Abstract Background The COVID-19 pandemic has triggered crises in the public health sector that have complex and multifaceted interrelationships with antimicrobial resistance. It is important to evaluate the impact of COVID-19 on microbiological profile, antibiotic and alcohol gel consumption in Intensive Care Units (ICU). Methods This is a retrospective study undertaken in an infectious disease hospital located in Bahia/Brazil during three periods: from March 2019 to February 2020; from March 2020 to February 2021; and from March 2021 to February 2022. It was evaluated the incidence density of Candida spp and of multidrug-resistant Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species (ESKAPE group) in blood, urine and tracheal secretion isolated 48 h after the patient's admission to the ICU, as well as the use of alcohol gel (in milliliters) and consumption of antibiotics in Defined Daily Dose (DDD) per 1,000 ICU patient-days in the previous year and in the first two years of COVID-19 pandemic. Results There was an increase in Candida spp. (5.81, p < 0.001, IRR = 10.47, 95 % CI 2.57‒42.62) and in carbapenem-resistant A. baumannii in clinical cultures (4.71, p < 0.001, IRR = 8.46, 95 % CI 2.07‒34.60), the latter mainly in tracheal secretions (3.18, p =0.02, IRR = 11.47, 95 % CI 1.58‒83.39). A rise in the consumption of ceftriaxone and piperacillin-tazobactam, along with an increase in the utilization of alcohol gel were observed. Conclusion The shifting microbiological profile can be attributed to both the unique characteristics of patients with COVID-19 and the adjustments made to healthcare facilities' structural and work routines. Understanding these changes is essential in addressing the accelerated impact of antimicrobial resistance during the pandemic. Therefore, conducting thorough reviews of institutional practices and routines becomes critical in mitigating the consequences of antimicrobial resistance and its implications for patient care. COVID19 COVID 19 COVID-1 ICU. . (ICU) BahiaBrazil Bahia Brazil periods 201 202 2022 multidrugresistant multidrug resistant faecium aureus pneumoniae aeruginosa ESKAPE group blood 4 s milliliters DDD (DDD 1000 1 000 1,00 patientdays days 5.81, 581 5 81 (5.81 0001 0 001 0.001 1047 10 47 10.47 9 2.57‒42.62 2574262 2 57 42 62 carbapenemresistant carbapenem 4.71, 471 71 (4.71 846 8 46 8.46 2.07‒34.60, 2073460 2.07‒34.60 , 07 34 60 2.07‒34.60) 3.18, 318 3 18 (3.18 002 02 =0.02 1147 11 11.47 1.58‒83.39. 1588339 1.58‒83.39 58 83 39 1.58‒83.39) piperacillintazobactam, piperacillintazobactam piperacillin tazobactam, tazobactam piperacillin-tazobactam observed facilities Therefore care COVID1 COVID- (ICU 20 100 00 1,0 5.81 (5.8 0.00 104 10.4 2.57‒42.6 257426 6 4.71 7 (4.7 84 8.4 207346 2.07‒34.6 3.18 31 (3.1 =0.0 114 11.4 158833 1.58‒83.3 1, 5.8 (5. 0.0 10. 2.57‒42. 25742 4.7 (4. 8. 20734 2.07‒34. 3.1 (3. =0. 11. 15883 1.58‒83. 5. (5 0. 2.57‒42 2574 4. (4 2073 2.07‒34 3. (3 =0 1588 1.58‒83 ( 2.57‒4 257 207 2.07‒3 158 1.58‒8 2.57‒ 25 2.07‒ 15 1.58‒ 2.57 2.07 1.58 2.5 2.0 1.5 2. 1.

ABSTRACT Background: This study investigated the self-rated general health, mental health, and work absenteeism among patients with laboratory-confirmed chikungunya. Methods: Telephone interviews were conducted with 63 patients ≥22 months after infection. Results: Patients who reported (N=42) or did not report (N=21) chronic arthralgia, defined by duration ≥90 days, had different frequencies for low scores for general health (68.3% vs. 30.0%, respectively; prevalence ratio, 95% confidence interval: 2.3, 1.1-4.6), symptoms of depression (31.7% vs. 15.0%; 2.1, 0.7-6.6), symptoms of anxiety (43.9% vs. 35.0%; 1.3, 0.6-2.5), and work absenteeism (76.5% and 40.0%; 1.9, 0.9-4.2). Conclusions: Chikungunya chronic arthralgia impacts long-term health and work. Background selfrated self rated laboratoryconfirmed laboratory confirmed chikungunya Methods 6 22 ≥2 infection Results N=42 N42 N 42 (N=42 N=21 N21 21 (N=21 90 ≥9 days 68.3% 683 68 3 (68.3 vs 300 30 0 30.0% respectively ratio 95 interval 23 2 2.3 1.14.6, 1146 1.1 4.6 , 1 4 1.1-4.6) 31.7% 317 31 7 (31.7 15.0% 150 15 2.1 0.76.6, 0766 0.7 6.6 0.7-6.6) 43.9% 439 43 9 (43.9 35.0% 350 35 13 1.3 0.62.5, 0625 0.6 2.5 5 0.6-2.5) 76.5% 765 76 (76.5 40.0% 400 40 19 1.9 0.94.2. 0942 0.9 4.2 . 0.9-4.2) Conclusions longterm long term ≥ N=4 N4 (N=4 N=2 N2 (N=2 68.3 (68. 30.0 2. 14 1.14.6 114 11 1. 46 4. 1.1-4.6 31.7 (31. 15.0 0.76.6 076 07 0. 66 6. 0.7-6.6 43.9 (43. 35.0 62 0.62.5 062 06 25 0.6-2.5 76.5 (76. 40.0 94 0.94.2 094 09 0.9-4.2 N= (N= 68. (68 30. 1.14. 1.1-4. 31. (31 15. 0.76. 0.7-6. 43. (43 35. 0.62. 0.6-2. 76. (76 40. 0.94. 0.9-4. (N (6 1.14 1.1-4 (3 0.76 0.7-6 (4 0.62 0.6-2 (7 0.94 0.9-4 ( 1.1- 0.7- 0.6- 0.9-

ABSTRACT Background: Domiciliation by Triatoma sordida is a public health concern in South America. This study aimed to evaluate the morphometric changes in the domestic and peridomestic populations of T. sordida. Methods: Specimen hemelytra were mounted, digitized, and processed for geometric morphometric analyses. Results: The specimens captured in houses were smaller than those captured in peridomiciles. A large size reduction effect was observed in female peridomicile populations compared with female house populations. Conclusions: T. sordida house populations were smaller than peridomestic populations. Wing geometric morphometry can be used as a tool to indicate T. sordida domiciliation. Background America T Methods mounted digitized analyses Results peridomiciles Conclusions domiciliation

ABSTRACT Background: Chagas disease (CD) is caused by Trypanosoma cruzi and transmitted by triatomines. Historical information from the 20th century demonstrates T. cruzi records in the metropolitan region of Salvador (MRS), the third largest urban agglomeration in the Brazilian Northeast and the eighth largest in Brazil, an area with intense migratory activity from CD-endemic regions. Therefore, this study aimed to evaluate CD indicators (prevalence and mortality) in the MRS. Methods: A mixed ecological and descriptive study was conducted using secondary data. We analyzed data from 2008 to 2015: deaths due to CD, self-reported cases of CD, and blood donors that were non-negative for T. cruzi infection. Results: São Francisco do Conde was one of the municipalities with the highest mortality rates due to CD. The seroprevalence rates varied by year and municipality; those with the highest values were 2008: Vera Cruz, 2009: Mata de São João, 2010: Dias D'Ávila, 2011 and 2015: São Francisco do Conde, 2012: São Sebastião do Passé, and 2013 and 2014: Pojuca. Spatial correlations between the municipalities were not detected. Conclusions: We conclude that CD is present in the MRS. The indicators analyzed in the MRS are below-state-level data. Given the importance of indicator analysis for the surveillance and control of CD at the state and national levels, it is important to strengthen the surveillance program at the municipal level, including the regions classified as low risk for T. cruzi vector transmission. Background (CD triatomines th T MRS, , (MRS) Brazil CDendemic endemic Therefore prevalence Methods 200 2015 selfreported self reported nonnegative non negative infection Results municipality Cruz 2009 João 2010 DÁvila, DÁvila D Ávila, Ávila D'Ávila 201 2012 Passé 2014 Pojuca detected Conclusions belowstatelevel below level levels transmission (MRS 20 2

ABSTRACT Background: The World Health Organization recommends a market-ready, urine-based point-of-care diagnostic test for circulating cathodic antigens (CCA) to determine the prevalence of S. mansoni. This study evaluated the performance of the URINE CCA (SCHISTO) ECO TESTE® (POC-ECO), which is currently available in Brazil. Methods: Residents from eight sites with different prevalence estimates provided one urine sample for POC-ECO and one stool sample for Kato-Katz (KK) and Helmintex® (HTX) testing as an egg-detecting reference for infection status. Results: None of the study sites had significantly higher POC-ECO accuracy than KK. Conclusions: POC-ECO is not currently recommended in Brazilian schistosomiasis elimination programs. Background marketready, marketready market ready, ready market-ready urinebased based pointofcare point care (CCA S mansoni SCHISTO (SCHISTO TESTE POCECO, POCECO POC , (POC-ECO) Brazil Methods KatoKatz Kato Katz KK (KK Helmintex HTX (HTX eggdetecting egg detecting status Results Conclusions programs (POC-ECO

ABSTRACT Background The World Health Organization recommends reliable point-of-care (POC) diagnostic testing to eliminate schistosomiasis. Lateral flow immunoassay that detects schistosome circulating cathodic antigen (CCA) in urine to establish prevalence thresholds for intervention in endemic areas is recommended. Stored urine may be useful if surveying at-risk populations is delayed or interrupted by unforeseen circumstances, such as the current COVID-19 pandemic. This study evaluated the manufacturer’s claim that Schistosoma mansoni infection can be reliably diagnosed in urine samples stored at -20°C for one year. Methods Two-hundred-forty-two subjects from an endemic site in Brazil provided one urine sample each for testing with URINE CCA (SCHISTO) ECO TESTE® (POC-ECO) and one stool sample each for testing with Kato-Katz (KK) and Helmintex® (HTX) as a robust reference standard for infection status. At least 2 ml of urine from each participant was stored at -20°C; after one year, 76 samples were randomly selected for POC-ECO retesting. Results: The POC-ECO agreement between freshly collected and stored urine was inadequate considering trace results as positive (Cohen’s kappa coefficient κ = 0.08) and negative (κ = 0.36). POC-ECO accuracy was not significantly greater than that of routine KK (54%; 95% confidence interval: 42.1%-65.5%). Conclusions The precision and accuracy of POC-ECO have to be optimized in both freshly collected and stored urine before it can be recommended for use in control programs in Brazil.

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: Inadequate wastewater treatment and fecal contamination have a strong environmental impact on antimicrobial resistance (AMR). This study evaluated the profile of AMR enterobacteria and fecal contamination from four surface waters: Jiquiriça-Brejões River and Cabrito, Tororó, and Abaeté Lagoons. METHODS: We analyzed AMR β-lactamase genes using the polymerase chain reaction method and fecal contamination using Coliscan®. RESULTS: We found high levels of fecal contamination, β-lactamase producers, and AMR genes (blaOXA-48, blaSPM, and blaVIM) in all waterbodies. CONCLUSIONS: Poor sanitation evidenced by fecal contamination and human activities around these surface waters contributed to the distribution and increase in AMR enterobacteria.

Abstract INTRODUCTION: Chagas disease (CD) affects 5.7-7.0 million individuals worldwide, and its prevalence reached 25.1% in the state of Bahia, Brazil. There is an association between the prevalence of CD, the socioeconomic status of the population, and the risk of re-emergence due to non-vectorial transmission, such as blood transfusion. This study determined the seroprevalence of T. cruzi infection among blood donors in the state of Bahia, located in northeastern Brazil, and their epidemiological profile during a 10-year period. METHODS: We performed a descriptive cross-sectional study involving a database review. Data were collected from patients with non-negative results for T. cruzi infection during a 10-year period. RESULTS: A total of 3,084 (0.62%) samples were non-negative for T. cruzi infection in an initial serological screening, and 810 (0.16%) samples were non-negative in the second screening. The correlation between infection and age (30 years or older) and between infection and lower educational level (12 years or less) in the first and second screening was statistically significant. The seroprevalence of T. cruzi infection was higher in men in the first screening. In addition, 99.52% of the municipalities of Bahia had at least one case of CD. Livramento de Nossa Senhora and Salvador presented the highest disease prevalence and recurrence, respectively. CONCLUSIONS: The seroprevalence of T. cruzi infection in these populations was lower than that found in other studies in Brazil but was comparatively higher in densely-populated areas. The demographic characteristics of our population agreed with previous studies.

Abstract We evaluated the renal colonization by Leptospira interrogans in Rattus norvegicus (rats), as it is the major natural reservoir of urban leptospirosis. We caught 72 R. norvegicus, out of which 32 were found to be positive for L. interrogans by immunofluorescence assay. From these rats, we selected 17 and divided them into six groups based on the mass-age/sex. We performed the immunohistochemistry test against L. interrogans in the kidney sections of the rats and systematically counted the colonized tubules (CTs) in 20 fields. The proportion of positive fields varied from 5% to 95%. The number of CTs in 20 fields varied from 0.5 to 85.5. These differences were not related to age or sex of the animals. The characterization of leptospiral colonization patterns in the natural reservoirs is important to better understand the host-pathogen interactions in leptospirosis.

Leptospirosis in humans usually involves hypokalaemia and hypomagnesaemia and the putative mechanism underlying such ionic imbalances may be related to nitric oxide (NO) production. We previously demonstrated the correlation between serum levels of NO and the severity of renal disease in patients with severe leptospirosis. Methylene blue inhibits soluble guanylyl cyclase (downstream of the action of any NO synthase isoforms) and was recently reported to have beneficial effects on clinical and experimental sepsis. We investigated the occurrence of serum ionic changes in experimental leptospirosis at various time points (4, 8, 16 and 28 days) in a hamster model. We also determined the effect of methylene blue treatment when administered as an adjuvant therapy, combined with late initiation of standard antibiotic (ampicillin) treatment. Hypokalaemia was not reproduced in this model: all of the groups developed increased levels of serum potassium (K). Furthermore, hypermagnesaemia, rather than magnesium (Mg) depletion, was observed in this hamster model of acute infection. These findings may be associated with an accelerated progression to acute renal failure. Adjuvant treatment with methylene blue had no effect on survival or serum Mg and K levels during acute-phase leptospirosis in hamsters.

OBJECTIVE: To characterize current leptospirosis reporting practices in the Americas. METHODS: Information was collected from the official websites of national ministries of health from the Americas region and two international organizations; personal communications; and three international morbidity databases. For all sources other than the morbidity databases, the review was limited to official reports citing clinically suspected and laboratory confirmed leptospirosis cases or deaths during the period 1996-2005. RESULTS: A total of 73 out of 1 644 reports met the selection criteria and were included in the analysis. Published leptospirosis data were available from half of the countries/sovereign territories (24 out of 48), and 18 of them had mandatory notification policies for leptospirosis. The sum of the median number of leptospirosis cases notified annually by the 24 countries/territories was 4 713.5, but just three countries (Brazil, Costa Rica, and Cuba) accounted for 83.1% (3 9cas20 es) of the notifications. Eight (16.7%) countries reported deaths due to leptospirosis. The sum of the median number of deaths reported annually for the eight countries was 380, but 349 (91.8%) were reported by Brazil. CONCLUSIONS: Notification practices in the Americas for leptospirosis are limited. Therefore, the numbers of cases and deaths reported are not representative for the region. The lack of leptospirosis data for many countries/territories may reflect weaknesses in certain aspects of national surveillance systems, including mandatory reporting policies, clinical laboratory infrastructure for performing case confirmation, and capacity to collect reported cases. Improved surveillance of leptospirosis cases and deaths in the Americas is needed to allow monitoring of regional epidemiological patterns and to estimate the burden of this important disease.

OBJETIVO: Determinar los procedimientos actuales de notificación de la leptospirosis en la Región de las Américas. MÉTODOS: Se recopiló información de los sitios web oficiales de los ministerios de salud de los países de la Región de las Américas y dos organizaciones internacionales, de comunicaciones personales y de tres bases de datos internacionales de morbilidad. Con la excepción de las bases de datos de morbilidad, el análisis se limitó a los informes oficiales que citaban casos de leptospirosis, clínicamente presuntos o confirmados por el laboratorio o defunciones por esta infección, ocurridos durante el período de 1996 al 2005. RESULTADOS: Un total de 73 informes de los 1 644 considerados reunían los criterios de selección y se incluyeron en el análisis. Se dispuso de datos publicados sobre leptospirosis de la mitad de los países o territorios soberanos (24 de 48), 18 de los cuales contaban con políticas de notificación obligatoria de la leptospirosis. La suma de las medianas del número de casos de leptospirosis notificados anualmente por los 24 países o territorios fue de 4 713,5, pero tres países en particular (Brasil, Costa Rica y Cuba) representaban 83,1% (3 920 casos) de las notificaciones. Ocho países (16,7%) notificaron defunciones debidas a leptospirosis. La suma de las medianas del número de defunciones notificadas anualmente por los ocho países fue de 380, pero 349 (91,8%) fueron notificadas por Brasil. CONCLUSIONES: Los procedimientos de notificación de la leptospirosis en la Región de las Américas son limitados. Por consiguiente, los números de casos y muertes notificados no son representativos de la Región. La carencia de datos de leptospirosis de muchos países o territorios puede reflejar los puntos débiles de ciertos aspectos de los sistemas nacionales de vigilancia, incluidas las políticas de notificación obligatoria, la infraestructura de laboratorios clínicos para confirmar los casos y la capacidad para recopilar los casos notificados. Es necesario mejorar la vigilancia de los casos y las defunciones por leptospirosis en la Región de las Américas con objeto de permitir el seguimiento de los perfiles epidemiológicos regionales y calcular la carga de esta importante enfermedad.

We examined strains of Trypanosoma cruzi isolated from patients with acute Chagas disease that had been acquired by oral transmission in the state of Santa Catarina, Brazil (2005) and two isolates that had been obtained from a marsupial (Didelphis aurita) and a vector (Triatoma tibiamaculata). These strains were characterised through their biological behaviour and isoenzymic profiles and genotyped according to the new Taxonomy Consensus (2009) based on the discrete typing unities, that is, T. cruzi genotypes I-VI. All strains exhibited the biological behaviour of biodeme type II. In six isolates, late peaks of parasitaemia, beyond the 20th day, suggested a double infection with biodemes II + III. Isoenzymes revealed Z2 or mixed Z1 and Z2 profiles. Genotyping was performed using three polymorphic genes (cytochrome oxidase II, spliced leader intergenic region and 24Sα rRNA) and the restriction fragment length polymorphism of the kDNA minicircles. Based on these markers, all but four isolates were characterised as T. cruzi II genotypes. Four mixed populations were identified: SC90, SC93 and SC97 (T. cruzi I + T. cruzi II) and SC95 (T. cruzi I + T. cruzi VI). Comparison of the results obtained by different methods was essential for the correct identification of the mixed populations and major lineages involved indicating that characterisation by different methods can provide new insights into the relationship between phenotypic and genotypic aspects of parasite behaviour.

Este é o primeiro estudo realizado na Bahia, Brasil, visando à descrição da estrutura da população genética circulante do Mycobacterium tuberculosis na cidade de Salvador. Um total de 56 casos confirmados de tuberculose pulmonar, identificados entre março e junho de 2008, foi analisado pelo método Restriction Fragment Lenght Polymorphism (IS6110-RFLP). A população de estudo foi caracterizada como a maioria do sexo masculino (71,43 %), idade acima de 30 anos (68,75%). Quarenta e um isolados (73,21%) com padrão único, enquanto 15 (26,75%) apresentaram padrões agrupáveis, formando seis clusters. A alta taxa de diversidade das cepas de M. tuberculosis observada é mais sugestiva de reativação endógena do que transmissão recente.

This study constitutes a first attempt to describe the genetic population structure of Mycobacterium tuberculosis circulating in Salvador, Bahia State, Brazil. A total of 56 confirmed cases of pulmonary tuberculosis, identified between March and June 2008, were analyzed using restriction fragment length polymorphism (IS6110-RFLP). The study population was characterized by a predominance of males (71.43%) over 30 years of age (68.75%). Forty-one isolates were found to belong to a single pattern (73.2%), while 15 (26.7%) were found in group patterns, forming six clusters. The higher level of diversity observed is much more suggestive of endogenous reactivation than recent transmission.

Este é o primeiro estudo realizado na Bahia, Brasil, visando à descrição da estrutura da população genética circulante do Mycobacterium tuberculosis na cidade de Salvador. Um total de 56 casos confirmados de tuberculose pulmonar, identificados entre março e junho de 2008, foi analisado pelo método Restriction Fragment Lenght Polymorphism (IS6110-RFLP). A população de estudo foi caracterizada como a maioria do sexo masculino (71,43 %), idade acima de 30 anos (68,75%). Quarenta e um isolados (73,21%) com padrão único, enquanto 15 (26,75%) apresentaram padrões agrupáveis, formando seis clusters. A alta taxa de diversidade das cepas de M. tuberculosis observada é mais sugestiva de reativação endógena do que transmissão recente.

This study constitutes a first attempt to describe the genetic population structure of Mycobacterium tuberculosis circulating in Salvador, Bahia State, Brazil. A total of 56 confirmed cases of pulmonary tuberculosis, identified between March and June 2008, were analyzed using restriction fragment length polymorphism (IS6110-RFLP). The study population was characterized by a predominance of males (71.43%) over 30 years of age (68.75%). Forty-one isolates were found to belong to a single pattern (73.2%), while 15 (26.7%) were found in group patterns, forming six clusters. The higher level of diversity observed is much more suggestive of endogenous reactivation than recent transmission.