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Factors associated with tuberculosis deaths during hospitalization in Midwest Brazil
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Oliveira Junior, Ademar Rodrigues de

; Volpe-Chaves, Cláudia Elizabeth

; Lacerda, Mara Luci Gonçalves Galiz

; Bertucci, Alexandre Albuquerque

; Saad, Bruna Abdul Ahad

; Oliveira, Caroline Tieppo Flores de

; Venturini, James

; Oliveira, Sandra Maria do Valle Leone de

; Paniago, Anamaria Mello Miranda

Revista do Instituto de Medicina Tropical de São Paulo

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2025, Volume 67 elocation e11

Abstract: En | Text: En | PDF: En

ABSTRACT Tuberculosis (TB) is a treatable disease and one of the leading causes of death worldwide, notably affecting people living with the human immunodeficiency virus. The COVID-2019 pandemic worsened TB outcomes, particularly in high-burden countries such as Brazil. Accurate data on the mortality of hospitalized patients is limited. This study aimed to evaluate clinical and epidemiological characteristics and identify mortality risk factors among all hospitalized patients with TB at a tertiary hospital in Midwest Brazil from 2017 to 2019. The median age of the 154 patients included in the study was 48 years (interquartile range: 38–59 years), and the majority were male (74.68%). The main comorbidities were diabetes mellitus and chronic obstructive pulmonary disease; 44 patients (28.57%) were admitted to the intensive care unit (ICU). The mortality rate was 33.12%, and the leading cause of death was septic shock, followed by respiratory failure due to TB. The main factors associated with death were age (p=0.001), central nervous system TB (p=0.026), reduced consciousness (p<0.001), ICU admission (p<0.001), mechanical ventilation (p<0.001), use of vasoactive drugs (VAD) (p<0.001), and duration of VAD use (p=0.038). A high rate of inpatient deaths was observed, reflecting the severity of TB and the challenges in its clinical management. It is imperative to implement strategies to reduce the mortality rate.

https://doi.org/10.1590/s1678-9946202567011

First documentation of Aspergillus welwitschiae in COVID-19-associated pulmonary aspergillosis in the Americas
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Cocio, Tiago Alexandre

; Coelho, Vivian Caso

; Del Negro, Gilda Maria Barbaro Leite, Ingrid Gonçalves Costa Gomes, Davi Carvalho Leal Xavier, Roseli Santos de Freitas Martínez, Roberto Bollela, Valdes Roberto Benard, Gil

Revista do Instituto de Medicina Tropical de São Paulo

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2025, Volume 67 elocation e8

Abstract: En | Text: En | PDF: En

ABSTRACT This study reports the first documented case of COVID-19-associated pulmonary aspergillosis (CAPA) caused by Aspergillus welwitschiae in the Americas, which occurred in a rural area of Sao Paulo State, Brazil. The case involves a 52-year-old woman with COVID-19, hypertension, and dyslipidemia, who was admitted following severe respiratory deterioration. Imaging tests revealed extensive pulmonary involvement, including nodular and cavitary lesions indicative of CAPA. Bronchoalveolar lavage (BAL) analysis identified Aspergillus spp. using morphological and molecular techniques, and sequencing of the benA gene confirmed the isolate as A. welwitschiae, closely related to the reference strain CBS 139.54. Matrix-assisted laser desorption/ionization-time of flight mass spectrometry further validated this identification. Traditionally recognized as a plant pathogen, A. welwitschiae has recently been implicated in human diseases, such as otomycosis, and is increasingly detected in respiratory samples. However, its association with CAPA remains underreported globally, particularly in the Americas. This case highlights the critical importance of accurate fungal diagnosis, as overlapping morphological features among Aspergillus species can hinder clinical management. The identification of A. welwitschiae in this context raises concerns about its potential as an emerging pathogen in agricultural regions, where environmental exposure may drive its epidemiological relevance. Given the growing recognition of A. welwitschiae as a CAPA agent, this report underscores its importance in the epidemiology of the disease and its potential role in regions with high agricultural activity. Accurate identification is essential for guiding targeted interventions and addressing the public health risks posed by this emerging fungal threat toCOVID-19 patients.

https://doi.org/10.1590/s1678-9946202567008

Myiasis infestation in advanced lip squamous cell carcinoma due to COVID-19 pandemic-related treatment delays
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Silva, Lucas Emanuel Macena da

; Lopes, Natália Vitória de Araújo Oliveira, Diego de Sena Costa de Vieira, Luiz Eduardo Marinho Medeiros, Hianne Cristinne de Morais Andrade, Bruno Augusto Benevenuto de Souza, Carolina Carvalho de Cunha, John Lennon Silva Barnabé, Luan Éverton Galdino

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2025, Volume 67 elocation e6

Abstract: En | Text: En | PDF: En

ABSTRACT Myiasis, a condition stemming from the parasitic infestation of Diptera fly larvae, constitutes a complication for cancer patients, particularly those with malignant skin wounds. The factors that contribute to myiasis include old age, inadequate hygiene, poor living conditions, vascular disease, and diabetes. Cases of myiasis in neoplastic wounds in the head and neck region are rare and guidelines or recommendations regarding the best treatment approach remain lacking. Herein, we describe a case of myiasis that developed into an extensive squamous cell carcinoma of the lip in an older male adult due to the delay in oncological treatment stemming from the COVID-19 pandemic. Patients with oral squamous cell carcinoma, especially those residing in rural areas, face a notable risk of developing oral myiasis. Therefore, it is imperative that patients and caregivers adopt strict preventive measures to avoid fly infestations in wounds. Maintaining optimal hygiene (including meticulous cleaning with antiseptic solutions before daily dressing changes) is essential to prevent myiasis. Adequate wound coverage is crucial, especially during warmer seasons.

https://doi.org/10.1590/s1678-9946202567006

An integrative review on treatment guidelines for complicated urinary tract infections: a synthesis of evidence-based recommendations
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Bittencourt, Amanda Azevedo

; Paula, Marina Della Negra de Ribeiro-Pereira, Ana Carolina Padula Batista, Paula de Mendonça Polis, Thales José

Revista do Instituto de Medicina Tropical de São Paulo

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2025, Volume 67 elocation e7

Abstract: En | Text: En | PDF: En

ABSTRACT Urinary tract infections (UTI) lie among the most common bacterial infections worldwide. Since their manifestations can range from laboratory findings (asymptomatic bacteriuria) to septic shock, using appropriate antimicrobial agents is crucial to avoid complications and the misuse of antibiotics. This study aims to review scientific publications and the main guidelines to treat complicated UTI. A literature review was carried out in September 2022 on the LILACS, MEDLINE via PubMed, and SciELO databases. Descriptors, keywords, and MeSH terms were used to develop search strategies. Full documentation meeting the following criteria was included: management of patients with a diagnosis of complicated UTI; guidelines, recommendations, consensus articles, expert opinion articles (with recommendations), and meta-analyses including data from randomized controlled trials; and articles published from 2001 to 2022. Articles published in languages other than English, Spanish, French, and Portuguese and those unrelated to complicated UTI were excluded. After applying the eligibility criteria, 28 studies were included in this review. Fluoroquinolones are the most frequently recommended option for complicated cystitis and pyelonephritis. Guideline recommendations for recurrent UTI include antibiotic prophylaxis and treatment. Guidelines developed to propose treatment strategies for the pediatric population typically stratify cases according to their infection site (upper or lower),and the presence of fever. Guidelines propose different approaches, likely related to local antibiotic resistance and varying clinical manifestations. In this context, antimicrobial stewardship practices are essential to promote the adequate use of antibiotics for complicated UTI and to avoid antimicrobial resistance.

https://doi.org/10.1590/s1678-9946202567007

Gas necrosis and sepsis due to recreational ketamine use
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Bezerra, Alexandre Sacchetti

; Vazquez, Carla Maria Pasquareli Guilherme, Ana Carolina Troise Rodrigues, Ana Beatriz Retamero Crivillari, Murillo Barbosa Queiroz, Wladimir

Revista do Instituto de Medicina Tropical de São Paulo

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2025, Volume 67 elocation e9

Abstract: En | Text: En | PDF: En

ABSTRACT Although ketamine is an FDA-approved drug, its mechanism of action is not fully understood. Currently, there is an increase in its recreational use, causing irreparable social and physical damage. We report the case of a musician who developed sepsis due to gas necrosis in his arm after using veterinary ketamine purchased via the internet. Despite the amputation recommendation, it was possible to save the arm and preserve motor and sensory function. The scientific community, as well as the police and the government, must ponder the prescription, efficacy and safety of ketamine for medical treatments.

https://doi.org/10.1590/s1678-9946202567009

Addressing under-registration in Chagas disease mortality: insights from the SaMi-Trop and REDS cohorts
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Bierrenbach, Ana Luiza

; Oliveira, Claudia Di Lorenzo

; Quintino, Nayara Dornela

; Baldoni, Nayara Ragi

; Moreira, Carlos Henrique Valente

; Ferreira, Ariela Mota

; Silva, Lea Campos de Oliveira da

; Oikawa, Márcio

; Nunes, Maria do Carmo Pereira

; Cardoso, Clareci Silva

; Haikal, Desirée Sant’Ana

; Ghilardi, Fabio de Rose

; Vieira, Thallyta Maria

; Ribeiro, Antonio Luiz Pinho

; Sabino, Ester Cerdeira

Revista do Instituto de Medicina Tropical de São Paulo

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2025, Volume 67 elocation e10

Abstract: En | Text: En | PDF: En

ABSTRACT Chagas disease (ChD) remains a significant public health concern in the Americas, with challenges to accurately assessing its mortality burden due to under-reporting and misclassification. This study aimed to analyze mortality patterns of two cohorts of individuals with ChD—one comprising asymptomatic individuals with positive serology (REDS) and another with patients showing Chagas cardiomyopathy (SaMi-Trop)—to propose a method for estimating the potential under-registration of Chagas-related deaths and to find the factors influencing the identification of ChD as the underlying cause of death. We carried out a retrospective analysis of mortality data from these cohorts together with data on the Brazilian Mortality Information System. Causes of death were classified according to ICD-10 codes, and an expert review was used to find possible Chagas-related deaths. Logistic regression was used to explore predictors of ChD identification considering demographic and clinical variables. Of 2,488 patients, 381 died, 28.9% attributed to ChD, predominantly chronic ChD with cardiac involvement (B57.2). Using our method, we estimated a 53.8% potential under-registration rate for possible Chagas deaths. Males were negatively associated with Chagas disease identification, with an odds ratio of 0.52 (95%CI 0.24–1.1). No other significant associations were found, and the overall significance of the model was low. Our findings provide a potential measurement of under-registration, indicating that it may be substantial. These results underscore the need for improved identification and accurate reporting on death certificates. Strengthening the quality of mortality data is essential to understand Chagas-related mortality and guide public health strategies to reduce its impact.

https://doi.org/10.1590/s1678-9946202567010

Immune thrombocytopenia possibly triggered by multiple tick bites
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Silva-Ramos, Carlos Ramiro

; Prieto-Torres, Andrés Eduardo

; Zuñiga, Abraham Katime

; Cortés-Vecino, Jesús A.

; Ortiz, Bertha Lacouture

; Cuellar, Constanza

; Medina-Lozano, Leidy J.

; Faccini-Martínez, Álvaro A.

Revista do Instituto de Medicina Tropical de São Paulo

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2025, Volume 67 elocation e1

Abstract: En | Text: En | PDF: En

ABSTRACT Immune thrombocytopenia (ITP) is an autoimmune hematological condition characterized by a markedly isolated decrease in platelets without any apparent associated clinical conditions, resulting in bleeding and bruising of the skin, mucous membranes, and major organs. It is often triggered by preceding illness or several immune stimulants such as immunizations, infections, allergic reactions, among others. While uncommon, arthropod bites can trigger acute ITP. Four cases have been reported due to bee stings and insect bites, as well as a case of ITP following honeybee-venom therapy. Here, we report a case of acute ITP possibly triggered by multiple tick bites.

https://doi.org/10.1590/s1678-9946202567001

An unusual cause of unilateral epistaxis: a leech in the nose
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Yaşar, Murat

; Atalay, Fatma

Revista do Instituto de Medicina Tropical de São Paulo

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2025, Volume 67 elocation e12

Abstract: En | Text: En | PDF: En

ABSTRACT Leeches are segmental worms commonly found in fresh water in tropical regions. They can enter the human body via the consumption of contaminated water or through the mouth and nose during washing, generally affecting the upper airway and digestive tract. During the blood-sucking process, the leech releases the anticoagulant enzyme “hirudin” from the wound site into the host’s circulation together with an anesthetic to prevent the host from feeling its attachment. Leech endoparasitism is a very rare cause of epistaxis. We report a case of a living leech lodged in the posterior nasal floor in a patient that presented to the emergency department with unilateral epistaxis and a difficult diagnosis.

https://doi.org/10.1590/s1678-9946202567012

Higher T-bet and IFN-γ expression in advanced chagasic megaesophagus indicates Th1 response in the chronic phase
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Ribeiro, Betânia Maria

; Helmo, Fernanda Rodrigues Rodrigues, Denise Bertulucci Rocha Silva, Marcos Vinícius da Rodrigues Jr, Virmondes

Revista do Instituto de Medicina Tropical de São Paulo

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2025, Volume 67 elocation e4

Abstract: En | Text: En | PDF: En

ABSTRACT Myenteric plexus injury is responsible for the morpho-functional alterations observed in chagasic megaesophagus (CME). The inflammatory response, characterized by elevated synthesis of IFN-γ, TNF-α, and IL-4, contributes to the persistence of parasitism and inflammation. This study assessed the mRNA expression of cytokines, transcription factors, and metalloproteases in subjects with CME. From 2011 to 2017, esophageal samples were collected from 54 subjects with CME (38 advanced and 16 nonadvanced) and eight subjects with idiopathic megaesophagus (IME). The quantitative mRNA expression of TNF-α, IFN-γ, IL-4, IL-10, IL-17, IL-22, IL-23, IL-27, T-bet, ROR-γT, GATA-3, MMP-1, MMP-2, and TIMP-3 genes was analyzed using SYBR Green systems. T-bet expression was significantly higher in the CME group compared to the IME group and the GATA-3 and ROR-γT expression in the CME group, corroborating the higher IFN-γ expression observed in subjects with advanced CME. The increased T-bet and IFN-γ expression in advanced CME reflects the maintenance of a Th1 response in situ and the morpho-functional changes seen in the organ.

https://doi.org/10.1590/s1678-9946202567004

10.

Immunomodulatory effects of Triatoma dimidiata feces on Trypanosoma cruzi infection in a murine model
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Escobar-Laines, Sergio

; Monteon, Victor

; Ramírez-Sarmiento, Carlos

; Macedo-Reyes, Verónica

; Pérez, Floribeth León

Revista do Instituto de Medicina Tropical de São Paulo

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2025, Volume 67 elocation e5

Abstract: En | Text: En | PDF: En

ABSTRACT Trypanosoma cruzi infection involves transmission of metacyclic trypomastigotes through injured skin or mucosa via contaminated feces from insect vectors like Triatoma dimidiata (Latreille, 1811). Currently, there is insufficient information describing the immune response to feces naturally contaminated with metacyclic trypomastigotes. Mice subcutaneously inoculated with tissue-culture derived trypomastigotes (TCT) or T. dimidiata feces containing metacyclic trypomastigotes (MT) or previously multi-exposed (ME) with feces without metacyclic trypomastigotes and then infected with feces containing metacyclic parasites or only T. dimidiata feces (F) was studied from 15 min to three months post-infection. PCR detection of parasite DNA at the inoculation site demonstrated persistence of T. cruzi DNA up to 20 days in MT and TCT but disappeared earlier in the ME test group. A rapid spread of T. cruzi DNA to regional lymph nodes was observed in all experimental groups. A lower amount of amastigote nests in the heart with concomitant intense inflammation was noticed in ME mice in comparison to the MT group. CD4 + T cell subtypes at popliteal lymph nodes shows early Th1 and Th17 responses at seven days in ME mice, whereas Th1, Th17 and Treg predominate in MT mice after three weeks, and feces induces Th1, Th17 and Treg at a later stage. Our study shows that previous exposure to feces prior to infection with T. cruzi helps control parasitism at the inoculation site and in heart tissue, and an early induction of Th1 and Th17 T cell subtypes.

https://doi.org/10.1590/s1678-9946202567005

11.

Bartonellas: could they cause reproductive disorders in humans?
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Silva, Rafaela de Paula

; Drummond, Marina Rovani

; Velho, Paulo Eduardo Neves Ferreira

Revista do Instituto de Medicina Tropical de São Paulo

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2025, Volume 67 elocation e15

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/s1678-9946202567015

12.

Central sterile supply departament management on hospital-associated infections: a systematic review and meta-analysis
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Shuai, Jing

; Liu, Maoyu Hou, Jialing Chen, Yu Jiang, Jun Yu, Jing Yin, Liang

Revista do Instituto de Medicina Tropical de São Paulo

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2025, Volume 67 elocation e16

Abstract: En | Text: En | PDF: En

ABSTRACT Hospital-associated infections (HAIs) pose significant risks in clinical settings, and sterile supply centers management plays a crucial role in infection control. This systematic review and meta-analysis aimed to evaluate the impact of supply center management on the incidence of HAIs and adverse events. The systematic review encompassed studies that compared supply center management protocols with standard care. The PRISMA guidelines were followed to search seven databases for relevant studies. The meta-analysis calculated pooled odds ratios (OR) for HAIs and adverse events, and heterogeneity was assessed using Tau2, Chi-squared, and I2 statistics. Eight studies were included in the final analysis, each assessing intervention efficacy. The results revealed a significant reduction in HAIs (pooled OR=0.3; 95%CI [0.19; 0.49]). Adverse events were also significantly reduced (pooled OR=0.15; 95%CI [0.09; 0.25]). Heterogeneity was low for both HAIs (Tau2=0.00; I2=0%) and adverse events (Tau2=0.04; I2=19%), which indicated a consistent effect across the studies. Sterile supply center management significantly reduced the incidence of HAIs and adverse events. This suggests these interventions are effective in improving clinical outcomes and could be a vital component of infection control strategies in healthcare facilities.

https://doi.org/10.1590/s1678-9946202567016

13.

Eradicating latent tuberculosis: use of interferon gamma release assay and isoniazid/rifapentine in people living with HIV/AIDS
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Monteiro, Mariana Amélia

; Apoliano, Carlos Fernando

; Martins, José Eduardo Rodrigues

; Sunada, Noemia Orii

; Folgosi, Víctor Ângelo

; Nascimento, Najara Ataíde de Lima

; Chimara, Erica

; Veiga, Ana Paula Rocha

; Pereira, Luisa de Oliveira

; Andrade, Luisa Caracik de Camargo

; Tiberto, Larissa

; Ferreira, Maurício Domingues

; Fonseca, Luiz Augusto Marcondes

; Duarte, Alberto José da Silva

; Arakaki-Sanchez, Denise

; Hong, Marisa Ailin

; Casseb, Jorge

Revista do Instituto de Medicina Tropical de São Paulo

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2025, Volume 67 elocation e14

Abstract: En | Text: En | PDF: En

ABSTRACT Tuberculosis (TB) is the most common comorbidity in people living with HIV/AIDS (PLWH), including those under antiretroviral treatment. PLWH are 28 times more likely to develop TB in Brazil, the leading cause of HIV-related deaths globally, with approximately 161,000 reported deaths worldwide in 2023. Early diagnosis of latent tuberculosis infection (LTBI) and prophylactic therapy can reduce TB cases, prevent disease progression, and decrease transmission in high-risk populations. This study assessed the prevalence of LTBI in PLWH using the interferon-gamma release assay (IGRA) and the impact of the 3HP regimen (isoniazid [INH]/rifapentine [RPT]) as prophylactic treatment. Blood samples from 335 PLWH (78% of the 427 in the cohort) were tested for IGRA; 50 PLWH (15%) tested positive and were treated with 3HP. Treatment included 900 mg of INH and 900 mg of RPT in 12 weekly doses according to the Brazilian health guidelines. No specific risk factors, including nadir CD4+T count, age, gender, or antiretroviral therapy (ART), were more frequently observed in the PLWH with LTBI compared to the PLWH without LTBI. All PLWH with LTBI received treatment and no cases of active TB were observed. Our findings highlight the need for wider LTBI screening and treatment among PLWH in the latent phase, emphasizing more stringent approaches for implementing 3HP prophylaxis.

https://doi.org/10.1590/s1678-9946202567014

14.

Prevalent zoonoses in Sao Paulo State, Brazil: the role of bats and molecular diagnosis
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França, Danilo Alves de

; Langoni, Helio

Revista do Instituto de Medicina Tropical de São Paulo

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2025, Volume 67 elocation e17

Abstract: En | Text: En | PDF: En

ABSTRACT This review explores the landscape of prevalent zoonotic diseases in Sao Paulo State, Brazil, focusing on the role of bats as reservoirs and the application of molecular biology in the diagnosis. The zoonoses covered include visceral and cutaneous leishmaniasis, Chagas disease, toxoplasmosis, bartonellosis, Q fever, Brazilian spotted fever, and leptospirosis. Molecular techniques can improve public health responses by accurately identifying pathogens and tracking their transmission dynamics in populations, thus enhancing early detection, characterization of strains, and monitoring of disease outbreaks. By elucidating the epidemiology and molecular aspects of zoonoses associated with bats in Sao Paulo State, we highlight the importance of integrated surveillance systems and multidisciplinary approaches to effectively manage and prevent these diseases.

https://doi.org/10.1590/s1678-9946202567017

15.

A complex case of Nocardia keratitis: challenges in diagnosis and therapy
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Claudia, Maria Astrid

; Zuhria, Ismi

Revista do Instituto de Medicina Tropical de São Paulo

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2025, Volume 67 elocation e19

Abstract: En | Text: En | PDF: En

ABSTRACT Nocardia keratitis is a rare cause of microbial keratitis, primarily affecting patients in tropical and subtropical regions. Its diagnostic challenge arises from this keratitis uncommon presentation, which often mimics other infectious keratitis types, leading to delays in appropriate treatment. This case report aims to elucidate the complexities of diagnosing and managing Nocardia keratitis of a 41-year-old male who had a chronic, progressively worsening wreath-pattern corneal infiltrate and hypopyon following ocular trauma. Initial empirical treatments were ineffective. Diagnostic confirmation via corneal scraping culture enabled targeted antimicrobial therapy. Subconjunctival amikacin and topical tobramycin led to gradual improvement, though complications such as corneal scarring and neovascularization remained, indicating potential need for surgical intervention. This case emphasizes the importance of high clinical suspicion and precise laboratory diagnostics in managing rare cases of Nocardia keratitis. Establishing standardized treatment guidelines for rare ocular infections could improve clinical outcomes.

https://doi.org/10.1590/s1678-9946202567019

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