BACKGROUND Erythema nodosum leprosum (ENL) is an acute and systemic inflammatory reaction of leprosy characterised by painful nodules and involvement of various organs. Thalidomide is an immunomodulatory and anti-inflammatory drug currently used to treat this condition. Cereblon (CRBN) protein is the primary target of thalidomide, and it has been pointed out as necessary for the efficacy of this drug in others therapeutics settings. OBJECTIVES In this study, we aimed to evaluate the influence of CRBN gene variants on the dose of thalidomide as well as its adverse effects during treatment of ENL. METHODS A total of 103 ENL patients in treatment with thalidomide were included in this study. DNA samples were obtained from saliva and molecular analysis of CRBN gene were performed to investigate the variants rs1620675, rs1672770 and rs4183. Different genotypes of CRBN variants were evaluated in relation to their influence on the dose of thalidomide and on the occurrence of adverse effects. FINDINGS No association was found between CRBN variants and thalidomide dose variation. However, the genotypes of rs1672770 showed association with gastrointestinal effects (p = 0.040). Moreover, the haplotype DEL/C/T (rs4183/rs1672770/rs1620675) was also associated with gastrointestinal adverse effects (p = 0.015). MAIN CONCLUSIONS Our results show that CRBN variants affect the treatment of ENH with thalidomide, especially on the adverse effects related to the drug.

Abstract INTRODUCTION: Triatomines are hematophagous insects that are important to public health since they are the vectors of American Trypanosomiasis. The objective of this study was to describe the occurrence of triatomines in homes in Cruzeiro do Sul, Acre, Brazil. METHODS The specimens were collected by an active search inside homes and also by a passive search by the residents. RESULTS: A total of 55 triatomines were captured comprising of 5 species each of the genera Rhodnius, Eratyrus, and Panstrongylus. No colonies were detected, ruling out the possibility of domiciliation. CONCLUSIONS: Information on regional epidemiological dynamics contributes to the prevention and control of disease.

Abstract INTRODUCTION: Triatomines are insect vectors of Trypanosoma cruzi, the etiological agent of Chagas disease. METHODS: Triatomines were collected from households and by dissecting palm trees in the peri-urban areas of Cruzeiro do Sul (Acre); they were identified using a specific key and via genital analyses. Trypanosomatid infection was determined through microscopy and polymerase chain reaction. RESULTS: In total, 116 triatomines of the species Eratyrus mucronatus, Rhodnius pictipes, R. stali, and R. montenegrensis were collected, of which 13.8% were positive for T. cruzi. CONCLUSIONS: Four species of triatomines presented an infection rate above 13% in the Boca do Moa community.

Resumo O estado do Acre está localizado na Amazônia ocidental brasileira e apresenta poucos estudos envolvendo carrapatos. O presente estudo objetivou relatar, pela primeira vez, a ocorrência da espécie Amblyomma latepunctatum e o segundo registro de Ixodes luciae no estado do Acre, Brasil. A coleta de carrapatos foi realizada em outubro de 2020 no interior de uma floresta aberta no município de Rio Branco, capital do estado do Acre. Carrapatos ixodídeos foram identificados de acordo com suas características morfológicas externas. Três espécimes foram encontrados sobre a vegetação pelo método de inspeção visual e identificados como as espécies Amblyomma scalpturatum (um macho e uma fêmea) e Amblyomma latepunctatum (um macho); e outro foi encontrado parasitando uma fêmea de Didelphis marsupialis que foi capturada por uma armadilha Tomahawk, e identificado como Ixodes luciae (um macho). Este primeiro relato de A. latepunctatum no estado do Acre aumenta o número de espécies registradas aqui para 22. Além disso, a presença de I. luciae é confirmada no estado do Acre (segundo registro), na região da Amazônia ocidental brasileira.

Abstract The state of Acre is in the western part of the Brazilian Amazon region and few studies involving ticks are available. The aim of the present study was to provide the first report of occurrence of Amblyomma latepunctatum and the second record of Ixodes luciae in Acre. Ticks were collected in October 2020 inside an open forested area in the municipality of Rio Branco, the state capital of Acre. Ixodid ticks were identified according to their external morphological characteristics. Three specimens were found on the vegetation by means of a visual search and were identified as Amblyomma scalpturatum (one male and one female) and Amblyomma latepunctatum (one male). Another specimen was found parasitizing a Didelphis marsupialis female that was caught using a Tomahawk trap; this was identified as Ixodes luciae (one male). This first report of A. latepunctatum in the state of Acre increases the number of species recorded here to 22. In addition, presence of I. luciae is confirmed in this state (second record), in the western Brazilian Amazon region.

Abstract The present study aims to describe the occurrence of triatomines and their infection rate by Trypanosoma cruzi, in an area of Chagas disease outbreak in Rodrigues Alves municipality, Acre state, Brazil. Collections were performed by passive search (capture of specimens by local people) and dissection of palm trees (Attalea butyracea and Mauritia flexuosa). Thirty two triatomines belonging to four species grouped into two genera (Rhodnius and Eratyrus) had T. cruzi infection rate of 15.6%. Only in A. butyracea triatomines were captured. The passive search was the most effective method for collection. The Nova Cintra triatomine fauna comprises four species and it is important to carry out future studies to understand the biology of these triatomines.

Resumen El presente estudio tiene como objetivo describir la aparición de triatominos y la infección causada por Trypanosoma cruzi, en un área de brote de la enfermedad de Chagas en el municipio de Rodrigues Alves, estado de Acre, Brasil. Las recolecciones se realizaron mediante búsqueda pasiva y disección en palmeras (Attalea butyracea y Mauritia flexuosa). Treinta y dos triatominos pertenecientes a cuatro especies agrupadas en dos géneros (Rhodnius y Eratyrus) tenían una tasa de infección por T. cruzi del 15,6%. Solo en A. butyracea se capturaron triatominos. La búsqueda pasiva fue el método más efectivo para la recolección. La fauna triatomina de Nova Cintra comprende cuatro especies, es importante realizar futuros estudios para comprender su biología.

ABSTRACT The etiological agent of American trypanosomiasis is the protozoan Trypanosoma cruzi , typically transmitted by triatomines. The aim of this study was to investigate the triatomine fauna and trypanosomiasis infections in Acre State , Western Brazilian Amazon. Insect collection was performed by dissecting palm trees and installing traps. We found that T. cruzi infection rate was 24.5% and Rhodnius pictipes (57.1%) was the most abundant triatomine species. Health education as well as epidemiological and entomological surveillance are necessary to diagnose and prevent new cases of Chagas disease in the region.

Resumo A maioria das espécies de água doce de Cymothoidae está distribuída na Sul e foi registrada principalmente nas regiões Leste e Oeste da bacia do Rio Amazonas. Entretanto, nesse ecossistema, a biodiversidade desse grupo pode ser maior se toda a bacia amazônica for considerada. Nesse sentido, o objetivo do presente estudo foi fornecer uma lista atualizada de espécies de isópodes da família Cymothoidae que são encontrados em peixes na Região Amazônica brasileira e relatar novas ocorrências de peixes hospedeiros, ampliando as distribuições geográficas para isópodes cimotoides que parasitam peixes na região Sudoeste da Amazônia brasileira. Os parasitos encontrados em espécimes de peixes coletados foram analisados e posteriormente identificados. Foram encontradas oito espécies de Cymothoidae parasitando diferentes espécies de peixes hospedeiros na região Sudoeste da Amazônia. No entanto, foram encontradas 14 espécies de Cymothoidae em toda a Região Amazônica brasileira. Três novos relatos de espécies foram observados, o que aumenta o número de espécies de Cymothoidae nessa região para 17. Essas espécies relatadas, também são novos registros para o Brasil. Portanto, este estudo ajudou a expandir o conhecimento sobre a distribuição e diversidade de Cymothoidae na bacia amazônica.

Abstract Most freshwater species of Cymothoidae are distributed in South America. They have mainly been recorded in the eastern and western regions of the Amazon River basin. However, in this ecosystem, the biodiversity of this group may be greater if the entire Amazon basin is considered. In this regard, the aim of the present study was to provide an updated list of isopod species of the family Cymothoidae that are found in fish in the Brazilian Amazon region and to report on new fish host occurrences and expanded geographical distributions for cymothoid isopods that parasitize fish in the southwestern Brazilian Amazon region. The parasites found in fish specimens were collected, fixed and identified later. We found eight species of Cymothoidae parasitizing different host fish species in the southwestern Amazon region. However, we found 14 species of Cymothoidae throughout the Brazilian Amazon region. Three additional species are thus reported here, which increases the number of species of Cymothoidae in this region to 17. These additional species are also new records for Brazil. Therefore, this study has contribute to expand the knowledge about the distribution and diversity of Cymothoidae in the Amazon basin.

Abstract INTRODUCTION: Triatomines are hematophagous insects of epidemiological importance because they are vectors of Chagas disease. We present here the first report of Rhodnius montenegrensis in Amazonas, Brazil. METHODS: Triatomines were collected from Attalea butyracea palm trees in the municipality of Guajará. RESULTS: Two adult female R. montenegrensis specimens were identified. CONCLUSIONS: The present study confirms that the number of triatomine species within the Amazon has increased from 10 to 11, and the number of Brazilian states with R. montenegrensis has increased from two to three.

Abstract We present the first recent reported case of traumatic injury caused by catfish in the Americas. Although 66.2% of fish-related injuries occur in the Amazon Region, they are scarcely reported. We report a traumatic injury in a 2-year-old boy who entered Madeira River. The use of traditional methods to treat the injury and his incomplete vaccination history reflect the weakness of the health system. Further, the fact that it was the second time that such an incident had occurred in the locality in 3 weeks during the dry season suggests that this could be a frequent occurrence during this period.

Abstract INTRODUCTION: Trypanosomes can infect humans and animals. This is the first record of the occurrence of Trypanosoma evansi in Rondônia. METHODS: Blood samples were collected from 7 dogs and 22 humans. Furthermore, triatomines and tabanids were collected. RESULTS: It was observed that 42.8% of the dogs tested positive for T. evansi and 14.3% presented mixed infection; 15% of the triatomines tested positive for flagellates identified as T. cruzi TCI (3 specimens), T. cruzi TCI, and T. rangeli (1 specimen), and one with T. cruzi TCV. Two tabanids were infected with T. theileri. CONCLUSIONS: These findings may benefit vector control strategies.

Abstract: INTRODUCTION This study aimed to confirm the occurrence of Panstrongylus rufotuberculatus in the state of Acre, Brazil. METHODS The four specimens of P. rufotuberculatus were obtained from the entomological collection of the Zoobotanical Park of the Federal University of Acre (UFAC). RESULTS Confirmation of the occurrence of this species in the state of Acre increases the number of species already registered, from nine to ten. CONCLUSIONS The necessity to develop further studies was verified, especially with the domiciliary process of P. rufotuberculatus, resulting in tracing prophylactic measures against the vector transmission of Trypanosoma cruzi.

Abstract INTRODUCTION: This study reports, for the first time, the presence of Panstrongylus lignarius in the State of Rondonia, Brazil. METHODS: Specimen of P. lignarius was collected from a flat in an urban area of the municipality of Porto Velho, Western Amazon. RESULTS: With this finding of P. lignarius, the number of Triatominae species in the State of Rondonia has increased from six to seven. CONCLUSIONS: The occurrence of P. lignarius is worrisome, because this species has been found to be naturally infected with Trypanosoma cruzi and there has been evidence of its domiciliation capabilities in other countries of South America.

The sandfly Trichophoromyia auraensis has recently evolved as a proven vector of Leishmania (Viannia) endemic to state of Acre in the north of Brazil. This note is intended to propose a correction in the report of the first occurrence of natural infection of Leishmania (Viannia) in this species. We and the other scientific groups reinforced that Tr. auraensis is a possible vector involved in the transmission of American cutaneous leishmaniasis in Acre, Brazil.

RESUMO A esquistossomose é uma doença parasitária, causada por helmintos do gênero Schistosoma e transmitida no Brasil por caramujos do gênero Biomphalaria. O município de Ouro Preto do Oeste, Rondônia, Amazônia brasileira, notificou, de forma não usual, mais de 900 casos de esquistossomose mansônica nos últimos 10 anos. O objetivo deste estudo foi investigar o potencial de transmissão da esquistossomose em Ouro Preto do Oeste. Um total de 1.196 pessoas residindo em áreas de risco para a transmissão da doença foram abordadas para responderem um questionário clínico-epidemiológico e realização de exame parasitológico de fezes. Todas as amostras foram negativas para S. mansoni. Duzentos e sessenta e oito caramujos foram coletados em Ouro Preto do Oeste, de 32 localidades diferentes. Entre estes, 44% foram classificados como pertencendo ao gênero Biomphalaria. Outra amostra de caramujos (146 exemplares), coletada nos mesmos locais, foi submetida in vitro a cepas de Schistosoma mansoni, sendo todos incapazes de transmitirem o parasito. Por fim, discute-se a importância epidemiológica desses achados e a falta de atenção ao paciente portador da parasitose em áreas indenes. O estudo não conseguiu demonstrar a ocorrência de transmissão na localidade e nem a habilidade dos planorbídeos locais transmitirem Shistosoma mansoni. Talvez o pequeno tamanho da amostra e/ou a técnica de exame de fezes (pouco sensível) possam ter contribuído para este resultado. Estudos futuros, em outras localidades e com uma amostra maior podem colocar um pouco de luz nesta questão.

ABSTRACT Schistossomiasis is a parasitic disease, caused by helminths of the genus Schistosoma and transmitted in Brazil by snails of the genus Biomphalaria. The municipality of Ouro Preto do Oeste, Rondônia, in the Brazilian Amazon Region, has unusually registered more than 900 cases of schistosomiasis in the last 10 years. The aim of this study was to investigate de potential of transmission of schsitosomiasis in Ouro Preto do Oeste. A total of 1,196 people in a risk area for the disease transmission were requested to answer a clinical-epidemiological survey and to collect feces samples for examination. All the samples that underwent examination resulted negative for S. mansoni. Two hundred and sixty-eight snails were collected in the locality of Ouro Preto do Oeste in 32 different locations. Among these, 44% were classified as belonging to the genus Biomphalaria. Another sample of snails (146 specimens), collected at the same sites, were submitted to an in vitro challenge with Schistosoma mansoni, and none of them were able to transmit the parasite. Finally, we discuss the epidemiological importance of these findings and the lack of attention to a patient with the disease in a non-endemic area. We failed to detected any association between shistossomiasis and the snails from the genus Biomphalaria, that exists in the local, as the planorbids were unable to transmit Shistosoma mansoni. Perhaps the small sample and/or the stool examination technique can have contributed to the results. Further studies, in other localities of Rondônia and with a greater sample could put some light in this question.

Abstract: INTRODUCTION: The morbidity and mortality profile in a given region reflects its quality of life and provides tools for improving public health policies in that region. METHODS A cross-sectional epidemiological study was performed using secondary mortality data collected from the Monte Negro municipality of the Brazilian Western Amazon from 2000 to 2011. These data were compared with data from similar municipalities in other Brazilian macro-regions. Data were obtained through the Departamento de Informática do Sistema Único de Saúde (DATASUS) information system. RESULTS The number of deaths reported over the study period was 606. The most common cause of death was external causes of morbidity and mortality [International Classification of Diseases (ICD)-10 chapter 20], followed by diseases of the circulatory system (ICD-10 chapter 9). Among the causes of death according to age group, infectious and parasitic diseases were the most common for 2- to 9-year-old children; external causes of disease were the most prevalent for 10- to 59-year-old people; and circulatory diseases prevailed in individuals over 60 years of age. Eleven percent of deaths were due to unknown causes. CONCLUSIONS These results point to a fragility in the public policies for prevention and awareness of this problem. Infectious and parasitic diseases contribute only 4.5% of deaths, but had the third highest Disability-Adjusted Life Year score (1,190 days). Improving support to the Estratégia Saúde da Família (Family Health Strategy) program and implementing a death verification service would significantly aid in reducing the occurrence of non-transmissible chronic diseases and clarifying unknown causes of death.