BACKGROUND Despite public health efforts to reduce the global burden of leprosy, gaps remain in the knowledge surrounding transmission of infection. Helminth co-infections have been associated with a shift towards the lepromatous end of the disease spectrum, potentially increasing transmission in co-endemic areas.OBJECTIVES Using this biologically plausible association, we conducted a geographic information systems (GIS) study to investigate the spatial associations of schistosomiasis and leprosy in an endemic area of Minas Gerais (MG), Brazil.METHODS Data on new cases of Mycobacterium leprae and Schistosoma mansoni infections from 2007-2014 were retrieved from the Brazilian national notifiable diseases information system for seven municipalities in and surrounding Vespasiano, MG. A total of 139 cases of leprosy and 200 cases of schistosomiasis were mapped to a municipality level. For one municipality, cases were mapped to a neighborhood level and a stratified analysis was conducted to identify spatial associations.FINDINGS A relative risk of 6.80 [95% confidence interval (CI) 1.46 - 31.64] of leprosy was found in neighborhoods with schistosomiasis. Incidence rates of leprosy increased with corresponding incidence rates of schistosomiasis, and the temporal trends of both infections were similar.CONCLUSIONS The associations found in this project support the hypothesis that helminth infections may influence the transmission of leprosy in co-endemic areas.

Leprosy reactions are immune-mediated complications occurring in up to 50% of patients. The immune consequences of helminth infections and micronutrient deficiencies suggest a potential role in type 1 reactions (T1R) or type 2 reactions (T2R). We conducted a case-control study in Minas Gerais, Brazil, to evaluate whether comorbidities and other factors are associated with reactions in patients with multibacillary leprosy. Stool and serum were tested for helminth infections. Deficiencies of vitamin A, D, and iron were measured using serum retinol, 25-hydroxyvitamin D, and ferritin, respectively. Logistic regression models identified associations between reactions and helminth infections, micronutrient deficiencies, and other variables. Seventy-three patients were enrolled, 24 (33%) with T1R, 21 (29%) with T2R, 8 (15%) with mixed T1R/T2R, and 20 (27%) without reactions. Evidence of helminth infections were found in 11 participants (15%) and included IgG4 reactivity against Schistosoma mansoni, Strongyloides, and Ascaris antigens. Thirty-eight (52%) had vitamin D deficiency, eight (11%) had vitamin A insufficiency, 21 (29%) had anemia, and one (1.4%) had iron deficiency. Multivariable logistic regression showed no statistically significant associations between helminth coinfections and total reactions (adjusted odds ratios [aOR]: 1.36, 95% CI: 0.22, 8.33), T1R (aOR: 0.85, 95% CI: 0.17, 4.17), or T2R (aOR: 2.41, 95% CI: 0.29, 20.0). Vitamin D deficiency and vitamin A insufficiency were also not statistically associated with reactions. However, vitamin deficiencies and helminth infections were prevalent in these patients, suggesting a potential role for additional treatment interventions. Studying reactions prospectively may further clarify the role of comorbidities in the clinical presentation of leprosy.

Balantidium coli is a parasitic ciliate protozoan that affects pigs and nonhuman primates. It rarely affect humans, however it might become an opportunistic parasite in immunosuppressed hosts. Balantidiasis is the disease caused by ingestion of B. coli cysts. Infected individuals may present abdominal pain, headaches, asthenia, tenesmus, meteorism and diarrhea characterized by five or six bowel movements per day. This paper is the first to report the presence of B. coli in a person living with HIV/AIDS (PLWHA) in Brazil.KEY WORDS: Balantidiasis. AIDS. Diarrhea. RESUMORelato de caso: balantidíase em pessoa vivendo com HIV/AIDS (PVHA) Balantidium coli é um protozoário parasito ciliado que afeta os porcos e primatas não-humanos. Sua presença em seres humanos é rara e pode se tornar um parasito oportunista em hospedeiros imunodeprimidos. Balantidíase é uma doença causada pela ingestão de cistos de B. coli. Os indivíduos infectados podem apresentar dor abdominal, cefaléia, astenia, tenesmo, meteorismo e

Background In Brazil, new leprosy cases with grade-2 disability (G2D) have been increasing. Physical disability has been associated with experienced stigmatization, psychological distress, and social restriction. Objectives To identify factors associated with leprosy disability in an endemic area of Brazil focusing on occupational and other sociodemographic factors. Methods Between July and December 2015, adult patients with multibacillary leprosy who attended a clinic in Belo Horizonte, Brazil were enrolled. Social, clinical, and demographic factors were collected from an administered questionnaire and medical charts. Occupations were categorized as manual vs non-manual. Descriptive statistics and multivariable logistic regression were performed to study associated factors with disability (Grade 1 disability (G1D) and G2D combined). Findings Seventy-three patients were enrolled with 48 (65.8%) presenting with either G1D or G2D at the time of enrollment. Twenty-nine (39.7%) had G2D. About half of the patients (n = 36, 49%) reported a manual labor occupation and reactions were common (n = 53, 73%). On univariate analyses, older age (p = 0.048) and low education (p = 0.007) were associated with disability. On multivariable analyses, only low education (primary or less) was associated with disability (OR = 6.34, 95% CI 1.37, 29.26). Greater distance from clinic, income, smoking, marital status, and occupation were not associated. Main conclusions Low education was associated with leprosy disability, consistent with prior studies, and therefore should be a focus for disability reduction programs. While the sample size of this study may have limited detection of associations between disability and social determinants tested, half of the patients reported a manual job, highlighting the need for more extensive studies on associations between occupation, disability, and related injuries.

A entomologia forense, apesar de séculos de sua existência, tem se desenvolvido lentamente no Brasil devido à dedicação de um número de cientistas relativamente baixo quando comparado com outras áreas das ciências forenses. No estado de Minas Gerais, os estudos nessa área praticamente inexistem, necessitando de trabalhos científicos para formar especialistas que possam auxiliar as investigações em crimes que haja encontro de cadáveres em estado de putrefação.  Um dos principais objetivos da entomologia forense é a estimativa do intervalo pós-morte mínimo (IPM), permitindo calcular qual o tempo mínimo da morte do cadáver. Nesse contexto, o presente trabalho teve como finalidade analisar a diversidade e sucessão da entomofauna colonizadora em porco doméstico (Sus scrofa), bem como estimar o IPM por meio das larvas coletadas ao longo do experimento. O experimento ocorreu em mata urbana, no período de março a abril de 2017, utilizando uma carcaça de suíno de aproximadamente 3 kg. Durante o período de experimento foi possível verificar cinco fases de decomposição, sendo necessários 20 dias para alcançar a fase de esqueletização. Na classe Insecta a ordem mais abundante foi dos dípteros da família Calliphoridae (n=305), sendo as espécies Chrysomya megacephala (n=103) e Chrysomya putoria  (n=78) as mais representativas. Utilizando os métodos grau-dia acumulado (GDA) e período de atividade do inseto (PAI) para estimar o IPM, foi possível calcular com certa exatidão o período em que o porco havia sido morto, demonstrando a aplicabilidade dessa ferramenta para esclarecer tempo de morte em casos de encontro de cadáveres onde os fenômenos cadavéricos não são mais confiáveis para essa finalidade.