The coronavirus disease of 2019 (COVID-19) pandemic challenges public health systems around the world. Tropical countries will face complex epidemiological scenarios involving the simultaneous transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with viruses transmitted by Aedes aegypti. The occurrence of arboviral diseases with COVID-19 in the Latin America and the Caribbean (LAC) region presents challenges and opportunities for strengthening health services, surveillance and control programs. Financing of training, equipment and reconversion of hospital spaces will have a negative effect on already the limited resource directed to the health sector. The strengthening of the diagnostic infrastructure reappears as an opportunity for the national reference laboratories. Sharing of epidemiological information for the modeling of epidemiological scenarios allows collaboration between health, academic and scientific institutions. The fear of contagion by COVID-19 is constraining people with arboviral diseases to search for care which can lead to an increase in serious cases and could disrupt the operation of vector-control programs due to the reluctance of residents to open their doors to health personnel. Promoting intense community participation along with the incorporation of long lasting innovations in vector control offers new opportunities for control. The COVID-19 pandemic offers challenges and opportunities that must provoke positive behavioral changes and encourage more permanent self-care actions.

Objetivos: Este trabalho teve o objetivo de identificar possível associação entre conjuntivite alérgica e infecção por Chlamydia trachomatis. Método: Realizamos um estudo prospectivo em 104 olhos de 52 pacientes com hipótese diagnóstica de conjuntivite alérgica primaveril e atópica. Os pacientes foram examinados no Núcleo Especializado em Oftalmologia de João Pessoa - NEO. Foi realizada em todos os 52 pacientes, a citologia conjuntival, uma vez que pode evidenciar a presença de eosinófilos e corpúsculos de inclusões no esfregaço do raspado conjuntival, como também a imunofluorescência direta por ser o exame de escolha para confirmação de infecção por Chlamydia trachomatis. Todos os procedimentos foram aprovados pelo Comitê de Ética em pesquisa. Resultados: Dos 52 pacientes, 41 (78,8%) apresentou conjuntivite primaveril e 11 (21,2%) conjuntivite atópica. Quarenta e um (78,8%) eram do sexo masculino e 11 (21,2%) do feminino. As idades variaram de 3 a 19 anos, com uma média de 9,8 anos. Quanto à distribuição racial, 16 (30,8%) pacientes eram brancos, 14 (26,9%) eram negros e 22 (42,3%) eram pardos. Pacientes com doença alérgica sistêmica observou-se que 25 (48,1%) pacientes apresentaram asma brônquica, 20 (38,5%) rinite alérgica e 5 (9,6%) dermatite atópica. Os principais sintomas relatados pelos pacientes foram coriza (59,6%), prurido ocular (98,1%), ardor ou queimação (61,5%), lacrimejamento (65,3%) e fotofobia (61,5%). Os principais sinais clínicos foram: hiperemia ocular (100%), bilateralidade (100%), papilas no tarso (92,3%) e secreção mucosa (82,7%). A citologia do raspado conjuntival encontrou o eosinófilo em 86,5% dos casos. Apenas 7 pacientes não apresentaram eosinófilos no raspado conjuntival. Observamos que 3 pacientes (5,8%) apresentou imunofluorescência positiva para Chlamydia, evidenciando associação entre conjuntivite alérgica e tracoma. Conclusão: É importante determinar a existência simultânea de Chlamydia trachomatis com a conjuntivite alérgica, dada à possibilidade de alterar o prognóstico visual e os sintomas se potencializarem no caso de acometimento duplo. Desta forma faz-se necessário a realização da imunofluorescência direta para o devido diagnóstico em pacientes com conjuntivite alérgica.

Purpose: The aim of this paper was to identify a possible association between allergic conjunctivitis and Chlamydia trachomatis infection. Methods: A prospective study was carried out in 104 eyes of 52 patients with diagnosis of vernal conjunctivitis and atopic keratoconjunctivitis. Conjunctival cytology was performed in all the 52 patients, once it can evidence eosinophils presence and inclusions corpuscles in the conjunctival scraping smear, as well as the direct immunofluorescence that is the choice exam for Chlamydia trachomatis infection confirmation. All procedures were approved by the Institutional Review Board Ethics Committee. Results: Of the 52 patients, 41 (78.8%) presented vernal conjunctivitis and 11 (21.2%) atopic keratoconjunctivitis. Forty-one patients (78.8%) were male and 11 (21.2%) female. The ages varied from 3 to 19 years, with an average of 9.8 years. Regarding racial distribution, 16 (30.8%) patients were caucasian, 14 (26.9%) were black and 22 (42.3%) were brown. Regarding systemic allergic diseases, it was observed that 25 (48.1%) patients presented asthma, 20 (38.5%) allergic rhinitis and 5 (9.6%) atopic dermatitis. The main symptoms complained by the patients were coryza (59.6%), ocular itching (98.1%), burning (61.5%), tearing (65.3%) and photophobia (61.5%). The main clinical signs were: ocular hyperemia (100%), bilaterality (100%), superior tarsal papilla (92.3%) and mucous secretion (82.7%). The cytology of the conjunctival scrapings found eosinophil in 86.5% of the cases. Only seven patients did not present eosinophils in the conjunctival scrapings. Three patients (5.8%) presented positive immunofluorescence for Chlamydia, evidencing an association between allergic conjunctivitis and trachoma. Conclusion: It is important to determine the simultaneous coexistence of Chlamydia trachomatis and allergic conjunctivitis, due to the possibility to change the visual prognostic and of symptoms potentiation in case of double attack. Therefore, it is necessary to performe direct immunofluorescence for the correct diagnosis in patients with allergic conjunctivitis.

OBJETIVO: Avaliar a albumina como fixador de material obtido de raspado conjuntival para citologia esfoliativa. MÉTODOS: Foi realizada citologia esfoliativa conjuntival por meio de estudo prospectivo em quarenta e seis olhos de vinte e três pacientes com conjuntivite alérgica. Foram realizadas três colheitas: (1) na fase aguda, (2) após uso de corticosteróides (tratamento A) e (3) após uso de estabilizador de membrana de mastócitos (tratamento B); em dois tipos de lâminas, com e sem albumina, sendo submetidas à coloração pelo método de Giemsa. RESULTADOS: Dos vinte e três pacientes, cinco (21,7%) eram do sexo feminino e dezoito (78,3%) do sexo masculino, com média de 10,8 anos. Dezoito (78,3%) apresentaram conjuntivite primaveril e cinco (21,7%) ceratoconjuntivite atópica. Após análise estatística da citologia conjuntival, as lâminas tratadas com albumina apresentaram maior número de células epiteliais íntegras em relação às não tratadas, apenas nos grupos pré-tratamento e no grupo do tratamento B. A contagem de neutrófilos foi significativamente maior no grupo de tratamento B nas lâminas não tratadas com albumina em relação às tratadas. Na contagem de eosinófilos não houve diferença entre as lâminas tratadas com albumina em relação às não tratadas, já no grupo de tratamento B houve diferença estatística entre olho direito e esquerdo na lâmina sem albumina. CONCLUSÃO: Não houve diferenças estatísticas entre as lâminas tratadas com albumina e as não tratadas para a maioria das células pesquisadas, além disso, a albumina adere muco dificultando a observação das lâminas, não sendo indicada na citologia esfoliativa de conjuntiva.

PURPOSE: To evaluate albumin as fixative material of conjunctival scrapings for exfoliative cytology. METHODS: Conjunctival exfoliative cytology was performed through a prospective study in forty-six eyes of twenty-three patients with clinical diagnosis of allergic conjunctivitis. Three scrapings were performed: (1) in the pretreatment period, (2) after use of corticosteroids (treatment A) and (3) after use of mast cell stabilizer (treatment B); in two types of smears, with and without albumin, which were then submitted to staining by the Giemsa method. RESULTS: Of the twenty-three patients, five (21.7%) were female and eighteen (78.3%) male, with an age average of 10.8 years. Eighteen (78.3%) presented vernal conjunctivitis and five (21.7%) atopic keratoconjunctivitis. By the statistical analysis of the conjunctival cytology, the smears treated with albumin presented a larger number of intact epithelial cells in relation to the nontreated, only in the pretreatment and in the B treatment groups. The number of neutrophils was significantly greater in the B treatment group than in the smears not treated with albumin in relation to the treated ones. Regarding the number of eosinophils there was no difference between the smears treated with albumin in relation to the nontreated, while in the B treatment group there was a statistical difference between the right and left eye regarding smears without albumin. CONCLUSION: There were no statistical differences between smears treated with albumin and those not treated for most researched cells; in addition, albumin adheres mucus hindering the observation of smears, and thus is not indicated for conjunctival exfoliative cytology.

OBJETIVO: Avaliar a resposta terapêutica das alergias oculares por meio da citologia esfoliativa de material obtido de raspado conjuntival. MÉTODO: Foi realizada citologia esfoliativa conjuntival mediante estudo prospectivo em quarenta e seis olhos de vinte e três pacientes com conjuntivite alérgica. Foram realizadas três colheitas: (1) na fase aguda (pré-tratamento), (2) após uso de corticosteróides (tratamento A) e (3) após uso de estabilizador de membrana de mastócitos (tratamento B), e que foram submetidas à coloração pelo método de Giemsa. RESULTADOS: Dos vinte e três pacientes, cinco (21,7%) eram do sexo feminino e dezoito (78,3%) do sexo masculino, com média de 10,8 anos. Dezoito (78,3%) apresentaram conjuntivite primaveril e cinco (21,7%) ceratoconjuntivite atópica. Após análise estatística da citologia conjuntival, o número de células epiteliais degeneradas foi maior para os dois grupos de tratamento em relação à citologia pré-tratamento. A contagem de neutrófilos foi estatisticamente menor no grupo de tratamento A em relação ao tratamento B e pré-tratamento. Quanto aos eosinófilos, os dois tratamentos apresentaram distribuição percentual estatisticamente menor do que o pré-tratamento. O número de monócitos foi estatisticamente menor após o tratamento A do que o grupo B e o pré-tratamento. CONCLUSÃO: A citologia esfoliativa conjuntival mostrou-se um teste apropriado para avaliar a resposta terapêutica nas alergias oculares.

PURPOSE: To evaluate the therapeutic response of ocular allergies through exfoliative cytology of conjunctival scrappings. METHOD: Conjunctival exfoliative cytology was performed through a prospective study in forty six eyes of twenty-three patients with clinical diagnosis of allergic conjunctivitis. Three scrappings were performed: (1) in the pre-treatment period, (2) after use of corticosteroids (treatment A) and (3) after use of mast cell stabilizer (treatment B); in two types of smears, with and without albumin. The smears were stained with Giemsa. RESULTS: Of the twenty-three patients, five (21.7%) were female and eighteen (78.3%) male, with an average of 10.8 years. Eighteen (78.3%) presented vernal conjunctivitis and five (21.7%) atopic keratoconjunctivitis. After statistical analysis of the conjunctival cytology, the number of degenerate epithelial cells was higher in the two treatment groups in relation to the pre-treatment period. The number of neutrophils was smaller in the A treatment group than in the B treatment and pre-treatment groups. Regarding the number of eosinophils, the two treatments presented a lower percentile distribution than that of the pre-treatment period. The number of monocytes was smaller after the A treatment than the B group and the pre-treatment period. CONCLUSION: Exfoliative conjunctival cytology is an appropriate test to evaluate the therapeutic response in ocular allergies.

Deltamethrin-impregnated PVC dog collars were tested to assess if they were effective in protecting dogs from sand fly bites of Lutzomyia longipalpis and Lu. migonei. A protective effect against Old World species Phlebotomus perniciosus was demonstrated before. Four dogs wearing deltamethrin collars and three dogs wearing untreated collars (not impregnated with deltamethrin) were kept in separate kennels for over eight months in a village on the outskirts of Fortaleza in Ceará, Brazil. Periodically, a dog from each group was sedated, placed in a net cage for 2 h in which 150 female sand flies had been released 10-15 min before. Lu. longipalpis were used 4, 8, 12, 16, 22, 27, and 35 weeks after the attachment of the collars. Lu. migonei were used 3, 7, 11, 15, 22, 26, and 36 weeks after attachment. During 35 weeks, only 4.1% (81 of 2,022) Lu. longipalpis recovered from the nets with the deltamethrin collared dogs were engorged, an anti-feeding effect of 96%. Mortality initially was over 90% and at 35 weeks was 35% with half of the sand flies dying in the first 2 h. In contrast, 83% of the 2,094 Lu. longipalpis recovered from the nets containing the untreated collared dogs were engorged and the mortality ranged from zero to 18.8% on one occasion with 1.1% dying in the first 2 h. Similar findings were found with Lu. migonei: of 2,034 sand flies recovered over this period, only 70 were engorged, an anti-feeding effect of 96.5%, and mortality ranged from 91% initially to 46% at 36 weeks. In contrast, engorgement of controls ranged from 91 to71% and a mortality ranged from 3.5 to 29.8%. These studies show that deltamethrin impregnated collars can protect dogs against Brazilian sand flies for up to eight months. Thus, they should be useful in a program to control human and canine visceral leishmaniasis.

Previous reports showed that Lutzomyia longipalpis saliva exacerbate Leishmania braziliensis infection in mice. The sand fly Lu. whitmani is one of the vectors of L. (Viannia) braziliensis (LVb), a causative agent of cutaneous leishmaniasis in the State of Ceará, Brazil. To determine whether saliva of Lu. whitmani could increase the infectivity of LVb in mice, we inoculated groups of BALB/c mice with LVb promastigotes in the presence or absence of the salivary glands lysate from Lu. whitmani. We found that coinjection with Lu. whitmani saliva increased size but not longevity of cutaneous LVb lesions in BALB/c mice, since the formed lesions gradually resolved. The mechanism(s) by which Lu. whitmani saliva might exacerbate LVb infection in BALB/c mice is speculated.

RESUMO Foram analisados em estudo retrospectivo 89 pacientes com hipótese diagnóstica de Síndrome de Vogt-Koyanag-Harada, com o objetivo de descrever e analisar suas manifestações clínicas e oculares. Sessenta e oito (76,4%) pacientes eram do sexo feminino e 21 (23,6%) do sexo masculino. A média de idade foi de 34 anos. Houve um predomínio da raça branca (59,6%). O envolvimento ocular foi bilateral em 100% dos casos. Doença do tipo I esteve presente em 25 pacientes (28,1%), tipo II em 36 (40,4%) e tipo III em 28 (31,5%). No tipo I encontramos uma menor incidência de manifestações neurológicas (p < 0,01). Dentre as manifestações extra-oculares a cefaléia (56,2%), zumbido (41,6%), hipoacusia (28,1%) e alopecia (27,0%) foram os mais citados. Os achados oculares mais freqüentes foram: "sunset glow fundus" (65,2%), nódulos de Dallen-Fuchs (49,4%), hiperemia de papila (48,3%), iridociclite granulomatosa (48,3%) e descolamento exsudativo de retina : (31,5%). Catarata (52,8%) e glaucoma: (270%) foram as complicações mais encontradas. Dos 18 pacientes que realizaram o exame do líquor, 10 (55,6%) apresentaram pleiocitose com linfocitose. A ultrassonografia ocular foi realizada em 30 pacientes e as principais alterações evidenciadas foram: membranas vítreas móveis e tênues, (43,3%), espessamento de parede (26,7%) e descolamento de retina (23,3%). 68,5% dos pacientes foram tratados com uma combinação de corticosteróides tópicos e sistêmicos.

SUMMARY We retrospectively examined 89 patients with presumptive diagnosis of Vogt-Koyanagi-Harada syndrome. Sixty-eight (76.4%) patients were women and 21 (23.6%) men. Mean age was 34 years and 53 (59.6%) were white. Bilateral ocular involvement was observed in all patients. Twenty-five patients (28.1 %) developed type I disease, 36 (40.4%) type 11 and 28 (31.5%) type 111. In the last two groups we found a larger incidence of neurological disturbances when compared with the first group (p < 0.01). The most frequent extraocular manifestations were headache (56.2%), tinnitus (41.6%), dysacusis (28.1%) and alopecia (27.0%). The most frequent ocular findings were "sunset glow fundus'' (65.2%), Dallen-Fuchs nodules (49.4%)), disc hyperemia (48.3%), granulomatous reaction in the anterior segment (48.3%) and serous retina/ detachment (31.5%). Cataract (52.8%) and glaucoma (27.0%) were the most common complications. Of 18 patients whose cerebrospinal jluid was evaluated, 10 (55.6%) showed pleocytosis with lymphocytosis. Ocular ultrasonography was performed in 30 patients and the changes observed were mild vitreous opacities (43.3%), thickening of the sclera, choroid and episclera (26.7%) and retinal detachment (23.3%).

Com o objetivo de avaliar a aplicabilidade do Teste de Aglutinação Direta (TAD) como método de detecção da infecção natural canina por Leishmania (Viannia) braziliensis, foi realizado um estudo envolvendo soros de cães residentes em uma área endêmica de leishmaniose tegumentar, Serra de Baturité, CE e soros de cães provenientes da cidade de Curitiba, PR, área não endêmica de leishmaniose. Os resultados obtidos com o TAD neste trabalho indicam a possibilidade do uso deste teste sorológico para levantamentos epidemiólogicos da infecção em reservatórios; neste estudo, o cão doméstico.

In order to evaluate the aplicability of the Direct Agglutination Test (DAT) as a method of detection of the natural canine infection for Leishmania (Viannia) braziliensis, it was realized a study involving the serum of naive dogs from Serra de Baturite, Ceara State, an endemic area of cutaneous leishmaniasis, and others from Curitiba, Parana State, a non endemic area. The results indicate the possibility of using this sorologic test to the epidemiologic research of the infection in the reservoir host; in this case, the dog.