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Introduction: Rabies is considered one of the most relevant public health problems owing to its high fatality rate and the high number of deaths worldwide., Methods: We included patients with human rabies who attended a reference hospital in the state of Ceará during 1976-2019., Results: Data were available for 63 out of 171 (36.8%) patients. Of these patients, 48 (76.2%) were attacked by dogs. In recent years, wild animals have been the most common aggressor species (marmosets and bats). Only 39 (70%) patients were initially correctly suspected with rabies. Bites were the most frequent exposure (56; 96%), most commonly on the hands (21; 42%) and the head (9; 18.4%). Only 14 (22%) patients had sought medical assistance before the onset of symptoms, and only one completed post-exposure prophylaxis. The most prevalent signs and symptoms included aggressiveness/irritability (50; 79.4%), fever (42; 66.7%), sore throat/dysphagia (40; 63.5%), and myalgia (28; 44.4%). Hydrophobia was present in 17 patients (22.0%)., Conclusions: Most cases of human rabies in Ceará occurred due to the failure to seek medical assistance and/or the failure of the health system in initiating early post-exposure prophylaxis. There is a need for specific information and education campaigns focusing on the cycle of sylvatic rabies as well as prevention measures. Health professionals should undergo refresher training courses on the signs and symptoms of rabies and on the specific epidemiological features of the disease in Brazil.

Objective: To describe cases of human rabies in Ceará State, Brazil between 1970 and 2019., Methods: This was a descriptive study using secondary data from the Ceará State Department of Health and the state reference hospital., Results: Of 171 cases, 75.7% occurred in males, 60.0% in <19-year-olds, and 56.0% in urban areas. Rabies was transmitted by dogs in 74.0% of cases, marmosets in 16.7% and bats in 7.3%. Between 1970 and 1978, there was an increase of cases (using the Joinpoint Regression Program, annual percentage change [APC] = 13.7 - 95%CI 4.6;41.5), while between 1978 and 2019 there was a decrease (APC = -6.7 - 95%CI -8.8;-5.9). There was a reduction in transmission by dogs (71 cases, last case in 2010) and an increase by sylvatic animals (5 cases since 2005)., Conclusion: This study demonstrates changes in rabies transmission dynamics during the period studied, with a reduction in transmission by dogs and an increase of transmission by sylvatic animals.

The northeastern semiarid region stands out in the Brazilian context regarding the eco-epidemiology of Chagas disease, in which Triatoma brasiliensis is the main vector of Trypanosoma cruzi. Persistent house invasion threatens the relative levels of progress achieved over previous decades. We conducted an intervention trial with a five-year follow-up to assess the impacts of residual spraying with pyrethroid insecticides on house infestation with T. brasiliensis in 18 rural villages (242 houses) located in the Tauá, Ceará. House infestations were assessed by systematic manual searches for triatomines in every domestic and peridomestic habitat on five occasions. Triatomines were collected in peridomestic (57.5%), sylvatic (35.8%), and intradomiciliary (6.7%) habitats. The most important ecotopes of T. brasiliensis were containing roofing tiles, bricks or rocks (23.4% ± 9.1). Residual insecticide spraying substantially reduced baseline house infestation rates from 27.9% to 5.9% by 6 months post first spraying (MPS). The decline was substantially greater in intradomiciles (11.2% to 0.8%) than in peridomiciles (16.7% to 5%). The mean relative density of triatomines recovered its preintervention values at 14 MPS in intradomiciles, and in the main peridomestic ecotopes. The house infestation levels recorded at 14 MPS persisted thereafter despite all reinfested houses were selectively sprayed on every occasion. Overall average bug infection rates with T. cruzi in the five occasions were in intradomiciles (11.1%), peridomiciles (4.7%) and wild habitats (3.3%). In peridomicile T. cruzi infection rates decreased significantly at all stages after chemical intervention. In intradomicile, the only significant difference occurred at 20 MPS (7.7% to 30.8%). The vectorial capacity of T. brasiliensis, combined with its invasive potential from sylvatic sources and the limited effectiveness of chemical control in the harsh caatinga landscape, pose serious obstacles to the definite elimination of domestic transmission risks. Systematic vector surveillance supported by community participation and locally adapted environmental management measures are needed to reduce the risks of establishment of domestic transmission with T. cruzi in this region., Competing Interests: The authors have declared that no competing interests exist.

The Micrurus snake venoms mainly cause systemic complications, essentially neurotoxicity. Previous studies, however, have described that they are involved in the occurrence of acute kidney injury (AKI) in animal models. AKI pathogenesis in snakebites is multifactorial and involves immunological reactions, hemodynamic disturbances, and direct nephrotoxicity. The aim of this study was to compare the nephrotoxic effects of coral snake venoms from M. browni (MbV) and M. laticollaris (MlV) on the proximal tubular epithelial cell line (LLC-MK2) and isolated perfused kidney. Using an MTT assay, both venoms significantly reduced cell viability at higher concentrations (25-100 μg/mL). MlV (10 μg/mL) increased the perfusion pressure (PP) at 60, 90 and 120 min, while the MbV did it only at 90 and 120 min. Renal vascular resistance (RVR) decreased at 60 min and increased at 120 min with MbV, but decreased at 60, 90 and 120 min with MlV. Urinary flow (UF) alterations were not observed with MlV, but MbV elevated them at 90 and 120 min. Both venoms significantly decreased the glomerular filtration rate (GFR), %TNa + , %TK + and %TCl - levels as of 60 min of perfusion. Oxidative stress analysis revealed that both venoms behaved similarly, reducing glutathione and increasing malondialdehyde levels. Kidney injury is not usually described in clinical cases of Micrurus snakebites. However, the potential for nephrotoxicity should be considered in the overall picture of envenomation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Introduction: COVID-19 emerged in late 2019 and quickly became a serious public health problem worldwide. This study aim to describe the epidemiological course of cases and deaths due to COVID-19 and their impact on hospital bed occupancy rates in the first 45 days of the epidemic in the state of Ceará, Northeastern Brazil., Methods: The study used an ecological design with data gathered from multiple government and health care sources. Data were analyzed using Epi Info software., Results: The first cases were confirmed on March 15, 2020. After 45 days, 37,268 cases reported in 85.9% of Ceará's municipalities, with 1,019 deaths. Laboratory test positivity reached 84.8% at the end of April, a period in which more than 700 daily tests were processed. The average age of cases was 67 (<1 - 101) years, most occurred in a hospital environment (91.9%), and 58% required hospitalization in an ICU bed. The average time between the onset of symptoms and death was 18 (1 - 56) days. Patients who died in the hospital had spent an average of six (0 - 40) days hospitalized. Across Ceará, the bed occupancy rate reached 71.3% in the wards and 80.5% in the ICU., Conclusions: The first 45 days of the COVID-19 epidemic in Ceará revealed a large number of cases and deaths, spreading initially among the population with a high socioeconomic status. Despite the efforts by the health services and social isolation measures the health system still collapsed.