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: 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: 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 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 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.

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.

OBJETIVO: Avaliar a influência do déficit de crescimento sobre o retardo maturacional de crianças e adolescentes com infecção helmíntica. MÉTODOS: Trata-se de um estudo transversal, em que participaram 1 764 indivíduos de 7 a 17 anos de idade, de ambos os sexos, infectados por Schistosoma mansoni isoladamente ou Schistosoma mansoni associado a geohelmintos, residentes na cidade de Jequié (BA). Os participantes foram submetidos a avaliação antropométrica, dos estágios de desenvolvimento puberal e a exame parasitológico de fezes. Foram coletadas informações referentes às condições sanitárias do domicílio e socioeconômicas da família. Optou-se pela análise de regressão logística multivariada para as análises estatísticas de interesse. RESULTADOS: Os resultados deste trabalho mostraram uma prevalência de 15,4% de déficit estatural entre os integrantes do estudo. O déficit de crescimento físico associou-se ao atraso da puberdade (0R=4,01; IC95%1,01-15,8). Esta associação pode ser explicada pelo impacto negativo que a desnutrição exerce sobre a produção de hormônios associados ao crescimento e sobre a produção dos hormônios sexuais. CONCLUSÃO: Estes achados sugerem que as condições inadequadas de nutrição contribuem para o retardo maturacional. Ressalta-se assim, a importância de estratégias de intervenção que possam garantir melhores condições de vida, saúde e nutrição para o desenvolvimento adequado das potencialidades vitais.

OBJECTIVE: The objective of this study is to assess the influence of stunting on the developmental delay of helminth-infected children and adolescents. METHODS: The sample of this cross-sectional study consisted of 1,764 subjects of both sexes from the city of Jequié (Bahia, Brazil), aged 7 to 17 years, infected with helminths (either Schistosoma mansoni alone or associated with associated with geohelminths). All subjects underwent anthropometric and Tanner stage assessment, and stool testing. Data on the family's socioeconomic status and sanitary conditions of the household were also collected. The data was analyzed by multivariate logistic regression. RESULTS: The results of this study show a prevalence of stunting of 15.4% and an association between stunting and pubertal delay (0R=4.01; CI 95% 1.01-15.8). The negative impact of malnutrition on the production of both sexual and growth-related hormones may explain this association. CONCLUSION: These findings suggest that inadequate nutrition contributes to developmental delay. This shows the importance of intervention strategies that guarantee better living and health conditions and nutrition for proper development.

A frequência de genótipos do vírus da hepatite C (HCV) em pacientes soropositivos anti-HCV no estado de Alagoas, Brasil, foi determinada através da RT-PCR aninhada da região 5'NCR seguida pela análise do polimorfismo de comprimento dos fragmentos de restrição (RFLP). A RT-PCR aninhada utilizando primers genótipo-específicos da região core foi efetuada quando não foi possível determinar o genótipo pelo primeiro método. Níveis detectáveis de HCV-RNA estavam presentes em 115 (74,7%) das 154 amostras de soro. O genótipo 1 foi o mais freqüente (77,4%), contra 20,9% do genótipo 3 e 0,8% do genótipo 2. O subtipo 1b foi predominante (65,2%), seguido pelos subtipos 1a (8,7%) e 3a (6,1%). Co-infecção (1a/3a) foi detectada em 0,8% das amostras. Não foram encontradas diferenças significativas quanto à prevalência do genótipo 1 em relação ao que tem sido obtido de pacientes soropositivos anti-HCV de outras localidades do Brasil. Este é o primeiro relato da presença do genótipo 2 no estado.

We determined the frequency of hepatitis C virus (HCV) genotypes in anti-HCV seropositive patients in the state of Alagoas, Brazil, by means of nested-reverse transcription-polymerase chain reaction (RT-nested-PCR) followed by restriction fragment length polymorphism (RFLP) of amplified fragments of the 5´NCR. The nested-PCR with genotype-specific primers from the core region was carried out when detection was not possible by the first approach. Detectable HCV-RNA was present in 115 (74.7%) of 154 serum samples. Genotype 1 was the most frequent (77.4%), against 20.9% of genotype 3 and 0.8% of genotype 2. Subtype 1b was predominant (65.2%), followed by subtypes 1a (8.7%), and 3a (6.1%). Coinfection (1a/3a) was detected in 0.8% of the samples. Indeed, there was no significant differences in the prevalence of genotype 1 compared to what has been obtained from anti-HCV seropositive patients from other locations in Brazil. Here we report for the first time the genotype 2 in the state of Alagoas.