ABSTRACT This review aims to provide current information about Q fever, elucidating the etiological, epidemiological, pathogenic, clinical, diagnostic, therapeutic, and prophylactic aspects of the disease for the medical community. We discuss the main forms of presentation of the agent, its ability to persist in the body, the infinite possibilities of susceptible hosts, the main known forms of transmission, its importance in populations at occupational risk, and the role of arthropods in the natural history of the disease. Focusing on Brazil, we present the cases already described and studies developed since its first report, and how there is still much to unravel. We are aware of the possibilities of the persistence of the agent and the development of severe clinical pictures and the specific treatments currently instituted. We also wish to raise awareness about the future, the new genotypes that are emerging, the need to study the effects of vaccines, and the impact of Q fever on the population. Q fever is a poorly understood disease in Latin America, and recent studies, especially in Brazil, have revealed the importance of developing new studies. etiological epidemiological pathogenic diagnostic therapeutic community body hosts transmission risk Brazil report unravel instituted future emerging vaccines population America

Resumo Algumas espécies de Bartonella têm os felinos como principais hospedeiros reservatórios. Tais patógenos são transmitidos ao homem por intermédio da arranhadura ou mordedura de gatos e entre os gatos, por meio da pulga Ctenocephalides felis. O objetivo deste estudo foi investigar a ocorrência de DNA de Bartonella spp. em gatos de abrigos e seus ectoparasitas e a relação entre o estado de infecção dos gatos e dos ectoparasitas albergados por estes. Material genético bacteriano foi detectado em 47,8% das amostras de sangue de gatos, 18,3% das pulgas C. felis, 13,3% dos "pools" de ovos de pulgas e 12,5% dos "pools" de piolhos. DNA de B. henselae e B. clarridgeiae foi detectado em pulgas, e B. henselae, B. clarridgeiae e B. koehlerae, em amostras de sangue de gatos. Gatos infestados por ectoparasitas que carreavam DNA de Bartonella spp. demonstraram aproximadamente o dobro de chance de estarem infectados. Esses resultados indicam que os gatos de abrigos têm alta prevalência de infecção por espécies de Bartonella, capazes de causar doenças no homem. E também destacam a importância do controle e prevenção da infestação por ectoparasitas, no intuito de prevenir a infecção em gatos e humanos.

Abstract Feline Bartonella can be transmitted to humans through cat scratches or bites, and between cats, by the flea Ctenocephalides felis. The study was carried out in order to investigate the occurrence of Bartonella DNA in cats living in shelters and their ectoparasites and the relationship between the infection status of cats and ectoparasites they host. Bartonella DNA was detected in 47.8% of the cat blood samples, 18.3% of C. felis fleas, 13.3% of flea egg pools and 12.5% of lice pools. B. henselae and B. clarridgeiae DNA were detected in cat fleas, while B. henselae, B. clarridgeiae and B. koehlerae were found in blood samples from bacteremic cats. Cats infested by positive ectoparasites showed approximately twice the odds of being infected. Our results indicate that shelter cats have high prevalence of Bartonella species that are known to be human pathogens. This highlights the importance of controlling infestations by ectoparasites to avoid cat and human infection.

ABSTRACT Brazilian spotted fever, a zoonotic disease transmitted by ticks, is caused by Rickettsia rickettsii. We report a fulminant case of this zoonosis in a healthy 46-year-old military man in the urban region of Rio de Janeiro city, in October, 2021. Ticks and capybaras (Amblyomma sculptum, Hydrochoerus hydrochaeris, respectively) were identified in the military fields, pointing to the participation of this large synanthropic rodent, recognized as an efficient amplifier host of Rickettsia rickettsii in Brazil. As the military population is considered a risk group for spotted fever, it is necessary to alert health professionals to the importance of the early detection of the disease and its adequate management, mainly in populations that are particularly at risk of exposure to ticks, in order to avoid fatal outcomes.

Resumo Objetivo: descrever um cluster da COVID-19 e as estratégias utilizadas para a contenção do vírus, num município do interior de Mato Grosso, Brasil. Métodos: estudo descritivo com dados dos registros documentais da investigação epidemiológica realizada em abril de 2020. Resultados: a introdução do vírus SARS-CoV-2 no município foi identificada a partir do cluster com cinco pessoas, sendo quatro sintomáticas e uma assintomática, consequente à importação pelos casos índices C01 e C02; além da transmissão intradomiciliar (C03 e C04), uma fisioterapeuta (C05) foi infectada por C02; com exceção do C04, todos apresentaram um quadro influenza símile e somente C02 necessitou de internação; quanto aos testes laboratoriais, todos foram sororreativos, e somente C01 foi RT-PCR positivo. Conclusão: a disseminação da COVID-19 foi contida pelo isolamento domiciliar, uma importante estratégia que deve ser adotada precocemente pelos municípios indenes na contenção da disseminação viral, e pelo teste sorológico, que detectou a infecção em assintomáticos.

Abstract Objective: to describe a COVID-19 cluster and the strategies used to contain the virus, in a municipality in the interior region of Mato Grosso state, Brazil. Methods: this is a descriptive study of documental records of an epidemiological investigation conducted in April 2020. Results: introduction of SARS-CoV-2 in the municipality was identified through a cluster comprised of five people, 4 were symptomatic and 1 was asymptomatic, after the virus was imported by index cases C01 and C02; in addition to household transmission (C03, C04), a physiotherapist (C05) was infected through contact with C02; with the exception of C04, all had an influenza-like symptoms and C02 required hospitalization; as for laboratory tests, all were seroreactive and C01 was RT-PCR positive. Conclusion: dissemination of COVID-19 was contained by effective home isolation, an important instrument that should be adopted early by unaffected municipalities to contain virus dissemination, as well as by serological testing that detected infection in asymptomatic patients.

Resumen Objetivo: describir un grupo de COVID-19 y las estrategias para contener el virus, en el interior de Mato Grosso, Brasil. Métodos: estudio descriptivo de los registros documentales de la investigación epidemiológica realizada en abril de 2020. Resultados: la introducción del SARS-CoV-2 en el municipio se identificó del grupo con cinco personas, cuatro sintomáticas y una asintomática, como consecuencia de la importación por los casos índices C01 y C02; además de la transmisión domiciliaria (C03 y C04), una fisioterapeuta (C05) infectada con C02; con excepción de C04, todos presentaron un cuadro influenza símile y solamente C02 requería hospitalización; en cuanto a las pruebas de laboratorio, todas fueron serorreactivas y sólo C01 fue RT-PCR positivo. Conclusión: la diseminación de COVID-19 fue contenida por el aislamiento domiciliario efectivo, un instrumento importante que los municipios indemnes deben adoptar con anticipación a la diseminación viral, y mediante la prueba serológica que detectó la infección en pacientes asintomáticos.

Resumo Objetivo: descrever um cluster da COVID-19 e as estratégias utilizadas para a contenção do vírus, num município do interior de Mato Grosso, Brasil. Métodos: estudo descritivo com dados dos registros documentais da investigação epidemiológica realizada em abril de 2020. Resultados: a introdução do vírus SARS-CoV-2 no município foi identificada a partir do cluster com cinco pessoas, sendo quatro sintomáticas e uma assintomática, consequente à importação pelos casos índices C01 e C02; além da transmissão intradomiciliar (C03 e C04), uma fisioterapeuta (C05) foi infectada por C02; com exceção do C04, todos apresentaram um quadro influenza símile e somente C02 necessitou de internação; quanto aos testes laboratoriais, todos foram sororreativos, e somente C01 foi RT-PCR positivo. Conclusão: a disseminação da COVID-19 foi contida pelo isolamento domiciliar, uma importante estratégia que deve ser adotada precocemente pelos municípios indenes na contenção da disseminação viral, e pelo teste sorológico, que detectou a infecção em assintomáticos.

Abstract Objective: to describe a COVID-19 cluster and the strategies used to contain the virus, in a municipality in the interior region of Mato Grosso state, Brazil. Methods: this is a descriptive study of documental records of an epidemiological investigation conducted in April 2020. Results: introduction of SARS-CoV-2 in the municipality was identified through a cluster comprised of five people, 4 were symptomatic and 1 was asymptomatic, after the virus was imported by index cases C01 and C02; in addition to household transmission (C03, C04), a physiotherapist (C05) was infected through contact with C02; with the exception of C04, all had an influenza-like symptoms and C02 required hospitalization; as for laboratory tests, all were seroreactive and C01 was RT-PCR positive. Conclusion: dissemination of COVID-19 was contained by effective home isolation, an important instrument that should be adopted early by unaffected municipalities to contain virus dissemination, as well as by serological testing that detected infection in asymptomatic patients.

Resumen Objetivo: describir un grupo de COVID-19 y las estrategias para contener el virus, en el interior de Mato Grosso, Brasil. Métodos: estudio descriptivo de los registros documentales de la investigación epidemiológica realizada en abril de 2020. Resultados: la introducción del SARS-CoV-2 en el municipio se identificó del grupo con cinco personas, cuatro sintomáticas y una asintomática, como consecuencia de la importación por los casos índices C01 y C02; además de la transmisión domiciliaria (C03 y C04), una fisioterapeuta (C05) infectada con C02; con excepción de C04, todos presentaron un cuadro influenza símile y solamente C02 requería hospitalización; en cuanto a las pruebas de laboratorio, todas fueron serorreactivas y sólo C01 fue RT-PCR positivo. Conclusión: la diseminación de COVID-19 fue contenida por el aislamiento domiciliario efectivo, un instrumento importante que los municipios indemnes deben adoptar con anticipación a la diseminación viral, y mediante la prueba serológica que detectó la infección en pacientes asintomáticos.

Abstract INTRODUCTION: The Amazon tropical rainforest has the most dense and diverse ecosystem worldwide. A few studies have addressed rodent-borne diseases as potential hazards to humans in this region. METHODS: A retrospective survey was conducted using enzyme-linked immunosorbent assay for detecting mammarenavirus and orthohantavirus antibodies in 206 samples collected from rural settlers of the Brazilian Western Amazonian region. RESULTS: Six (2.91%) individuals in the age group of 16 to 36 years were found to possess antibodies against mammarenavirus. CONCLUSION: Evidence of previous exposure to mammarenavirus in the rural population points to its silent circulation in this region.

ABSTRACT During the Brazilian slavery period, many African migrants were brought to the American continent. Historically, some of these migrants escaped from the Brazilian gold mines and farms to which they had been brought and settled in remote valleys and this was the main mode of resistance to the slavery system. These runaway-slave descendant communities are called quilombos, a group with distinct ethnic identity, specific behavioral habits, including geographic isolation and conservative practices. The objective of this study was to investigate the prevalence of rodent-borne viruses in two Afro-descendent communities from Mato Grosso do Sul State, Midwestern Brazil. A total of 319 individuals from rural and urban quilombola communities were enrolled. Twelve (3.76%) had anti-rodent-borne virus IgG antibodies. Seven (2.19%) were anti-mammarenavirus reactive and nine (2.82%) had anti-orthohantavirus antibodies. The literature includes limited data on the health status of quilombola communities, but all the studies emphasize the disparity of attention of local healthcare personnel to these communities compared to the general population. The findings of this study highlight the vulnerability and the precarious health conditions of quilombola groups, especially those living in rural areas and thus, point to the need of preventive measures to improve access to healthcare for this ethnic group.

ABSTRACT Hantavirus Cardiopulmonary Syndrome (HCPS) is an important emergent zoonosis associated with wild rodents in Brazil, where this viral infection in children is generally rare. We present HCPS in a child from the Pantanal Biome and a review of all reported pediatric cases in Mato Grosso State, an endemic area for HCPS in Brazil. The investigation used the Information System for Notifiable Diseases database (SINAN). A 12-year-old boy was hospitalized with fever and respiratory failure and hantavirus IgM and IgG antibodies were detected by ELISA in serum samples. During the period of 1999 to 2016, 32 HCPS pediatric cases confirmed by serology were reported to SINAN with a mortality rate of 34.4%. The possibility of hantavirus infection in children with acute febrile illness associated with respiratory failure should be considered mainly in recognized endemic areas as Mato Grosso State, contradicting a hypothesis that children are more protected from lung involvement.

Abstract INTRODUCTION: Infective endocarditis (IE) is a systemic infectious disease requiring a multidisciplinary team for treatment. This study presents the epidemiological and clinical data of 73 cases of IE in Rio de Janeiro, Brazil. METHODS This observational prospective cohort study of endocarditis patients during an eight-year study period described 73 episodes of IE in 70 patients (three had IE twice). Community-associated (CAIE) and healthcare-acquired infective endocarditis (HAIE) were diagnosed according to the modified Duke criteria. The collected data included demographic, epidemiologic, and clinical characteristics, including results of blood cultures, echocardiographic findings, surgical interventions, and outcome. RESULTS: Analysis of data from the eight-year study period and 73 cases (70 patients) of IE showed a mean age of 46 years (SD=2.5 years; 1-84 years) and that 65.7% were male patients. The prevalence of CAIE and HAIE was 32.9% and 67.1%, respectively. Staphylococcus aureus (30.1%), Enterococcus spp. (19.1%), and Streptococcus spp. (15.0%) were the prevalent microorganisms. The relevant signals and symptoms were fever (97.2%; mean 38.6 + 0.05°C) and heart murmur (87.6%). Vegetations were observed in the mitral (41.1%) and aortic (27.4%) valves. The mortality rate of the cases was 47.9%. CONCLUSIONS: In multivariate analysis, chronic renal failure (relative risk [RR]= 1.60; 95% confidence interval [CI] 1.01-2.55), septic shock (RR= 2.19; 95% CI 1.499-3.22), and age over 60 years (RR= 2.28; 95% CI 1.44-3.59) were indirectly associated with in-hospital mortality. The best prognosis was related to the performance of cardiovascular surgery (hazard ratio [HR]= 0.51; 95% CI 0.26-0.99).

Anthropogenic environmental changes arising from settlement and agriculture include deforestation and replacement of natural vegetation by crops providing opportunities for pathogen spillover from animals to humans. This study aimed to investigate the prevalence of rodent-borne virus infections in seven rural settlements from Midwestern Brazil. Of the 466 individuals tested 12 (2.57%) were reactive for orthohantavirus and 3 (0.64%) for mammarenavirus. These rural settlers lived under unfavorable infrastructure, socioeconomic disadvantages, and unsanitary conditions, representing a risk for rodent-borne infections. Development of public policies towards the improvement of health, sanitation and awareness of rodent-borne diseases in improvised camps and settlements is imperative, in order to reduce morbidity and mortality caused by these diseases.

ABSTRACT The increasing use of illicit drugs imposes a public health challenge worldwide. People who inject drugs (PWID) are more susceptible to health complications due to immunosuppression associated with drug use and non-hygienic self-administration of substances, contaminants, and liquids. PWID are subjected to increased risk of acquiring and transmitting different pathogens (frequently functioning as sentinel cases for (re)emerging pathogens), including those transmitted by arthropods and vertebrate reservoirs in unhealthy environments. A clear association between injection drug use and HIV, HBV, and HCV infections has been described; however, other infectious viral and bacterial agents have been seldomly assessed. In this study, we investigated the seroprevalence of Bartonella spp., Coxiella burnetii, and Hantavirus among 300 randomly selected PWIDs from Rio de Janeiro, as part of a multi-city cross-sectional study carried out in the 1990s. Point seroprevalences and respective 95% CIs are as follows: 9.3% for C. burnetii (95% CI: 6.0%-13.0%), 1.0% for Bartonella spp. (95% CI: 0.0%-3.0%), and 4.0% for Hantavirus (95% CI: 2.0%-7.0%). In addition to the blood-borne pathogens, the results of this study increase our knowledge on other transmissible infectious agents in PWID. The high seroprevalence of C. burnetii and Hantavirus found among PWID is intriguing and suggests the need to carry out prospective studies, including molecular analyses, to confirm these findings and allow a better understanding of the putative relevance of these zoonotic infectious agents among PWID.

ABSTRACT This study verified the occurrence of Bartonella spp. in dogs, cats, wild mammals and their ectoparasites in Petrolina and Lagoa Grande Counties, Pernambuco, located in a semi-arid region in Northeastern Brazil. Anti-Bartonella spp. antibodies were detected by indirect immunofluorescence assay (IFA) in 24.8% of dogs (27/109) and in 15% of cats (6/40). Bartonella sp. DNA was identified by PCR performed on DNA extracted from blood and ectoparasites using primers targeting Bartonella sp. gltA and ribC genes in 100% (9/9) of Pulex irritans from Cerdocyon thous, 57.4% (35/61) of P. irritans from dogs, 2.3% (1/43) of Ctenocephalides felis felis from dogs, 53.3% (24/45) of C. felis felis from cats, and 10% (1/10) of Polyplax spp. from Thrichomys apereoides. DNA sequencing identified Bartonella clarridgeiae and Bartonella henselae in C. felis felis from cats, Bartonella rochalimae in P. irritans from dog and C. thous, and Bartonella vinsoni berkhofii in P. irritans from dog.

Introduction Over the last recent years, the number of Q fever cases have has increased throughout the world. An epidemiological investigation was performed in the area in which the first molecular documentation of Q fever in Brazil was previously reported. Methods Indirect immunofluorescence assay (IFA) and PCR of Coxiella burnetii targeting the htpAB gene were performed in samples from 14 dogs (blood); 1 cat (blood); 10 goats (blood, milk, vaginal swab and anal swab); 3 sheep (blood); and 2 horses (blood). Results Two dogs, two sheep and five goats were seroreactive. DNA was amplified from 6 milk and 2 blood samples from goats and from dogs, respectively. The sequence of the amplicons exhibited 99% sequence similarity with the homologous sequence of the htpAB gene of C. burnetii RSA 331 (GenBank - CP000890). Conclusions The results confirm C. burnetii infection in animals in Rio de Janeiro and reinforce the need for the surveillance of Q fever in Brazil.