Resumo Em São Luís, Maranhão, região Nordeste do Brasil, a notificação de casos de Leishmaniose Visceral (LV) intensificou-se em 1982, com padrão epidêmico e endêmico. Nessa cidade, o Centro de Controle de Zoonoses (CCZ) era uma entidade que realizava ações de controle e prevenção da doença, mas, nos últimos anos, a periodicidade de suas atividades reduziram-se significativamente, devido a diversos fatores técnico-políticos. Portanto, neste estudo avaliou-se o cenário epidemiológico da leishmaniose visceral humana (LVH) e a prevalência da doença em cães, após a descontinuidade das atividades do CCZ, no período de 2007-2016. A soroprevalência canina foi determinada de acordo com o perfil clínico e a sorologia. Os casos notificados de LVH foram realizados a partir de dados da Secretaria Municipal de Saúde de São Luís. Observou-se frequência de 45,8% (p = 0,0001) de cães soropositivos, dos quais 54% (p = 0,374) eram assintomáticos. Em relação aos casos humanos, ocorreram 415 notificações, com aumento na incidência das zoonoses observada no período. Assim, pode-se inferir que, com a interrupção das atividades de controle e vigilância, houve um grande número de animais circulantes positivos, atuando como fonte de infecção tanto para cães quanto para humanos.

Abstract In São Luís, Maranhão, northeastern Brazil, the notification of visceral leishmaniasis (VL) cases intensified in 1982, showing endemic and epidemic patterns. In this city, the Center for Zoonoses Control (CZC) was an organization in charge of the control and prevention of the disease. However, technical and political reasons have led to a significant decline in the periodicity of its activities. Therefore, in this study we evaluated the epidemiological scenario of human visceral leishmaniasis (HVL) and the prevalence of the disease in dogs after the cessation of the CZC activities, covering the period of 2007 to 2016. The seroprevalence of canine leishmaniasis was determined based on clinical and serological profiles. HVL cases were notified using data provided by the Municipal Health Department of São Luís. A seropositivity rate of 45.8% (p = 0.0001) was found among dogs, 54% (p = 0.374) of which were asymptomatic. As for human cases, there were 415 notifications, with an increase in the incidence of the zoonosis observed during the aforementioned period. Thus, it can be inferred that after the control and surveillance activities were curtailed, there was an increase in the number of seropositive animals in circulation, acting as reservoirs of infection for dogs and humans.

Extensively drug-resistant tuberculosis (XDR-TB) is an emerging health problem that threatens tuberculosis (TB) control worldwide, since suitable treatment for this disease has not yet been found. We report a case of secondary pulmonary XDR-TB in a 54-year-old, HIV-negative male from Goiânia, Brazil. The patient had long-standing pulmonary tuberculosis (nine years) with extensive bilateral lung damage and had been treated with multiple antituberculosis drugs (self-administered) before XDR-TB diagnosis. The strain of Mycobacterium tuberculosis was resistant to R- rifampicin, H-isoniazid, E-ethambutol, Eto-ethionamide, Ofx-ofloxacin, and Am-amikacin. This patient died with multiple organ failure due to sepsis secondary to bacterial pneumonia.

Multidrug-resistant tuberculosis (MDR-TB) is an emerging and worrisome health problem that threatens tuberculosis (TB) control worldwide. The clinical management of MDR-TB is a complex issue associated with the use of multiple drugs for a long period, usually accompanied by side effects and high costs. The objective of this work was to relate cases of MDR-TB occurring in Goiás, a central state of Brazil. We related five cases of MDR-TB, three women and two men. All were pulmonary cases. Three were in their second treatment and two in their first treatment. Surgical pulmonary resection was performed in one case. One death occurred. Lack of adherence, gastric intolerance to anti-TB drugs and poor clinical management were the main aspects related to the emergent resistance. A revision of the main clinical aspects of this disease was performed.