ABSTRACT Background: Triatomines infest atypical public spaces in the Western Amazon. Methods: Frequent visitors to these spaces captured the insects in the state of Acre, Brazil (Rio Branco and Cruzeiro do Sul). Results: Six insects were found in a penitentiary, a church, a school, a university, a hospital, and a health center. Five of the insects were adults (three positive for Trypanosoma cruzi) and one was a nymph. Conclusions: This is the first report of triatomine occurrence in schools or churches. These data are important for implementing surveillance strategies and alerting individuals about possible changes in Chagas disease transmission dynamics. Background Amazon Methods Acre Rio Sul. Sul . Sul) Results penitentiary church school university hospital center three cruzi nymph Conclusions churches dynamics

Resumo O objetivo do presente estudo foi relatar a ocorrência de parasitismo por carrapatos Amblyomma rotundatum em duas espécies de lagartos Teiidae, e testar a presença de riquétsias nos carrapatos coletados, na região da Amazônia Ocidental brasileira. Os carrapatos foram coletados em julho de 2019, em um fragmento de floresta de terra firme no município de Senador Guiomard, Acre, Brasil. Dois lagartos infestados por estágios imaturos de carrapatos foram capturados com rede de neblina e armadilhas Tomahawk. Os ectoparasitos foram coletados manualmente, e os espécimes de lagartos foram identificados e soltos no mesmo local onde foram capturados. Três ninfas e 49 larvas foram coletadas de Ameiva ameiva, enquanto 25 ninfas e nove larvas foram coletadas de Tupinambis cuzcoensis, ambas da família Teiidae. Os carrapatos foram identificados morfologicamente como pertencentes ao gênero Amblyomma. As ninfas foram identificadas em nível de espécie por meio de análise molecular, resultando na espécie de carrapato Amblyomma rotundatum. Este é o primeiro registro de parasitismo pelo carrapato A. rotundatum em lagarto T. cuzcoensis, e o primeiro relato de associação entre A. rotundatum e as espécies de lagartos A. ameiva e T. cuzcoensis, no Acre, na parte ocidental da região amazônica. Teiidae brasileira 2019 Guiomard Acre Brasil Tomahawk manualmente 4 2 cuzcoensis molecular A T amazônica 201 20

Abstract The aim of the present study was to report on the occurrence of parasitism by Amblyomma rotundatum ticks on two species of Teiidae lizards and test the presence of rickettsiae in the collected ticks, in the western Brazilian Amazon region. Ticks were collected in July 2019, from a fragment of terra firme forest in the municipality of Senador Guiomard, Acre, Brazil. Two lizards that were infested by immature stages of ticks were caught using mist net and Tomahawk traps. Ectoparasites were collected manually, and the lizard specimens were identified and released at the same location where they had been caught. Three nymphs and 49 larvae were collected from Ameiva ameiva, while 25 nymphs and nine larvae were collected from Tupinambis cuzcoensis, which are both in the family Teiidae. The ticks were identified morphologically as belonging to the genus Amblyomma. Nymphs were identified at species level through molecular analysis, resulting in the tick species Amblyomma rotundatum. This is the first record of parasitism by the tick A. rotundatum on T. cuzcoensis lizard, and the first report of an association between A. rotundatum and the lizard species A. ameiva and T. cuzcoensis in Acre, in the western part of the Amazon region. region 2019 Guiomard Acre Brazil traps manually 4 2 analysis A T 201 20

Objective: To analyze the temporal trend of accidents by venomous animals in Brazil from 2007 to 2019. Methods: Cross-sectional study carried out with data from the Notifiable Diseases Information System – Sinan. For the temporal analysis, the Prais-Wistein Linear Regression was used. The incidences by sex and age group, relative risk and lethality were calculated. Results: During the study period there were 2,102,657 cases of accidents by venomous animals. With the exception of snakebite, the other accidents showed an increasing temporal trend in most regions of the country. Scorpionism, snakebite and spider bites were responsible for 86% of accidents, mainly affecting men of working age. Snake (0.4%) and beetle (0.3%) accidents were the most lethal. Children were the main victims of accidents by bees, caterpillars and 'others'. Conclusion: Accidents by venomous animals showed an increasing temporal trend for most diseases and different epidemiological profiles.

Objetivo: Analizar la tendencia temporal de los accidentes por animales ponzoñosos en Brasil de 2007 a 2019. Métodos: Estudio transversal realizado con datos del Sistema de Información de Enfermedades de Declaración Obligatoria – Sinan. Para el análisis temporal se utilizó la Regresión Lineal de Prais-Wistein. Se calcularon las incidencias por sexo y grupo de edad, riesgo relativo y letalidad. Resultados: Durante el período de estudio hubo 2.102.657 casos de accidentes por animales ponzoñosos. Con excepción de la mordedura de serpiente, los demás accidentes mostraron una tendencia temporal creciente en la mayoría de las regiones del país. El escorpionismo (51,2%), la mordedura de serpiente (17,4%) y la mordedura de araña (17,3%) fueron responsables del 86% de los accidentes, afectando principalmente a hombres en edad laboral. Conclusión: Los accidentes por animales venenosos mostraron una tendencia temporal creciente para la mayoría de las enfermedades y diferentes perfiles epidemiológicos.

Objetivo: Analisar a tendência temporal dos acidentes causados por animais peçonhentos no Brasil, de 2007 a 2019. Métodos: Estudo transversal, realizado com dados do Sistema de Informação de Agravos de Notificação – Sinan. Para a análise temporal, utilizou-se a regressão linear de Prais-Wistein. Foram calculadas as incidências por sexo e faixa etária, risco relativo e letalidade. Resultados: No período de estudo, houve 2.102.657 casos de acidentes por animais peçonhentos. Com exceção do ofidismo, os demais acidentes apresentaram tendência temporal crescente na maioria das macrorregiões nacionais. Escorpionismo, ofidismo e araneísmo foram responsáveis por 86% dos acidentes, principalmente entre homens em idade economicamente ativa. As taxas de letalidade mais elevadas foram por acidentes ofídicos (0,4%) e apílicos (0,3%). As crianças foram as principais vítimas de acidentes com abelhas, lagartas e ‘outros’. Conclusão: Os acidentes com animais peçonhentos apresentaram tendência temporal crescente para a maioria dos agravos e diferentes perfis epidemiológicos.

Resumo Objetivo: Analisar a tendência temporal dos acidentes causados por animais peçonhentos no Brasil, de 2007 a 2019. Métodos: Estudo transversal, realizado com dados do Sistema de Informação de Agravos de Notificação (Sinan). Para a análise temporal, utilizou-se a regressão linear de Prais-Winsten. Foram calculadas as incidências por sexo e faixa etária, risco relativo e letalidade. Resultados: No período de estudo, houve 2.102.657 casos de acidentes por animais peçonhentos. Com exceção do ofidismo, os demais acidentes apresentaram tendência temporal crescente na maioria das macrorregiões nacionais. Escorpionismo, ofidismo e araneísmo foram responsáveis por 86% dos acidentes, principalmente entre pessoas do sexo masculino em idade economicamente ativa. A de letalidade foi mais elevada para acidentes ofídicos (0,4%) e apílicos (0,3%). As crianças foram as principais vítimas de acidentes com abelhas, lagartas e "outros". Conclusão: Os acidentes com animais peçonhentos apresentaram tendência temporal crescente para a maioria dos agravos e diferentes perfis epidemiológicos.

Abstract Objective: to analyze the temporal trend of accidents involving venomous animals in Brazil from 2007 to 2019. Methods: this was a cross-sectional study carried out with data from the Notifiable Health Conditions Information System (SINAN). Prais-Winsten linear regression was used for the temporal analysis. We calculated incidence rates according to sex and age group, relative risk and case fatality ratio. Results: during the study period there were 2,102,657 cases of accidents involving venomous animals. With the exception of snakebite, the remaining accidents showed a rising temporal trend in most regions of the country. Scorpion stings, snake bites and spider bites were responsible for 86% of accidents, mainly affecting male people of working age. Accidents involving snakes (0.4%) and bees (0.3%) had the highest case fatality ratios. Children were the main victims of accidents involving bees, caterpillars and "others". Conclusion: accidents involving venomous animals showed a rising temporal trend for most conditions, as well as different epidemiological profiles.

Resumen Objetivo: Analizar la tendencia temporal de los accidentes con animales ponzoñosos en Brasil de 2007 a 2019. Métodos: Estudio transversal realizado con datos del Sistema de Información de Enfermedades de Declaración Obligatoria (Sinan). Para el análisis temporal se utilizó la Regresión Lineal de Prais-Wisten. Se calcularon las incidencias por sexo y grupo de edad, riesgo relativo y letalidad. Resultados: Durante el período del estudio hubo 2.102.657 casos de accidentes con animales ponzoñosos. Con excepción de la mordedura de serpiente, los demás accidentes mostraron una tendencia temporal creciente en la mayoría de las regiones del país. El escorpionismo, la mordedura de serpiente y la picadura de araña fueron responsables del 86% de los accidentes, afectando principalmente a personas del sexo masculino en edad laboral. Las tasas de letalidad más altas fueron por accidentes de mordedura de serpiente (0,4%) y picadura de araña (0,3%). Los niños fueron las principales vitimas de los acidentes con abejas, lagartas y "otros". Conclusión: Los accidentes com animales ponzoñosos mostraron una tendencia temporal creciente para la mayoría de las enfermedades y diferentes perfiles epidemiológicos.

ABSTRACT In the Brazilian Amazon, envenomations by lancehead pit vipers prevail across the region, while bushmaster (Lachesis muta) envenomations are rarely confirmed. Here, we described a moderate snakebite, diagnosed as a lancehead pit viper envenomation upon admission and treated with four vials of Bothrops antivenom. Blood remained unclottable for 4 days of hospitalization. On day 4, after admission, the patient presented pictures of the perpetrating snake to the hospital staff, which was identified as a Lachesis muta specimen. After administering 10 vials of Lachesis antivenom, blood became clottable 12 hours after treatment. The patient was discharged without complaints.

Resumo Objetivo: Analisar a tendência temporal dos acidentes causados por animais peçonhentos no Brasil, de 2007 a 2019. Métodos: Estudo transversal, realizado com dados do Sistema de Informação de Agravos de Notificação (Sinan). Para a análise temporal, utilizou-se a regressão linear de Prais-Winsten. Foram calculadas as incidências por sexo e faixa etária, risco relativo e letalidade. Resultados: No período de estudo, houve 2.102.657 casos de acidentes por animais peçonhentos. Com exceção do ofidismo, os demais acidentes apresentaram tendência temporal crescente na maioria das macrorregiões nacionais. Escorpionismo, ofidismo e araneísmo foram responsáveis por 86% dos acidentes, principalmente entre pessoas do sexo masculino em idade economicamente ativa. A de letalidade foi mais elevada para acidentes ofídicos (0,4%) e apílicos (0,3%). As crianças foram as principais vítimas de acidentes com abelhas, lagartas e "outros". Conclusão: Os acidentes com animais peçonhentos apresentaram tendência temporal crescente para a maioria dos agravos e diferentes perfis epidemiológicos.

Abstract Objective: to analyze the temporal trend of accidents involving venomous animals in Brazil from 2007 to 2019. Methods: this was a cross-sectional study carried out with data from the Notifiable Health Conditions Information System (SINAN). Prais-Winsten linear regression was used for the temporal analysis. We calculated incidence rates according to sex and age group, relative risk and case fatality ratio. Results: during the study period there were 2,102,657 cases of accidents involving venomous animals. With the exception of snakebite, the remaining accidents showed a rising temporal trend in most regions of the country. Scorpion stings, snake bites and spider bites were responsible for 86% of accidents, mainly affecting male people of working age. Accidents involving snakes (0.4%) and bees (0.3%) had the highest case fatality ratios. Children were the main victims of accidents involving bees, caterpillars and "others". Conclusion: accidents involving venomous animals showed a rising temporal trend for most conditions, as well as different epidemiological profiles.

Resumen Objetivo: Analizar la tendencia temporal de los accidentes con animales ponzoñosos en Brasil de 2007 a 2019. Métodos: Estudio transversal realizado con datos del Sistema de Información de Enfermedades de Declaración Obligatoria (Sinan). Para el análisis temporal se utilizó la Regresión Lineal de Prais-Wisten. Se calcularon las incidencias por sexo y grupo de edad, riesgo relativo y letalidad. Resultados: Durante el período del estudio hubo 2.102.657 casos de accidentes con animales ponzoñosos. Con excepción de la mordedura de serpiente, los demás accidentes mostraron una tendencia temporal creciente en la mayoría de las regiones del país. El escorpionismo, la mordedura de serpiente y la picadura de araña fueron responsables del 86% de los accidentes, afectando principalmente a personas del sexo masculino en edad laboral. Las tasas de letalidad más altas fueron por accidentes de mordedura de serpiente (0,4%) y picadura de araña (0,3%). Los niños fueron las principales vitimas de los acidentes con abejas, lagartas y "otros". Conclusión: Los accidentes com animales ponzoñosos mostraron una tendencia temporal creciente para la mayoría de las enfermedades y diferentes perfiles epidemiológicos.

Abstract Introduction: The efficacy of 20-minute whole blood clotting (WBCT20) and the Lee-White clotting time (LWCT) tests in diagnosing coagulation alterations from snakebites were compared. Methods: We evaluated 89 snakebite cases treated at the Hospital Regional do Juruá em Cruzeiro do Sul, Acre, Brazil. Results: WBCT20 results were normal in 33.7% and unclottable in 66.3% of cases, while LWCT results were normal in 23.6% and altered (prolonged or unclottable) in 76.4% of cases, with no significant differences. Conclusions: The WBCT20 is important for rapidly diagnosing coagulation alterations from snakebites. Furthermore, it is efficient, inexpensive, and can be deployed in isolated hospitals.

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 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.

RESUMO Este estudo aborda os aspectos clínicos e epidemiológicos dos envenenamentos ofídicos tratados em um hospital em Cruzeiro do Sul, Acre, resultantes de acidentes que ocorreram na região do Alto Juruá, no oeste da Amazônia brasileira. A identidade específica das serpentes que causaram os envenenamentos foi inferida (a) pelos sinais e sintomas apresentados pelo paciente na admissão hospitalar, (b) por imunoensaio enzimático para detecção de veneno de Bothrops atrox e Lachesis muta em amostras de soro retiradas de pacientes antes da soroterapia, e (c) pela identificação direta da serpente, quando esta foi levada para o hospital ou fotografada. Houve 133 casos (76,2 casos por 100.000 habitantes) de acidentes ofídicos registrados durante um ano (julho 2017 a junho 2018). A maioria das picadas de serpentes (88,7%) foi causada por Bothrops spp., e o restante por espécies não peçonhentas ou “picadas secas”. Os acidentes ofídicos tenderam a ocorrer com maior frequência durante a estação chuvosa, coincidindo com o período de maior atividade reprodutiva das serpentes e maior disponibilidade de suas presas. Além disso, o aumento dos níveis de rios e lagos pode fazer com que esses animais procurem locais mais secos, aumentando a frequência de encontro com seres humanos. Campanhas educativas sobre prevenção e primeiros socorros, principalmente entre os grupos mais vulneráveis (indígenas, agricultores, crianças e adolescentes em áreas rurais), e sobre a importância da utilização de equipamentos de proteção (botas, perneiras, luvas de couro) em determinadas atividades de maior risco (e.g., agricultura e extrativismo em florestas), são fundamentais para reduzir a morbidade de picadas de serpentes.

ABSTRACT This study addresses the clinical and epidemiological aspects of envenoming cases resulting from snakebites treated at a hospital in Cruzeiro do Sul, in the upper Juruá River region, western Brazilian Amazonia. The specific identity of snakes that caused the envenomings was inferred (a) from the diagnosis of patient symptoms and signs upon hospital admission, (b) by enzyme immunoassay for detection of Bothrops atrox and Lachesis muta venom from serum samples taken from patients before antivenom therapy, or (c) by direct identification of the snake, when it was brought along to the hospital or photographed. There were 133 snakebites (76.2 cases per 100,000 inhabitants) registered during one year (July 2017 to June 2018). Most snakebites (88.7%) were caused by Bothrops spp., and the rest by non-venomous snakes or dry bites. Snakebites tended to occur more often during the rainy season, coinciding with the period of greater reproductive activity of the snakes and greater availability of their prey. In addition, the increase in the water level of rivers and lakes during the rainy season tends to concentrate snakes in dry places and, thus, to increase encounters with humans. Information campaigns on prevention and first aid, specially among the most vulnerable groups (indigenous people, farmers, and children and teenagers in rural areas), and the importance of using protective equipment (boots, leggings, leather gloves) in certain high risk activities (e.g. agriculture and extractivism in forests) are fundamental for the reduction of snakebite morbidity.

Abstract INTRODUCTION Snakebites are considered a neglected tropical disease in many countries in Latin America, including Brazil. As few studies have assessed snakebites in the Amazon region and especially in the state of Acre, epidemiological studies are of great importance. The present study aimed to describe the epidemiological characteristics of snakebites in the Rio Branco region, observing their characteristics in rural and urban areas and their correlation with rainfall and river outflow. METHODS This retrospective, descriptive study analyzed epidemiological information obtained from snakebite notifications registered on the Information System for Notifiable Diseases that occurred from March, 2018 to February, 2019. The cases of snakebite were correlated with rainfall and flow. RESULTS A total of 165 cases of snakebite were registered in the period. Most cases were caused by Bothrops and affected mainly individuals of the male sex who were between 21 and 30 years old. Most of the snakebites occurred in Rio Branco (71.52%; 29 cases per 100,000 inhabitants). Of these, 60.2% occurred in the urban area and 39.8% in the rural area and the majority occurred during the rainy season. CONCLUSIONS Although studies have shown that a majority of cases occur in rural areas, in this study, urbanization of snakebites was observed. The Bothrops genus was responsible for the highest number of snakebites and, during the rainy season, bites occurred more frequently. Educational prevention campaigns, population advice, and first aid in case of snakebites for the population are thus suggested.

Abstract INTRODUCTION: We examined the ethnobiological perception of the population of the Alto Juruá region about different snake species, in terms of their dangerousness and manifestations of envenomation. METHODS: We interviewed 100 villagers who were active in the forests. RESULTS: Lachesis muta was considered the most venomous snake, and Bothrops atrox appeared to be the most feared snake species. CONCLUSIONS: The high incidence, severity, and mortality of B. atrox bites and the severity and mortality of L. muta bites were the factors that contributed to these species being perceived as the most feared and venomous snakes.

Abstract INTRODUCTION: This study aimed to document injuries caused by fish among professional fishermen in the Western Brazilian Amazon. METHODS: We undertook a descriptive, retrospective study, involving 51 professional fishermen, to determine clinical, epidemiological, and therapeutic aspects of their injuries. RESULTS: Among 51 fishermen interviewed, most injuries were due to mandi (Pimelodus spp.), and the hands were the most injured region, resulting in pain and bleeding in all cases. CONCLUSIONS: Our study findings confirm the morbidity of fish-related injuries, and reaffirm the need for relevant information regarding prevention and injury management.

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.