Genetic variability of Leishmania (Leishmania) infantum causing human visceral leishmaniasis in the Southeastern Brazil

ABSTRACT Leishmania infantum is a protozoan that causes visceral leishmaniasis (VL) in the Americas and some regions of Europe. The disease is mainly characterized by hepatosplenomegaly and fever, and can be fatal. Factors related to the host and parasite can contribute to the transmission of Leishmania and the clinical outcome. The intraspecific genetic variability of L. infantum strains may be one of these factors. In this study, we evaluated the genetic variability of L. infantum obtained from bone marrow smear slides from patients in the Sao Paulo State, Brazil. For this, the minicircle of the kDNA hypervariable region was used as target by Sanger sequencing. By analyzing the similarity of the nucleotides and the maximum likelihood tree (Fasttree), we observed a high similarity (98%) among samples. Moreover, we identified four different profiles of L. infantum. In conclusion, L. infantum strains from Sao Paulo State, Brazil, showed low diversity measured by minicircle of the kDNA hypervariable region.

Visceral Leishmaniasis Revealing Undiagnosed Inborn Errors of Immunity

ABSTRACT Visceral Leishmaniasis (VL) is a potentially fatal disease and may be associated with primary or acquired immunodeficiencies. There are few reports, in the literature, of inborn errors of immunity. Here, we report two cases of VL as a marker of inborn errors of immunity, namely, GATA2 and RAB27A deficiency. Our data suggest that VL patients should be screened for primary immunodeficiency, particularly in cases of VL relapse.

Prevalence of SARS-CoV-2 infection among health care workers in a reference hospital in Brazil

ABSTRACT Health care workers (HCW) are the frontline workforce for COVID-19 patient care and, consequently, are exposed to SARS-CoV-2 infection due to close contact to infected patients. Here, we evaluate the prevalence of SARS-CoV-2 infection among HCW from an infectious disease hospital, reference center for COVID-19 care in the metropolitan area of Sao Paulo city, Brazil. Among 2,204 HCW, 1,417 (64.29%) were subjected to detection of anti-SARS-CoV-2 antibodies by chemiluminescent immunoassay. Out of the total, 271 (19.12%) presented anti-SARS-CoV-2 antibodies. Prevalence varied according to HCW categories. The highest prevalence was observed in workers from outsourced companies, cooks and kitchen assistants, hospital cleaning workers, and maintenance workers. On the other hand, resident physicians and HCW from the institution itself presented lower prevalence (nurses, nursing assistants, physicians, laboratory technicians). Social and environmental factors are important determinants, associated with exposure in the hospital environment, which can determine the greater or lesser risk of infection by pathogens that spread rapidly by air.

Can COVID-19 impact the natural history of paracoccidioidomycosis? Insights from an atypical chronic form of the mycosis

ABSTRACT Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by Paracoccidioides spp. It can occur as an acute/subacute form (A/SAF), a chronic form (CF) and rarely as a mixed form combining the features of the two aforementioned forms in an immunocompromised patient. Here, we report a 56-year-old male patient with CF-PCM who presented with atypical manifestations, including the development of an initial esophageal ulcer, followed by central nervous system (CNS) lesions and cervical and abdominal lymphatic involvement concomitant with severe SARS-CoV-2 infection. He was HIV-negative and had no other signs of previous immunodeficiency. Biopsy of the ulcer confirmed its mycotic etiology. He was hospitalized for treatment of COVID-19 and required supplemental oxygen in the intensive unit. The patient recovered without the need for invasive ventilatory support. Investigation of the extent of disease during hospitalization revealed severe lymphatic involvement typical of A/SAF, although the patient`s long history of high-risk exposure to PCM, and lung involvement typical of the CF. Esophageal involvement is rare in non-immunosuppressed PCM patients. CNS involvement is also rare. We suggest that the immunological imbalance caused by the severe COVID-19 infection may have contributed to the patient developing atypical severe CF, which resembles the PCM mixed form of immunosuppressed patients. Severe COVID-19 infection is known to impair the cell-mediated immune response, including the antiviral response, through T-lymphopenia, decreased NK cell counts and T-cell exhaustion. We hypothesize that these alterations would also impair antifungal defenses. Our case highlights the potential influence of COVID-19 on the course of PCM. Fortunately, the patient was timely treated for both diseases, evolving favorably.

First case report of monkeypox in Brazil: clinical manifestations and differential diagnosis with sexually transmitted infections

ABSTRACT In 2022, an outbreak of monkeypox is being reported in non-endemic areas, with unusual clinical manifestations. The detailed clinical description of the first patient that received the diagnosis of monkeypox in Brazil is reported here, whose clinical manifestations can easily lead to misdiagnosis of sexually transmitted infections. A 41 years old male presented to an emergency room with a vesicular rash with eight days of evolution. He had traveled to Portugal and Spain and reported non-penetrative sexual involvement with three different male individuals. On the third day of symptoms, he sought medical care and received empirical treatment directed to sexually transmitted infections. As the symptoms did not improve, he sought medical attention at an infectious disease referral center presenting, on admission, an ulcerated penile lesion with central necrotic crusts, a disseminated pleomorphic skin rash and an oropharyngeal ulcer. The monkeypox diagnosis was suspected due to the characteristics of the lesions and the history of intimate contact with casual partners, and it was later confirmed by sequencing the almost complete monkeypox genome. The patient was hospitalized for pain control, which required opiate administration. He developed a secondary bacterial infection on the penile lesions, which were treated with oral antibiotics. He was discharged after 14 days, with lesions in process of re-epithelialization. Given the current outbreak, we must consider the possibility of monkeypox in patients with suggestive lesions, anywhere on the body (including the genitals), added to an epidemiological link or history of intimate contact with strangers or casual partners.

Visceral leishmaniasis caused by Leishmania (Leishmania) amazonensis associated with Hodgkin's lymphoma

ABSTRACT Visceral leishmaniasis (VL) is mainly caused by Leishmania (Leishmania) donovani and Leishmania (L.) infantum; however, other Leishmania species have been associated with VL. We report a case of a patient simultaneously diagnosed with VL caused by Leishmania (L.) amazonensis and Hodgkin's lymphoma. After treatment with liposomal amphotericin B and chemotherapy, the patient presented a clinical cure. This case report reinforces the hypothesis that other Leishmania species can cause visceral lesions mainly related to immunosuppression.

Shotgun metagenomic sequencing of the first case of monkeypox virus in Brazil, 2022

ABSTRACT Monkeypox virus (MPXV), a zoonotic virus endemic to the African continent, has been reported in 33 non-endemic countries since May 2022. We report an almost complete genome of the first confirmed case of MPXV in Brazil. Shotgun metagenomic sequencing was completed in 18 hours, from DNA extraction to consensus sequence generation.

Unusual manifestation of genital cutaneous leishmaniasis in an immunocompetent patient from São Paulo, Brazil: A case report

Abstract A 31-year-old male patient developed an ulcer on the glans penis that evolved for three months without healing. We diagnosed it as leishmaniasis using polymerase chain reaction. No immunosuppression or associated diseases were observed. The patient was treated with meglumine antimoniate that cured the lesion in a month post-treatment. Here, we report this case of cutaneous leishmaniasis lesion at the unusual location of glans penis in an immunocompetent individual. The lesion likely developed due to the bite of a vector, highlighting the need for considering cutaneous leishmaniasis among differential diagnosis of sexually transmitted diseases in areas endemic for leishmaniasis.

Aspectos clínicos e tratamento de pacientes com tuberculose ocular presumida em centro de referência de São Paulo, Brasil. Estudo retrospectivo / Clinical description and treatment of patients with presumed ocular tuberculosis in São Paulo, Brazil. Retrospective study

Resumo Objetivo: Descrever aspectos clínicos e esquema terapêutico dos pacientes com tuberculose ocular presumida tratados em um centro de referência em tuberculose de São Paulo. Métodos: Estudo retrospectivo descritivo. O teste exato de Fisher foi realizado quando apropriado. Resultados: A queixa mais comum foi baixa acuidade visual (83,1%), seguida por dor ocular generalizada (25,3%) e visão turva (22,8%). A uveíte posterior foi a apresentação mais comum (35,7%). O tratamento consistiu no esquema atualmente recomendado de rifampicina, isoniazida, pirazinamida e etambutol (RHZE). A prednisona oral foi incluída no tratamento de 37 pacientes, para tratamento da inflamação aguda, embora não tenha diminuído a prevalência de complicações crônicas, em comparação com a recuperação completa (p = 0,1). O diagnóstico precoce (<70 dias) foi associado a maiores taxas de recuperação total (p = 0,005). Não houve significância estatística quando se comparou a terapia de 6 a 9 meses (p = 0,7). Conclusão: A uveíte tuberculosa pode ser tratada por uma terapia com duração de seis meses. Um breve curso de esteroides melhora os sintomas agudos, embora não reduza as complicações a longo prazo.

Abstract Purpose: To analyze and describe the therapy used in presumed ocular tuberculosis in a referral center in São Paulo, Brazil. Methods: Retrospective, descriptive study. Fisher's exact test was performed when appropriate. Results: The most common complaint was low visual acuity (83.1%), followed by generalized ocular pain (25.3%) and blurred vision (22.8%). Posterior uveitis was the most common presentation (35.7%). Treatment consisted of the currently recommended association of rifampin, isoniazid, pyrazinamide, ethambutol (RHZE) regimen. Oral prednisone was included in the treatment of 37 patients for acute inflammation, although it did not significantly decrease the prevalence of chronic complications compared to full recovery (p = 0,1). Early diagnosis (< 70 days) was associated with higher rates of full recovery (p = 0.005). No statistical significance was observed when comparing 6 to 9-month therapy (p = 0.7). Conclusion: Tuberculous uveitis can be treated with a 6-month duration RHZE therapy. A brief course of steroids may improve acute symptoms, although it did not reduce long-term disabilities.

Diversidade clínica e tratamento da leishmaniose visceral / Clinical diversity and treatment of visceral leishmaniasis

A leishmaniose visceral (LV) é causada por protozoários do gênero Leishmania, sendo as duas principais espécies: Leismania (Leishmania) donovani e Leishmania (Leishmania) infantum, as quais tem ocorrência geográfica diversa e estão relacionadas com diversidade de manifestações clinicas e de resposta terapêutica. Notadamente, a LV que ocorre, principalmente, na Índia Sudão, Sudão do Sul, Bangladesh e Etiópia é causada pela espécie L. donovani, enquanto nas Américas e em algumas regiões da África e Europa, a espécie causadora é a L. infantum. A LV causada pela L. (L.) donovani tem um espectro clínico variando de comprometimento visceral à lesão cutânea que ocorre após um episódio de LV, que é a leishmaniose dérmica póskalazar (PKDL), manifestações esta que não é muito frequente na LV causada pela L. infantum. Ademais, a resposta terapêutica é divergente entre essas espécies, visto que na LV causada por L. donovani há pobre resposta ao antimonial pentavalente, configurando um padrão de resistência elevado, enquanto que na LV causada pela L. infantum essa informação não é muito clara. Neste artigo abordamos a diversidade clínica e a resposta terapêutica da LV causada principalmente por L. infantum, que é de ocorrência nas Américas. (AU)

Visceral leishmaniasis (VL) is caused by protozoa of the genus Leishmania, of the species Leismania (Leishmania) donovani and Leishmania (Leishmania) infantum, which occur in different geographic regions and are related to the diversity of clinical manifestations and therapeutic response. Notably, VL occurring mainly in India, Sudan, South Sudan, Bangladesh and Ethiopia is caused by L. donovani, while in the Americas and in some regions of Africa and Europe is caused by L. infantum. Visceral leishmaniasis caused by L. donovani has a clinical spectrum ranging from visceral involvement to cutaneous lesion that occurs after a VL episode, which is post-kala-azar-dermal-leishmaniasis (PKDL), which is not very frequent in the VL caused by L. infantum. In addition, the therapeutic response is divergent among these species, since in VL caused by L. donovani there is poor response to pentavalent antimony, setting a high resistance pattern, whereas in VL caused by L. infantum this information is not very clear. In this article, we discuss the clinical diversity and therapeutic response of VL caused mainly by L. infantum, which is occurring in the Americas. (AU)

Diversidade clínica e tratamento da leishmaniose visceral / Clinical diversity and treatment of visceral leishmaniasis

A leishmaniose visceral (LV) é causada por protozoários do gênero Leishmania, sendo as duas principais espécies: Leismania (Leishmania) donovani e Leishmania (Leishmania) infantum, as quais tem ocorrência geográfica diversa e estão relacionadas com diversidade de manifestações clinicas e de resposta terapêutica. Notadamente, a LV que ocorre, principalmente, na Índia Sudão, Sudão do Sul, Bangladesh e Etiópia é causada pela espécie L. donovani, enquanto nas Américas e em algumas regiões da África e Europa, a espécie causadora é a L. infantum. A LV causada pela L. (L.) donovani tem um espectro clínico variando de comprometimento visceral à lesão cutânea que ocorre após um episódio de LV, que é a leishmaniose dérmica póskalazar (PKDL), manifestações esta que não é muito frequente na LV causada pela L. infantum. Ademais, a resposta terapêutica é divergente entre essas espécies, visto que na LV causada por L. donovani há pobre resposta ao antimonial pentavalente, configurando um padrão de resistência elevado, enquanto que na LV causada pela L. infantum essa informação não é muito clara. Neste artigo abordamos a diversidade clínica e a resposta terapêutica da LV causada principalmente por L. infantum, que é de ocorrência nas Américas.

Visceral leishmaniasis (VL) is caused by protozoa of the genus Leishmania, of the species Leismania (Leishmania) donovani and Leishmania (Leishmania) infantum, which occur in different geographic regions and are related to the diversity of clinical manifestations and therapeutic response. Notably, VL occurring mainly in India, Sudan, South Sudan, Bangladesh and Ethiopia is caused by L. donovani, while in the Americas and in some regions of Africa and Europe is caused by L. infantum. Visceral leishmaniasis caused by L. donovani has a clinical spectrum ranging from visceral involvement to cutaneous lesion that occurs after a VL episode, which is post-kala-azar-dermal-leishmaniasis (PKDL), which is not very frequent in the VL caused by L. infantum. In addition, the therapeutic response is divergent among these species, since in VL caused by L. donovani there is poor response to pentavalent antimony, setting a high resistance pattern, whereas in VL caused by L. infantum this information is not very clear. In this article, we discuss the clinical diversity and therapeutic response of VL caused mainly by L. infantum, which is occurring in the Americas.

Efficiency of noninvasive sampling methods (swab) together with Polymerase Chain Reaction (PCR) for diagnosing American Tegumentary Leishmaniasis

ABSTRACT Traditional diagnostic methods used to detect American Tegumentary Leishmaniasis, such as histopathology using biopsy samples, culture techniques, and direct search for parasites, have low sensitivity and require invasive collection procedures. This study evaluates the efficiency of noninvasive sampling methods (swab) along with Polymerase Chain Reaction (PCR) for diagnosing American Tegumentary Leishmaniasis using skin and mucous samples from 25 patients who had tested positive for leishmaniasis. The outcome of the tests performance on swab samples was compatible with PCR results on biopsy samples. The findings have also shown that PCR-kDNA test is more efficient than PCR-HSP70 and qPCR tests (sensitivity of 92.3%, 40.7%, and 41%, respectively). Given the high sensitivity of the tests and the fact that the sampling method using swabs affords greater patient comfort and safety, it could be said that this method is a promising alternative to conventional biopsy-based methods for the molecular diagnosis of leishmaniasis.

Dinâmica das alterações do baço associadas ao estado clínico de cães com leishmaniose visceral / Dynamic of changes of the spleen associated with the clinical status ofdogs with visceral leishmaniasis

Foram avaliadas as alterações esplênicas de cães com leishmaniose visceral, sintomáticos e assintomáticos, em relação ao número de sinais clínicos observados nestes animais. Cães sintomáticos foram divididos em cinco grupos de acordo com o número de sinais clínicos presentes. Nos grupos com três ou mais sinais, houve hipertrofia e hiperplasia dos cordões esplênicos e depleção de células linfóides da bainha periarteriolar. No grupo de cães com apenas um sinal clínico houve depleção de folículos da polpa branca. Hiperplasia dos folículos foi observada em intensidade maior no grupo de cães mostrando mais de cinco sinais clínicos.Granulomas estavam presentes em maior intensidade no grupo de cães exibindo cinco sinais. Granulações eosinofílicas no citoplasma de células plasmáticas (corpúsculos de Russell) foram significativamente maiores no grupo de cães com cinco sinais clínicos em comparação com aqueles com apenas um, dois, três e quatro sinais clínicos e cães assintomáticos. Os resultados mostram que o baço apresenta profundas alterações morfológicas que podem influenciar a evolução da infecção.

Alterations in the spleen of dogs with symptomatic and asymptomatic leishmaniasis have been evaluated with respect to the number of clinical signs observed in such animals. Symptomatic dogs were divided into five groups according to the number of clinical signs presented. In groups with three or more signs, there was hypertrophy and hyperplasia of the splenic cords and depletion of periarteriolar lymphatic sheath cells. In the group of dog with only one clinical sign, a there was follicle depletion in the white pulp. Follicle hyperplasia was higher in the canine group showing more than five clinical signs. Granulomas were present in a greater quantity in the canine group exhibiting five signs. Eosinophil granulations in the cytoplasm of plasma cells (Russell bodies) were significantly greater in the canine group with five clinical manifestations compared to those with only one, two, three and four manifestations and to asymptomatic dogs. The results show that the spleen undergoes profound morphologic changes that can influence the outcome of infection.