Cryptococcosis, caused by yeasts of the genus Cryptococcus, is an infectious disease with a worldwide distribution. Cryptococcus neoformans and Cryptococcus gattii are the species that commonly cause this disease in humans; however, infections caused by Cryptococcus laurentii, especially in immunocompromised patients, are increasingly being reported. Owing to the increase in the resistance of fungi to antifungals, and a lack of treatment options, it is important to seek new therapeutic alternatives such as natural products. Among these are plant species such as Punica granatum, which is used in folk medicine to treat various diseases. This study aimed to evaluate the activity of the acetate fraction of P. granatum leaf extract against environmental and clinical isolates of Cryptococcus. Three environmental isolates of C. laurentii, PMN, PMA, and PJL II, isolated from soils of different municipalities in the state of Maranhão, a clinical isolate, C. gattii, from a patient with neurocryptococcosis, and a standard strain of C. gattii (ATCC 32068) were used. The minimum and fractional inhibitory concentrations (MIC and FIC, respectively) and time-kill curve of the extract and fluconazole were determined to assess the susceptibility profile of the fungal isolates. Larvae of Tenebrio molitor were infected with Cryptococcus strains, and the effects of acetate fraction of P. granatum extract and fluconazole on the survival and fungal burden were determined. The extract activity was tested against pre-formed biofilms. The acetate fraction of P. granatum extract showed promising antifungal activity against all the species of Cryptococcus evaluated in this study, with an MIC value lower than that of fluconazole. The indices obtained in the FIC test indicated that the antimicrobial effect of the combination of the extract and antifungal was indifferent for 80% of the isolates. The P. granatum acetate fraction reduced the pre-formed biofilm of some isolates, showing better activity than fluconazole, which is consistent with results from fluorescence microscopy. This is the first study on the use of P. granatum and its ability to inhibit Cryptococcus biofilms; therefore, further studies and tests are needed to investigate the components and mechanism of action of P. granatum against cryptococcosis agents.

Sickle cell anaemia is one of the most common hemoglobinopathies worldwide and an important public health problem in Brazil. This study evaluated the prevalence of sickle cell anaemia and its traits in newborns from the Amazon-Savanna Transition Region in the state of Maranhão, Brazil. A cross-sectional study was carried out, based on data from neonatal screening tests performed in 2013–2015 in Maranhão. The Hardy-Weinberg theorem was applied to analyse the frequency of expected homozygotes based on HbSS phenotype. A spatial-temporal distribution analysis was performed to delimit the regions with the greatest number of newborn cases with sickle cell anaemia. Of 283,003 newborns, 162 were found to have sickle cell anaemia, while 10,794 had a sickle cell trait, with a prevalence of 0.05% and 3.8%, respectively. The prevalence of expected homozygotes was higher in the North Region and in the state capital of Maranhão. This study may contribute to existing social and public health actions or the creation of new strategies for sickle cell disease in endemic areas in Brazil to improve the quality of life.

A Candidíase Vulvovaginal (CVV) é um dos principais problemas ginecológicos. Sua prevalência parece ter aumentado nos últimos anos, evoluindo de 0,5% em 1968 para 22,5% em 1998, época em que se tornou a causa mais comum de infecção da mucosa vulvovaginal. Aproximadamente 5% das mulheres diagnosticadas desenvolvem candidíase vulvovaginal recorrente (CVVR). A CVV possui vários fatores de risco e é resistente a maioria dos antifúngicos. O objetivo deste estudo é analisar a prevalência de candidíase vulvovaginal e os seus fatores de riscos por meio de revisão bibliográfica, análise realizada no período de Janeiro a Julho de 2018, utilizando os descritores: Candidíase Vulvovaginal, Fatores de Risco. As espécies mais predominantes na CVV dependem do local de estudo e os principais fatores predisponentes são a falta de conhecimento sobre a candidíase, fatores geográficos, hábitos culturais, entre outros. Existe uma falta de concordância entre os autores em relação aos fatores de risco, sendo necessárias novas pesquisas para propor medidas preventivas para a candidíase vulvovaginal.

Cryptococcal infections are distributed worldwide and mainly caused by Cryptococcus neoformans and Cryptococcus gattii. The reduced number of antifungals and increasing number of cases of resistance require the search for new therapeutic options, such as natural products. Among these, Punica granatum L. has demonstrated antifungal activity. The present study aimed to evaluate the in vitro activity of the hydroethanolic extract of the leaf of P. granatum (HEPg) alone or in antifungal combination against C. neoformans and C. gattii and the interference of P. granatum in the mitochondrial membrane of Cryptococcus using flow cytometry. The minimum inhibitory concentration was determined, which showed inhibitory activity against Cryptococcus isolates. The fractional inhibitory concentration resulted in an indifferent interaction between the combination of amphotericin B + HEPg, whereas the combination of fluconazole + HEPg was synergistic against C. gattii. The depolarisation of mitochondrial membranes was more pronounced when C. gattii was previously treated with P. granatum, either individually or in combination with antifungal agents. In contrast, prior treatment of C. gattii with fluconazole promoted the hyperpolarisation of mitochondrial membranes. Considering the growing search for alternative forms of treatment for cryptococcosis, this study highlights the antifungal potential of P. granatum.