Background SARS-CoV-2 predisposes patients to secondary infections; however, a better understanding of the impact of coinfections on the outcome of hospitalized COVID-19 patients is still necessary. Aim To analyse death risk due to coinfections in COVID-19 patients. Methods We evaluated the Odds of death of 212 severely ill COVID-19 patients, with detailed focus on the risks for each pathogen, site of infection, comorbidities and length of hospitalization. Findings The mortality rate was 50.47%. Fungal and/or bacterial isolation occurred in 89 patients, of which 83.14% died. Coinfected patients stayed hospitalized longer and had an increased Odds of dying (OR = 13.45, R 2 =0.31). The risk of death was increased by bacterial (OR=11.28) and fungal (OR=5.97) coinfections, with increased levels of creatinine, leukocytes, urea and C-reactive protein. Coinfections increased the risk of death if patients suffer from cardiovascular disease (OR= 11.53), diabetes (OR=6.00) or obesity (OR=5.60) in comparison with patients with these comorbidities but without pathogen isolation. The increased risk of death was detected for negative-coagulase Staphylococcus (OR=25.39), Candida non- albicans (OR=11.12), S. aureus (OR=10.72), Acinetobacter spp. (OR=6.88), Pseudomonas spp. (OR=4.77) and C. albicans (OR=3.97). The high-risk sites of infection were blood, tracheal aspirate and urine. Patients with coinfection undergoing invasive mechanical ventilation were 3.8 times more likely to die than those without positive cultures. Conclusions Severe COVID-19 patients with secondary coinfections required longer hospitalization and had higher risk of death. The early diagnosis of coinfections is essential to identify high-risk patients and to determine the right interventions to reduce mortality.

Introduction: Paracoccidioidomycosis (PCM) is the most important systemic mycosis in South America. Central nervous system involvement is potentially fatal and can occur in 12.5% of cases. This paper aims to contribute to the literature describing eight cases of neuroparacoccidioidomycosis (NPMC) and compare their characteristics with patients without neurological involvement, to identify unique characteristics of NPCM. Methods: A cohort of 213 PCM cases was evaluated at the Infectious Diseases Clinic of the University Hospital, Federal University of Minas Gerais, Brazil, from October 1976 to August 2008. Epidemiological, clinical, laboratory, therapeutic and follow-up data were registered. Results: Eight patients presented NPCM. The observed NPCM prevalence was 3.8%. One patient presented the subacute form of PCM and the other seven presented the chronic form of the disease. The parenchymatous form of NPCM occurred in all patients. 60% of the patients who proceeded from the north/ northeast region of Minas Gerais State developed NPCM. The neurological involvement of a mother and her son was observed. NPCM patients exhibited demographical and clinical profiles similar to what is described in the literature. When NPCM cases were compared to PCM patients, there were differences in relation to origin and positive PCM family history. Conclusions: The results corroborate the clinical view that the neurological findings are extremely important in the evaluation of PCM patients. Despite the limitations of this study, the differences in relation to patient's origins and family history point to the need of further studies to determine the susceptibility factors involved in the neurological compromise.

ML Flow and anti-PGL-I ELISA are serological tests that detect IgM antibodies against the phenolic glycolipid I (PGL-I), specific to Mycobacterium leprae. To evaluate the outcomes of ML Flow and ELISA (PGL-I) serological tests in leprosy-endemic areas in comparison to non-endemic ones, a total of 351 volunteers from Brazil and Chile were examined, including leprosy patients, healthy controls and others affected by other infectious or non-infectious diseases that are common differential diagnoses for leprosy. The ELISA cut-off point was established using the ROC Curve method (> 0.157). In endemic areas, 70% of leprosy patients present positive ML Flow results and 53.3% were ELISA-positive. In non-endemic areas, ML Flow was negative in all the subjects tested and ELISA was positive in 4 volunteers. ML Flow is faster and more easily performed and, therefore, a more adequate test for use in basic, primary-level health care centers. ELISA requires trained personnel, in addition to a more complex laboratory infrastructure.Key-words: Serologic tests. PGL-I antigen. Leprosy. ML Flow. ELISA. RESUMOO ML Flow e o ELISA PGL-I são testes sorológicos que detectam anticorpos IgM contra o glicolipídio fenólico I específico do Mycobacterium leprae. Para avaliar o comportamento destes testes em áreas endêmica e não endêmica para hanseníase foram estudados 351 voluntários no Brasil e no Chile, incluindo pacientes com hanseníase, controles sadios, portadores de outras doenças infecciosas, não infecciosas e dermatoses que fazem diagnóstico diferencial com hanseníase. O ponto de corte do ELISA foi estabelecido pelo método da Curva ROC (> 0,157). Em área endêmica, o ML Flow apresentou resultados positivos em 70% dos pacientes com hanseníase; o ELISA foi positivo em 53,3%. Em área não endêmica, o ML Flow foi negativo em todos os voluntários testados; o ELISA foi positivo em 4 voluntários. O ML Flow é um ensaio mais rápido, facilmente aplicável e, portanto, mais adequado para ser utilizado na Atenção Básica; o ELISA necessita, alem de uma infra-estrutura de laboratório adequada, pessoal treinado e especializado em sua execução.

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Symptomatic prostatic paracoccidioidomycosis (PCM) is a very rare condition; however, it may express as a typical benign prostatic hyperplasia or a simulating prostatic adenocarcinoma. This case report presents PCM mimicking prostatic adenocarcinoma. The purpose of this paper is to call the general physician's attention to this important differential diagnosis.Key words: Paracoccidioides brasiliensis -paracoccidioidomycosis -prostatitis -prostate cancer Paracoccidioidomycosis (PCM) is an important deep mycosis in Latin America. It is caused by the dimorphic fungus Paracoccidioides brasiliensis, whose spores enter the body via the respiratory tract and evolve either asymptomatically or in a sub-acute or chronic manner. The parasite is able to provoke several clinical presentations due to its capacity to disseminate itself from the lungs through the lymphatic system or via the blood stream to any organ or system. PCM mainly affects adult males, preferentially in the lungs, mucosa, skin and phagocytic-monocytic system (Paniago et al. 2003. On a smaller scale, it reaches the nervous, musculoskeletal and suprarenal systems (Paniago et al. 2003). Its clinical incidence in the urinary tract, especially in prostatic injuries, is not well known. In a few necropsy studies involving disseminated PCM cases, its incidence varies from 2.7-9% (Salfelder et al. 1969, Begliomini et al. 1993.Prostatic diseases have become more common due to the increase in the population's age. Generally, they appear in males over 40-years-old, being more often bacterial and viral infections, benign hyperplasia and adenocarcinoma. Prostatic adenocarcinoma is the most fearful lesion due to its malignant and metastatic potential, and it is seen clinically in 10% of cases. Its diagnosis must always be set apart because its mortality is 3%, making it the greatest cause of morbi-mortality among men (Crawford 2003).Fungal prostatitis is unusual, having as its most common agents Coccidioides immitis, Candida albicans, Aspergillus sp., Cryptococcus neoformans and Blastomyces dermatitidis, which mainly affect patients who are immune-suppressed. The symptomatic attack of the prostate by PCM has rarely been described. Its potential severity justifies the reporting of this case. In this paper, infection of the prostate by P. brasiliensis is described, mimicking cancer with urethral obstruction and urgent expansion of the bladder. Case studyAAF, a 54-year-old married rural worker who was born in and is a current resident of São Sebastião do Maranhão, Minas Gerais, Brazil, presented in December 2003 with palate stomatitis associated with dysphagia and odynophagia. A biopsy of this injury revealed P. brasiliensis. He was treated with Sulfametoxazol (800 mg) and Trimethoprim (160 mg) daily in an irregular way for 20 months. In December 2004, he started to complain of dysuria, polyuria and urinary urgency and frequency, which culminated after one year in prompt urinary retention. Concomitantly, a stomatitis with moriforme injury of the palate appeared.A digital r...