acerca de las investigaciones sobre enfermedades tropicales y ciencias relacionadas.
publisher: Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo
language: es
publication name: Revista do Instituto de Medicina Tropical de São Paulo
issn: 0036-4665
items: Zoonotic potential of bovine Sarcocystis species: a challenge for public health and meat inspection
items: Phase-dependent dynamics of circulating cell-free mitochondrial DNA reflect distinct immunometabolic states
items: Congenital toxoplasmosis in a newborn of a chronically infected mother
items: Disseminated sporotrichosis with orbital osteomyelitis in a child: a case report
items: Association between atmospheric SO2 exposure and severity of respiratory infections in infants: a systematic review
items: Temporal trends and spatial distribution of leishmaniasis based on biomes in Brazil, 2007 to 2020
items: Disseminated tuberculosis with Poncet's disease mimicking childhood-onset systemic lupus erythematosus: a unique case report
items: Post-treatment paradoxical reaction in tuberculous flexor tenosynovitis with rice bodies after a cat bite
items: Emergence of difficult-to-treat lymphocutaneous sporotrichosis? Analysis based on three cases with high and low MIC Sporothrix brasiliensis isolates
items: The potential of molecular testing and mutation analysis for detecting isoniazid and rifampicin-resistant Mycobacterium tuberculosis in Thailand
items: The potential of essential oils as mosquito (Diptera: Culicidae) bio-repellents: a systematic review
items: Strain-dependent duodenal structural alterations in hamsters infected with Leishmania (Viannia) braziliensis
items: 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
items: https://revistas.usp.br/rimtsp/es/article/view/250022
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

Zoonotic potential of bovine Sarcocystis species: a challenge for public health and meat inspection
type: item
description: 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.
subject: Original Article
  topic: section
subject: Sarcocystis spp;
  topic: keywords
subject: Zoonosis
  topic: keywords
subject: Food safety
  topic: keywords
subject: Sarcocystis sigmoideus
  topic: keywords
subject: One Health
  topic: keywords
creator: Cayuan Tadeu Brandão Pinto
creator: Luciana Regina Meireles
rights: Derechos de autor 2026 Cayuan Tadeu Brandão Pinto, Luciana Regina Meireles https://creativecommons.org/licenses/by-nc/4.0
date: 2026-08-05
publication date: 2026-08-05
starting page: e49
ending page: e49
doi: 10.1590/S1678-9946202668049

Phase-dependent dynamics of circulating cell-free mitochondrial DNA reflect distinct immunometabolic states
type: item
description: 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 (m…
subject: Original Article
  topic: section
subject: Cell-free mitochondrial DNA
  topic: keywords
subject: qPCR
  topic: keywords
subject: tuberculosis
  topic: keywords
subject: Chronic pediatric diseases
  topic: keywords
subject: Systemic inflammation
  topic: keywords
subject: Biomarker
  topic: keywords
creator: Karen Alessandra Rodrigues
creator: Emilly Henrique dos Santos
creator: Gabriel Acca Barreira
creator: Maria Carolina Pires Cruz
creator: Kelly Aparecida Kanunfre
creator: Thelma Suely Okay
rights: Derechos de autor 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
date: 2026-08-05
publication date: 2026-08-05
starting page: e48
ending page: e48
doi: 10.1590/S1678-9946202668048

Congenital toxoplasmosis in a newborn of a chronically infected mother
type: item
description: 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.
subject: Case Report
  topic: section
subject: Congenital toxoplasmosis
  topic: keywords
subject: Pregnancy
  topic: keywords
subject: Reinfection
  topic: keywords
subject: Vertical transmission
  topic: keywords
subject: Reactivation
  topic: keywords
creator: Vitória Schneider Müller
creator: Júlia Sales Machado
creator: Wilson Hoshino
creator: Aida de Fátima Tomé Barbosa Gouvêa
creator: Fabiana Bononi do Carmo
creator: Kelly Simone Almeida Cunegundes
creator: Maria Aparecida Ferrarini
creator: Annelise Pereira Barreto Monteiro
creator: Daisy Maria Machado
creator: Ana Isabel Melo Pereira Monteiro
rights: Derechos de autor 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
date: 2026-08-05
publication date: 2026-08-05
starting page: e47
ending page: e47
doi: 10.1590/S1678-9946202668047

Disseminated sporotrichosis with orbital osteomyelitis in a child: a case report
type: item
description: 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.
subject: Case Report
  topic: section
subject: Sporotrichosis
  topic: keywords
subject: Fungal infection
  topic: keywords
subject: Sporothrix spp
  topic: keywords
subject: Cutaneous lesion
  topic: keywords
subject: Osteomyelitis
  topic: keywords
subject: Children
  topic: keywords
creator: Fabiana Bononi do Carmo
creator: Kimberly Souza Rocha
creator: Caio Vinícius Luís
creator: Aída de Fátima Thomé Barbosa Gouvea
creator: Daisy Maria Machado
creator: Ana Isabel Melo Pereira Monteiro
creator: Érica Regina Cruz Paulino
creator: Marina Gomes Pereira Sardinha
creator: Kelly Simone Almeida Cunegundes
creator: Paulo Gois Manso
creator: Anderson Messias Rodrigues
creator: Pedro Fiorini Pucchini
creator: Marcelo Luiz Abramczyk
creator: Maria Aparecida Gadiani Ferrarini
creator: Carolina Sanchez Aranda Lago
creator: Regina Célia de Menezes Succi
rights: Derechos de autor 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
date: 2026-08-05
publication date: 2026-08-05
starting page: e46
ending page: e46
doi: 10.1590/S1678-9946202668046

Association between atmospheric SO2 exposure and severity of respiratory infections in infants: a systematic review
type: item
description: 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.
subject: Review
  topic: section
subject: SO2
  topic: keywords
subject: Air pollution
  topic: keywords
subject: Infants
  topic: keywords
subject: Respiratory infections
  topic: keywords
subject: Bronchiolitis
  topic: keywords
subject: Pneumonia
  topic: keywords
creator: Sandra Elisabete Vieira
creator: Alexandre Archanjo Ferraro
rights: Derechos de autor 2026 Sandra Elisabete Vieira, Alexandre Archanjo Ferraro https://creativecommons.org/licenses/by-nc/4.0
date: 2026-08-04
publication date: 2026-08-04
starting page: e45
ending page: e45
doi: 10.1590/S1678-9946202668045

Temporal trends and spatial distribution of leishmaniasis based on biomes in Brazil, 2007 to 2020
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;">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 …
subject: Original Article
  topic: section
subject: American cutaneous leishmaniasis
  topic: keywords
subject: Visceral leishmaniasis
  topic: keywords
subject: Amazon
  topic: keywords
subject: Prais–Winsten method
  topic: keywords
creator: Geisa Bezerra Ferreira
creator: Leonardo Augusto Kohara Melchior
creator: Andreia Fernandes Brilhante
rights: Derechos de autor 2026 Geisa Bezerra Ferreira, Leonardo Augusto Kohara Melchior, Andreia Fernandes Brilhante https://creativecommons.org/licenses/by-nc/4.0
date: 2026-08-04
publication date: 2026-08-04
starting page: e44
ending page: e44
doi: 10.1590/S1678-9946202668044

Disseminated tuberculosis with Poncet's disease mimicking childhood-onset systemic lupus erythematosus: a unique case report
type: item
description: 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.
subject: Case Report
  topic: section
subject: Poncet's disease
  topic: keywords
subject: Tuberculosis
  topic: keywords
subject: Childhood-onset systemic lupus erythematosus
  topic: keywords
creator: Matheus Santos França
creator: Fernanda Lima Gomes
creator: Marina de Azambuja Nogueira
creator: Maria Fernanda Bádue Pereira
creator: Heloisa Helena de Sousa Marques
creator: Katia Tomie Kozu
creator: Lucia Maria Arruda Campos
creator: Clovis Artur Silva
rights: Derechos de autor 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
date: 2026-08-04
publication date: 2026-08-04
starting page: e43
ending page: e43
doi: 10.1590/S1678-9946202668043

Post-treatment paradoxical reaction in tuberculous flexor tenosynovitis with rice bodies after a cat bite
type: item
description: 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.
subject: Case Report
  topic: section
subject: Paradoxical reaction
  topic: keywords
subject: Rice bodies
  topic: keywords
subject: Tenosynovitis
  topic: keywords
subject: Extrapulmonary tuberculosis
  topic: keywords
subject: Osteoarticular tuberculosis
  topic: keywords
creator: Zehra Çağla Karakoç
creator: Sait Ada
creator: Önder Pekel
creator: Arzu Avcı
creator: Kubilay Erol
creator: Mahir Kapmaz
creator: Ali Mert
rights: Derechos de autor 2026 Zehra Çağla Karakoç, Sait Ada, Önder Pekel, Arzu Avcı, Kubilay Erol, Mahir Kapmaz, Ali Mert https://creativecommons.org/licenses/by-nc/4.0
date: 2026-08-04
publication date: 2026-08-04
starting page: e42
ending page: e42
doi: 10.1590/S1678-9946202668042

Emergence of difficult-to-treat lymphocutaneous sporotrichosis? Analysis based on three cases with high and low MIC Sporothrix brasiliensis isolates
type: item
description: 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.
subject: Original Article
  topic: section
subject: Sporotrichosis
  topic: keywords
subject: Sporothrix brasiliensis
  topic: keywords
subject: Itraconazole
  topic: keywords
subject: Terbinafine
  topic: keywords
creator: Juliana Carreiro Avila
creator: Ana Paula Carvalho Reis
creator: Kaique Arriel
creator: Amanda Azevedo Bittencourt
creator: Livia Vieira Almeida
creator: Rita de Cassia Soler
creator: Giovanna Azevedo Celestrino
creator: Ana Paula Cordeiro Lima
creator: Maria Gloria Teixeira Sousa
creator: José Angelo Lauletta Lindoso
creator: Gil Benard
rights: Derechos de autor 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
date: 2026-08-04
publication date: 2026-08-04
starting page: e41
ending page: e41
doi: 10.1590/S1678-9946202668041

The potential of molecular testing and mutation analysis for detecting isoniazid and rifampicin-resistant Mycobacterium tuberculosis in Thailand
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;">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 !im…
subject: Original Article
  topic: section
subject: Mycobacterium tuberculosis
  topic: keywords
subject: Mutations
  topic: keywords
subject: Isoniazid
  topic: keywords
subject: Rifampicin
  topic: keywords
subject: Anyplex
  topic: keywords
creator: Janisara Rudeeaneksin
creator: Benjawan Phetsuksiri
creator: Sopa Srisungngam
creator: Supranee Bunchoo
creator: Payu Bhakdeenuan
creator: Wiphat Klayut
rights: Derechos de autor 2026 Janisara Rudeeaneksin, Benjawan Phetsuksiri, Sopa Srisungngam, Supranee Bunchoo, Payu Bhakdeenuan, Wiphat Klayut https://creativecommons.org/licenses/by-nc/4.0
date: 2026-08-03
publication date: 2026-08-03
starting page: e40
ending page: e40
doi: 10.1590/S1678-9946202668040

The potential of essential oils as mosquito (Diptera: Culicidae) bio-repellents: a systematic review
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;">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-sty…
subject: Review
  topic: section
subject: Repellents
  topic: keywords
subject: Essential oils
  topic: keywords
subject: Culicidae
  topic: keywords
subject: Pathogens
  topic: keywords
creator: Adeilson Pimentel Rabelo
creator: Rodrigo Alves Soares Cruz
creator: Everson dos Santos David
creator: Erique da Costa Fonseca
creator: Karen Carmo dos Santos
creator: Raimundo Nonato Picanço Souto
rights: Derechos de autor 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
date: 2026-08-03
publication date: 2026-08-03
starting page: e39
ending page: e39
doi: 10.1590/S1678-9946202668039

Strain-dependent duodenal structural alterations in hamsters infected with Leishmania (Viannia) braziliensis
type: item
description: 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.
subject: Original Article
  topic: section
subject: Cutaneous leishmaniasis
  topic: keywords
subject: Small intestine
  topic: keywords
subject: Histology
  topic: keywords
creator: Maria Gabriela Lima da Silva- Zussa
creator: Amanda Gubert Alves dos Santos
creator: Thaís Gomes Verzignassi Silveira
creator: Andrea Claudia Bekner Silva Fernandes
creator: Lainy Leiny de Lima
creator: Roberto Keiji Nakamura Cuman
creator: Débora de Mello Gonçales Sant’Ana
creator: Gessilda de Alcantara Nogueira-Melo
rights: Derechos de autor 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
date: 2026-08-03
publication date: 2026-08-03
starting page: e38
ending page: e38
doi: 10.1590/S1678-9946202668038

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
type: item
description: 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.
subject: Original Article
  topic: section
subject: Infective endocarditis
  topic: keywords
subject: Staphylococcus aureus
  topic: keywords
subject: Echocardiography
  topic: keywords
subject: Blood cultures
  topic: keywords
subject: Cardiac surgery
  topic: keywords
subject: Mortality
  topic: keywords
creator: Raquel Couto e Silva
creator: Danilo Bortolotto Gurian
creator: Guilherme Barbosa Pinto
creator: Murilo Freua Sequeira
creator: Erika Yukie Ishigaki
creator: Eloisa Basile Siqueira Ayub
creator: Nicoly Caroline de Andrade Delmondes
creator: Gabriel Fialkovitz
creator: Rinaldo Focaccia Siciliano
creator: Olavo Henrique Munhoz Leite
creator: Marcello Mihailenko Chaves Magri
rights: Derechos de autor 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
date: 2026-07-14
publication date: 2026-07-14
starting page: e37
ending page: e37
doi: 10.1590/S1678-9946202668037

https://revistas.usp.br/rimtsp/es/article/view/250022
type: item
title: 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
description: 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.
subject: Original Article
  topic: section
subject: Bartonella
  topic: keywords
subject: Triatominae
  topic: keywords
subject: Zoonoses
  topic: keywords
subject: Arthropod vectors
  topic: keywords
creator: Luciene Silva dos Santos
creator: Paulo Eduardo Neves Ferreira Velho
creator: Jader de Oliveira
creator: João Aristeu da Rosa
creator: Osvaldo Campos dos Santos Nonato
creator: Francine Ramos Scheffer
creator: Marina Rovani Drummond
rights: Derechos de autor 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
date: 2026-06-12
publication date: 2026-06-12
starting page: e36
ending page: e36
doi: 10.1590/S1678-9946202668036

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: Derechos de autor 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: Derechos de autor 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: Derechos de autor 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: Derechos de autor 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: Derechos de autor 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: Derechos de autor 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: Derechos de autor 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: Derechos de autor 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: Derechos de autor 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: Derechos de autor 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: Derechos de autor 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: Derechos de autor 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: Derechos de autor 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: Derechos de autor 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: Derechos de autor 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: Derechos de autor 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