ABSTRACT Visceral leishmaniasis (VL) is an opportunistic disease in immunosuppressed individuals, who may present severe clinical conditions, such as the ones described in this patient. She lived in an endemic region for VL, and was possibly infected with L. (L.) infantum chagasi through the bite of a contaminated sand fly. This initial infection has triggered a pemphigus vulgaris condition by immunogenic proteins present in the mosquito's saliva. The immunosuppression caused by the use of high doses of corticosteroids to control the disease promoted a severe VL condition, with hepatosplenomegaly, thrombocytopenia and hemorrhages, requiring hospitalization and the onset of a subsequent SARS-CoV-2 infection. Due to the intensity of clinical manifestations related to VL, aggravated by COVID-19, she died two days after admission to the Clinical Hospital of Marilia Medical School (HC–Famema).

Abstract INTRODUCTION: Stimulation of inflammatory mediators such as cytokines and chemokines may cause oxidative stress in Chagas disease. In this study, we evaluated the merit of vitamins C and E as antioxidant therapy to minimize the oxidative stress-induced damage in an experimental model of Chagas disease. METHODS: Ninety-six Swiss mice were infected with Trypanosoma cruzi QM2 and treated with vitamins C, E, or both (C/E) for 60 and 120 days, and their effects compared to placebo administration were evaluated in the acute and chronic disease phases. RESULTS: There was no difference in parasitemia among treatment groups. However, histological analysis showed more severe inflammation in the skeletal muscle in the vitamin supplementation groups at both the acute and chronic phases. Biochemical analyses during the acute phase showed increased ferric-reducing ability of plasma (FRAP) and glutathione (GSH) levels in the vitamin C and C/E groups. In the chronic phase, a decrease in GSH levels was observed in the vitamin E group and a decrease in thiobarbituric acid reactive substances (TBARS) was observed in the vitamin C/E group. Moreover, there was a decrease in TBARS in the cardiac tissues of the vitamin C and C/E groups compared to that of the placebo group, although this level was greater in the vitamin E group than in the vitamin C group. CONCLUSIONS: The antioxidant action of vitamins C and E reduced oxidative stress in both the acute and chronic phases of Chagas disease, with a marked effect from joint administration, indicating their inherent synergism.

We describe two patients with HIV/AIDS who presented pulmonary and intestinal infection caused by Cryptosporidium parvum, with a fatal outcome. The lack of available description of changes in clinical signs and radiographic characteristics of this disease when it is located in the extra-intestinal region causes low prevalence of early diagnosis and a subsequent lack of treatment.

Introdução:Para verificar a eficácia da vitamina C em combater o insulto oxidativo causado pelo Trypanosoma cruzi durante a evolução da fase crônica da doença de Chagas, camundongos Swiss foram previamente infectados via intraperitoneal com 5.0 × 104 tripomastigotas da cepa QM1 de T. cruzi.Métodos:Camundongos foram suplementados com duas diferentes doses de vitamina C por 180 dias. Foram mensurados os níveis de peroxidação lipídica (indicado por substâncias reativas ao ácido tiobarbitúrico-TBARS), peróxido total, vitamina C, e glutationa reduzida no plasma e TBARS, peróxido total e vitamina C no miocárdio, e foi realizado o estudo histopatológico em coração, cólon e músculo esquelético.Resultados:Animais que receberam diariamente uma dosagem equivalente a 500 mg de vitamina C apresentaram aumento na produção de ROS e RNS no plasma e no miocárdio e maior grau de inflamação e necrose em músculo esquelético em comparação àqueles que receberam doses menores ou nenhuma vitamina C.Conclusão:Embora muitas pesquisas tenham mostrado o efeito antioxidante da vitamina C, nossos resultados mostraram que os animais que foram expostos a 500 mg de vitamina C apresentaram maior dano tecidual na fase crônica da doença de Chagas, provavelmente devido a ações paradoxais desta substância, onde nesta patologia, poderá agir como pró-oxidante ou pró-inflamatória.

Introduction:In order to examine the effectiveness of vitamin C (ascorbic acid) in combating the oxidative insult caused by Trypanosoma cruzi during the development of the chronic phase of Chagas disease, Swiss mice were infected intraperitoneally with 5.0 × 104 trypomastigotes of T. cruzi QM1strain.Methods:Mice were given supplements of two different doses of vitamin C for 180 days. Levels of lipid oxidation (as indicated by thiobarbituric acid reactive substances-TBARS), total peroxide, vitamin C, and reduced glutathione were measured in the plasma, TBARS, total peroxide and vitamin C were measured in the myocardium and histopathologic analysis was undertaken in heart, colon and skeletal muscle.Results:Animals that received a dose equivalent to 500 mg of vitamin C daily showed increased production of ROS in plasma and myocardium and a greater degree of inflammation and necrosis in skeletal muscles than those that received a lower dose or no vitamin C whatsoever.Conclusion:Although some research has shown the antioxidant effect of vitamin C, the results showed that animals subject to a 500 mg dose of vitamin C showed greater tissue damage in the chronic phase of Chagas disease, probably due to the paradoxical actions of the substance, which in this pathology, will have acted as a pro-oxidant or pro-inflammatory.

As alterações teciduais que ocorrem na doença de Chagas estão relacionadas ao grau de estresse oxidativo e à capacidade antioxidante do tecido afetado. Estudos realizados com suplementação de vitamina C revelaram redução no dano oxidativo causado no hospedeiro pela doença de Chagas, porém outros estudos citam o uso de peroxiredoxinas dependentes de ascorbato pelo T. cruzi para se proteger da ação imune. Com base nessas proposições, trinta camundongos "Swiss" foram infectados com a cepa QM1 de T. cruzi e tratados com duas diferentes doses de vitamina C para estudar a evolução da parasitemia, alterações histopatológicas e dosagem de biomarcadores de peroxidação lipídica durante a fase aguda da doença de Chagas. Os resultados mostraram que a parasitemia foi maior nos animais que receberam uma superdosagem de vitamina C. Não houve diferenças significativas quanto aos biomarcadores de peroxidação lipídica e houve maior processo inflamatório no miocárdio dos animais tratados com dosagem recomendada. O maior crescimento parasitário ao fim da fase aguda sugere benefício de altas doses de vitamina C aos tripomastigotas. A suplementação não exerceu influência sobre a produção de radicais livres e o número de ninhos de amastigotas na fase aguda da doença de Chagas.

The tissue changes that occur in Chagas disease are related to the degree of oxidative stress and antioxidant capacity of affected tissue. Studies with vitamin C supplementation did not develop oxidative damage caused by Chagas disease in the host, but other studies cite the use of peroxiredoxins ascorbate - dependent on T. cruzi to offer protection against immune reaction. Based on these propositions, thirty "Swiss" mice were infected with T. cruzi QM1 strain and treated with two different vitamin C doses in order to study the parasitemia evolution, histopathological changes and lipid peroxidation biomarkers during the acute phase of Chagas disease. The results showed that the parasite clearance was greater in animals fed with vitamin C overdose. There were no significant differences regarding the biomarkers of lipid peroxidation and inflammatory process or the increase of myocardium in animals treated with the recommended dosage. The largest amount of parasite growth towards the end of the acute phase suggests the benefit of high doses of vitamin C for trypomastigotes. The supplementation doesn't influence the production of free radicals or the number of amastigote nests in the acute phase of Chagas disease.

INTRODUÇÃO: Para avaliar a eficácia da vitamina C em reduzir as consequências geradas pela produção de readicais livres na fase aguda e crônica da doença de Chagas, duas diferentes dosagens de ácido ascórbico foram administradas oralmente para 60 camundongos infectados pela cepa QM2 de Trypanosoma cruzi. MÉTODOS: Estes animais foram divididos em seis grupos: G1, G2 e G3 para o estudo da fase aguda e G'1, G'2 e G'3 para o estudo da fase crônica. Diariamente, G1-G'1 recebeu 8.6 x 10-4 mg/g de vitamina C, G2- G'2 recebeu 7.14 x 10-3 mg/g. Os outros grupos, G3-G'3, foram considerados placebos e receberam 10µL of de água mineral. RESULTADOS: O estudo da fase aguda mostrou diferenças estatisticamente significativas entre G1 e os outros grupos em vários dias de contagens na evolução da parasitemia, e até o 11º dia a multiplicação parasitária foi menor em G1, mas no 22º dia ele tinha parasitemia maior que G2 e G3, e a partir do 36º, a parasitemia estabilizou em altos níveis. Quando considerado o histopatológico da fase aguda e crônica, não foi notado, entretanto, diferença significativa. CONCLUSÕES: Assim, foi encontrado que a administração de duas diferentes dosagens de vitamina C não foi capaz de proteger o camundongo e conter o estresse oxidativo causado pelos radicais livres formados pelo metabolismo do oxigênio (ROS) e nitrogênio (RNS).

INTRODUCTION: To evaluate the efficacy of vitamin C in reducing the consequences generated by the production of free radicals in the acute and chronic phases of Chagas disease, two different doses of ascorbic acid were administered orally to 60 mice infected by Trypanosoma cruzi QM2 strain. METHODS: The animals were divided into six groups: G1, G2, and G3 for the acute phase study, and G'1, G'2, and G'3 for the chronic stage. The groups G1 and G'1 received 8.6x10-4mg/g of vitamin C daily, whereas G2 and G'2 received 7.14x10-3mg/g daily. The other groups, G3 and G'3, were considered placebos and received 10µL of mineral water. RESULTS: The study of the acute phase showed statistically significant differences between G1 and the other groups at various count days of the parasitemia evolution. The multiplying parasite was slower in G1 until the 11th day, but on the 22nd day it had greater parasitemia than in G2 and G3, and from the 36th day on, parasitemia stabilized at higher levels. However, when the histopathology of acute and chronic phases is considered, one does not note significant differences. CONCLUSIONS: The administration of two different doses of vitamin C was not able to protect mice and to contain the oxidative stress caused by free radicals formed by the metabolism of oxygen (reactive oxygen species) and nitrogen (reactive nitrogen species).

OBJECTIVE: To verify the incidence of T. cruzi transmission through breastfeeding during acute experimental Chagas' disease. METHODS: Fifteen female Swiss mice were mated and, after pregnancy confirmation, placed in individual cages. A few hours after birth, the females were inoculated with 0.1 mL of blood containing approximately 3 x 10(5) trypomastigote forms of Y strain of T. cruzi and continued breastfeeding for 25 days. RESULTS: In 142 offspring examined no infection through breast-feeding was observed. CONCLUSIONS: The low number of trypomastigote forms ingested by the newborn mice combined with biological and biochemical characteristics of blood trypomastigotes may explain the lack of transmission in this experiment.

Foram capturados triatomíneos rupestres em seis localidades do município de Quaraí-RS, com o intuito de verificar o índice de infecção por Trypanosomatidae, bem como o animal reservatório. A captura ocorreu no ambiente silvestre, sendo coletados 453 exemplares, os quais foram identificados e separados por estádio ninfal. Coletaram-se 421 (92,9%) exemplares de Triatoma rubrovaria, 26 (5,7%) de Triatoma circummaculata e 6 (1,3%) de Panstrongylus tupynambai. Dentre as três espécies coletadas, somente Triatoma rubrovaria mostrou-se positivo para Trypanosomatidae, num total de 13 (4,2%) exemplares. Após a inoculação em camundongos e meio de cultura LIT, isolaram-se cinco cepas de Trypanosoma cruzi. Dos triatomíneos infectados com Trypanosomatidae, 4 (30,8%) tiveram a reação de precipitina não reagente para os anti-soros testados, 4 (30,8%) positivos para anti-soro de roedor, 4 (30,8%) para anti-soro de cabra e 1 (7,7%) para anti-soro de porco e humano.

Rupestrian triatomines were captured in six Quaraí city localities, RS, to verify the level of Trypanosomatidae infection, as well as the animal reservoir. The capture occurred in a wild environment and 453 samples were collected, which were identified and separated by nymphal instar. 421 (92.9%) samples of Triatoma rubrovaria, 26 (5.7%) of Triatoma circummaculata and 6 (1.3%) of Panstrongylus tupynambai were collected. Only 13 samples (4.2%) of Triatoma rubrovaria presented Trypanosomatidae infection. After mice and LIT culture inoculation, five strains of Trypanosoma cruzi were isolated. Of these triatomines, 4 (30.8%) displayed no reagent precipitin for the antiserum tested, 4 (30.8%) were positive for rodent antiserum, 4 (30.8%) were positive for goat antiserum and 1 (7.7%) were positive for human and pig antiserum.

Estudou-se o comportamento biológico e histopatológico de uma cepa genuínamente mariliense de Trypanosoma cruzi, isolada em 1997 através de xenodiagnóstico artificial. Vinte e cinco camundongos swiss foram infectados intraperitonealmente, sendo 11 utilizados para a realização da curva parasitêmica e observação da morfologia dos tripomastigotas e 14 foram sacrificados após o 17, 23, 30, 60 e 180 dias pós-infecção e coletados coração, esôfago, fígado, cólon, e músculo esquelético (fragmento da coxa direita) para análise histopatológica. Cultura em meio LIT foi realizada para análise de DNA. Os resultados mostraram predomínio de formas largas, baixa parasitemia com picos médios de 860 tripomastigotas/5mil de sangue ao redor do 20º dia de infecção. Nenhum camundongo morreu na fase aguda da infecção. Exame histopatológico mostrou poucos ninhos de amastigotas em coração, raros em músculo esquelético e cólon com discreto processo inflamatório. Comparada com a cepa Y, que foi isolada de uma paciente da mesma região, notamos diferentes características biológicas e comportamentais, porém a análise de DNA as coloca no mesmo grupo, demonstrando a proximidade dessas cepas.

The aim of this report was to study the biological and histopathological behavior of a Trypanosoma cruzi strain, which is found in the region of Marília. The strain was isolated in 1997, by artificial xenodiagnosis. Twenty-five swiss mice were intraperitoneally inoculated. Eleven were used for observation of parasitemia and trypomastigotes morphology and 14 were sacrificed after 17, 23, 30, 60 and 180 days post-infection. Heart, esophagus, liver, colon, and skeletal muscle (fragment of the right thigh) were collected for histopathological study. LIT culture medium was accomplished for DNA analysis. The results showed predominance of broad forms, low parasitemia with mean peaks of 860 trypomastigotes/5mul of blood of the 20th day of infection. No animal died in the acute phase of infection. Histopathological analysis showed several pseudocysts of amastigotes in heart, rare in skeletal muscle and colon with discreet inflammatory process. When Famema strain was compared with Y strain, which was isolated from a patient who lived in the same area, a distinct behaviour and biological characteristics were observed. However, DNA analysis placed them in same group, hence displaying the proximity of these strains.

A susceptibilidade de ninfas de 3º estádio de Rhodnius neglectus, R. robustus e Triatoma infestans às cepas Y e AMJM de Trypanosoma cruzi foi verificada utilizando xenodiagnóstico artificial. Para a leitura do xenodiagnóstico, as fezes dos triatomíneos foram examinadas a cada dois dias, a partir do 5º até o 31º dia pós infecção, pela técnica de compressão abdominal. Os resultados mostraram diferenças na susceptibilidade dos triatomíneos para as duas cepas estudadas e o período ótimo de leitura variou do 11º ao 19º dias para a cepa Y e do 11º ao 15º dias para a cepa AMJM. Também, pôde-se concluir que para a cepa Y, as três espécies de triatomíneos demonstraram boa susceptibilidade, enquanto para a cepa AMJM, a melhor susceptibilidade foi observada com R. neglectus, seguida pelo T. infestans e R. robustus.

The susceptibility of 3rd instar nymph of Triatominae Rhodnius neglectus, R. robustus and Triatoma infestans to Trypanosoma cruzi Y and AMJM strains was verified using artificial xenodiagnosis. After the accomplishment of the xenodiagnosis, the faeces of the Triatominae were analyzed on two-day intervals from day 5 until day 31 post infection, using the abdominal compression technique. The results showed differences in the susceptibility of the Triatominae for the two strains studied, and the optimal period reading differed from day 11 to day 19 for the Y strain and from day 11 to day 15 for the AMJM strain. For the Y strain, all three Triatominae species showed good susceptibility, whereas in the AMJM strain, the highest susceptibility was observed with R. neglectus, followed by T. infestans and R. robustus.