RESUMO
Background: Nitazoxanide exerts antiviral activity in vitro and in vivo and anti-inflammatory effects, but its impact on patients hospitalized with COVID-19 pneumonia is uncertain. Methods: A multicentre, randomized, double-blind, placebo-controlled trial was conducted in 19 hospitals in Brazil. Hospitalized adult patients requiring supplemental oxygen, with COVID-19 symptoms and a chest computed tomography scan suggestive of viral pneumonia or positive RT-PCR test for COVID-19 were enrolled. Patients were randomized 1:1 to receive nitazoxanide (500 mg) or placebo, 3 times daily, for 5 days, and were followed for 14 days. The primary outcome was intensive care unit admission due to the need for invasive mechanical ventilation. Secondary outcomes included clinical improvement, hospital discharge, oxygen requirements, death, and adverse events within 14 days. Results: Of the 498 patients, 405 (202 in the nitazoxanide group and 203 in the placebo group) were included in the analyses. Admission to the intensive care unit did not differ between the groups (hazard ratio [95% confidence interval], 0.68 [0.38-1.20], p = 0.179); death rates also did not differ. Nitazoxanide improved the clinical outcome (2.75 [2.21-3.43], p < 0.0001), time to hospital discharge (1.37 [1.11-1.71], p = 0.005), and reduced oxygen requirements (0.77 [0.64-0.94], p = 0.011). C-reactive protein, D-dimer, and ferritin levels were lower in the nitazoxanide group than the placebo group on day 7. No serious adverse events were observed. Conclusions: Nitazoxanide, compared with placebo, did not prevent admission to the intensive care unit for patients hospitalized with COVID-19 pneumonia. Clinical Trial Registration: Brazilian Registry of Clinical Trials (REBEC) RBR88bs9x; ClinicalTrials.gov, NCT04561219.
RESUMO
We compared lizard endoparasite assemblages between the Atlantic Forest and naturally isolated forest enclaves to test the ecological release hypothesis, which predicts that host specificity should be lower (large niche breadth) and parasite abundance should be greater for parasites from isolated forest enclaves (poor assemblages) than for parasites from the coastal Atlantic Forest (rich assemblages). Parasite richness per specimen showed no difference between the isolated and non-isolated areas. Parasite abundance did not differ between the isolated and non-isolated areas but showed a positive relationship with parasite richness considering all areas (isolated and non-isolated). Furthermore, host specificity was positively related to parasite richness. Considering that host specificity is inversely proportional to the host range infected by a parasite, our results indicate that in assemblages with greater parasite richness, parasites tend to infect a smaller range of hosts than do those in simple assemblages. In summary, our study partially supports the ecological release hypothesis: in assemblages with greater parasite richness, lizard parasites from Atlantic Forest are able to increase their parasite abundance (per host), possibly through facilitated infection; however, the amplitude of infected hosts only expands in poor assemblages (lower parasite richness).
Assuntos
Biodiversidade , Interações Hospedeiro-Parasita , Características de História de Vida , Lagartos/parasitologia , Parasitos/fisiologia , Animais , Brasil , Especificidade de HospedeiroRESUMO
Parapharyngodon silvoi n. sp. (Nematoda: Pharyngodonidae) is described from the large and small intestine of the Muller's termite frog Dermatonotus muelleri (Boettger, 1885) from the biome Caatinga, Exu municipality, Pernambuco State, Brazil, Dermatonotus muelleri is a fossorial species with a specialized termite diet, and feeding and reproductive behavior occurring only during the wet season. The new species is distinguished from other species of the genus Parapharyngodon by showing ovary not coiled around the esophagus, morphology of anterior cloacal lip, spicule size and number of caudal papillae.
Assuntos
Anuros/parasitologia , Oxiuríase/veterinária , Oxyuroidea/classificação , Estruturas Animais/anatomia & histologia , Estruturas Animais/crescimento & desenvolvimento , Animais , Tamanho Corporal , Brasil , Feminino , Masculino , Tamanho do Órgão , Oxiuríase/parasitologia , Oxyuroidea/anatomia & histologia , Oxyuroidea/crescimento & desenvolvimentoRESUMO
Co-infections with human immunodeficiency virus (HIV) and Mycobacterium leprae represent unique opportunities to investigate the interaction of both pathogens. We determined the immunologic, virologic, and histopathologic characteristics of 22 co-infected Brazilian patients (median age = 38 years, 81.8% males, 72.2% with paucibacillary leprosy, and 95.4% with acquired immunodeficiency syndrome). The HIV-1 subtypes B and BF predominated in envelope and gag heteroduplex mobility analysis. Borderline tuberculoid (BT), tuberculoid, lepromatous, and indeterminate morphology with CD3+, CD8+, and CD68+ cell distributions compatible with leprosy patients not infected with HIV were observed. Histologic evidence of nerve damage was observed in BT lesions. IgM antibody to M. leprae-specific phenolic glycolipid I was not detected. Two of six co-infected patients monitored during highly active antiretroviral therapy (HAART) developed a leprosy type 1 reaction after an increase in CD4+ cells, suggesting an immune restoration phenomenon. Clinical, immunologic, histopathologic, and virologic features among these HIV-leprosy co-infected patients indicate that each disease progressed as in single infection. However, HAART immune reconstitution may trigger potential adverse effects, such as leprosy acute inflammatory episodes.
Assuntos
Infecções por HIV/epidemiologia , Hanseníase/epidemiologia , Adulto , Anticorpos Antibacterianos/análise , Brasil/epidemiologia , Contagem de Linfócito CD4 , Estudos de Coortes , Comorbidade , DNA Viral/análise , Feminino , Infecções por HIV/sangue , Infecções por HIV/complicações , HIV-1/genética , HIV-1/isolamento & purificação , Humanos , Hanseníase/sangue , Hanseníase/complicações , Masculino , Mycobacterium leprae/imunologia , Mycobacterium leprae/isolamento & purificaçãoRESUMO
Co-infections with human immunodeficiency virus (HIV) and Mycobacterium leprae represent unique opportunities to investigate the interaction of both pathogens. We determined the immunologic, virologic, and histopathologic characteristics of 22 co-infected Brazilian patients (median age = 38 years, 81.8% males, 72.2% with paucibacillary leprosy, and 95.4% with acquired immunodeficiency syndrome). The HIV-1 subtypes B and BF predominated in envelope and gag heteroduplex mobility analysis. Borderline tuberculoid (BT), tuberculoid, lepromatous, and indeterminate morphology with CD3+, CD8+, and CD68+ cell distributions compatible with leprosy patients not infected with HIV were observed. Histologic evidence of nerve damage was observed in BT lesions. IgM antibody to M. leprae-specific phenolic glycolipid I was not detected. Two of six co-infected patients monitored during highly active antiretroviral therapy (HAART) developed a leprosy type 1 reaction after an increase in CD4+ cells, suggesting an immune restoration phenomenon. Clinical, immunologic, histopathologic, and virologic features among these HIV-leprosy co-infected patients indicate that each disease progressed as in single infection. However, HAART immune reconstitution may trigger potential adverse effects, such as leprosy acute inflammatory episodes