ABSTRACT Tuberculosis stands as one of humanity’s oldest afflictions, intrinsically intertwined with social disparities. This formidable disease spares no age group and remains the prevailing cause of infection-induced mortality worldwide, particularly in developing nations. We present a case of a 56-year-old woman with diabetes who was diagnosed with Pulmonary Tuberculosis. After receiving antituberculosis drugs as part of her treatment, she experienced a range of systemic manifestations and suffered from severe ulcerative esophagitis. This adverse reaction led to uncontrollable gastrointestinal intolerance, tragically resulting in her untimely demise. The incident underscores the potential seriousness of adverse reactions that can arise from tuberculosis treatment medications. humanitys humanity s afflictions disparities infectioninduced infection induced worldwide nations 56yearold yearold 56 year old esophagitis intolerance demise medications 5

ABSTRACT In Brazil, the COVID-19 burden was substantial, and risk factors associated with higher in-hospital mortality rates have been extensively studied. However, information on short-term all-cause mortality and the factors associated with death in patients who survived the hospitalization period of acute SARS-CoV-2 infection is limited. We analyzed the six-month post-hospitalization mortality rate and possible risk factors of COVID-19 patients in a single center in Brazil. This is a retrospective cohort study focused on a six-month follow-up. The exclusion criteria were death during hospitalization, transference to another hospital, and age under 18. We collected data from the charts of all hospitalized patients from March 2020 to December 2020 with a positive RT-PCR test for SARS-CoV-2, resulting in a sample size of 106 patients. The main outcome was death after hospitalization, whereas comorbidities and demographics were evaluated as risk factors. The crude post-hospitalization death rate was 16%. The first 30 days of follow-up had the highest mortality rate. In a Cox regression model for post-hospitalization mortality, previous chronic kidney disease (HR, 4.06, 95%CI 1.46 – 11.30) and longer hospital stay (HR 1.01, 95%CI 1.00 – 1.02) were the only factors statistically associated with death. In conclusion, a high six-month all-cause mortality was observed. Within the six-month follow-up, a higher risk of death was observed for patients who had prior CKD and longer hospital stay. These findings highlight the importance of more intensive medical surveillance during this period. Brazil COVID19 COVID 19 COVID-1 substantial inhospital studied However shortterm short term allcause cause SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- limited sixmonth six month posthospitalization post followup. followup follow up. up 18 202 RTPCR RT PCR SARSCoV2, 2, 10 16 16% 3 HR, HR 406 4 06 4.06 95CI CI 95 146 1 46 1.4 11.30 1130 11 101 01 1.01 100 00 1.0 1.02 102 02 conclusion followup, up, COVID1 COVID- SARS-CoV 20 40 0 4.0 9 14 1. 11.3 113 4. 11.

ABSTRACT The global reemergence of measles in 2018–2019 reinforces the relevance of high-coverage immunization to maintain the disease elimination. During an outbreak in the Sao Paulo State in 2019, several measles cases were reported in individuals who were adequately vaccinated according to the current immunization schedule recommends. This study aimed to assess measles IgG antibody seropositivity and titers in previously vaccinated adults. A cross-sectional study was conducted at CRIE-HC-FMUSP (Sao Paulo, Brazil) in 2019. It included healthy adults who had received two or more Measles-Mumps-Rubella vaccines (MMR) and excluded individuals with immunocompromising conditions. Measles IgG antibodies were measured and compared by ELISA (Euroimmun®) and chemiluminescence (LIASON®). The association of seropositivity and titers with variables of interest (age, sex, profession, previous measles, number of measles-containing vaccine doses, interval between MMR doses, and time elapsed since the last MMR dose) was analyzed. A total of 162 participants were evaluated, predominantly young (median age 30 years), women (69.8%) and healthcare professionals (61.7%). The median interval between MMR doses was 13.2 years, and the median time since the last dose was 10.4 years. The seropositivity rate was 32.7% by ELISA and 75.3% by CLIA, and a strong positive correlation was found between the tests. Multivariate analyses revealed that age and time since the last dose were independently associated with positivity. Despite being a single-center evaluation, our results suggest that measles seropositivity may be lower than expected in adequately immunized adults. Seropositivity was higher among older individuals and those with a shorter time since the last MMR vaccine dose. 20182019 2018 2019 2018–201 highcoverage high coverage elimination recommends crosssectional cross sectional CRIEHCFMUSP CRIE HC FMUSP Brazil MeaslesMumpsRubella Mumps Rubella (MMR conditions Euroimmun® Euroimmun (Euroimmun® LIASON®. LIASON LIASON® . (LIASON®) age, (age sex profession measlescontaining containing analyzed 16 evaluated 3 years , years) 69.8% 698 69 8 (69.8% 61.7%. 617 61.7% 61 7 (61.7%) 132 13 2 13. 104 10 4 10. 327 32 32.7 753 75 75.3 CLIA tests positivity singlecenter single center evaluation 2018201 201 2018–20 (Euroimmun (LIASON® 1 69.8 6 (69.8 61.7 (61.7% 32. 75. 201820 20 2018–2 (LIASON 69. (69. 61. (61.7 20182 2018– (69 (61. (6 (61 (

ABSTRACT This study aimed to determine the antibiotic profile of microorganisms isolated from urine samples of patients with community urine tract infections (UTI) admitted to the University Hospital of the Federal University of Sao Carlos to support an appropriate local empirical treatment. A retrospective cross-sectional study was conducted from October 2018 to October 2020. Data from 1,528 positive urine cultures for bacterial pathogens and antibiograms were tabulated. Bacterial species prevalence and their resistance profile were analyzed and compared by sex and age. For Gram-negative fermenting bacteria, resistance rates were compared between patients with previous hospitalization and the total of infections caused by this group. For comparisons, the Chi-square test was performed, using Fisher’s exact test when necessary (BioEstat program, adopting p ≤ 0.05). A multivariate analysis was applied to assess the effect of the studied variables in predicting multidrug resistance. Infections were more prevalent in women and older adults. Gram-negative bacteria represented 90.44% of total cultures. In both sexes, E. coli prevalence was significantly higher in adults compared with older adults (p < 0.0001). For several antibiotics, resistance rates were higher in the older adults compared with other ages and in patients with Gram-negative fermenting infections and previous hospitalization compared with the total of infections by this group of bacteria. The closer to the hospitalization, the higher the number of antibiotics with superior resistance rates. Resistance rates for aminoglycosides, carbapenems, ceftazidime, nitrofurantoin, piperacillin+tazobactam, and fosfomycin were less than 20%, considered adequate for empirical treatment. Only hospitalization in the previous 90 days was statistically significant in predicting infections by multidrug-resistant bacteria. UTI (UTI treatment crosssectional cross sectional 201 2020 1528 1 528 1,52 tabulated age Gramnegative Gram negative comparisons Chisquare Chi square performed Fishers Fisher s BioEstat program 0.05. 005 0.05 . 0 05 0.05) 9044 44 90.44 sexes E 0.0001. 00001 0.0001 0001 0.0001) aminoglycosides carbapenems ceftazidime nitrofurantoin piperacillintazobactam piperacillin tazobactam piperacillin+tazobactam 20 20% 9 multidrugresistant resistant 202 152 52 1,5 00 0.0 904 4 90.4 0000 0.000 000 2 15 5 1, 0. 90. 0.00

ABSTRACT Despite being subject to lower AIDS-related mortality rates and having a higher life expectancy, patients with HIV are more prone to develop non-AIDS events. A low CD4+/CD8+ ratio during antiretroviral therapy identifies people with heightened immune senescence and increased risk of mortality. In clinical practice, finding determinants of a low CD4+/CD8+ ratio may be useful for identifying patients who require close monitoring due to an increased risk of comorbidities and death. We performed a prospective study on the evolution of the CD4+/CD8+ ratio in 60 patients infected with HIV (80% males), who were subjected to two different antiretroviral regimens: early and deferred therapy. The initial CD4+/CD8+ ratio was ≤1 for 70% of the patients in both groups. Older age, CD4+ cell count at inclusion, Nadir CD8+T-cell count, and Initial CD4+/CD8+ ratio ≤ 1 were risk factors for lack of ratio recovery. In the multivariate analysis, a CD4+/CD8+ ratio > 1 at the start of the treatment was found to be a determinant factor in maintaining a CD4+/CD8+ ratio > 1. The nadir CD4+T-cell count was lower in the deferred therapy group (p=0.004), and the last CD4+/CD8+ ratio ≤1 was not associated with comorbidities. Ratio recovery was not associated with the duration of HIV infection, time without therapy, or absence of AIDS incidence. A greater improvement was observed in patients treated early (p=0.003). In contrast, the slope of increase was slower in patients who deferred treatment. In conclusion, the increase in the CD4+/CD8+ ratio occurred mostly for patients undergoing early strategy treatment and its extension did not seem to be related to previous HIV-related factors. AIDSrelated expectancy nonAIDS non events CD4CD8 CDCD CD4 CD8 CD CD4+/CD8 practice death 6 80% 80 (80 males, males , males) regimens 70 groups age inclusion CD8+Tcell CD8Tcell CDTcell CD8+T T analysis CD4+Tcell CD4Tcell CD4+T p=0.004, p0004 p p=0.004 0 004 (p=0.004) infection incidence p=0.003. p0003 p=0.003 . 003 (p=0.003) contrast conclusion HIVrelated CD4CD CD4+/CD 8 (8 7 Tcell CD8T CDT CD4T p000 p=0.00 00 (p=0.004 (p=0.003 ( p00 p=0.0 (p=0.00 p0 p=0. (p=0.0 p=0 (p=0. p= (p=0 (p= (p

ABSTRACT This study presents a case of atypical manifestation of secondary syphilis. Diagnosis was initiated prompted by the patient’s complaint of a lower lip lesion, present for three months, resembling a malignant neoplasm. The lesion, a 3 cm (diameter) ulcerated nodule, arising from conjunctive tissue, raised concern. However, further physical examination revealed additional clinical features, including cervical micropolyadenopathy and erythematous skin lesions, prompting a reevaluation of the diagnosis, most likely secondary syphilis. These findings led to a serological investigation, which, ultimately, confirmed the diagnosis of syphilis. The case underscores the importance of recognizing syphilis as a formidable imitator, posing challenges in establishing differential diagnoses of mucocutaneous diseases. patients patient s lesion months neoplasm diameter (diameter nodule tissue concern However features lesions investigation which ultimately imitator diseases

ABSTRACT Bartonella spp. are bacteria responsible for neglected diseases worldwide. Bartonella henselae is the species most associated with human infections. It is associated with a large spectrum of clinical manifestations and is potentially fatal. The identification of Bartonella spp. is considered a challenge in clinical routine. These bacteria are fastidious, and the time required to isolate them varies from one to six weeks. MALDI-TOF mass spectrometry has emerged as an application for research on Bartonella spp. , and has still been little explored. We investigated whether three different B. henselae strains with different growth times—14 and 28 days—could be correctly identified by MALDI-TOF mass spectra fingerprint comparison and matching. We found that the spectra from strains with different growth times do not match each other, leading to misidentification. We suggest creating database entries with multiple spectra from strains with different growth times to increase the chances of accurate identification of Bartonella spp. by MALD-TOF MS. spp worldwide infections fatal routine fastidious weeks MALDITOF MALDI TOF explored B times14 14 times—1 2 dayscould days could matching other misidentification MALDTOF MALD MS times1 1 times—

ABSTRACT Extended-spectrum beta-lactamase producing and ciprofloxacin-non-susceptible Escherichia coli are clinical and environmental issues. We evaluated the susceptibility profile of fosfomycin in non-susceptible E. coli isolated from urine and the environment. We measured the activity of fosfomycin against 319 and 36 E. coli strains from urine and environmental isolates, respectively, collected from rivers. Fosfomycin resistance profiles were investigated using the minimal inhibitory concentration (MIC), according to the Clinical and Laboratory Standards Institute (CLSI) and the European Committee for Antimicrobial Susceptibility Testing (EUCAST) guidelines. Antibiotic susceptibility testing revealed that 5% and 6.6% of urine samples were non-susceptible to fosfomycin according to CLSI and EUCAST guidelines, respectively. The fosfomycin MIC50/90 was 0.5/4 mg/L. Of the 36 E. coli isolates from river water, 11.1% and 13,8% were non-susceptible to fosfomycin according to CLSI and EUCAST, respectively (range ≤0.25 ≥512 mg/L). All the isolates with MIC ≥512 mg/L for fosfomycin showed the fosA3 gene. Fosfomycin resistance was more frequent in the environment than in clinical samples. Extendedspectrum Extended spectrum betalactamase beta lactamase ciprofloxacinnonsusceptible ciprofloxacin non susceptible issues nonsusceptible E 31 3 rivers MIC, , (MIC) (CLSI (EUCAST guidelines 5 66 6 6.6 MIC5090 MIC50 90 MIC50/9 054 0 4 0.5/ mgL mg L water 111 11 1 11.1 138 13 8 13,8 range 025 25 ≤0.2 512 ≥51 . mg/L) fosA gene (MIC 6. MIC509 MIC5 9 MIC50/ 05 0.5 11. 13, 02 2 ≤0. 51 ≥5 0. ≤0 ≥ ≤

ABSTRACT Hepatitis C virus (HCV) infection is a significant cause of morbidity and mortality among hematopoietic stem cell transplant (HCT) recipients. In Brazil, its occurrence in HCT recipients remains undetermined. We now report on HCV prevalence in HCT recipients and its clinical consequences. The medical records of all HCT recipients seen at Hospital das Clinicas, Sao Paulo University Medical School, from January 2010 to January 2020 were reviewed to determine HCV serostatus. A retrospective analysis of medical charts was undertaken on all seropositive cases to determine HCV genotype, presence of liver fibrosis, co-infections with other viruses, previous treatments, and clinical evolution of liver pathology after HCT. Of the 1,293 HCT recipients included in the study, seven (0.54%) were HCV antibody-positive and five (0.39%) were also viremic for HCV-RNA. Four of these individuals had moderate to severe liver fibrosis (METAVIR F2/F3) and one was cirrhotic. Two of the viremic patients developed acute liver dysfunction following transplantation. All patients had their acute episode of liver dysfunction resolved with no further complications. Four of the viremic patients were treated for HCV infection with direct acting agents (DAA). Information regarding HCV treatment was lacking for one of the viremic HCV patients due to loss of follow up. Sustained anti-virologic responses were observed in three cases after the use of DAA. The detection of HCV in hematological adults undergoing HCT and its successful treatment with DAA highlight the necessity of testing for HCV both prior to and following transplantation. (HCV (HCT Brazil undetermined consequences Clinicas School 201 202 serostatus genotype coinfections co infections viruses treatments 1293 1 293 1,29 study 0.54% 054 0 54 (0.54% antibodypositive antibody positive 0.39% 039 39 (0.39% HCVRNA. HCVRNA RNA. RNA HCV-RNA METAVIR F2/F3 F2F3 FF F2 F3 F cirrhotic transplantation complications . (DAA) up antivirologic anti virologic 20 129 29 1,2 0.54 05 5 (0.54 0.39 03 3 (0.39 F2/F F2F (DAA 2 12 1, 0.5 (0.5 0.3 (0.3 0. (0. (0 (

ABSTRACT Currently, there are some concerns about the situation and, in particular, about the future of the COVID-19 pandemic and the new emerging variants of SARS-CoV-2. Rodents are an example of synanthropic animals in urban environments that harbor important zoonoses. Although the molecular identification of SARS-CoV-2 in Rattus norvegicus from New York City had been reported, in other studies, urban wild rodents infected with this virus have not been found. This study aimed to molecularly identify the presence of SARS-CoV-2 in urban wild rodents from Mexico City, trapped along a water channel of a public park as part of a pest control program, at the beginning of the COVID-19 pandemic, during the fall and winter of 2020. Up to 33 Mus musculus and 52 R. norvegicus were captured and euthanized, large intestine samples with feces from the animals were obtained. RNAs were obtained and subjected to qRT-PCR for SARS-CoV-2 identification and threshold cycle (Ct) values were obtained. Four mice (12.1%) and three rats (5.8%) were positive, three rodents exhibited Ct<30. Our results on the frequency of SARS-CoV-2 in urban rats are in line with other previous reports. Thus, similar to other authors, we suggest that surveillance for the detection of SARS-CoV-2 in urban wild rodents, as sentinel animals, should be maintained. Currently particular COVID19 COVID 19 COVID-1 SARSCoV2. SARSCoV2 SARSCoV SARS CoV 2. 2 zoonoses SARS-CoV- reported studies found program 2020 3 5 R euthanized qRTPCR qRT PCR Ct (Ct 12.1% 121 12 1 (12.1% 5.8% 58 8 (5.8% positive Ct30 30 Ct<30 reports Thus authors maintained COVID1 COVID- SARS-CoV 202 12.1 (12.1 5.8 (5.8 Ct3 Ct<3 20 12. (12. 5. (5. Ct< (12 (5 (1 (

ABSTRACT Multiple myeloma (MM) associated with Chagas disease is rarely described. This disease and its therapy suppress T cell and macrophage functions and increase regulatory T cell function, allowing the increase of parasitemia and the risk of Chagas Disease Reactivation (CDR). We aimed to analyze the role of conventional (cPCR) and quantitative Polymerase Chain Reaction (qPCR) for prospective monitoring of T. cruzi parasitemia, searching for markers of preemptive antiparasitic therapy in MM patients with Chagas disease. Moreover, we investigated the incidence and management of hematological diseases and CDR both inside and outside the transplant setting in the MEDLINE database. We found 293 studies and included 31 of them. Around 1.9–2.0% of patients with Chagas disease were reported in patients undergoing Stem Cell Transplantation. One case of CDR was described in eight cases of MM and Chagas disease. We monitored nine MM and Chagas disease patients, seven under Autologous Stem Cell Transplantation (ASCT), during 44.56±32.10 months (mean±SD) using parasitological methods, cPCR, and qPCR. From these patients, three had parasitemia. In the first, up to 256 par Eq/mL were detected, starting from 28 months after ASCT. The second patient dropped out and died soon after the detection of 161.0 par Eq/mL. The third patient had a positive blood culture. Benznidazole induced fast negativity in two cases; followed by notably lower levels in one of them. Increased T. cruzi parasitemia was related to the severity of the underlying disease. We recommend parasitemia monitoring by qPCR for early introduction of preemptive antiparasitic therapy to avoid CDR. (MM function . (CDR) cPCR (cPCR (qPCR Moreover database 29 3 them 1920 1 9 2 0 1.9–2.0 ASCT, ASCT , (ASCT) 44563210 44 56 32 10 44.56±32.1 mean±SD meanSD mean SD (mean±SD methods first 25 EqmL Eq mL detected 1610 161 161. culture (CDR 192 1.9–2. (ASCT 4456321 4 5 44.56±32. 16 19 1.9–2 445632 44.56±32 1.9– 44563 44.56±3 1.9 4456 44.56± 1. 445 44.56 44.5 44.

ABSTRACT The varied clinical presentations of SARS-CoV-2 infection have raised concerns about long-term consequences, especially “long-COVID” or “post-COVID-19 syndrome.” In this context, the cardiorespiratory optimal point (COP) within the Cardiopulmonary Exercise Test (CPET) emerges as a crucial metric for evaluating functional capacities and detecting cardiovascular and pulmonary anomalies post-COVID-19. This study aimed to assess COP values among post-COVID-19 patients and categorized them based on the initial severity of their disease. In this cross-sectional study conducted in the Northeast Brazil, 80 patients (26 females and 54 males) previously infected with SARS-CoV-2 underwent CPET. We clinically stratified patients into mild, moderate, or severe COVID-19 categories and assessed COP values and other cardiorespiratory metrics. We found differences in the predicted COP between patients with mild and severe COVID-19 (p=0.042). Additionally, patients with moderate and severe COVID-19 record had an average COP value exceeding 22. Other parameters, including respiratory exchange ratio, heart rate, and oxygen uptake efficiency slope, did not differ across the groups. Patients with a history of severe COVID-19 showed altered COP values, suggesting potential discrepancies in cardiovascular and respiratory system integration. The outcomes emphasize the importance of continuous monitoring and assessment of the cardiorespiratory domain for post-COVID-19 patients. Further research is needed to understand the relationship between elevated COP in post-severe COVID-19 and its long-term prognostic implications. SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- longterm long term consequences longCOVID COVID “long-COVID postCOVID19 postCOVID post 19 “post-COVID-1 syndrome. syndrome context (COP CPET (CPET postCOVID19. 19. post-COVID-1 disease crosssectional cross sectional Brazil 8 26 (2 5 males COVID19 COVID-1 metrics p=0.042. p0042 p p=0.042 . 0 042 (p=0.042) Additionally 22 parameters ratio rate slope groups integration postsevere implications SARS-CoV postCOVID1 1 “post-COVID- post-COVID- ( COVID1 COVID- p004 p=0.04 04 (p=0.042 “post-COVID post-COVID p00 p=0.0 (p=0.04 p0 p=0. (p=0.0 p=0 (p=0. p= (p=0 (p= (p

ABSTRACT We conducted a spatial case-control study nested in a dengue incidence cohort to explore the role of the spatial and socioeconomic factors in the proportion of symptomatic (cases) and inapparent primary dengue virus infections (controls). Cohort participants were children and adolescents (2 to 16 years of age) at the beginning of the follow-up. Case definitions were, for symptomatic cases, fever plus a positive lab result for acute dengue (NS1, RT-PCR, ELISA IgM/IgG), and for inapparent infection a positive result for dengue IgG (ELISA) in subjects without symptoms and with a previously negative result at baseline. The covariates included sociodemographic factors, residential location, and socioeconomic context variables of the census tracts of residence of cases and controls. We used principal component analysis to reduce the contextual covariates, with the component values assigned to each one based on their residences. The data were modeled in a Bayesian context, considering the spatial dependence. The final sample consisted of 692 children, 274 cases and 418 controls, from the first year of follow-up (2014-2015). Being male, older age, higher educational level of the head of the family and having a larger number of rooms in the household were associated with a greater chance of presenting dengue symptomatic infection at the individual level. The contextual covariates were not associated with the outcome. Inapparent dengue infection has extensive epidemiological consequences. Relying solely on notifications of symptomatic dengue infections underestimates the number of cases, preserves a silent source of the disease, potentially spreading the virus to unaffected areas. casecontrol case control (cases controls . (controls) 2 ( 1 age followup. followup follow up. up NS1, NS1 NS (NS1 RTPCR, RTPCR RT PCR, PCR RT-PCR IgM/IgG, IgMIgG IgM/IgG , IgM IgM/IgG) (ELISA baseline location residences dependence 69 27 41 20142015. 20142015 2014 2015 (2014-2015) male outcome consequences disease areas (controls (NS 6 4 2014201 201 (2014-2015 201420 20 (2014-201 20142 (2014-20 (2014-2 (2014- (2014 (201 (20

ABSTRACT Asymptomatic infection (the absence or inapparent signs and symptoms) has been observed in many endemic areas of leishmaniasis, however, little is known about the parasitological and immunological factors associated with this type of infection. This study aimed to identify the in vitro expression of IFN-γ in asymptomatic carriers of viable Leishmania parasites. Asymptomatic infection was identified using the Montenegro skin test in an at-risk population from Yucatan, Mexico. Parasite viability was evinced in the blood by 7SL RNA transcripts amplification. The expression of mRNA IFN-γ was analyzed in peripheral blood mononuclear cells stimulated with soluble Leishmania antigen, using RT-qPCR. Parasite viability was observed in 33.3 % (5/15) of asymptomatic subjects. No differences were found in the expression of IFN-γ between asymptomatic and healthy subjects, and no correlation was found between the presence of viable parasites and the expression of IFN-γ. This study demonstrates the persistence of Leishmania parasites in the absence of an in vitro IFN-γ response in asymptomatic carriers from Mexico. symptoms leishmaniasis however IFNγ IFN γ atrisk at risk Yucatan Mexico SL amplification antigen RTqPCR. RTqPCR RT qPCR. qPCR RT-qPCR 333 33 3 33. 5/15 515 5 15 (5/15 subjects IFNγ. γ. 5/1 51 1 (5/1 5/ (5/ (5 (