Background Histoplasmosis is highly endemic in the American continent. This condition is associated with a high mortality, particularly in people living with HIV/AIDS (PLWHA). Diagnosis of histoplasmosis is usually late in South America, as Histoplasma antigen detection is rarely available. Here we determined the prevalence, risk factors, and outcome of histoplasmosis in PLWHA in Brazilian hospitals. Methods This was a prospective cohort study (2016–2018) involving 14 tertiary medical centers in Brazil. We included hospitalized PLWHA presenting with fever and additional clinical findings. Patients were investigated at each participant center with classical mycology methods. Also, Histoplasma antigen detection was performed in urine samples (IMMY). Probable/proven histoplasmosis was defined according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group/National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria. Results From 616 eligible patients, 570 were included. Histoplasmosis was identified in 21.6% (123/570) of patients. Urine antigen testing increased the diagnostic yield in 53.8%, in comparison with standard mycology methods. Variables independently associated with histoplasmosis were CD4+ count <50 cells/mm 3 , use of an antiretroviral (protective effect), and sample collection in the Northeast region of Brazil. Dyspnea at presentation was independently associated with death. Histoplasmosis was more frequent than tuberculosis in patients with low CD4+ counts. Overall 30-day mortality was 22.1%, decreasing to 14.3% in patients with antigen-based diagnosis. Conclusions Histoplasmosis is a very frequent condition affecting PLWHA in Brazil, particularly when CD4+ counts are lower than 50 cells/mm 3 . Antigen detection may detect earlier disease, with a probable impact on outcomes. Access to this diagnostic tool is needed to improve clinical management of PLWHA in endemic countries.

Resistance to antimicrobial agents is increasing worldwide and imposes significant life-threatening risks to several different populations, especially those in intensive care units (ICUs). Bacteria can quickly develop or acquire resistance to antimicrobial drugs, and combined with their intrinsic potential to cause disease in humans, these bacteria can become deadly. Among Gram-negative bacteria, Acinetobacter baumannii is notorious as a frequent opportunistic pathogen associated with critically ill patients, and understanding the genetic basis of A. baumannii resistance to beta-lactams among patients in ICUs will result in better protocols to prevent the development of resistance as well as improved treatment regimens. In this study, we assessed 1333 patients in five ICUs, 56 of whom developed A. baumannii infections. Most of the A. baumannii isolates were resistant to beta-lactam antimicrobial drugs, specifically, 3rd- and 4th-generation cephalosporins and carbapenems, and 91.1% of the isolates were multi-drug resistant (MDR). The most frequent OXA gene present was OXA-23 (55.1%), which is significantly associated with MDR strains. Most of the A. baumannii isolates (76.8%) were capable of forming a biofilm. The antimicrobial drug classes that were effective against most of these isolates were polymyxins and tigecycline. The molecular profile of the isolates allowed detection of 12 different clusters comprising 2 to 8 isolates each. In conclusion, our data indicate a high incidence of resistance to carbapenems as well as MDR strains among the observed A. baumannii isolates, most of which exhibited a high prevalence of OXA-23 gene expression. Only a few selective drugs were effective, reinforcing the notion that bacterial resistance is an emerging problem that should be prioritized in every healthcare facility.

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Aim: to identify the epidemiology of fungal infections in the pediatric service of a reference hospital for the treatment of cancer for 2016 to 2019, through the dispensing of antifungal drugs by the hospital pharmacy. Methods: Retrospective cohort analysis of 1.211 antifungal requests. Results and Discussion: 1.211 treatments with antifungal agents were performed in the period, with 71.9% of cases treated with empirical therapy, 64.1% of cases of mucocutaneous candidiasis and with the use of nystatin in 48.6% of cases. There were 114 episodes of IFIs, in which probable fungal pneumonia represented 40.4% of the therapeuticindications, based on suggestive tomographic images and clinical and epidemiological criteria in 40.3% of cases. Conclusions: There was an agreement between the epidemiology of fungal infections and the worldwide epidemiology, but there was disagreement between the therapies applied in the study hospital and the recent guidelines.

Objetivo: Elucidar o processo de diagnóstico cirúrgico de Neuromicoses e implicações prognósticas em uma unidade oncológica, entre os anos de 2009 e 2020. Métodos: Trata-se de um estudo retrospectivo em que foram analisados 129 laudosanatomopatológicos negativos para neoplasia, dos quais quatro casos concluíram etiologia fúngica, sendo três paracoccidioidomicose e um mucormicose. Uma revisão sistemática da literatura foi conduzida para referencial teórico, que levantou 77 casos para comparação. Resultados e Discussão: Os achados apresentados nesse estudo superaram a incidênciamundial documentada de neuroparacoccidioidomicose em mais de 2 vezes. Nessa série, a mucormicose do sistema nervoso central refletiu apresentação típica de doença rinocerebral, com desfecho fatal. Todos os pacientes desse estudo eram HIV negativos, mas provenientes de áreas endêmicas do Centro-Oeste e Sudeste brasileiros, além de possuírem fatores de riscopara infecções fúngicas invasivas e demonstrarem focos de acometimento extracraniano. Considerações finais: A ausência de investigação sobre o comprometimento em outros órgãos, bem como a espera por procedimento neurocirúrgico para o diagnóstico estão associadas a prejuízos à terapia adequada e tempo de hospitalização prolongada, que expõe os pacientes a maior risco de infecções nosocomiais. A subnotificação estatística supõe obstáculo importante ao avanço dos estudos em Neuromicoses, por isso é necessário investir em sistemas nacionais de vigilância e transformar as micoses endêmicas em doenças de notificação compulsória.

Introduction: Histoplasmosis is a fungal disease, caused by Histoplasma capsulatum. Goal: To report a case of an immunocompromised patient with diagnosis of histoplasmosis in a non-endemic region. Methodology: Case report. Case report: Patient carrier of rheumatoid arthritis, makes continuous use of methotrexate and has reported contact with large amount of bat guano. Result of cervical lymph node culture was positive for H. capsulatum. Discussion: The infection was presented related to drug-induced immunosuppression in a non-endemic area. Conclusion: In view of the location where the infection occurred, the geographic expansion of the disease and the importance of this report for the literature are clear.