Explore the vast range of titles available.

Zika virus (ZIKV) infection is spreading rapidly within the Americas after originating from an outbreak in Brazil. We describe the current ZIKV infection epidemic in Brazil and the neurological symptoms arising. First cases of an acute exanthematic disease were reported in Brazil’s Northeast region at the end of 2014. In March 2015, autochthonous ZIKV was determined to be the causative agent of the exanthematic disease. As cases of neurological syndromes in regions where ZIKV, dengue and/or Chikungunya viruses co-circulate were reported, ZIKV was also identified in the cerebrospinal fluid of patients with acute neurological syndromes and previous exanthematic disease. By the end of September 2015, an increasing number of infants with small head circumference or microcephaly were noted in Brazil’s Northeast which was estimated to be 29 cases between August and October. ZIKV was identified in blood and tissue samples of a newborn and in mothers who had given birth to infants with microcephaly and ophthalmological anomalies. In 2015, there were an estimated 440,000 - 1,300,000 Zika cases in Brazil. There have been 4,783 suspected cases of microcephaly, most of them in the Northeast of Brazil associated with 76 deaths. The Ministry of Health is intensifying control measures against the mosquito Aedes aegypti and implemented intensive surveillance actions. Further studies are needed to confirm the suspected association between ZIKV infection and microcephaly; to identify antiviral, immunotherapy, or prophylactic vaccine; to introduce diagnostic ELISA testing. Clinical and epidemiological studies must be performed to describe viral dynamics and expansion of the outbreak.

Determine characteristics associated with hospitalization in the acute phase of Chikungunya. Cross-sectional study including data on Chikungunya cases reported in Vitória, Espírito Santo state, Brazil, between March 2016 and December 2021. Hospitalizations accounted for 1.42% (n = 41) of the 2,868 cases included. There were statistically significant differences between hospitalized and non-hospitalized regarding age (P 0.001), which was lower among hospitalized patients, and pregnancy, which was more frequent in the hospitalized group (P 0.010). Patients younger than two years old and older than 65 years corresponded to 31.7% of hospitalizations. Back pain (OR = 0.134; 95% CI = 0.044-0.409) and arthralgia (OR = 0.226; 95% CI = 0.083-0.613) were protective factors for hospitalization. Groups at risk of severe Chikungunya, including those under two and over 65 years of age, may require more hospitalization, even with milder manifestations.

In this scenario, despite the advances in diagnostic methods in recent decades, a well-performed autopsy remains the gold standard methodology for diagnosing the cause of death [4]. Cultural barriers and the reluctance of families to provide informed consent are additional factors contributing to the decline in autopsy numbers. [...]due to the COVID-19 pandemic, some countries have decided not to allow complete autopsies, which limits the proper investigation of the disease pathophysiology and the death confirmations that were not diagnosed during clinical evolution [11]. [...]although verbal autopsy provides a broad approach, its performance for etiological diagnosis is still limited, as it may misclassify some deaths caused by infectious diseases [13]. [...]the minimally invasive autopsy (MIA) has emerged as an innovative strategy. Specifically, in the case of COVID-19 pandemic, in addition to being efficient in establishing the diagnosis of infections, it is a method that offers more safety to the professionals and can be performed with the body closed and surrounded by a plastic cover.

TORCH: Acronym for toxoplasmosis other infections (syphilis, varicella-zoster, parvovirus b19), rubella, cytomegalovirus and herpes infections

Background CoronaVac was the first COVID-19 vaccine deployed at scale in Brazil, yet evidence on its real-world impact and the durability of immune responses in small municipalities remains limited. Understanding vaccine performance in diverse settings is essential for informing public health strategies. This study aimed to evaluate the seroprevalence and durability of the immune response and investigate the real-world impact of the CoronaVac vaccine in adults from a small municipality in Northeast Brazil. Methods This is an analytical, observational, population-based study comprising a cross-sectional seroepidemiological survey and a retrospective cohort analysis conducted in Guaramiranga, Ceará, between September 2021 and August 2022. A total of 1,714 individuals who had received two doses of CoronaVac were included. Serological survey (anti-SARS-CoV-2 IgG), molecular testing (RT‒PCR), and linkage of official vaccinations and notification records were performed. The analyses included Fisher’s Exact Test for categorical comparisons and Poisson regression with robust variance to estimate prevalence ratios. Results The seroprevalence of neutralizing IgG antibodies was 83.1% (95% CI: 79.7–86.0). Seropositivity showed a significant temporal decline, decreasing from 94.3% (≤ 180 days post-vaccination) to 79.4% (181–270 days post-vaccination) ( p  = 0.0012). RT‒PCR positivity was 15.3% (95% CI: 12.8–18.2%), increasing to 29.0% 270 days after the second dose ( p  = 0.0006). In multivariable Poisson regression, time since D2 (PR = 0.9987; p  < 0.001), age (PR = 0.9924; p  < 0.001), and male sex (PR = 0.9176; p  = 0.018) were associated with lower seropositivity. A total of 116 symptomatic cases and 2 severe cases (0.117%) were confirmed, corresponding to an observed incidence of severe disease of 117 per 100,000 person-years (95% CI: 14–422). Conclusions This population-based surveillance study demonstrates that universal CoronaVac vaccination was followed by a robust initial humoral immune response, which subsequently declined over time. The observed low incidence of severe disease in this fully vaccinated population is consistent with protection against severe outcomes. These findings reinforce the need for booster doses and ongoing epidemiological surveillance in small municipalities. Clinical trial number Not applicable.

In 2016/2017 we had a major epidemic of chikungunya (CHIK) in Brazil, with many deaths. We evaluated to factors associated with deaths from CHIK that occurred in the city of Fortaleza, Brazil. A matched case-control study was conducted (1:2), by sex, age (± 5 years) and neighborhood. Cases were CHIK deaths that occurred between January 1 and December 31, 2017, in Fortaleza, Brazil, and which were laboratory confirmed. Controls were laboratory confirmed CHIK patients occurring in the same neighborhood and in the same period, but which did not progress to death. 82 cases of CHIK and 164 controls were included. Considering the clinical history, significant associations were found between other chronic heart diseases (OR 3.8; CI: 1.53-9.26) and chronic kidney disease (OR 12.77; CI: 2.75-59.4). In the multivariate analysis of the variables related to signs and symptoms, fever (OR: 19.23 CI: 1.73-213.78), abdominal pain (OR: 3; 74 CI: 1.06-13.16), apathy (OR: 11.62 CI: 2.95-45.82) and dyspnea (OR: 50.61; CI: 12.37-207.18) were identified with greater likelihood of death from CHIK. It also stood out that altered blood glucose was associated with cases with a worse prognosis (OR: 13.5; CI: 1.3-135.0). Among the laboratory findings, only lymphocytes and albumin were not associated with greater likelihood of death. The factors related with deaths were chronic kidney disease and previous heart disease, presence of fever, abdominal pain, apathy, dyspnea and arthritis and laboratory findings such as leukocytosis, leukopenia, thrombocytopenia, neutropenia and lymphopenia.

Background Co-infections involving dengue virus (DENV) and opportunistic fungal pathogens are rarely reported alongside human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). To our knowledge, no prior cases of DENV and Cryptococcus neoformans coinfection have been documented. This case highlights a novel presentation of concurrent DENV and cryptococcal meningoencephalitis in an immunocompromised host, reinforcing the importance of considering multiple etiologies in patients from tropical regions presenting with neurological symptoms. Case presentation A 21-year-old Brazilian male with previously unknown HIV status presented with fever and signs of meningeal irritation, without neurological deficits. Initial laboratory evaluations revealed lymphopenia, thrombocytopenia, and elevated transaminase levels. DENV infection was confirmed by serological testing (NS1 antigen and IgM positivity) and by cerebrospinal fluid with DENV IgM reactivity, leading to a diagnosis of dengue meningoencephalitis. HIV serology subsequently tested positive. After the initiation of antiretroviral therapy, he developed worsening headaches followed by neurological deficits. A second lumbar puncture confirmed cryptococcal meningitis by India ink staining and multiplex PCR, with additional confirmation by fungal culture. The patient was diagnosed with concomitant dengue fever and cryptococcal meningoencephalitis. Conclusions This is the first reported case of concurrent DENV and C. neoformans meningoencephalitis in a patient with HIV. The overlapping symptomatology of arboviral and opportunistic infections can complicate diagnosis, particularly in endemic areas with limited resources. This case underscores the importance of maintaining a broad differential diagnosis in patients presenting with systemic and neurological symptoms who are immunocompromised, especially in tropical regions where multiple pathogens may co-circulate. Awareness of unusual co-infections is essential to ensure timely diagnosis and appropriate management, ultimately improving patient outcomes. Clinical trial number Not applicable.

We report the behavioral changes in use of oviposition sites in Aedes aegypti in Fortaleza, Brazil. We evaluated the relationship between different types of breeding sites and changes in use from 2001 to 2012. More than 40% of the infested breeding sites were used to store water. We observed a three-fold reduction in the infestation of water tanks (p = 0.038) and more than nine-fold in tires (p = 0.035). The proportion of infested plant pots increased six-fold (p < 0.001). Infested breeding sites changed over time from domestic water tanks to small-volume breeding sites.

Chagas disease (CD) is currently considered a neglected disease; hence, identifying the factors associated with its high prevalence is essential. This study aimed to identify the seroprevalence of and the possible factors associated with CD in inhabitants of the City of Limoeiro do Norte, Northeastern Brazil. Between April and November 2013, blood collection was conducted and a semi-structured questionnaire was administered. Blood samples that showed positive or possible serology for anti-Trypanosoma cruzi antibodies based on indirect immunofluorescence, hemagglutination indirect, and an enzyme-linked immunosorbent assay were analyzed. Associations between CD positivity and the study variables were analyzed using prevalence ratios (PR) with 95% confidence intervals (CI). A total of 812 individuals were analyzed, of which T. cruzi seropositivity was determined in 4.2% (34 individuals). Sociodemographic variables showing a significant association with T. cruzi positivity included age >50 years (PR = 27.6; 95% CI = 6.66-114.4), elementary level education (PR = 5.15; 95% CI = 1.83-14.47), and retirement (PR = 7.25; 95% CI = 3.72-14.14). Positivity for T. cruzi was 6.17 times higher in those who had a history of living in rammed earth houses compared with those who did not (95% CI = 2.19-17.37). There was no evidence of vertical transmission in the individuals studied. Among the individuals infected with T. cruzi, the majority reported having a comorbidity (p < 0.01). This study demonstrated the seroprevalence of CD and identified factors associated with a high prevalence of CD.