Revista da Sociedade Brasileira de Medicina Tropical最新文献

{"title":"Interdisciplinary and Participatory Research for the Elimination of Socially Determined Diseases in the Amazon: A Narrative Review.","authors":"Alícia Patrine Cacau Dos Santos, Vinícius Azevedo Machado, Wuelton Marcelo Monteiro, Felipe Leão Gomes Murta","doi":"10.1590/0037-8682-0487-2025","DOIUrl":"10.1590/0037-8682-0487-2025","url":null,"abstract":"<p><p>This narrative review examines how interdisciplinary and participatory research has advanced the understanding and control of socially determined diseases in the Brazilian Amazon. The integration of social sciences into the Tropical Medicine Foundation Dr. Heitor Vieira Dourado marks a shift from purely biomedical approaches toward those recognizing the cultural, environmental and territorial dimensions of health. Qualitative studies on snakebite envenoming among Indigenous populations revealed that treatment integrates biomedical and spiritual practices, highlighting the need for intercultural dialogue. In malaria elimination, research emphasized evaluating the acceptability and feasibility of new tools such as point-of-care G6PD testing and single-dose tafenoquine, demonstrating that understanding perceptions of innovations is indispensable for effective implementation. Studies on human immunodeficiency virus (HIV) prevention and trachoma among Indigenous and urban populations illustrated how stigma, gender relations and structural inequalities shape health outcomes. Extreme climate events, such as the 2023 Amazon drought, exacerbate vulnerabilities by disrupting livelihoods and healthcare access. The article concludes by proposing an interdisciplinary research agenda aligned with Brazil's Healthy Brazil Program, emphasizing community engagement, intersectional analysis, One Health integration and implementation science as key strategies for equitable disease elimination in the Amazon.</p>","PeriodicalId":21199,"journal":{"name":"Revista da Sociedade Brasileira de Medicina Tropical","volume":"59 suppl 1","pages":"e04872025"},"PeriodicalIF":2.4,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical aspects of envenomation by a green pit viper (Bothrops bilineatus), an arboreal snake.","authors":"César Mancilha Carvalho Pedigone, Marcela Thiemi Andrade Korogi, Vidal Haddad Junior","doi":"10.1590/0037-8682-0178-2026","DOIUrl":"10.1590/0037-8682-0178-2026","url":null,"abstract":"","PeriodicalId":21199,"journal":{"name":"Revista da Sociedade Brasileira de Medicina Tropical","volume":"59 ","pages":"e01782026"},"PeriodicalIF":2.4,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Favorable clinical outcome of recurrent deep chest wall infection caused by pan-resistant Klebsiella pneumoniae treated with cefotaxime plus polymyxin B: a case report.","authors":"Sophia Aléo Bomfim, José Eduardo Souza Echeverria, Ruana Carolina Cabral da Silva, Andyane Freitas Tetila, Andressa Leite Ferraz de Melo, Gleyce Hellen de Almeida de Souza, Cleide Adriane Signor Tirloni, Simone Simionatto","doi":"10.1590/0037-8682-0088-2026","DOIUrl":"10.1590/0037-8682-0088-2026","url":null,"abstract":"<p><p>This case report describes a 43-year-old man admitted in November 2024 with recurrent deep anterior chest wall and thoracoabdominal soft-tissue infection caused by Klebsiella pneumoniae. Multidrug-resistant K. pneumoniae was isolated in December 2024. From January to April 2025, the patient required prolonged hospitalization, repeated debridements, and skin grafting, complicated by flap infection, acute kidney injury, and ICU admission. After initial improvement with polymyxin B and tigecycline, a severe recurrent infection caused by pan-resistant K. pneumoniae occurred in June 2025. Given the limited therapeutic options, treatment was changed to cefotaxime plus polymyxin B, leading to complete clinical recovery, which was later confirmed by in vitro synergy results.</p>","PeriodicalId":21199,"journal":{"name":"Revista da Sociedade Brasileira de Medicina Tropical","volume":"59 ","pages":"e00882026"},"PeriodicalIF":2.4,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scorpion Envenomation: An Intensive Care Unit Transfer Prediction Score.","authors":"Matheus Henrique Leite E Silva, Juliana Sartorelo Almeida, Stefania Villela Moreira Reis, Luiz Eduardo Leverentz Souto, Rafael Lopes de Souza Alves, Heloísa Guimarães Alves Lopes, Marcus Vinícius de Melo Andrade","doi":"10.1590/0037-8682-0052-2026","DOIUrl":"10.1590/0037-8682-0052-2026","url":null,"abstract":"<p><strong>Background: </strong>Scorpion envenomation frequently requires critical care intervention. Early determination of cases with a higher likelihood of clinical deterioration may allow for resource optimization and improvement of clinical endpoints. In this study, patients from a tertiary hospital with similar clinical characteristics but diverse outcomes were analyzed to propose a clinical deterioration prediction score.</p><p><strong>Methods: </strong>Demographic, clinical, laboratory, and imaging findings of patients with scorpion envenomation were retrieved from a database used in a toxicology center based on in-person attendance data from 2019 to 2024. Multivariate models were defined and evaluated using receiver operating characteristic curves. A nomogram was created to estimate the probability of ICU transfer. Optimal cutoff points, sensitivity, and specificity were computed. Multiple imputation was performed using chained equations. Normality of errors in linear regressions was assessed via QQ plots.</p><p><strong>Results: </strong>Overall, 146 patients were eligible for enrolment. Sex (p = 0.06), weight (p = 0.30), time-to-serum (p = 0.89), and exposure area (p = 0.49) were comparable between patients admitted to the intensive care unit (ICU) and other inpatients, whereas age (p = 0.006) and initial severity (p < 0.001) displayed significant differences. Logistic regression models displayed area-under-the-curve metrics ranging from 65% to 93%, with high specificity. Hyperamylasemia (p = 0.004), vomiting (p = 0.006), and cardiac dysfunction on echocardiography or point-of-care ultrasound (p < 0.001) were strongly associated with critical care.</p><p><strong>Conclusion: </strong>Prognostication of factors leading to ICU transfer from initial clinical and laboratory findings is feasible. The regression model achieved high specificity and moderate sensitivity; being a potentially useful confirmatory test in cases with clinical suspicion.</p>","PeriodicalId":21199,"journal":{"name":"Revista da Sociedade Brasileira de Medicina Tropical","volume":"59 ","pages":"e00522026"},"PeriodicalIF":2.4,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes Associated With the Timing of Antivenom Administration in Bothrops and Crotalus Snakebite Envenomations.","authors":"Rafaele Maria Tirolla, Edmarlon Girotto, Alberto Duran Gonzalez, Camilo Molino Guidoni","doi":"10.1590/0037-8682-0588-2025","DOIUrl":"10.1590/0037-8682-0588-2025","url":null,"abstract":"<p><strong>Background: </strong>Snakebite envenomation is a significant public health problem. We aimed to analyze the clinical outcomes associated with the timing of antivenom administration in Bothrops and Crotalus snakebite envenomations.</p><p><strong>Methods: </strong>This descriptive, retrospective, census-based cohort study included patients who attended the Toxicological Information and Assistance Center-Londrina from 2017 to 2024. Sociodemographic, clinical, exposure-related, and antivenom therapy data were obtained from the national DATATOX system and clinical records. Descriptive statistics and Poisson regression (for relative risks [RRs] and 95% confidence intervals [CIs]) were used; significance was set at p<0.05.</p><p><strong>Results: </strong>Data from 1,162 cases were analyzed, with 72.8% caused by Bothrops and 27.2% by Crotalus. Most patients were male (78.6%), rural workers (59.0%), and residents of rural areas (88.4%). Antivenom therapy was administered with 98.2% adequacy, according to institutional protocols. The median time from bite to completion of antivenom infusion was 450 minutes, with 75% of patients treated within 12 hours; 2.7% of patients developed renal complications and 1.1% died. Both outcomes were more frequent among patients with longer intervals between the bite and antivenom administration (>75th percentile). In the crude analysis, delays were associated with renal complications (RR: 3.21; 95% CI: 1.61-6.41; p=0.001) and death (RR: 4.81; 95% CI: 1.59-14.59; p=0.006). After adjustment, the association remained significant for renal complications (RR: 2.88; 95% CI: 1.37-6.06; p=0.005), but not for death.</p><p><strong>Conclusions: </strong>Delayed antivenom administration is associated with an increased risk of renal complications, reinforcing the timing of therapy as a critical and modifiable factor influencing snakebite outcomes.</p>","PeriodicalId":21199,"journal":{"name":"Revista da Sociedade Brasileira de Medicina Tropical","volume":"59 ","pages":"e05882025"},"PeriodicalIF":2.4,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacological therapies for neglected tropical diseases: a systematic review and evidence gap mapping.","authors":"Julia Barbosa Domingues da Silva, Fernando Fernandez-Llimos, Helena Hiemisch Lobo Borba","doi":"10.1590/0037-8682-0056-2026","DOIUrl":"10.1590/0037-8682-0056-2026","url":null,"abstract":"<p><strong>Background: </strong>Neglected tropical diseases (NTDs) comprise 21 endemic infections that affect over one billion people worldwide. This study mapped and identified evidence gaps regarding pharmacological therapies for all WHO-recognized NTDs.</p><p><strong>Methods: </strong>We systematically searched PubMed for systematic reviews (SRs) and randomized controlled trials (RCTs), and the ClinicalTrials.gov database for ongoing RCTs. Methodological quality was assessed using the AMSTAR-2 for SRs and the Cochrane Risk of Bias tool for RCTs. Data were synthesized into evidence and gap maps, and the distribution of evidence was analyzed according to quality.</p><p><strong>Results: </strong>Twenty-four maps were developed, including 74 SRs, 500 RCTs, and 70 ongoing clinical trials; of these, only seven SRs and 17 RCTs were rated as high quality or as having a low risk of bias, respectively. Trachoma exhibited the highest number of evidence gaps, while Buruli ulcer had the lowest. Taeniasis/cysticercosis presented the highest proportion (31.8%) of high-quality SRs, whereas Chagas disease showed the highest proportion of RCTs with a low risk of bias (18.4%).</p><p><strong>Conclusions: </strong>Significant gaps remain in the evidence regarding the efficacy and safety of pharmacological treatments for WHO-recognized NTDs. The currently available evidence is predominantly of low methodological quality and is often insufficient to support robust therapeutic conclusions, highlighting the urgent need for rigorously designed clinical trials.</p>","PeriodicalId":21199,"journal":{"name":"Revista da Sociedade Brasileira de Medicina Tropical","volume":"59 ","pages":"e00562026"},"PeriodicalIF":2.4,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neutrophil extracellular traps and parasite load are associated with dermal matrix remodeling in Leishmania braziliensis infection.","authors":"Gislainy Pereira da Silva, Joselina Maria da Silva, Diego Luiz Doneda, Eudes Thiago Pereira Ávila, Vanina Danuza Toso, Marcia Hueb, Thiago da Rosa Lima, Amílcar Sabino Damazo","doi":"10.1590/0037-8682-0506-2025","DOIUrl":"10.1590/0037-8682-0506-2025","url":null,"abstract":"<p><strong>Background: </strong>Cutaneous leishmaniasis is a chronic parasitic condition. The association of neutrophil extracellular traps with dermal extracellular matrix degradation, parasite load, and leukocyte profiles in cutaneous leishmaniasis lesions remains underexplored. This study aimed to investigate these associations in patients with cutaneous leishmaniasis.</p><p><strong>Methods: </strong>Patients (n=78) from Cuiabá, Mato Grosso, Brazil, diagnosed with cutaneous leishmaniasis were included. Biopsy samples were collected.. Species were identified by polymerase chain reaction. Leukocytes, amastigotes, and neutrophil extracellular traps were identified and quantified, and extracellular matrix degradation was assessed using immunohistochemistry, Masson's trichrome, Sirius Red, and reticulin stains. Statistical associations were determined using Pearson's correlation coefficient.</p><p><strong>Results: </strong>All patients exhibited L. braziliensis infection. Most patients (76.9%) had cellular and exudative reaction lesions, while 23.1% exhibited granulomatous and exudative reaction lesions. A significant correlation was observed between extracellular matrix degradation and amastigote load in cellular and exudative reaction lesions (r=0.599; p=0.0001) but not in granulomatous and exudative reaction lesions (r=0.068; p=0.263). Similarly, in cellular and exudative reaction lesions, neutrophil extracellular trap formation showed a strong positive correlation with amastigote numbers (r=0.423; p=0.0001), a relationship absent in granulomatous and exudative reaction lesions (r=0.0009; p=0.9036).</p><p><strong>Conclusion: </strong>In L. braziliensis infection with cellular and exudative reaction lesions, neutrophil extracellular traps function as an active, proportional defense mechanism against parasite load. However, in granulomatous and exudative reaction lesions, they contribute to a more structured containment but lack a direct proportional relationship to parasite numbers. This distinction provides critical insights into cutaneous leishmaniasis pathogenesis.</p>","PeriodicalId":21199,"journal":{"name":"Revista da Sociedade Brasileira de Medicina Tropical","volume":"59 ","pages":"e05062025"},"PeriodicalIF":2.4,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The International Health Regulations and the imperative to strengthen global health: the case of Brazil.","authors":"Marcio Henrique de Oliveira Garcia, Ethel Leonor Maciel, Nisia Trindade Lima","doi":"10.1590/0037-8682-0135-2026","DOIUrl":"10.1590/0037-8682-0135-2026","url":null,"abstract":"","PeriodicalId":21199,"journal":{"name":"Revista da Sociedade Brasileira de Medicina Tropical","volume":"59 ","pages":"e01352026"},"PeriodicalIF":2.4,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypersensitivity reactions to dengue vaccine TAK-003 (Qdenga®) following an immunization campaign targeting children and adolescents.","authors":"Márcia Paulliny Soares Bahia, Silon de Souza Gomes Junior, Argus Leão Araújo, Hoberdan Oliveira Pereira, José Geraldo Leite Ribeiro, Alexandre Sampaio Moura","doi":"10.1590/0037-8682-0198-2026","DOIUrl":"10.1590/0037-8682-0198-2026","url":null,"abstract":"<p><strong>Background: </strong>A national dengue vaccination campaign using TAK-003 was launched in 2024, targeting adolescents. Post-licensure surveillance suggested higher-than-expected hypersensitivity reactions.</p><p><strong>Methods: </strong>We conducted a descriptive study using vaccine adverse event data and vaccination records from Belo Horizonte among individuals aged 6-14 years.</p><p><strong>Results: </strong>Of the 146,115 doses administered, 28 hypersensitivity reactions were reported (191.6 per million), including nine cases of anaphylaxis and two of anaphylactic shock. All events followed the first dose. Mean age was 9.4 years, and mean time to symptom onset was 31 minutes.</p><p><strong>Conclusions: </strong>Hypersensitivity rates exceeded expected vaccine-associated levels, reinforcing the need for continued pharmacovigilance.</p>","PeriodicalId":21199,"journal":{"name":"Revista da Sociedade Brasileira de Medicina Tropical","volume":"59 ","pages":"e01982026"},"PeriodicalIF":2.4,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scorpionism in the Amazon: Evidence, Challenges and Actions for Controlling a Neglected Disease.","authors":"Jacqueline Sachett, Fan Hui Wen, Elisangela Aparecida da Silva, Alexandre Vilhena da Silva Neto, Zehev Benzaken, Alessandro Júnio Campelo Feitosa, Yasmim da Silva Mendes, Handerson da Silva Pereira, Pedro Ferreira Bisneto, Maria Cristina Martins de Oliveira, Felipe Murta, Marco Aurélio Sartim, Wuelton Monteiro","doi":"10.1590/0037-8682-0497-2025","DOIUrl":"10.1590/0037-8682-0497-2025","url":null,"abstract":"<p><p>Scorpion sting envenomations impose an increasing burden in the Amazon and result in a considerable impact on public health. The genus Tityus accounts for nearly all clinically relevant cases, with T. metuendus, T. silvestris and T. obscurus being responsible for most of envenomations in the region. In the state of Amazonas, Manaus and Apuí account for most of cases reported, with an evident expansion to other regions, including the Solimões River region and the Upper Negro River region, where most of the exposed population is found in Indigenous and riverine communities. The increasing burden and high severity rates of scorpion stings in the Amazon may result from the capacity of adaptation of the endemic species to the environmental changes and limitations in providing adequate healthcare to patients. The clinical profile of patients stung by different species has similar local and systemic manifestations. In Manaus, T. metuendus is the species that is most commonly responsible for severe cases observed in children, due to them presenting circulatory collapse and acute respiratory distress, while T. apiacas and T. silvestris present systemic neurological manifestations, characterized by generalized muscle spasms described as the sensation of receiving an electric shock, apparently not reversed by the available antivenom. Scorpionism in the Amazon combines the biological complexity and variability of Tityus species and their venoms, social and environmental determinants and healthcare challenges. These features require solutions of interinstitutional, interdisciplinary networks that are capable of integrating biology, venomics, clinical medicine, public health, environmental sciences and the social sciences.</p>","PeriodicalId":21199,"journal":{"name":"Revista da Sociedade Brasileira de Medicina Tropical","volume":"59 suppl 1","pages":"e0497"},"PeriodicalIF":2.4,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13286606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}