Objectives To describe the first outbreak of Candida auris in Brazil, including epidemiological, clinical and microbiological data. Methods After the first Candida auris ‐colonised patient was diagnosed in a COVID‐19 ICU at a hospital in Salvador, Brazil, a multidisciplinary team conducted a local C . auris prevalence investigation. Screening cultures for C . auris were collected from patients, healthcare workers and inanimate surfaces. Risk factors for C . auris colonisation were evaluated, and the fungemia episodes that occurred after the investigation were also analysed and described. Antifungal susceptibility of the C . auris isolates was determined, and they were genotyped with microsatellite analysis. Results Among body swabs collected from 47 patients, eight ( n = 8/47, 17%) samples from the axillae were positive for C . auris . Among samples collected from inanimate surfaces, digital thermometers had the highest rate of positive cultures ( n = 8/47, 17%). Antifungal susceptibility testing showed MICs of 0.5 to 1 mg/L for AMB, 0.03 to 0.06 mg/L for voriconazole, 2 to 4 mg/L for fluconazole and 0.03 to 0.06 mg/L for anidulafungin. Microsatellite analysis revealed that all C . auris isolates belong to the South Asian clade (Clade I) and had different genotypes. In multivariate analysis, having a colonised digital thermometer was the only independent risk factor associated with C . auris colonisation. Three episodes of C . auris fungemia occurred after the investigation, with 30‐day attributable mortality of 33.3%. Conclusions Emergence of C . auris in Salvador, Brazil, may be related to local C . auris clade I closely related genotypes. Contaminated axillary monitoring thermometers may facilitate the dissemination of C . auris reinforcing the concept that these reusable devices should be carefully cleaned with an effective disinfectant or replaced by other temperature monitoring methods.

Objectives To assess SARS-CoV-2 prevalence and health outcomes among inmates over 60 years of age during a COVID-19 outbreak in a major penitentiary complex in the Federal District, Brazil. Methods A mass test campaign was performed on May 13, 2020, with the use of antibody-detection rapid tests for asymptomatic inmates and RT-PCR for symptomatic. Those with negative results were retested on June 16. Inmates were interviewed for the characterization of background health conditions and the presence of symptoms. Results A total of 159 inmates were evaluated. In the first mass testing, we found that 79.9% (127/159) had been infected and 53.5% (68/127) of those reported symptoms. There were 17 new cases after the second testing, meaning 90.6% (144/159) of inmates had some positive result. Comorbidities were present in 67.3%; two hospitalizations and no COVID-related deaths were recorded. Conclusion More than 90% of inmates over the age of 60 were infected with SARS-CoV-2 during the outbreak. Periodic health monitoring, active case finding and early care for symptomatic patients were the main actions that contributed to positive post-infection outcomes. Such measures must be considered as essential components for the surveillance of COVID-19 in environments with limited capacity to promote social distance, such as penitentiary institutions.

The power of interpretation in the analysis of cranial computed tomography (CCT) among neurosurgeons and radiologists has rarely been studied. This study aimed to assess the rate of agreement in the interpretation of CCTs between neurosurgeons and a radiologist in an emergency department. Method 227 CCT were independently analyzed by two neurosurgeons (NS1 and NS2) and a radiologist (RAD). The level of agreement in interpreting the examination was studied. Results The Kappa values obtained between NS1 and NS2 and RAD were considered nearly perfect and substantial agreement. The highest levels of agreement when evaluating abnormalities were observed in the identification of tumors, hydrocephalus and intracranial hematomas. The worst levels of agreement were observed for leukoaraiosis and reduced brain volume. Conclusions For diseases in which the emergency room procedure must be determined, agreement in the interpretation of CCTs between the radiologist and neurosurgeons was satisfactory.

Purpose This study aims to estimate the overall SARS-CoV-2 seroprevalence and evaluate the accuracy of an antibody rapid test compared to a reference serological assay during a COVID-19 outbreak in a prison complex housing over 13,000 prisoners in Brasília. Design/methodology/approach The authors obtained a randomized, stratified representative sample of each prison unit and conducted a repeated serosurvey among prisoners between June and July 2020, using a lateral-flow immunochromatographic assay (LFIA). Samples were also retested using a chemiluminescence enzyme immunoassay (CLIA) to compare SARS-CoV-2 seroprevalence and 21-days incidence, as well as to estimate the overall infection fatality rate (IFR) and determine the diagnostic accuracy of the LFIA test. Findings This study identified 485 eligible individuals and enrolled 460 participants. Baseline and 21-days follow-up seroprevalence were estimated at 52.0% (95% CI 44.9–59.0) and 56.7% (95% CI 48.2–65.3) with LFIA; and 80.7% (95% CI 74.1–87.3) and 81.1% (95% CI 74.4–87.8) with CLIA, with an overall IFR of 0.02%. There were 78.2% (95% CI 66.7–89.7) symptomatic individuals among the positive cases. Sensitivity and specificity of LFIA were estimated at 43.4% and 83.3% for IgM; 46.5% and 91.5% for IgG; and 59.1% and 77.3% for combined tests. Originality/value The authors found high seroprevalence of anti-SARS-CoV-2 antibodies within the prison complex. The occurrence of asymptomatic infection highlights the importance of periodic mass testing in addition to case-finding of symptomatic individuals; however, the field performance of LFIA tests should be validated. This study recommends that vaccination strategies consider the inclusion of prisoners and prison staff in priority groups.