ABSTRACT Deforestation and high human mobility due to mining activities have been key to the increase in malaria cases in the Americas. Here, we review the epidemiological and control aspects of malaria in the Amazon mining areas. Epidemiological evidence shows: 1) a positive correlation between illegal mining activity and malaria incidence, mostly in the Amazon region; 2) most Brazilian miners are males aged 15-29 years who move between states and even countries; 3) miners do not fear the disease and rely on medical care, diagnosis, and medication when they become ill; 4) illegal mining has emerged as the most reported anthropogenic activity within indigenous lands and is identified as a major cause of malaria outbreaks among indigenous people in the Amazon; and 5) because mining is largely illegal, most areas are not covered by any healthcare facilities or activities, leading to little assistance in the diagnosis and treatment of malaria. Our review identified five strategies for reducing the malaria incidence in areas with mining activities: 1) reviewing legislation to control deforestation and mining expansion, particularly in indigenous lands; 2) strengthening malaria surveillance by expanding the network of community health agents to support rapid diagnosis and treatment; 3) reinforcing vector control strategies, such as the use of insecticide-treated nets; 4) integrating deforestation alerts into the national malaria control program; and 5) implementing multi-sectoral activities and providing prompt assistance to indigenous populations. With this roadmap, we can expect a decrease in malaria incidence in the Amazonian mining areas in the future. Americas Here shows 1 region 2 1529 15 29 15-2 countries 3 care ill 4 5 expansion insecticidetreated insecticide treated nets program multisectoral multi sectoral populations roadmap future 152 15-

ABSTRACT Background: Neglected tropical diseases are a growing threat to global health, and endemic Chagas disease has emerged as one of the most important health problems in America. The main strategy to prevent Trypanosoma cruzi transmission is chemical control of vectors. This study presents a descriptive analysis of synanthropic triatomines before and after the implementation of a vector-control program in Bahia, Brazil. Methods: Descriptive analysis and geospatial statistics were performed on triatomine data, (1) the relative abundance and (2) proportional spatial distribution, from Bahia during two periods: (A) 1957 to 1971 and (B) 2006 to 2019. Results: We observed a decrease in the relative abundance of Panstrongylus megistus (A: n=22.032, 61.9%; B: n=1.842, 1.0%) and Triatoma infestans (A: n=1.310, 3.7%; B: n=763, 0.43%), as well as an increase in the relative abundance of T. sordida (A: n=8.314, 23.4%, B: n=146.901, 81.6%) and T. pseudomaculata (A: n=894, 2.5%, B: n=16.717, 9.3%). Conclusions: Our results indicate a clear reduction in the occurrence of P. megistus and T. infestans (last record in 2015) and an increase in the relative abundance and geographical distribution of T. sordida and T. pseudomaculata after 40 years of the vector-control program. The high frequency of other triatomine species in the municipalities of the state of Bahia and their abundance in recent years highlight the need to reinforce permanent entomological surveillance actions to prevent Chagas disease.

Abstract INTRODUCTION: We aimed to study intraspecific variation in Triatoma costalimai, a potential vector of Chagas disease present in Brazil and Bolivia. METHODS: We analyzed phenotypic (connexivum color patterns, wing morphometrics) and genetic variation (16S mtDNA) of three Brazilian T. costalimai populations. We compared 16S sequences with those of putative Bolivian T. costalimai and its sister species, T. jatai. RESULTS: Brazilian populations had different connexivum color patterns and forewing shapes. A 16S mtDNA haplotype network showed a clear separation of Brazilian T. costalimai from both T. jatai and Bolivian T. costalimai. CONCLUSIONS: We report considerable variability in T. costalimai populations.

RESUMO Deep Learning é uma técnica de aprendizado de máquina na qual o programa computacional aprende padrões diretamente a partir de imagens classificadas previamente. O presente ensaio objetivou apresentar essa técnica e algumas de suas aplicações para diagnóstico de doenças e identificação de insetos vetores para incentivar profissionais da saúde que não tenham conhecimento aprofundado em informática e que desejem utilizar a ferramenta para realizar análises automatizadas. Deep Learning tem sido aplicado para diagnóstico de câncer, fibrose cardíaca, tuberculose, detecção de parasitos como Plasmodium e Leishmania e ainda para identificação de insetos vetores. Na Universidade de Brasília, a técnica tem sido aplicada para desenvolver uma ferramenta para identificar lesões ulceradas de leishmaniose em diagnóstico diferencial e para detectar Leishmania em lâminas de estudos histopatológicos. Além disso, Deep Learning tem sido usado para identificar as espécies de vetores da doença de Chagas – o que é importante para auxiliar na vigilância epidemiológica. O uso da tecnologia envolve desafios éticos e procedimentais que são discutidos no presente ensaio. O ensaio aponta perspectivas de desenvolvimento de aplicativos que auxiliem os profissionais de saúde no diagnóstico de Leishmaniose e de vetores da doença de Chagas, o que vai ao encontro dos objetivos da pesquisa translacional.

ABSTRACT Deep Learning is a machine learning technique in which the computational algorithm learns patterns directly from images previously classified. The present essay aims to show some of its applications for clinical diagnosis and identification of insect vectors to encourage health professionals who do not have deep knowledge of computer science and who wish to use the tool to perform automated analyzes. Deep Learning has been applied to the diagnosis of cancer, cardiac fibrosis, tuberculosis, detection of parasites such as Plasmodium and Leishmania, and to identify insect vectors. At the University of Brasília, Deep Learning has been used to develop a tool to identify ulcers caused by leishmaniasis, as well as to detect Leishmania parasites. Moreover, Deep Learning was applied to identify the species of vectors of Chagas disease, an important contribution to the epidemiological surveillance of the disease. The use of Deep Learning involves some ethical and procedural issues that are discussed in this paper. Finally, the essay points out perspectives of development of apps that assist health professionals in the diagnosis of Leishmaniasis and Chagas disease vectors, which meets the goals of translational research.

RESUMO Deep Learning é uma técnica de aprendizado de máquina na qual o programa computacional aprende padrões diretamente a partir de imagens classificadas previamente. O presente ensaio objetivou apresentar essa técnica e algumas de suas aplicações para diagnóstico de doenças e identificação de insetos vetores para incentivar profissionais da saúde que não tenham conhecimento aprofundado em informática e que desejem utilizar a ferramenta para realizar análises automatizadas. Deep Learning tem sido aplicado para diagnóstico de câncer, fibrose cardíaca, tuberculose, detecção de parasitos como Plasmodium e Leishmania e ainda para identificação de insetos vetores. Na Universidade de Brasília, a técnica tem sido aplicada para desenvolver uma ferramenta para identificar lesões ulceradas de leishmaniose em diagnóstico diferencial e para detectar Leishmania em lâminas de estudos histopatológicos. Além disso, Deep Learning tem sido usado para identificar as espécies de vetores da doença de Chagas – o que é importante para auxiliar na vigilância epidemiológica. O uso da tecnologia envolve desafios éticos e procedimentais que são discutidos no presente ensaio. O ensaio aponta perspectivas de desenvolvimento de aplicativos que auxiliem os profissionais de saúde no diagnóstico de Leishmaniose e de vetores da doença de Chagas, o que vai ao encontro dos objetivos da pesquisa translacional.

ABSTRACT Deep Learning is a machine learning technique in which the computational algorithm learns patterns directly from images previously classified. The present essay aims to show some of its applications for clinical diagnosis and identification of insect vectors to encourage health professionals who do not have deep knowledge of computer science and who wish to use the tool to perform automated analyzes. Deep Learning has been applied to the diagnosis of cancer, cardiac fibrosis, tuberculosis, detection of parasites such as Plasmodium and Leishmania, and to identify insect vectors. At the University of Brasília, Deep Learning has been used to develop a tool to identify ulcers caused by leishmaniasis, as well as to detect Leishmania parasites. Moreover, Deep Learning was applied to identify the species of vectors of Chagas disease, an important contribution to the epidemiological surveillance of the disease. The use of Deep Learning involves some ethical and procedural issues that are discussed in this paper. Finally, the essay points out perspectives of development of apps that assist health professionals in the diagnosis of Leishmaniasis and Chagas disease vectors, which meets the goals of translational research.

ABSTRACT Consumption of ready-to-eat (RTE) vegetables is quick, easy and healthy, especially when eaten without cooking. However, they might be a source of foodborne pathogenic microorganisms. The objective of this study was to evaluate the microbiological and parasitological contamination of fresh RTE vegetables produced in agroindustries in the Federal District of Brazil (FD), and to correlate contamination with good manufacturing practices (GMP). One hundred and three samples of RTE vegetables were collected from six agroindustries for microbiology and parasitology analyses and correlate with GMP; 54 samples were collected from three hypermarkets for parasitological evaluation. None of the samples analyzed were positive for Salmonella sp. and for thermotolerant coliforms, but they were contaminated with total coliforms. All analyzed samples were contaminated with at least one species of enteroparasistes or commensals, which were identified as Ascaris sp., Balantidium coli, Entamoeba histolytica/dispar, Hookworm, Strongyloides sp., Trichuris sp., Entamoeba sp., eggs and larvae of Nematoda, insects and fungi. Agroindustries that adopted GMP showed less contamination with helminths. RTE vegetables sold in hypermarkets of the FD are unfit for human consumption. It is important to guide farmers in the FD on the need to adopt good practices in the production and processing of vegetables to reduce the microbial contamination.

Abstract We report an Acanthamoeba keratitis case associated with the use of contact lens in a 28-year-old female from Brasília, Brazil. Samples from corneal scraping and contact lens case were used for culture establishment, PCR amplification, and partial sequencing (fragments of ~400kb) of small subunit rDNA; both culture and PCR were positive. The sequence analyses of the cornea and of isolates from the contact lens case showed similarity with the T4 genotype. To the best of our knowledge, this is the first report of T4 Acanthamoeba keratitis case from the Midwest region of Brazil.

Abstract INTRODUCTION: Chagas disease surveillance requires current knowledge on synanthropic triatomines. We analyzed the occurrence and Trypanosoma cruzi infection rates of triatomine bugs in central Brazil, during 2012-2014. METHODS: Triatomines were collected inside or around houses, and T. cruzi infection was determined by optical microscopy and conventional/quantitative polymerase chain reaction. RESULTS: Of the 2706 triatomines collected, Triatoma sordida was the most frequent species in Goiás State, whereas Panstrongylus megistus predominated in the Federal District. Parasites identified were T. cruzi, T. rangeli, and Blastocrithidia sp. CONCLUSIONS: P. megistus and T. sordida sustained the risk of T. cruzi transmission to humans in central Brazil.

BACKGROUND Knowledge on synanthropic phlebotomines and their natural infection by Leishmania is necessary for the identification of potential areas for leishmaniasis occurrence. OBJECTIVE To analyse the occurrence of Phlebotominae in gallery forests and household units (HUs) in the city of Palmas and to determine the rate of natural infection by trypanosomatids. METHODS Gallery forests and adjacent household areas were sampled on July (dry season) and November (rainy season) in 2014. The total sampling effort was 960 HP light traps and eight Shannon traps. Trypanosomatids were detected in Phlebotominae females through the amplification of the SSU rDNA region, and the positive samples were used in ITS1-PCR. Trypanosomatid species were identified using sequencing. FINDINGS A total of 1,527 sand flies representing 30 species were captured in which 949 (28 spp.) and 578 (22 spp.) were registered in July and November, respectively. In July, more specimens were captured in the gallery forests than in the HUs, and Nyssomyia whitmani was particularly frequent. In November, most of the specimens were found in the HUs, and again, Ny. whitmani was the predominant species. Lutzomyia longipalpis was commonly found in domestic areas, while Bichromomyia flaviscutellata was most frequent in gallery forests. Molecular analysis of 154 pools of females (752 specimens) identified Leishmania amazonensis, L. infantum, and Crithidia fasciculata in Ny. whitmani, as well as L. amazonensis in Lu. longipalpis, Trypanosoma sp. and L. amazonensis in Pintomyia christenseni, and L. amazonensis in both Psathyromyia hermanlenti and Evandromyia walkeri. MAIN CONCLUSIONS These results show the importance of gallery forests in maintaining Phlebotominae populations in the dry month, as well as their frequent occurrence in household units in the rainy month. This is the first study to identify Leishmania, Trypanosoma, and Crithidia species in Phlebotominae collected in Palmas, Tocantins, Brazil.

RESUMO Aproximadamente 90% da população no noroeste da Amazônia é composta de grupos indígenas e o acesso deles aos serviços de saúde ainda é um desafio. O objetivo deste estudo foi determinar a frequência de parasitos em dois grupos indígenas (Baré e Baniwa) no noroeste da Amazônia. Amostras de fezes de 270 indivíduos (199 Baniwa e 71 Baré) foram analisadas pelos métodos de Richie e sedimentação espontânea. Foram determinadas diferenças estatísticas entre as proporções de indivíduos infectados com base no sexo, idade e etnia. Todos os indivíduos estavam infectados por protozoários ou helmintos. Os parasitos mais frequentes nos índios foram Ascaris lumbricoides (73%), Entamoeba spp. (53%), e Giardia intestinalis (48%). Protozoários parasitos foram mais comuns entre as crianças com idade entre 0-12 anos; no entanto, a frequência de ancilostomídeos e A. lumbricoides foi maior em adultos. Não houve diferenças significativas nas frequências de parasitos entre os diferentes sexos ou grupos étnicos. Infecções mistas por duas ou mais espécies de protozoários e/ou helmintos foram detectadas em 96% dos indivíduos. Um indivíduo estava infectado por 14 espécies. Uma alta frequência de parasitos intestinais foi encontrada em indígenas dos grupos Baré e Baniwa. Melhorias dos programas de infra-estrutura e educação em saúde são necessárias para reduzir o risco de infecção por parasitos intestinais.

ABSTRACT Approximately 90% of the population in the northwestern Amazonia is composed of indigenous people and their healthcare is still a challenge. The objective of this study was to determine the frequency of parasites in two indigenous ethnic groups (Baré and Baniwa) in northwestern Amazonia. Stool samples from 270 individuals (199 Baniwa and 71 Baré) were analyzed using Richie's method and the spontaneous sedimentation method. Statistical differences among the proportions of infected individuals based on gender, age, and ethnicity were determined. All individuals were infected by protozoans or helminths. The most frequent parasites in the indigenous people were Ascaris lumbricoides (73%), Entamoeba spp. (53%), and Giardia intestinalis (48%). Protozoan parasites were more common among children aged 0-12 years; however, the frequency of helminths, such as hookworms and A. lumbricoides, was higher in adults. There were no significant differences in parasite frequencies between different genders or ethnic groups. Mixed infections by two or more protozoan and/or helminth species were detected in 96% of individuals. One individual was infected by 14 species. A high frequency of intestinal parasites was found in Baré and Baniwa ethnic groups. Improvements to infrastructure and health education programs are required to reduce risk of infection by intestinal parasites.

Abstract Background Spotted fever is a tick-borne rickettsial disease. In Brazil, its notification to the Ministry of Health is compulsory. Since 2007, cases of spotted fever have been integrated to the Notifiable Diseases Information System, and epidemiological analyzes are part of the routines on surveillance programs. Methods This descriptive study updates epidemiological information on cases of spotted fever registered in Brazil between 2007 and 2015. Results In Brazil, 17,117 suspected cases of the disease were reported and 1,245 were confirmed in 12 states, mainly in São Paulo (550, 44.2 %) and Santa Catarina (276, 22.2 %). No geographic information was registered for 132 cases (10.6 %). Most of the infected people were men (70.9 %), mainly in rural areas (539, 43.3 %), who had contact with ticks (72.7 %). A higher number of suspected cases were registered between 2011 and 2015, but the number of confirmed cases and the incidence were relatively low. Moreover, 411 deaths were registered between 2007 and 2015, mainly in the southeastern region of the country, where the case-fatality rate was 55 %. Lack of proper filling of important fields of notification forms was also observed. Conclusions The results showed expansion of suspected cases of spotted fever and high case-fatality rates, which could be related to diagnostic difficulties and lack of prompt treatment. These factors may comprise limitations to the epidemiological surveillance system in Brazil, hence improvement of notification and investigation are crucial to reduce morbidity and mortality due to spotted fever in Brazil.

Abstract: INTRODUCTION : This study describes the occurrence of trypanosomatids in phlebotomines in Brasília, Brazil. METHODS : Two hundred and ten females of 13 sand fly species were analyzed by polymerase chain reaction (PCR) using different molecular markers (D7 24Sα rRNA, kDNA, and ITS1) and sequencing. RESULTS : PCR revealed trypanosomatid-positive samples from Nyssomyia whitmani and Evandromyia evandroi, which were negative by kDNA and ITS1 Leishmania-specific PCRs. DNA sequence analysis of D7 24Sα rRNA amplicons indicated the occurrence of Blastocrithidia sp. and Trypanosoma sp. in Nyssomyia whitmani and Evandromyia evandroi, respectively. CONCLUSIONS : Two trypanosomatid species other than Leishmania sp. were found to circulate in sand flies in Central Brazil.