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The Brazilian Northern region registered a high incidence of COVID-19 cases, particularly in the state of Pará. The present study investigated the risk factors associated with the severity of COVID-19 in a Brazilian Amazon region of 100,819 cases. An epidemiological, cross-sectional, analytical and demographic study, analyzing data on confirmed cases for COVID-19 available at the Brazilian Ministry of Health's surveillance platform, was conducted. Variables such as, municipalities of residence, age, gender, signs and symptoms, comorbidities were included and associated with COVID-19 cases and outcomes. The spatial distribution was performed using the ArcGIS program. A total of 100,819 cases were evaluated. Overall, patients had the mean age of 42.3 years, were female (51.2%) and with lethality reaching 4.79% of cases. Main symptoms included fever (66.5%), cough (61.9%) and sore throat (39.8%). Regarding comorbidities, most of the patients presented cardiovascular disease (5.1%) and diabetes (4.2%). Neurological disease increased risk of death by nearly 15 times, followed by obesity (5.16 times) and immunodeficiency (5.09 time). The municipalities with the highest incidence rate were Parauapebas, Canaã dos Carajás and Jacareacanga. Similarity between the Lower Amazon, Marajó and Southwest mesoregions of Pará state were observed concerning the highest morbidity rates. The obtained data demonstrated that the majority of cases occurred among young adults, females, with the classic influenza symptoms and chronic diseases. Finally, data suggest that the highest incidences were no longer in the metropolitan region of the state. The higher lethality rate than in Brazil may be associated with the greater impacts of the disease in this Amazonian population, or factors associated with fragile epidemiological surveillance in the notification of cases of cure.

Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Universidade do Estado do Par?. Program in Parasitic Biology in the Amazon. Bel?m, PA, Brasil. Universidade do Estado do Par?. Program in Parasitic Biology in the Amazon. Bel?m, PA, Brasil Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Centro Universit?rio do Estado do Par?. Department of Medicine. Bel?m, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Universidade do Estado do Par?. Program in Parasitic Biology in the Amazon. Bel?m, PA, Brasil. Abstract: In 2018, 208,619 new cases of leprosy were reported to the World Health Organization (WHO). Of these, 30,957 occurred in the Americas region and 28,660 (92.6% of the total in the Americas) were reported in Brazil. This study aimed to show the reality of the profile of a population in an endemic leprosy area in northern Brazil in relation to age, gender, and bacillus Calmette?Gu?rin (BCG) vaccination status through the collection of data in the field with the evaluation of the study individuals, who were recruited by spontaneous demand. A total of 405 individuals participated in the study, with 100 multibacillary, 57 paucibacillary, and 248 healthy contacts. A relationship was observed between the occurrence of the disease, as well as the multibacillary form with the largest age group. The male gender was associated with leprosy per se, with the multibacillary form and was the largest representative of the group that was not vaccinated once. BCG vaccination was effective both in protecting against leprosy per se and in the multibacillary form. These results are limited by sample size, may not be conclusive, and will need further confirmation in a larger cohort.

IntroductionThe disparities in the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among frontline health care workers (HCWs) and the unique work circumstances are poorly documented for low-and middle-income countries.MethodsWe assessed the frequency of SARS-CoV-2 infection, personal protective equipment (PPE) shortages, PPE use, and accidents involving biological material among HCWs in the Recife metropolitan area, Northeast Brazil. Using respondent driven sampling, we included HCWs attending suspected or confirmed COVID-19 patients from May 2020 to February 2021.ResultsWe analyzed 1,525 HCWs (527 physicians, 471 registered nurses, 263 nursing assistants/technicians, and 264 physical therapists). Women predominated in all categories (81.1%). Nurses were older and had more comorbidities (hypertension and overweight/obesity) than the other HCWs. The overall prevalence of SARS-CoV-2 infection was 61.8% after adjustment for the cluster random effect, weighted by network, and reference population size. The independent risk factors for a positive RT-PCR test were being a nursing assistant (OR adjusted: 2.56), not always using all recommended PPE in routine practice (ORadj: 2.15), and reporting a splash of biological fluid/respiratory secretion in the eyes (ORadj: 3.37).ConclusionsThe high risk of infection among HCWs reflects PPE shortages and younger, possibly less experienced, frontline HCWs. There were disparities in the risk of SARS-CoV-2 infection among HCWs, with nursing assistants being the most vulnerable, possibly due to their longer and frequent contact with COVID-19 patients.

Malaria is an acute febrile infectious disease that represents an important public health problem in the Brazilian amazon region. The present study described the socio-epidemiological and spatial characteristics of malaria in a population from the Tapajós mining areas, Pará, Brazilian Amazon. A cross-sectional study, including individuals from Itaituba city, an area under mining activity influence, was conducted. The geographic coordinates were obtained in the field using the Global Positioning System (GPS) Garmin 78csx, for spatial analysis, we used the Kernel Density Estimator with the application of scanning statistics with the SaTScan software. Of the 908 individuals, 311 were positive for malaria. Most of the malaria cases were associated with male individuals, gold miners and with a monthly income of 4-6 salaries. Binary logistic regression analysis demonstrated that gold miners were nearly five times more likely to acquire malaria. In addition, a context of risk for sexually transmitted infections, substance abuse and poor support conditions was observed, worsening the healthcare scenario in this endemic area for malaria. The spatial distribution of malaria cases is irregular in the municipality with hotspot areas located in the Amana Flona that coincide with areas of illegal mining and high human mobility. Finally, the presented socio-epidemiological and spatial distribution data may aid in the development of more effective control measures for malaria in the area.

Introduction: In the Americas, Brazil contributes 91.63% of the total cases and the state of Para still has high endemia for leprosy. Objective: To analyze the performance of a rapid test for the diagnosis and epidemiological surveillance of leprosy in endemic areas. Methods: The sample consisted of 70 MB multibacillary leprosy (MB) patients, 63 paucibacillary (PB) patients, and 80 intradomiciliary consanguineous contacts (ICSCO) of patients. A rapid test with a 15-minute reading was applied using two prototypes: prototype 1, double test with trisaccharide antigen (NT-P-BSA) at 1a. line (83.2 ng/test) and disaccharide antigen (ND-O-BSA) at 2a. (83.2 ng/test), both with a flow of 0.08 μL/mm with a 10 μC membrane, anti-IgM conjugate with a flow of 0.040 μL/mm and a Tris-Triton and prototype 2 runner buffer with MIX antigen (trisaccharide + disaccharide) in the same concentrations and conditions of prototype 1. Results: The comparison of the MIX test positivity rate and the disaccharide or trisaccharide doublet test across all samples was statistically significant, demonstrating that the MIX test had higher seropositivity rates compared to the ND-O-BSA or NT-P-BSA. It was demonstrated that the MIX test showed a good performance, with 25.39% of the PB patients negative for the disaccharide and trisaccharide duplet test, but positive for MIX. Conclusions: These data suggest the potential for further optimizing the performance by adding other synthetic antigens to the MIX antigens.

Funding: This research was funded by the National Council for the Improvement of Higher Education (CAPES), grant number 1660892 and the Amazon Foundation for Support to Studies and Research (FAPESPA), grant number 88887.358315. Universidade do Estado do Par?. Programa de P?s-Gradua??o em Biologia Parasit?ria na Amaz?nia. Bel?m, PA, Brazil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Programa de P?s-Gradua??o em Epidemiologia e Vigil?ncia em Sa?de. Ananindeua, PA, Brasil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Funda??o Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Programa de P?s-Gradua??o em Pesquisa Cl?nica em Doen?as Infecciosas. Rio de Janeiro, RJ, Brazil. Secretaria de Sa?de do Estado do Par?. Belem, PA, Brazil. Secretaria de Sa?de do Estado do Par?. Belem, PA, Brazil. Universidade do Estado do Par?. Programa de P?s-Gradua??o em Biologia Parasit?ria na Amaz?nia. Bel?m, PA, Brazil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Programa de P?s-Gradua??o em Epidemiologia e Vigil?ncia em Sa?de. Ananindeua, PA, Brasil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Universidade Federal do Par?. Programa de P?s-Gradua??o em Sa?de, Ambiente e Sociedade. Belem, PA, Brazil. Coordena??o Geral de Vigil?ncia das Doen?as de Transmiss?o Respirat?ria de Condi??es Cr?nicas. Rio de Janeiro, PA, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Programa de P?s-Gradua??o em Epidemiologia e Vigil?ncia em Sa?de. Ananindeua, PA, Brasil . Universidade do Estado do Par?. Programa de P?s-Gradua??o em Biologia Parasit?ria na Amaz?nia. Bel?m, PA, Brazil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Abstract: Tuberculosis (TB) is an infectious communicable disease, which despite global efforts, still needs special attention in regions with difficult access. This study aims to describe the spatial and epidemiological trends of TB incidences from 2013 to 2018 in Maraj? Island, the Amazonian region, Par?, Brazil. We have obtained secondary data from the Brazilian TB databases and performed geospatial and statistical analyses on the data for new TB cases, relapses, and re-admissions. From 2013 to 2018, 749 new cases were reported, in which the diagnostics (culture) was not performed for 652 (87.2%) patient samples, the drug resistance test (DST) was performed for nine (1.2%) samples, and one (0.13%) was multidrug-resistant TB (MDR-TB). The rapid molecular testing (RMT) was performed on 40 (5.3%) patient samples, with results indicating that eight (20%) were susceptible to rifampicin and two (5%) were rifampicin resistant. Overall, the cure rate was 449 (66.7%), while relapses and re-admissions were 41 and 44, respectively. On the geospatial distribution, the municipality of Soure stands out with a high number of incidences, relapses, and re-admissions. Spatially, the eight MDR cases were randomly distributed. Our data highlight the urgent need for TB control measures in this region, by introducing the Xpert-Ultra? MTB/RIF (Cepheid, Sunnyvale, CA, United States) and Ogawa-Kudoh.

Secretariat of Health Surveillance (SVS), Brazilian Ministry of Health (MS), Evandro Chagas Institute (IEC); Coordination for the Improvement of Higher Education Personnel (CAPES/Brazil) and National Council for Scientific and Technological Development (CNPq/Brazil). State University of Para. Program in Parasitic Biology in the Amazon Region. Belem, PA, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. University Center of the State of Para. Belem, PA, Brazil. State University of Para. Program in Parasitic Biology in the Amazon Region. Belem, PA, Brazil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. State University of Para. Program in Parasitic Biology in the Amazon Region. Belem, PA, Brazil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. State University of Para. Program in Parasitic Biology in the Amazon Region. Belem, PA, Brazil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Programa de P?s-Gradua??o em Epidemiologia e Vigil?ncia em Sa?de. Ananindeua, PA, Brasil. The transmission and evolution of leprosy depends on several aspects, including immunological and genetic factors of the host, as well as genetic factors of Mycobacterium leprae. The present study evaluated the association of single nucleotide polymorphisms (SNPs) on the FokI (rs2228570), TaqI (rs731236), ApaI (rs7975232) regions of the vitamin D receptor (VDR) gene with leprosy. A total of 405 individuals were evaluated, composed by groups of 100 multibacillary (MB) and 57 paucibacillary (PB) patients, and 248 healthy contacts. Blood samples were collected from patients and contacts. The genotyping was performed by sequencing of the interest regions. The alleles of the studied SNPs, and SNP FokI genotypes, were not associated with leprosy. For the SNP on TaqI region, the relationship between the tt genotype, and for the SNP ApaI, the AA genotype, revealed an association with susceptibility to MB form, while Aa genotype with protection. The extended genotypes AaTT and AaTt of ApaI and TaqI were associated with protection against MB form. Further studies analyzing the expression of the VDR gene and the correlation with its SNPs might help to clarify the role of polymorphisms on the immune response in leprosy.

Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Programa de P?s-Gradua??o em Epidemiologia e Vigil?ncia em Sa?de . Ananindeua, PA, Brasil. Universidade do Estado do Par?. Programa de P?s-Gradua??o em Biologia Parasit?ria na Amaz?nica. Bel?m, PA, Brasil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Universidade do Estado do Par?. Programa de P?s-Gradua??o em Biologia Parasit?ria na Amaz?nica. Bel?m, PA, Brasil. Universidade do Estado do Par?. Programa de P?s-Gradua??o em Biologia Parasit?ria na Amaz?nica. Bel?m, PA, Brasil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Universidade do Estado do Par?. Programa de P?s-Gradua??o em Biologia Parasit?ria na Amaz?nica. Bel?m, PA, Brasil. Universidade do Estado do Par?. Programa de P?s-Gradua??o em Biologia Parasit?ria na Amaz?nica. Bel?m, PA, Brasil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Secretaria de Estado de Sa?de P?blica do Par?. Bel?m, PA, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Programa de P?s-Gradua??o em Epidemiologia e Vigil?ncia em Sa?de . Ananindeua, PA, Brasil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Laborat?rio de Geoprocessamento. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Programa de P?s-Gradua??o em Epidemiologia e Vigil?ncia em Sa?de . Ananindeua, PA, Brasil / Universidade do Estado do Par?. Programa de P?s-Gradua??o em Biologia Parasit?ria na Amaz?nica. Bel?m, PA, Brasil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Cardiovascular Diseases represent the main cause of death in the world, and are associated with risk factors that cause serious complications in cases of infections, such as those of the respiratory tract. In March 2020 the World Health Organization declared a pandemic for SARS-CoV-2, a new coronavirus causing severe pneumonia, which emerged in December 2019 in Wuhan, China. The objective is to investigate the occurrence of cardiovascular complications associated with SARS-CoV-2 infection. It is a systematic review, quantitative, in the databases, PubMed and Science direct, including primary studies with hospitalized patients confirmed for COVID-19 and who presented cardiovascular complications, the form used tools for evaluation of quality and evidence, following the PRISMA recommendations. Results: 12 studies were included. The occurrence of cardiovascular complications was: 27.35% of the sample of 3,316 patients. Types: Acute cardiac injury 17.09%; Thromboembolism 4.73%; Heart failure 3.43%; Arrhythmias 1.77%; stroke 0.33%. Mean age 61 years. Conclusions: This study showed that there are several cardiovascular complications associated with SARS-CoV-2, that the main one is acute cardiac injury, which causes several instabilities in the cardiopulmonary system, and that it is associated with mortality.

Federal University of Cear?. School of Medicine. Department of Pathology and Legal Medicine. Fortaleza, CE, Brazil. Federal University of Cear?. School of Medicine. Department of Pathology and Legal Medicine. Fortaleza, CE, Brazil. Federal University of Cear?. School of Medicine. Department of Pathology and Legal Medicine. Fortaleza, CE, Brazil. Cear? State University. Center for Health Sciences. Fortaleza,CE, Brazil. Federal University of Cear?. School of Medicine. Department of Pathology and Legal Medicine. Fortaleza, CE, Brazil. Dona Libania National Reference Center in Sanitary Dermatology. Fortaleza, CE, Brazil Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Federal University of Cear?. School of Medicine. Department of Pathology and Legal Medicine. Fortaleza, CE, Brazil. Objectives: To investigate the subclinical infection of leprosy in contacts younger than 15 years old of new leprosy cases diagnosed at the Dona Libania Dermatology Center in Fortaleza, Ceara. Methods: This was a cross-sectional study involving 69 leprosy cases and 101 household contacts under 15 years old. Nasal secretion samples were collected in order to investigate the Bacilloscopic Index (BI) for M. leprae and to detect the DNA of the bacilli; we also investigated the seropositivity of the IgM antibody to the PGL1 antigen through the ML-Flow technique. Results: Evaluating the positivity of all three techniques used in the study, we obtained a frequency of 33.7% for ML-Flow, 16.1% for PCR of DNA and 1.98% for BI in nasal secretion. The positivity for RLEP PCR and in the anti-PGL-1 indicates stimulation of the immune response and consequent subclinical infection. In our study, all positive BI cases were also RLEP PCR positive, which confirms the presence of the bacillus in the nasal mucosa of the studied contacts. The seropositivity to anti-PGL-1 was higher among the female sex, the ones between 11 and 15 years old and among the contacts of paucibacillary (PB) cases. Conclusions: Such techniques when used together help the monitoring of contacts with greater risk of developing the disease, especially in childhood.

Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior ? Brazil (CAPES), Instituto Evandro Chagas/MS/SVS and Funda??o para o desenvolvimento cient?fco e tecnol?gico em sa?de [PRES-012-FIO-16]; CAPES ? Finance Code 001, [194?88881.187587/2018?01, 2018].; German Center for Infection Research (DZIF). European Society of Clinical Microbiology and Infectious Diseases, for which we would like to would like to acknowledge the Study Group for Mycobacterial Infections and Funda??o para a Ci?ncia e Tecnologia (UID/DTP/04138/2019). CEECIND/00394/2017. State University of Par?. Bel?m, PA, Brazil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Universidade de Lisboa. Faculty of Pharmacy. Research Institute for Medicines. Lisbon, Portugal. Federal University of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Oswald Cruz Foundation. Rio de Janeiro, RJ, Brazil. State University of Par?. Bel?m, PA, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. State University of Par?. Bel?m, PA, Brazil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Universidade de Lisboa. Faculty of Pharmacy. Research Institute for Medicines. Lisbon, Portugal. French Agency for Food, Environmental and Occupational Health and Safety. Maisons-Alfort, France. French Agency for Food, Environmental and Occupational Health and Safety. Maisons-Alfort, France. Leibniz Research Center Borstel. Borstel, Germany / German Center for Infection Research. Heidelberg, Germany. Research Center Borstel Leibniz Lung Center. National Reference Center for Mycobacteria. Borstel, Germany / London School of Hygiene and Tropical Medicine. London, UK / London School of Hygiene and Tropical Medicine. Clinical Research Department. London, UK. Federal Rural University of Amazon. Bel?m, PA, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Universidade de Lisboa. Faculty of Pharmacy. Research Institute for Medicines. Lisbon, Portugal. Universidade de Lisboa. Faculty of Pharmacy. Research Institute for Medicines. Lisbon, Portugal. State University of Par?. Bel?m, PA, Brazil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Lack of routine surveillance in countries endemic for bovine tuberculosis (TB) and limited laboratory support contributes to the inability to differentiate the Mycobacterium tuberculosis Complex species, leading to an underestimated burden of the disease. Here, Whole-Genome Sequencing of Mycobacterium bovis isolated from tissues with TB-like lesions obtained from cattle and buffalos at Maraj? Island, Brazil, demonstrates that recent transmission of M. bovis is ongoing at distinct sites. Moreover, the M. bovis epidemiology in this setting is herein found to be dominated by an endemic and unique clade composed of strains evolved from a common ancestor that are now genetically differentiated from other M. bovis clades. Additionally, envisioning a rapid strain differentiation and tracing across multiple settings, 28 globally validated strain-specific SNPs were identified, three of which considered as robust markers for the M. bovis Maraj? strain. In conclusion, this study contributes with data regarding the identification of a novel M. bovis phylogenetic clade responsible for ongoing transmission events in both cattle and buffalo species in Brazil, provides a framework to investigate the dissemination of this highly prevalent strain and, holds the potential to inform TB control strategies that may help to prevent the spread of bovine and zoonotic TB.

This research was supported by funding from the Funda??o de Amparo ? Pesquisa do Par?/Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (FAPESPA/CAPES) [Cooperation grant N?017/2014], Programa Institucional de Bolsas de Inicia??o Cient?fica/Funda??o Amaz?nia Paraense de Amparo ? Pesquisa/Universidade do Estado do Par? (FAPESPA/UEPA) [Cooperation grant N?001/2017/PPGBPA], Funda??o de Amparo ? Pesquisa do Par?/Universidade do Estado do Par? (FAPESPA/UEPA) [Cooperation grant N?004/2019] and the Instituto Evandro Chagas/Minist?rio da Sa?de/Secretaria de Vigil?ncia em Sa?de (IEC/MS/SVS) State University of Par?. Center of Biological and Health Sciences. Parasite Biology in the Amazon Region . Bel?m, PA, Brasil. State University of Par?. Center of Biological and Health Sciences. Parasite Biology in the Amazon Region . Bel?m, PA, Brasil. State University of Par?. Center of Biological and Health Sciences. Parasite Biology in the Amazon Region . Bel?m, PA, Brasil. State University of Par?. Center of Biological and Health Sciences. Parasite Biology in the Amazon Region . Bel?m, PA, Brasil. State University of Par?. Center of Biological and Health Sciences. Parasite Biology in the Amazon Region . Bel?m, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Programa de P?s- Gradua??o em Epidemiologia e Vigil?ncia em Sa?de. Ananindeua, PA, Brasil. State University of Par?. Center of Biological and Health Sciences. Parasite Biology in the Amazon Region . Bel?m, PA, Brasil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. State University of Par?. Center of Biological and Health Sciences. Parasite Biology in the Amazon Region . Bel?m, PA, Brasil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Abstract: Klebsiella pneumoniae appears as one of the most prevalent pathogens among cancer patients. The present study investigates the clinical, epidemiological and microbiological aspects related to infections caused by K. pneumoniae in cancer patients treated at an oncology referral center in the state of Par?, Amazon region, Brazil. Between July 2017 to July 2019, an epidemiological, observational, cross-sectional study, with a descriptive and analytical approach was conducted, including patients with confirmed diagnosis of cancer who acquired infection by K. pneumoniae 72 h after hospital admission. K. pneumoniae isolates included in the study were obtained from different clinical materials (blood, urine, catheter tip and bladder catheter, orotracheal secretions, oncological and surgical wounds). Antimicrobial susceptibility testing and molecular detection of the carbapenemase-encoding genes were performed. A high prevalence of MDR K. pneumoniae isolates was observed, including two colistin-resistant isolates and seven isolates harboring blaKPC-1 gene. To conclude, our findings provide the firsts insights into the epidemiology and infection by K. pneumoniae in the state of Par?, Brazil, and may be useful on treatment guidance and establishment of strategies to control the spread of resistance strains of K. pneumoniae in the region.

Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Bel?m, PA, Brasil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Programa de P?s-Gradua??o em Epidemiologia e Vigil?ncia em Sa?de. Bel?m, PA, Brasil. Fluminense Federal University. Department of Microbiology and Parasitology. Niter?i, RJ, Brazil. State University of Par?. Postgraduate Program in Parasitic Biology in the Amazon. Bel?m, PA, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Bel?m, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Bel?m, PA, Brasil / State University of Par?. Postgraduate Program in Parasitic Biology in the Amazon. Bel?m, PA, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Bel?m, PA, Brasil / State University of Par?. Postgraduate Program in Parasitic Biology in the Amazon. Bel?m, PA, Brazil. This study aimed to verify the relationship between the polymorphisms of the cytokines TNF-? rs1800629; IFN-? rs2430561; TGF-? rs1982073 e rs1800471; IL-6 rs180079 e IL-10 rs1800896, rs1800871 and rs1800872 and leprosy. Blood samples were analyzed from 106 individuals, of whom 24 were paucibacillary (PB), 28 were multibacillary (MB), 32 intradomiciliary consanguineal contacts of patients (CCOSI) and 22 intradomiciliary non-consanguineal contacts of patients (CNCOSI). Analysis of cytokine polymorphisms typified by the polymerase chain reaction (PCR) technique. For TGF?, a tendency to associate the presence of the C allele at rs1982073 with leprosy was demonstrated, with the T allele being most frequently found in the CCOSI (p = .056). For the polymorphisms IL-10 we found an association of the GCC/GCC genotype with the susceptibility to the disease and the A-allele rs1800896 with the leprosy protection. Greater predominance was found of ACC / ATA (31.3%) and GCC / ATA (37.5%) (p = .03) and the A-allele rs1800896 (76.85%) (p = .043) in the CCOSI groups, while the GCC/GCC was found in the MB group (22.2%) (p = .05). For the other cytokines's SNPs there were no associations with susceptibility to leprosy.These results are limited by sample size, may not be conclusive and will need further confirmation in a larger cohort.

Brazilian Ministry of Health, through the Secretariat for Health Surveillance and the Department of Prevention, Surveillance and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis (Projeto # 914BRZ1138, BRAZIL, AIDS-SUS) Tulane University, Global Community Health and Behavioral Sciences. New Orleans. LA, United States / Universidade Federal do Cear?. Faculdade de Medicina. Sa?de Comunit?ria. Fortaleza, CE, Brazil. Universidade Federal do Cear?. Faculdade de Medicina. Sa?de Comunit?ria. Fortaleza, CE, Brazil. Universidade Federal do Cear?. Departamento de Estat?stica e Matem?tica Aplicada. Fortaleza, CE, Brazil. Universidade Federal de Minas Gerais. Medicina Preventiva e Social. Belo Horizonte, MG, Brazil. Universidade Federal do Rio Grande do Sul. Departamento de Sociologia. Porto Alegre, RS, Brazil. Universidade de Bras?lia. Faculdade de Ci?ncias da Sa?de, Sa?de Coletiva. Bras?lia, DF, Brazil. Universidade Federal da Bahia. Instituto de Sa?de Coletiva. Salvador, BA, Brazil. Faculdade de Ci?ncias M?dicas da Santa Casa de S?o Paulo. Departamento de Sa?de Coletiva. S?o Paulo, SP, Brazil. Centro de Pesquisas Aggeu Magalh?es. Departamento de Sa?de Coletiva. Recife, PE, Brazil. Universidade Federal do Rio de Janeiro. Instituto de Psicologia. Rio de Janeiro, RJ, Brazil. Universidade Federal do Cear?. Faculdade de Medicina. Fortaleza, CE, Brazil. Universidade Federal do Rio Grande do Sul. Departamento de Medicina Social. Porto Alegre, RS, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Laborat?rio de Biologia Molecular. Ananindeua, PA, Brasil. Centro Universit?rio Aut?nomo do Brasil. Curitiba, PR, Brazil. Secretaria de Sa?de do Estado do Cear?. Fortaleza, CE, Brazil. Funda??o Alfredo da Matta. Manaus, AM, Brazil. Universidade de Bras?lia. Centro de Ci?ncias da Sa?de. Bras?lia, DF, Brazil. Instituto Adolfo Lutz. S?o Paulo, SP, Brazil. Minist?rio da Sa?de. Departamento de Vigil?ncia. Preven??o e Controle das IST, do HIV/Aids e das Hepatites Virais. Bras?lia, DF, Brazil. Introduction: This paper details the methods used in the second national Biological and Behavioral Surveillance Survey (BBSS) of HIV, syphilis, and hepatitis B and C among men who have sex with men in Brazil. Methods: Respondent-driven sampling (RDS) was used in 12 cities in 2016. The targeted sample size was initiated with five to six seeds in each city. HIV, syphilis, and Hepatitis B and C rapid tests were offered to participants. RDS Analyst with Gile?s successive sampling (SS) estimator was used to adjust results as recommended and a weight for each individual was generated for further analysis. Data for the 12 cities were merged and analyzed using Stata 14.0 complex survey data tools with each city treated as its own stratum. Results: Duration of data collection varied from 5.9 to 17.6 weeks. 4,176 men were recruited in the 12 cities. Two sites failed to achieve targeted sample size due to a six-month delay in local IRB approval. No city failed to reach convergence in our major outcome variable (HIV). Conclusion: The comprehensive BBSS was completed as planned and on budget. The description of methods here is more detailed than usual, due to new diagnostic tools and requirements of the new STROBE-RDS guidelines. Introdu??o: Este artigo detalha os m?todos utilizados na segunda Pesquisa Nacional de Vigil?ncia Biol?gica e Comportamental (BBSS) do HIV, s?filis e hepatite B e C entre os homens que fazem sexo com homens no Brasil. M?todos: O m?todo Respondent-driven Sampling (RDS) foi utilizado em 12 cidades em 2016. A amostra foi iniciada com cinco a seis sementes em cada cidade. Testes r?pidos para o HIV, s?filis e Hepatite B e C foram oferecidos aos participantes. O software RDS Analyst com o estimador de amostragem sucessiva (SS) de Gile foi utilizado para ajustar os resultados como recomendado, gerando um peso para cada indiv?duo para an?lises. Osdados das 12cidades foram unidos em um ?nico banco e analisados usando as ferramentas de dados complexos do Stata 14.0, com cada cidade sendo tratada como seu pr?prio estrato. Resultados: A dura??o da coleta de dados variou de 5,9 a 17,6 semanas e 4.176 homens foram recrutados nas 12 cidades. Dois sites n?o alcan?aram o tamanho da amostra alvo devido a uma demora de seis meses na aprova??o local do Comit? de ?tica. Todas as cidades atingiram a converg?ncia na principal vari?vel estudada (HIV). Conclus?o: O BBSS foi representativo e conclu?do conforme planejado e dentro do or?amento. A descri??o dos m?todos aqui ? mais detalhada do que o habitual, devido ?s novas ferramentas e requisitos de diagn?stico das novas diretrizes do STROBE-RDS

Universidade Federal Cear?. Faculdade de Medicina. Departamento de Cirurgia e Maternidade Escola Assis Chateaubriand. Fortaleza, CE, Brasil. Universidade Federal Cear?. Faculdade de Medicina. Departamento de Cirurgia e Maternidade Escola Assis Chateaubriand. Fortaleza, CE, Brasil. Universidade Federal Cear?. Faculdade de Medicina. Departamento de Patologia e Medicina Legal. Fortaleza, CE, Brasil. Universidade Federal Cear?. Faculdade de Medicina. Departamento de Patologia e Medicina Legal. Fortaleza, CE, Brasil. Universidade Federal Cear?. Faculdade de Medicina. Departamento de Patologia e Medicina Legal. Fortaleza, CE, Brasil. Universidade Federal Cear?. Faculdade de Medicina. Departamento de Patologia e Medicina Legal. Fortaleza, CE, Brasil. Universidade Federal Cear?. Faculdade de Medicina. Departamento de Patologia e Medicina Legal. Fortaleza, CE, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Universidade Federal Cear?. Faculdade de Medicina. Fortaleza, CE, Brasil. Universidade Federal Cear?. Faculdade de Medicina. Fortaleza, CE, Brasil. Universidade Federal Cear?. Faculdade de Medicina. Fortaleza, CE, Brasil. Universidade Federal Cear?. Faculdade de Medicina. Fortaleza, CE, Brasil. Universidade Federal Cear?. Faculdade de Medicina. Departamento de Patologia e Medicina Legal. Fortaleza, CE, Brasil. OBJECTIVE: The aim of this study is to investigate the presence of human papillomavirus DNA and genotypes in breast cancer and normal breast tissue samples obtained from women from the northeast region of Brazil. METHOD: One hundred three breast cancer samples and 95 normal breast samples, as the non-malignant controls, were studied. DNA extraction was verified by human beta-globin gene amplification, and polymerase chain reaction was conducted based on HPV L1-specific consensus primers MY09/MY11 and GP5+/GP6+, followed by nested multiplex polymerase chain reaction with type-specific primers for the E6/E7 consensus region. RESULTS: Human papillomavirus DNA was detected in 51 (49.5%) breast carcinoma samples and 15 (15.8%) normal breast samples (p

A case-control study was conducted to determine the presence of Mycobacterium leprae DNA in nasal secretions of leprosy cases and nonleprosy individuals in Fortaleza, Brazil. It included 185 cases identified by physicians at the Dona Libânia National Reference Centre for Sanitary Dermatology (CDERM). A control group (Co) (n = 136) was identified among individuals from CDERM not diagnosed as leprosy cases. To augment the spatial analysis of M. leprae specific repetitive element (RLEP) positive prevalence, an external group (EG) (n = 121), a convenience sample of healthy students, were included. Polymerase chain reaction for the RLEP sequence was conducted for all participants. Prevalence of RLEP positivity for cases and Co were 69.2% and 66.9%, respectively, significantly higher than for EG (28.1%), and reported elsewhere. Male sex, belonging to a lower socioeconomic status (D/E), history of a previous contact with a case and being older, were associated with being a leprosy case. Our geographical analysis demonstrated that the bacillus is widespread among the healthy population, with clusters of RLEP positive multibacillary cases concentrated in distinct areas of the city. Our results suggest that in endemic areas, as in Fortaleza, surveillance for both nonhousehold leprosy contacts and members of the general population living in cluster areas should be implemented.

This work was funded by Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES), Institut d'Estudis Catalans (IEC) and the Swiss National Science Foundation (grants 310030_166687 and IZRJZ3_164171). Universidade Federal do Rio de Janeiro. Instituto de Microbiologia Paulo de Go?s. Rio de Janeiro, RJ, Brazil. Universidade do Estado do Par?. Programa de P?s-gradua??o em Biologia Parasit?ria na Amaz?nia. Bel?m, PA, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Universidade do Estado do Par?. Programa de P?s-gradua??o em Biologia Parasit?ria na Amaz?nia. Bel?m, PA, Brazil. Universidade do Estado do Par?. Programa de P?s-gradua??o em Biologia Parasit?ria na Amaz?nia. Bel?m, PA, Brazil. Universidade do Estado do Par?. Programa de P?s-gradua??o em Biologia Parasit?ria na Amaz?nia. Bel?m, PA, Brazil. Universidade Federal do Par?. Hospital Universit?rio Jo?o de Barros Barreto. Bel?m, PA, Brazil. Universidade Federal do Par?. Hospital Universit?rio Jo?o de Barros Barreto. Bel?m, PA, Brazil. University of Delhi. Delhi College of Engineering. New Delhi, India. Universidade do Estado do Par?. Programa de P?s-gradua??o em Biologia Parasit?ria na Amaz?nia. Bel?m, PA, Brazil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Funda??o Oswaldo Cruz. Instituto Oswaldo Cruz. Laborat?rio de Biologia Molecular Aplicada as Micobact?rias, Rio de Janeiro, RJ, Brazil. Universidade Federal do Rio de Janeiro. Instituto de Microbiologia Paulo de Go?s. Rio de Janeiro, RJ, Brazil. Universidade Federal do Cear?. Departamento de Patologia e Medicina Legal. Fortaleza, CE, Brazil. Swiss Tropical & Public Health Institute. Basel, Switzerland / University of Basel. Basel, Switzerland. Swiss Tropical & Public Health Institute. Basel, Switzerland / University of Basel. Basel, Switzerland. Funda??o Oswaldo Cruz. Instituto Oswaldo Cruz. Laborat?rio de Biologia Molecular Aplicada as Micobact?rias, Rio de Janeiro, RJ, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Tuberculosis (TB) is an infectious disease with a higher risk for infection and disease among household contacts (HHC). Here, we report a molecular epidemiology-based approach to study disease transmission and the genetic characteristics of Mycobacterium tuberculosis (Mtb) strains among HHC in the city of Belem, the capital of the state of Para in north Brazil. The study included 63 TB patients belonging to 26 HHC groups (HHC1 to HHC26). Spoligotyping and 24-loci Mycobacterial Interspersed Repetitive Unit - Variable Number of Tandem Repeat (MIRU-VNTR) revealed indistinguishable bacterial genotypes among 26 patients in 14 (53.8%) HHC groups. Drug susceptibility testing (DST) revealed that 45 (71.4%) of the Mtb isolates were multidrug resistant. The major cluster composed of isolates from five HHCs and on three of these, whole genome sequencing (WGS) was performed confirming their high genetic similarity. These results pinpoint the need for improved vigilance for TB control in households in the city of Bel?m. When comparing WGS versus phenotypic resistance detection methods as DST and Minimum Inhibitory Concentration (MIC) our data suggest that depending on the colonies selection, results may present variation.

Brazilian Ministry of Health, through the Secretariat for Health Surveillance and the Department of Prevention, Surveillance and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis Universidade Federal do Cear?. Faculdade de Medicina. Departamento de Sa?de Comunit?ria. Fortaleza, CE, Brasil. Tulane University. Department of Global Community Health and Behavioral Sciences. New Orleans, LA, USA / Universidade Federal do Cear?. Faculdade de Medicina. Sa?de Comunit?ria. Fortaleza, CE, Brazil. Universidade Federal de Minas Gerais. Departamento de Medicina Preventiva e Social. Belo Horizonte, MG, Brazil. Universidade Federal do Cear?. Departamento de Estat?stica e Matem?tica Aplicada. Fortaleza, CE, Brazil. Faculdade de Ci?ncias Medicas da Santa Casa de S?o Paulo. Departamento de Sa?de Coletiva. S?o Paulo, SP, Brazil. Universidade Federal da Bahia. Instituto de Sa?de Coletiva. Salvador, BA, Brazil. Centro de Pesquisas Aggeu Magalhaes. Recife, PE, Brazil. Universidade de Bras?lia. Faculdade de Ci?ncias da Sa?de. Departamento de Sa?de Coletiva. Centro de Ci?ncias da Sa?de. Bras?lia, DF, Brazil. Universidade Federal do Rio de Janeiro. Instituto de Psicologia. Rio de Janeiro, RJ, Brazil. Sem Afilia??o. Universidade Federal do Rio Grande do Sul. Departamento de Medicina Social. Porto Alegre, RS, Brazil. Funda??o Oswaldo Cruz. Unidade Mato Grosso do Sul. Campo Grande, MS, Brazil / Universidade Federal do Mato Grosso do Sul. Campo Grande, MS, Brazil. Universidade Federal do Cear?. Faculdade de Medicina. Departamento de Fisioterapia. Fortaleza, CE, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Centro Universit?rio Aut?nomo do Brasil. Curitiba, PR, Brazil. Secretaria de Sa?de do Munic?pio de Fortaleza. Secretaria de Sa?de do Estado do Cear?. Fortaleza, CE, Brazil. Minist?rio da Sa?de. Departamento de IST e HIV/AIDS e Hepatites Virais. Bras?lia, DF, Brazil. Minist?rio da Sa?de. Departamento de IST e HIV/AIDS e Hepatites Virais. Bras?lia, DF, Brazil. Minist?rio da Sa?de. Departamento de IST e HIV/AIDS e Hepatites Virais. Bras?lia, DF, Brazil. Minist?rio da Sa?de. Departamento de IST e HIV/AIDS e Hepatites Virais. Bras?lia, DF, Brazil. Universidade de Bras?lia. Centro de Ci?ncias da Sa?de. Bras?lia, DF, Brazil. Instituto Adolfo Lutz. S?o Paulo, SP, Brazil. Instituto Adolfo Lutz. S?o Paulo, SP, Brazil. Funda??o Alfredo da Matta. Manaus, AM, Brasil. University of California. Center for Global Health. San Francisco, CA, USA. Tulane School of Public Health and Tropical Medicine. Department of Global Community Health and Behavioral Sciences. New Orleans, LA, USA. This paper reports human immuno-deficiency virus (HIV) prevalence in the 2nd National Biological and Behavioral Surveillance Survey (BBSS) among men who have sex with men (MSM) in 12 cities in Brazil using respondent-driven sampling (RDS). Following formative research, RDS was applied in 12 cities in the 5 macroregions of Brazil between June and December 2016 to recruit MSM for BBSS. The target sample size was 350 per city. Five to 6 seeds were initially selected to initiate recruitment and coupons and interviews were managed online. On-site rapid testing was used for HIV screening, and confirmed by a 2nd test. Participants were weighted using Gile estimator. Data from all 12 cities were merged and analyzed with Stata 14.0 complex survey data analysis tools in which each city was treated as its own strata. Missing data for those who did not test were imputed HIV+ if they reported testing positive before and were taking antiretroviral therapy. A total of 4176 men were recruited in the 12 cities. The average time to completion was 10.2 weeks. The longest chain length varied from 8 to 21 waves. The sample size was achieved in all but 2 cities. A total of 3958 of the 4176 respondents agreed to test for HIV (90.2%). For results without imputation, 17.5% (95%CI: 14.7?20.7) of our sample was HIV positive. With imputation, 18.4% (95%CI: 15.4?21.7) were seropositive. HIV prevalence increased beyond expectations from the results of the 2009 survey (12.1%; 95%CI: 10.0?14.5) to 18.4%; CI95%: 15.4 to 21.7 in 2016. This increase accompanies Brazil?s focus on the treatment to prevention strategy, and a decrease in support for community-based organizations and community prevention programs.

Universidade Federal do Cear?. Faculdade de Medicina. Departamento de Patologia e Medicina Legal. Fortaleza, CE, Brasil. Universidade Federal do Cear?. Faculdade de Medicina. Departamento de Patologia e Medicina Legal. Fortaleza, CE, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Universidade Federal do Cear?. Departamento de Geologia. Fortaleza, CE, Brasil. Universidade Federal do Cear?. Departamento de Geologia. Fortaleza, CE, Brasil. Universidade de Fortaleza. Programa de P?s-Gradua??o em Sa?de Coletiva. Fortaleza, CE, Brasil. Tulane University. School of Public Health and Tropical Medicine. Department of Global Community Health and Behavioral Sciences. New Orleans, LA, USA Universidade Federal do Cear?. Faculdade de Medicina. Departamento de Sa?de Comunit?ria. Fortaleza, CE, Brasil. Universidade Federal do Cear?. Faculdade de Medicina. Departamento de Patologia e Medicina Legal. Fortaleza, CE, Brasil. BACKGROUND: The detection of live Mycobacterium leprae in soil and animals other than humans suggests that the environment plays a role in the transmission of leprosy. OBJECTIVE: The objective of this study was to investigate the presence of viable M. leprae in natural water sources used by the local population in five municipalities in the state of Cear?, northeastern Brazil. METHODS: Samples were collected from 30 different sources. Viable bacilli were identified by reverse transcriptase polymerase chain reaction (PCR) of the M. leprae gyrA gene and sequencing of the PCR products. Physicochemical properties of each water source were also assessed. FINDINGS: M. leprae gyrA mRNA was found in 23 (76.7%) of the water sources. No association was found between depth of the water and sample positivity, nor was there any association between the type of water used by the population and sample positivity. An association between viable M. leprae and temperature and pH was found. Georeferencing showed a relation between the residences of leprosy cases and water source containing the bacterium. MAIN CONCLUSIONS: The finding of viable M. leprae in natural water sources associated with human contact suggests that the environment plays an important role in maintaining endemic leprosy in the study region.

The study was funded by a grant from the Financiadora de Estudos e Projetos (FINEP), Process N? 01.11.0025.00. Funda??o Oswaldo Cruz. Instituto Oswaldo Cruz. Laborat?rio de Microbiologia Celular. Rio de Janeiro, RJ, Brazil / Funda??o Oswaldo Cruz. Instituto Oswaldo Cruz. Laborat?rio de Inova??es em Terapias, Ensino e Bioprodutos. Rio de Janeiro, RJ, Brazil. Funda??o Oswaldo Cruz. Instituto Oswaldo Cruz. Laborat?rio de Inova??es em Terapias, Ensino e Bioprodutos. Rio de Janeiro, RJ, Brazil. Funda??o Oswaldo Cruz. Instituto Oswaldo Cruz. Laborat?rio de Inova??es em Terapias, Ensino e Bioprodutos. Rio de Janeiro, RJ, Brazil. Prefeitura de Benevides. Secretaria Municipal de Sa?de. Vigil?ncia Epidemiol?gica. Benevides, PA, Brazil. Universidade da Amaz?nia. Centro de Ci?ncias Biol?gicas e da Sa?de. Bel?m, PA, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Laborat?rio de Hansen?ase. Ananindeua, PA, Brasil. Universidade do Estado do Par?. Centro de Ci?ncias Biol?gicas e da Sa?de. Bel?m, PA, Brazil. Funda??o Oswaldo Cruz. Instituto Oswaldo Cruz. Laborat?rio de Microbiologia Celular. Rio de Janeiro, RJ, Brazil. We carried out a cross-sectional study from January to December 2015 on 1,425 inhabitants from a floating population in the Brazilian Amazon (Murinin district, Par? State) to describe the population-based prevalence of tuberculosis (TB) from 2011 to 2014, recent TB contacts (rCts) latently infected with Mycobacterium tuberculosis (LTBI), the coverage of the local health network, socio-environmental factors, and frequency of intestinal parasitic infection (IPI). We found that the sanitary structure was inadequate, with latrines being shared with other rooms within the same accommodation; well water was the main source of water, and 48% of families had low incomes. The average rate of TB was 105/100, 000 inhabitants per year; one third of TB patients had been household contacts of infected individuals in the past, and 23% of rCts were LTBI. More than half (65%) of 44% of the stools examined (representing 76% of the housing) had IPIs; the highest prevalence was of fecal-oral transmitted protozoa (40%, Giardia intestinalis), followed by soil-transmitted helminths (23%). TB transmission may be related to insufficient disease control of rCts, frequent relocation, and underreporting. Education, adopting hygienic habits, improving sanitation, provision of a treated water supply and efficient sewage system, further comprehensive epidemiological surveillance of those who enter and leave the community and resources for basic treatment of IPIs are crucial in combating the transmission of these neglected diseases.

Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Paciente com queixa principal de tosse produtiva cr?nica com tr?s meses de dura??o e expectora??o de muco purulento, perda de peso, falta de apetite, dispneia, dor na regi?o tor?cica e cansa?o, sendo ainda observados sintomas cl?nicos de hansen?ase, ?ndice bacilosc?pico da linfa de 4,25 e t?tulos de IgM anti-PGL-I positivos. Do escarro, pelo m?todo de Ziehl-Neelsen, foram observados bacilos isolados e globias, com aus?ncia de crescimento em L?wenstein-Jensen. Foi demonstrada amplifica??o do DNA de Mycobacterium leprae nas amostras de escarro e secre??o nasal. Assim, ilustramos um caso sintom?tico de tuberculose e hansen?ase, mas somente com hansen?ase multibacilar, podendo ter ocorrido dissemina??o do M. leprae para os pulm?es por contiguidade, uma vez que o bacilo ? encontrado rotineiramente na nasofaringe. Patient with main complaints of chronic productive cough lasted three months and expectoration of purulent sputum, weight loss, loss of appetite, dyspnea, pain in the thoracic region and tiredness, clinical symptoms of leprosy, lymph index of 4.25 and positive IgM anti-PGL-I titers. Of the sputum, by using the Ziehl-Neelsen method, isolated bacilli and in groups with lack of growth in L?wenstein-Jensen were observed. It was shown DNA amplification of Mycobacterium leprae in the sputum samples and nasal secretion. It is demonstrated a symptomatic case of tuberculosis and leprosy, but only in multibacillary leprosy, so the dissemination by contiguity of M. leprae to the lungs can occur, once bacillus is frequently found in the nasopharynx.

Leprosy is endemic in large part of Brazil with 28,761 new patients in 2015, the second largest number worldwide and reaches 9/10.000 in highly endemic regions and 2.7/10.000 in the city of Fortaleza, Ceará, Northeast Brazil. For better understanding of risk factors for leprosy transmission, we conducted an epidemiologic study supplemented by 17 locus VNTR and SNP 1–4 typing of Mycobacterium leprae in skin biopsy samples from new multibacillary (MB) patients diagnosed at a reference center in 2009 and 2010. Among the 1,519 new patients detected during the study period, 998 (65.7%) were MB and we performed DNA extraction and genotyping on 160 skin biopsy samples, resulting in 159 (16%) good multilocus VNTR types. Thirty-eight of these patients also provided VNTR types from M. leprae in nasal swabs. The SNP-Type was obtained for 157 patients and 87% were of type 4. Upon consideration all VNTR markers, 156 different genotypes and three pairs with identical genotypes were observed; no epidemiologic relation could be observed between individuals in these pairs. Considerable variability in differentiating index (DI) was observed between the different markers and the four with highest DI [(AT)15, (TA)18, (AT)17 and (GAA)21] frequently demonstrated differences in copy number when comparing genotypes from both type of samples. Excluding these markers from analysis resulted in 83 genotypes, 20 of which included 96 of the patients (60.3%). These clusters were composed of two (n = 8), three (n = 6), four (n = 1), five (n = 2), six (n = 1), 19 (n = 1) and 23 (n = 23) individuals and suggests that recent transmission is contributing to the maintenance of leprosy in Fortaleza. When comparing epidemiological and clinical variables among patients within clustered or with unique M. leprae genotypes, a positive bacterial index in skin biopsies and knowledge of working with someone with the disease were significantly associated with clustering. A tendency to belong to a cluster was observed with later notification of disease (mean value of 3.4 months) and having disability grade 2. A tendency for lack of clustering was observed for patients who reported to have lived with another leprosy case but this might be due to lack of inclusion of household contacts in the study. Although clusters were spread over the city, kernel analysis revealed that some of the patients belonging to the two major clusters were spatially related to some neighborhoods that report poverty and high disease incidence in children. Finally, inclusion of genotypes from nasal swabs might be warranted. A major limitation of the study is that sample size of 160 patients from a two year period represents only 15% of the new patients and this could have weakened statistical outcomes. This is the first molecular epidemiology study of leprosy in Brazil and although the high clustering level suggests that recent transmission is the major cause of disease in Fortaleza; the existence of two large clusters needs further investigation., Author summary Leprosy is a transmissible disease that is still endemic in several countries including in Brazil, a country with highly variable region associated incidence of disease. Fortaleza is a city in Northeast Brazil with high incidence and conventional epidemiology studies are suggestive for high levels of recent transmission. Genotyping of M. leprae allows the recognition of individuals that have been infected with the same strain (called a cluster) and therefore being suggestive for belonging to the same transmission network. In the present work, by analyzing genotypes of M. leprae in the skin lesion of multibacillary patients, we made observations that improve our knowledge on interpretation of genotypes and clusters and confirm the high levels of recent transmission in the city of Fortaleza. This is one of the few studies that used molecular epidemiology to look for risk factors for recent transmission of leprosy and to our knowledge, the first in Brazil. Our data support further investigation of the workplace as a source of infection, preferentially by a study designed on a larger number of patients and including analysis of M. leprae present in the nose.

p. 209-213 Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2014-04-24T14:27:32Z No. of bitstreams: 1 Maurício Lima Barreto.pdf: 309292 bytes, checksum: 875893a79fdbacccb571c4631d28558c (MD5) Made available in DSpace on 2014-04-24T14:27:33Z (GMT). No. of bitstreams: 1 Maurício Lima Barreto.pdf: 309292 bytes, checksum: 875893a79fdbacccb571c4631d28558c (MD5) Previous issue date: 2012 Human beings are the main reservoir of the causative agent of leprosy, Mycobacterium leprae. In the Americas, nine-banded armadillos (Dasypus novemcinctus) also act as a reservoir for the bacillus. In the state of Ceará (CE), which is located in Northeast Brazil and is an endemic area of leprosy, there are several species of armadillos, including D. novemcinctus and Euphractus sexcinctus (six-banded armadillo). Contact between humans and armadillos occur mainly through hunting, cleaning, preparing, cooking and eating. This study identified M. leprae DNA in the two main species of armadillos found in Northeast Brazil. A total of 29 wild armadillos (27 D. novemcinctus and 2 E. sexcinctus) were captured in different environments of CE countryside. Samples from the ear, nose, liver and spleen from each of these animals were tested by a nested M. leprae-specific repetitive element polymerase chain reaction assay. The samples that tested positive were confirmed by DNA sequencing. M. leprae was detected in 21% (6/29) of the animals, including five D. novemcinctus and one E. sexcinctus. This is the first Brazilian study to identify the presence of a biomarker of M. leprae in wild armadillos (D. novemcinctus and E. sexcinctus) in a leprosy hyperendemic area where there is continuous contact between humans and armadillos.

The seroprevalence rates of IgM anti-phenolic glycolipid-I (PGL-I) antibodies in four study groups with differing exposure to Mycobacterium leprae in Ceara, Brazil were investigated between March 2005 and August 2006. The first three groups in a high prevalence area included 144 cases of leprosy, their 380 contacts and 317 participants with no known leprosy contact. The fourth group in a low prevalence area consisted of 87 participants with no known leprosy contact living in an area in which no cases of leprosy had been reported in the previous 6 months. Seropositivity and levels of IgM antibodies to PGL-I were investigated using ELISA. The seropositivity levels of anti-PGL-I among the different clinical forms of leprosy cases were 61% for lepromatous, 25% for tuberculoid and 27% indeterminate. The levels of anti-PGL-I antibodies in the endemic area differentiated leprosy cases from non-cases. However, the seropositivity was similar among contact cases (15.8%) and no known leprosy contact cases from high (15.1%) and low (13.8%) prevalence areas. The seropositivity of both contacts and no known contacts was much higher than previously reported among no known contacts in other endemic areas. The study indicates that anti-PGL-I antibodies are not useful as immunological markers of household leprosy contacts and no known leprosy contacts in endemic areas.