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au:"Lindoso, José Angelo Lauletta"

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Can COVID-19 impact the natural history of paracoccidioidomycosis? Insights from an atypical chronic form of the mycosis
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Souza, César Augusto Tomaz de

; Ponce, Cesar Cilento

; Klautau, Gisele Burlamaqui

; Costa, André Nathan

; Queiroz, Wladimir

; Patzina, Rosely Antunes

; Benard, Gil

; Lindoso, José Angelo Lauletta

Revista do Instituto de Medicina Tropical de São Paulo

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2023, Volume 65 elocation e57

Resumo: En | Texto: En | PDF: En

ABSTRACT Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by Paracoccidioides spp. It can occur as an acute/subacute form (A/SAF), a chronic form (CF) and rarely as a mixed form combining the features of the two aforementioned forms in an immunocompromised patient. Here, we report a 56-year-old male patient with CF-PCM who presented with atypical manifestations, including the development of an initial esophageal ulcer, followed by central nervous system (CNS) lesions and cervical and abdominal lymphatic involvement concomitant with severe SARS-CoV-2 infection. He was HIV-negative and had no other signs of previous immunodeficiency. Biopsy of the ulcer confirmed its mycotic etiology. He was hospitalized for treatment of COVID-19 and required supplemental oxygen in the intensive unit. The patient recovered without the need for invasive ventilatory support. Investigation of the extent of disease during hospitalization revealed severe lymphatic involvement typical of A/SAF, although the patient`s long history of high-risk exposure to PCM, and lung involvement typical of the CF. Esophageal involvement is rare in non-immunosuppressed PCM patients. CNS involvement is also rare. We suggest that the immunological imbalance caused by the severe COVID-19 infection may have contributed to the patient developing atypical severe CF, which resembles the PCM mixed form of immunosuppressed patients. Severe COVID-19 infection is known to impair the cell-mediated immune response, including the antiviral response, through T-lymphopenia, decreased NK cell counts and T-cell exhaustion. We hypothesize that these alterations would also impair antifungal defenses. Our case highlights the potential influence of COVID-19 on the course of PCM. Fortunately, the patient was timely treated for both diseases, evolving favorably.

https://doi.org/10.1590/s1678-9946202365057

Prevalence of SARS-CoV-2 infection among health care workers in a reference hospital in Brazil
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Almeida, Vanessa Neves

; Cavalin, Roberta Figueiredo

; Gallo, Juliana Failde

; Guerra, Cleide Aparecida

; Madureira, Karen Cristina Rolim

; Rossi, Meire Bócoli

; Sobreira, Rozania Soeli dos Santos

; Santos, Ana Paula

; Luna, Expedito

; Lindoso, José Angelo Lauletta

Revista do Instituto de Medicina Tropical de São Paulo

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2023, Volume 65 elocation e52

Resumo: En | Texto: En | PDF: En

ABSTRACT Health care workers (HCW) are the frontline workforce for COVID-19 patient care and, consequently, are exposed to SARS-CoV-2 infection due to close contact to infected patients. Here, we evaluate the prevalence of SARS-CoV-2 infection among HCW from an infectious disease hospital, reference center for COVID-19 care in the metropolitan area of Sao Paulo city, Brazil. Among 2,204 HCW, 1,417 (64.29%) were subjected to detection of anti-SARS-CoV-2 antibodies by chemiluminescent immunoassay. Out of the total, 271 (19.12%) presented anti-SARS-CoV-2 antibodies. Prevalence varied according to HCW categories. The highest prevalence was observed in workers from outsourced companies, cooks and kitchen assistants, hospital cleaning workers, and maintenance workers. On the other hand, resident physicians and HCW from the institution itself presented lower prevalence (nurses, nursing assistants, physicians, laboratory technicians). Social and environmental factors are important determinants, associated with exposure in the hospital environment, which can determine the greater or lesser risk of infection by pathogens that spread rapidly by air.

https://doi.org/10.1590/s1678-9946202365052

Genetic variability of Leishmania (Leishmania) infantum causing human visceral leishmaniasis in the Southeastern Brazil
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Lima, Vinicius Alves

; Silva, Renata Elen Costa

; Camargo, Luiz Henrique Moraes Caetano

; Hiramoto, Roberto Mitsuyoshi

; Leal, Elcio de Souza

; Braz, Lucia Maria Almeida

; Lindoso, José Angelo Lauletta

Revista do Instituto de Medicina Tropical de São Paulo

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2023, Volume 65 elocation e55

Resumo: En | Texto: En | PDF: En

ABSTRACT Leishmania infantum is a protozoan that causes visceral leishmaniasis (VL) in the Americas and some regions of Europe. The disease is mainly characterized by hepatosplenomegaly and fever, and can be fatal. Factors related to the host and parasite can contribute to the transmission of Leishmania and the clinical outcome. The intraspecific genetic variability of L. infantum strains may be one of these factors. In this study, we evaluated the genetic variability of L. infantum obtained from bone marrow smear slides from patients in the Sao Paulo State, Brazil. For this, the minicircle of the kDNA hypervariable region was used as target by Sanger sequencing. By analyzing the similarity of the nucleotides and the maximum likelihood tree (Fasttree), we observed a high similarity (98%) among samples. Moreover, we identified four different profiles of L. infantum. In conclusion, L. infantum strains from Sao Paulo State, Brazil, showed low diversity measured by minicircle of the kDNA hypervariable region.

https://doi.org/10.1590/s1678-9946202365055

Visceral leishmaniasis caused by Leishmania (Leishmania) amazonensis associated with Hodgkin’s lymphoma
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Porto, Victor Bertolo Gomes

; Carvalho, Laína Bubach

; Buzo, Bruno Fernando

; Litvoc, Marcelo Nobrega

; Santos, Ana Catharina S.

; Rocci, Rafael Avila

; Soares, Sandra Regina Castro

; Zampieri, Ricardo Andrade

; Duarte, Maria Irma Seixas

; Lindoso, José Angelo Lauletta

Revista do Instituto de Medicina Tropical de São Paulo

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2022, Volume 64 elocation e51

Resumo: En | Texto: En | PDF: En

ABSTRACT Visceral leishmaniasis (VL) is mainly caused by Leishmania (Leishmania) donovani and Leishmania (L.) infantum; however, other Leishmania species have been associated with VL. We report a case of a patient simultaneously diagnosed with VL caused by Leishmania (L.) amazonensis and Hodgkin’s lymphoma. After treatment with liposomal amphotericin B and chemotherapy, the patient presented a clinical cure. This case report reinforces the hypothesis that other Leishmania species can cause visceral lesions mainly related to immunosuppression.

https://doi.org/10.1590/s1678-9946202264051

Shotgun metagenomic sequencing of the first case of monkeypox virus in Brazil, 2022
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Claro, Ingra Morales

; Romano, Camila Malta

; Candido, Darlan da Silva

; Lima, Evelyn Lepka de

; Lindoso, José Angelo Lauletta

; Ramundo, Mariana Severo

; Moreira, Filipe Romero Rebello

; Barra, Luiz Alberto Costa

; Borges, Luciana Marques Sansão

; Medeiros, Lucas Alberto

; Tomishige, Marcia Y. S.

; Moutinho, Tomas

; Silva, Anderson José Dias da

; Rodrigues, Camila Cristina Martini

; Azevedo, Luiz Cesar Fernandes de

; Villas-Boas, Lucy Santos

; Silva, Camila Alves Maia da

; Coletti, Thaís Moura

; Manuli, Erika R.

; O’Toole, Aine

; Quick, Joshua

; Loman, Nicholas

; Rambaut, Andrew

; Faria, Nuno R.

; Figueiredo-Mello, Claudia

; Sabino, Ester Cerdeira

Revista do Instituto de Medicina Tropical de São Paulo

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2022, Volume 64 elocation e48

Resumo: En | Texto: En | PDF: En

ABSTRACT Monkeypox virus (MPXV), a zoonotic virus endemic to the African continent, has been reported in 33 non-endemic countries since May 2022. We report an almost complete genome of the first confirmed case of MPXV in Brazil. Shotgun metagenomic sequencing was completed in 18 hours, from DNA extraction to consensus sequence generation.

https://doi.org/10.1590/s1678-9946202264048

First case report of monkeypox in Brazil: clinical manifestations and differential diagnosis with sexually transmitted infections
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Lima, Evelyn Lepka de

; Barra, Luiz Alberto Costa

; Borges, Luciana Marques Sansão

; Medeiros, Lucas Alberto

; Tomishige, Marcia Y. S.

; Santos, Lucas de Souza Loureiro Abbud

; Silva, Anderson José Dias da

; Rodrigues, Camila Cristina Martini

; Azevedo, Luiz Cesar Fernandes de

; Villas-Boas, Lucy Santos

; Silva, Camila Alves Maia da

; Coletti, Thaís Moura

; Manuli, Erika R.

; Claro, Ingra Morales

; Romano, Camila Malta

; Ramundo, Mariana Severo

; Moutinho, Tomas

; Sabino, Ester Cerdeira

; Lindoso, José Angelo Lauletta

; Figueiredo-Mello, Claudia

Revista do Instituto de Medicina Tropical de São Paulo

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2022, Volume 64 elocation e54

Resumo: En | Texto: En | PDF: En

ABSTRACT In 2022, an outbreak of monkeypox is being reported in non-endemic areas, with unusual clinical manifestations. The detailed clinical description of the first patient that received the diagnosis of monkeypox in Brazil is reported here, whose clinical manifestations can easily lead to misdiagnosis of sexually transmitted infections. A 41 years old male presented to an emergency room with a vesicular rash with eight days of evolution. He had traveled to Portugal and Spain and reported non-penetrative sexual involvement with three different male individuals. On the third day of symptoms, he sought medical care and received empirical treatment directed to sexually transmitted infections. As the symptoms did not improve, he sought medical attention at an infectious disease referral center presenting, on admission, an ulcerated penile lesion with central necrotic crusts, a disseminated pleomorphic skin rash and an oropharyngeal ulcer. The monkeypox diagnosis was suspected due to the characteristics of the lesions and the history of intimate contact with casual partners, and it was later confirmed by sequencing the almost complete monkeypox genome. The patient was hospitalized for pain control, which required opiate administration. He developed a secondary bacterial infection on the penile lesions, which were treated with oral antibiotics. He was discharged after 14 days, with lesions in process of re-epithelialization. Given the current outbreak, we must consider the possibility of monkeypox in patients with suggestive lesions, anywhere on the body (including the genitals), added to an epidemiological link or history of intimate contact with strangers or casual partners.

https://doi.org/10.1590/s1678-9946202264054

Unusual manifestation of genital cutaneous leishmaniasis in an immunocompetent patient from São Paulo, Brazil: A case report
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Reis, Luiza Campos

; Lindoso, José Angelo Lauletta

; Celeste, Beatriz Julieta

; Braz, Lucia Maria Almeida

; Ramos-Sanchez, Eduardo Milton

; Yamashiro-Kanashiro, Edite Hatsumi

; Goto, Hiro

; Oyafuso, Luiza Keiko Matsuka

Revista da Sociedade Brasileira de Medicina Tropical

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2021, Volume 54 elocation e0514-2020

Resumo: En | Texto: En | PDF: En

Abstract A 31-year-old male patient developed an ulcer on the glans penis that evolved for three months without healing. We diagnosed it as leishmaniasis using polymerase chain reaction. No immunosuppression or associated diseases were observed. The patient was treated with meglumine antimoniate that cured the lesion in a month post-treatment. Here, we report this case of cutaneous leishmaniasis lesion at the unusual location of glans penis in an immunocompetent individual. The lesion likely developed due to the bite of a vector, highlighting the need for considering cutaneous leishmaniasis among differential diagnosis of sexually transmitted diseases in areas endemic for leishmaniasis.

https://doi.org/10.1590/0037-8682-0514-2020 281 downloads

Visceral Leishmaniasis diagnosis: a rapid test is a must at the hospital bedside
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Braz, Lucia Maria Almeida

; Tahmasebi, Roozbeh

; Hefford, Philip Michael

; Lindoso, José Angelo Lauletta

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2020, Volume 75 elocation e2036

Resumo: En | Texto: En | PDF: En

https://doi.org/10.6061/clinics/2020/e2036 727 downloads

Aspectos clínicos e tratamento de pacientes com tuberculose ocular presumida em centro de referência de São Paulo, Brasil. Estudo retrospectivo
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Koller, Karine

; Ricci, Lucas Holderegger

; Lindoso, José Angelo Lauletta

; Lindoso, Ana Angélica Bulcão Portela

; Muccioli, Cristina

Revista Brasileira de Oftalmologia

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Dez 2019, Volume 78 Nº 6 Páginas 384 - 388

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: Descrever aspectos clínicos e esquema terapêutico dos pacientes com tuberculose ocular presumida tratados em um centro de referência em tuberculose de São Paulo. Métodos: Estudo retrospectivo descritivo. O teste exato de Fisher foi realizado quando apropriado. Resultados: A queixa mais comum foi baixa acuidade visual (83,1%), seguida por dor ocular generalizada (25,3%) e visão turva (22,8%). A uveíte posterior foi a apresentação mais comum (35,7%). O tratamento consistiu no esquema atualmente recomendado de rifampicina, isoniazida, pirazinamida e etambutol (RHZE). A prednisona oral foi incluída no tratamento de 37 pacientes, para tratamento da inflamação aguda, embora não tenha diminuído a prevalência de complicações crônicas, em comparação com a recuperação completa (p = 0,1). O diagnóstico precoce (<70 dias) foi associado a maiores taxas de recuperação total (p = 0,005). Não houve significância estatística quando se comparou a terapia de 6 a 9 meses (p = 0,7). Conclusão: A uveíte tuberculosa pode ser tratada por uma terapia com duração de seis meses. Um breve curso de esteroides melhora os sintomas agudos, embora não reduza as complicações a longo prazo.

Abstract Purpose: To analyze and describe the therapy used in presumed ocular tuberculosis in a referral center in São Paulo, Brazil. Methods: Retrospective, descriptive study. Fisher’s exact test was performed when appropriate. Results: The most common complaint was low visual acuity (83.1%), followed by generalized ocular pain (25.3%) and blurred vision (22.8%). Posterior uveitis was the most common presentation (35.7%). Treatment consisted of the currently recommended association of rifampin, isoniazid, pyrazinamide, ethambutol (RHZE) regimen. Oral prednisone was included in the treatment of 37 patients for acute inflammation, although it did not significantly decrease the prevalence of chronic complications compared to full recovery (p = 0,1). Early diagnosis (< 70 days) was associated with higher rates of full recovery (p = 0.005). No statistical significance was observed when comparing 6 to 9-month therapy (p = 0.7). Conclusion: Tuberculous uveitis can be treated with a 6-month duration RHZE therapy. A brief course of steroids may improve acute symptoms, although it did not reduce long-term disabilities.

https://doi.org/10.5935/0034-7280.20190166 1117 downloads

10.

Para-kala-azar dermal leishmaniasis in a patient in Brazil: a case report
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Lindoso, José Angelo Lauletta

; Moreira, Carlos Henrique Valente

; Celeste, Beatriz Julieta

; Oyafuso, Luiza Keiko Matsuka

; Folegatti, Pedro Moreira

; Zijlstra, Eduard Evert

Revista da Sociedade Brasileira de Medicina Tropical

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Fev 2018, Volume 51 Nº 1 Páginas 105 - 107

Resumo: En | Texto: En | PDF: En

Abstract Visceral leishmaniasis is common in Brazil and is caused by Leishmania (Leishmania) infantum/chagasi. Post-kala-azar dermal leishmaniasis frequently follows visceral leishmaniasis caused by L. donovani, and para-kala-azar dermal leishmaniasis refers to an uncommon presentation wherein it occurs simultaneously along with visceral leishmaniasis. While post-kala-azar dermal leishmaniasis only occurs occasionally in L. infantum/chagasi infections, it frequently occurs in patients with concomitant immunosuppression (HIV co-infection). Here, we describe the first case of para-kala-azar dermal leishmaniasis in Brazil. It is important to raise awareness of post- and para-kala-azar dermal leishmaniasis in L. infantum endemic areas as these patients may contribute to visceral leishmaniasis transmission.

https://doi.org/10.1590/0037-8682-0487-2016 1488 downloads

11.

Efficiency of noninvasive sampling methods (swab) together with Polymerase Chain Reaction (PCR) for diagnosing American Tegumentary Leishmaniasis
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Boni, Sara Macente

; Oyafuso, Luiza Keiko

; Soler, Rita de Cassia

; Lindoso, José Angelo Lauletta

Revista do Instituto de Medicina Tropical de São Paulo

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2017, Volume 59 elocation e38

Resumo: En | Texto: En | PDF: En

ABSTRACT Traditional diagnostic methods used to detect American Tegumentary Leishmaniasis, such as histopathology using biopsy samples, culture techniques, and direct search for parasites, have low sensitivity and require invasive collection procedures. This study evaluates the efficiency of noninvasive sampling methods (swab) along with Polymerase Chain Reaction (PCR) for diagnosing American Tegumentary Leishmaniasis using skin and mucous samples from 25 patients who had tested positive for leishmaniasis. The outcome of the tests performance on swab samples was compatible with PCR results on biopsy samples. The findings have also shown that PCR-kDNA test is more efficient than PCR-HSP70 and qPCR tests (sensitivity of 92.3%, 40.7%, and 41%, respectively). Given the high sensitivity of the tests and the fact that the sampling method using swabs affords greater patient comfort and safety, it could be said that this method is a promising alternative to conventional biopsy-based methods for the molecular diagnosis of leishmaniasis.

https://doi.org/10.1590/s1678-9946201759038 2143 downloads

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