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: Trypanosoma cruzi infection triggers an inflammatory process with exacerbated production of cytokines that stimulate inflammatory and anti-inflammatory signals, including the efferent anti-inflammatory signal known as the anti-inflammatory cholinergic pathway. Thus, the use of anticholinesterase drugs, such as galantamine, could minimize the inflammatory process caused by this disease. METHODS For the study at 30, 60, and 90 days, 120 Swiss mice were divided into three groups. Each group was subdivided into four subgroups: uninfected/untreated (CTRL), uninfected/treated (GAL), infected/untreated (INF), and infected/treated (GAL/INF). The infected groups were inoculated intraperitoneally with 0.1 ml of mouse blood containing 5 × 104 trypomastigote forms of the T. cruzi QM2 strain. The galantamine-treated groups received 5 mg/kg of galantamine orally, through pipetting. From each subgroup, the parameters of parasitemia, histopathological analysis, butyrylcholinesterase activity (BuChE), and functional study of the colon were evaluated. RESULTS: BuChE performance was observed when AChE was suppressed, with increased activity in the GAL/INF group similar to the INF group on the 30th day post infection, thus corroborating the absence of a significant difference in parasitic curves and histopathological analysis. CONCLUSIONS: The presence of an inflammatory process and nests of amastigotes, as well as evidence of reactivity to ACh and NOR, suggest that galantamine did not interfere with the colonic inflammatory response or even in colonic tissue parasitism at this stage of Chagas disease.

Resumen Introducción. Luego de la implementación de medidas de control de la transmisión vectorial por Triatoma infestans en Brasil, hubo una reducción en el número de nuevos casos de la enfermedad de Chagas (EC). Actualmente, en el continente americano la incidencia anual de EC es de 28 000 casos, pero cabe señalar que aún existe una gran cantidad de adultos mayores que padecen los síntomas y signos de la fase crónica de esta enfermedad. Objetivo. Caracterizar el perfil clínico y epidemiológico de pacientes chagásicos en fase crónica atendidos en un centro de referencia ubicado en el estado de São Paulo, Brasil. Materiales y métodos. Estudio transversal y descriptivo. Se analizaron las historias clínicas de 62 pacientes chagásicos crónicos atendidos en el Hospital das Clínicas de Marília. Resultados. No hubo diferencias significativas con respecto a sexo, edad y tiempo de diagnóstico. Los problemas cardiacos fueron el signo clínico más reportado. Se observó una diferencia significativa en el caso de la forma indeterminada de la enfermedad, siendo más predominante en los hombres. Por otra parte, el estadio B1 fue más frecuente en las mujeres, mientras que el estadio B2 fue predominante en los hombres. Conclusión. El diagnóstico tardío de la EC puede aumentar la probabilidad de presentar complicaciones digestivas. Sin embargo, las manifestaciones clásicas de esta enfermedad y sus comorbilidades pueden ser controladas siempre que se cuente con atención médica integral (multidisciplinar), ya que de esta forma se retrasa su evolución y, en consecuencia, se mejora la calidad de vida de estos pacientes.

Abstract Introduction: After implementing measures to control vector transmission by Triatoma infestans in Brazil, the number of new cases of Chagas disease (CD) decreased. Currently, the American continent has an annual incidence of 28 000 cases, but a large number of older adults are still affected by the chronic phase of this disease. Objective: To characterize the clinical and epidemiological profile of patients in the chronic phase of CD treated at a reference center located in the state of São Paulo, Brazil. Materials and methods: A cross-sectional, descriptive study was conducted based on the analysis of the medical records of 62 patients in the chronic phase of CD and treated at the Hospital das Clínicas de Marília. Results: No significant differences were found regarding sex, age and time of diagnosis. Cardiac problems were the most reported clinical sign. A significant difference was observed in the case of the indeterminate form of the disease, which was more predominant in males. In addition, functional classification B1 of CD was more common in women, while B2 predominated in men. Conclusion: A late diagnosis of CD may increase the chances of presenting digestive complications. However, the classic manifestations of the disease and its comorbidities can be successfully managed as long as comprehensive (multidisciplinary) medical care is provided, since this would help delay the course of the disease and, consequently, improve the patients' quality of life.

ABSTRACT Leishmaniasis comprises a group of zoonotic diseases caused by protozoa belonging to the Leishmania genus, noting that the visceral form is the most severe and lethal, if untreated. Nowadays visceral leishmaniasis is widespread in Brazil and the Adamantina microregion, located in the west of Sao Paulo State, has been affected by Human American Visceral Leishmaniasis (HAVL) since 2004. We evaluated the epidemiological profile of HAVL in the Adamantina microregion through a Geographic Information Systems (GIS) and established its incidence rate by location and time. Notified cases were provided by the Sao Paulo State Epidemiological Surveillance Center. Home addresses of patients who tested positive to HAVL were converted into geographic coordinates through the Google Geocoding Application Programming Interface submitted to ArcMap 10.5 System for georeferencing. Kernel spatial analyses were performed to obtain the incidence distribution and the total area involvement rate. From 2004 to 2018, 325 cases of HAVL were diagnosed in 11 of the 12 municipalities belonging to the of Adamantina microregion. The disease has disseminated to the Northwest and East-Southeast directions, taking place along the Comandante Joao Ribeiro de Barros highway, with higher incidences rates in the municipalities where the highway passes. HAVL incidence was higher in children aged between 0 to 9 years and in the elderly; there was no difference in relation to sex and the majority of cases were located in urban areas. The determination of the epidemiological profile and the the spread of disease patterns can indicate possible areas of vulnerability, in order to contribute to the management and prevention of the disease through a strategic resources optimization.

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.

ABSTRACT Considering the widespread popular use of Morus nigra and the amount of scientific information on its antioxidant and anti-inflammatory activity, the effectiveness of this phytotherapeutic compound in the parasitemia progression during the acute phase of Chagas disease and its role in the development of the inflammatory process as well as its effects on the oxidative damage in the chronic phase of infection were evaluated. Thus, 96 male Swiss mice were randomly divided into eight groups, four groups were uninfected controls, and four groups were intraperitoneally infected with 5.0 x 104 blood trypomastigotes forms of T. cruzi QM2 strain. Four batches composed of one uninfected and one infected group were respectively treated with 70% alcohol solution and 25 μL, 50 μL and 75 μL of the phytotherapeutic compound. Levels of antioxidant elements (TBARS, FRAP, GSH and Sulfhydryl groups) were measured in plasma samples. The phytotherapeutic compound’s antioxidant activity was measured by polyphenol and total flavonoid quantification, DPPH, NO, and FRAP method. Our results showed that the vehicle influenced some of the results that may have physiological relevance in Chagas disease. However, an important action of M. nigra tincture was observed in the progression of Chagas disease, since our results demonstrated a reduction in parasitemia of treated groups when compared to controls, especially in the group receiving 25 µL. However, in the chronic phase, the 50-µL dosage presented a better activity on some antioxidant defenses and minimized the tissue inflammatory process. Results indicated an important action of M. nigra tincture on the Chagas disease progression.

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 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).

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.