In this thesis we will consider two mathematical models on malaria transmission and patho- genesis. The transmission model is a human-mosquito interaction model that describes the development of malaria in a human population. It accounts for the various phases of the disease in humans and mosquitoes, together with treatment of both sick and partially im- mune humans. The partially immune humans (termed asymptomatic) have recovered from the worst of the symptoms, but can still transmit the disease. We will present a mathematical model consisting of a system of ordinary differential equations that describes the evolution of humans and mosquitoes in a range of malarial states. A new feature, in what turns out to be a key class, is the consideration of reinfected asymptomatic humans. The analysis will include establishment of the basic reproduction number, R0, and asymptotic analysis to draw out the major timescale of events in the process of malaria becoming non-endemic to endemic in a region following introduction of a few infected mosquitoes. We will study the model to ascertain possible time scale in which intervention programmes may yield better results. We will also show through our analysis of the model some evidence of disease control and possible eradication. The model on malaria pathogenesis describes the evolution of the disease in the human host. We model the effect of immune response on the interaction between malaria parasites and erythrocytes with a system of delay differential equations in which there is time lag between the advent of malaria merozoites in the blood and the training of adaptive immune cells. We will study the model to ascertain whether or not a single successful bite of an infected mosquito would result in death in the absence of innate and adaptive immune response. Stability analysis will be carried out on the parasite free state in both the immune and non immune cases. We will also do numerical simulations on the model to track the development of adaptive immunity and use asymptotic methods, assuming a small delay to study the evolution of the disease in a naive individual following the injection of small amount of merozoites into the blood stream. The effect of different levels of innate immune response to the pathogenesis of the disease will be considered in the simulations to elicit a possible immune level that can serve as a guide to producing a vaccine with high efficacy level.

La leishmaniose viscérale (LV) à Leishmania infantum est une zoonose qui sévit notamment autour du bassin méditerranéen. Elle atteint principalement le chien, qui représente le réservoir de l’infection. Chez l’homme, si la forme patente est rare, il existe de nombreux sujets porteurs asymptomatiques dans les zones d’endémies. Au cours de ce travail, nous avons abordé 3 problématiques importantes concernant la LV. La première problématique à porté sur l’importance du portage asymptotique humain à L. infantum au niveau mondial et de ses conséquences. Notre étude montre que la fréquence de porteurs asymptomatiques dépend des tests de détection utilisés et des populations étudiées et qu'elle peut atteindre jusqu'à 70% dans certaines zones d’endémies. Elle montre également que la transmission du parasite par don de sang est peu probable et que le rôle du portage asymptomatique comme réservoir n’est pas encore démontré. Elle souligne également la nécessité de détecter le portage asymptotique chez le donneur et le receveur de greffe et le risque de développement de la forme patente chez l’asymptomatique déprimé. La deuxième problématique porte sur le développement de procédés vaccinaux contre L. infantum par voie endonasale chez la souris BALB/c. Nos résultats montrent que la vaccination par voie nasale induit de manière reproductible une immunité systémique, cellulaire et humorale et que la protection dépend de paramètres tels que la nature et la dose des antigènes utilisées et la présence d’adjuvant tels que le CNF et le MPL. Enfin, la sélection d’une infection intradermique permet d’améliorer significativement la protection.La troisième partie porte sur la mise au point de modèles expérimentaux d’infection basés sur l’utilisation de parasites recombinants exprimant le gène de la luciférase. Nos travaux montrent que l’utilisation de tels outils permet de suivre l’infection à L. infantum in vitro, ex vivo et in vivo chez la souris BALB/c et de ce fait sont utiles pour le criblage de médicaments comme la miltéfosine et potentiellement pour tester des préparations vaccinales. Cet outil nous a permis en outre de révéler un nouveau site de prolifération parasitaire. / Visceral leishmaniasis (VL) caused by L. infantum is a zoonotic disease present in the Mediterranean basin (LVM). Dogs represent the reservoir and the main victim of the disease. In man, besides a limited number of cases of patent VL, a great number of infection remains asymptomatic. In this report, three different aspects of VL have been studied.First, the prevalence and the consequences of asymptomatic carriers of L. infantum was evaluated worldwide. The prevalence of asymptomatic carriers depends on the selected detection tests and the studied population and can reach 70% in some endemic zones. Our study also shows that the role of asymptomatic carriers as reservoirs remains to be established. However, in immunocompromised asymptomatic carriers such as HIV positive individuals, infection can be reactivated.Second, we developed vaccine trials against L. infantum in the BALB/c mouse model using the nasal route. Nasal immunization with Leishmania antigens induces cellular and humoral systemic immunity. Protection depends on various parameters including the nature of antigens, the dose and the presence of adjuvants such as CNF or MPL. Protection was improved when mice were challenged by ID route.Third, we set up experimental models of infection based on the use of recombinant parasites expressing the luciferase gene. These tools allow us to trace the infection in vitro, ex vivo and in vivo and therefore are useful to evaluate the efficiency of drugs and potentially to assess vaccine preparations. Bioluminescence imaging was also useful to evidence a new potential site of parasite proliferation.

Depression is a pervasive mental health disorder worldwide. Although being diagnosed with chronic illness exacerbates susceptibility to depression, detection and subsequent treatment of comorbid depression in primary care settings remain suboptimal because patients with chronic medical disorders are not commonly screened for depression. There is a need to initiate proactive measures by implementing routine screening in primary care settings. The plan-do-study-act (PDSA) model guided an intervention to establish a depression screening practice. This study aimed to determine if the implementation of evidence-based screening for depression using the Patient Health Questionnaire-9 (PHQ-9) tool could increase diagnosis of comorbid depression among patients suffering from chronic diseases. Convenience sampling served as the method for selecting healthcare records that met the predetermined criteria. Two hundred established patients over 18 years of age were screened for depression at a primary care clinic in Maryland within a 10-week period following Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Study participants included 84 (42%) males and 116 (58%) females. Of these, 84 (42%) had minimal depression, 57 (29%) had mild depression, 23 (12%) had moderate depression, 24 (12%) had moderate-severe depression, and 12 (6%) had severe depression. The baseline report from the clinic revealed 0% depression screening practices yet the post-project chart review revealed a surprisingly high rate of depression diagnosis in 34 (17%) of 200 patients suffering from chronic illnesses. Identification of a reliable tool that would be used to screen depression among patients with chronic diseases at primary care clinics to mitigate the deleterious effects of depression and promote the well-being and health of patients and their families is important.

Orientador: Valéria Marçal Felix de Lima / Banca: Rosangela Zacarias Machado / Banca: Alexandre Barbosa Reis / Resumo: O cão é o principal reservatório da Leishmania (Leishmania) chagasi, o parasita responsável pela Leishmaniose Visceral (LV) nas Américas. Na (LV) estudos em modelos experimentais, têm mostrado diferenças na resposta imunológica entre macho e fêmea. Na (L VC) tais estudos, não foram realizados. Este trabalho investigou em cães assintomáticos machos e fêmeas, naturalmente infectados por Leishmania (L.) chagasi, os níveis séricos de IgG contra antígenos totais de Leishmania, o nível de IL-10 e IFN-y, no sobrenadante do extrato do baço e fígado, e a citocina regulatória TGF-j3 no sobrenadante do extrato do baço e fígado, e sua produção natural no sobrenadante de cultura de células esplênicas. Os níveis de anticorpos anti-L. (L.) chagasi da classe IgG nos cães assintomáticos machos e fêmeas, não apresentaram diferença significativa entre o sexo. O nível de IL-10 mostrou-se elevado, no sobrenadante do extrato do fígado em cães infectados machos e fêmeas assintomáticos e apresentou dominância marcante em relação às outras citocinas. O nível do TGF-j3 mostrou-se aumentado no extrato do baço. O nível de IFN-y no baço dos grupos avaliados foi quantitativamente menor que as citocinas IL-10 e TGF-B. diferindo do observado no fígado onde foi observado uma baixa produção de TGF-j3 em relação ao IFN-y. No baço, o IFN-y apresentou diferença significativa em fêmeas assintomáticas quando comparadas com os machos assintomáticos. A observação da predominância das citocinas TGF-j3 no baço, e IL-10 no baço e fígado, em modelo ex vivo, sugere uma polarização da resposta imunológica para o padrão Th2 em cães naturalmente infectados por Leishmania (L.) chagasi. / Abstract: The dog is the main reservoir of Leíshmanía (Leíshmanía) chagasí, the parasite responsible for Visceral Leishmaniasis (VL) in the Americas. Experimental studies on VL have shown differences in the immune response of males and females. Such studies have not been carried out on canine visceral leishmaniasis. This study investigated the seric levei of IgG against Leíshmanía total antigens, the levels of IL-10 and IFN-y in the supernatant of spleen and liver extracts, the regulatory cytokine TGF-131 in the supernatant of spleen and liver extracts, and its natural production in the supernatant of spleen cell culture, in male and female asymptomatic dogs naturally infected by Leíshmanía (L.) chagasi. The levels of anti-L. (L.) chagasí IgG antibodies in male and female asymptomatic dogs did not differ significantly between the sexes. IL-10 levei was high in the supernatant of the liver extract of male and female asymptomatic infected dogs and predominated over the other cytokines. TGF-131 levei was increased in the spleen extract. The levei of IFN-y in the spleen of the group evaluated was quantitatively lower than the IL-10 and TGF-131 cytokine levels, different from what was observed in the liver, where a low productíon of TGF-131 was observed when compared to IFN-y. In the spleen, IFN-y presented a significant difference in the asymptomatic females when compared to the asymptomatic males. The observation of a predominance of TGF-131 cytokines in the spleen and of IL-10 in the spleen and liver of an ex vívo model suggests a polarization of the immune response towards the Th2 pattern in dogs naturally infected by Leíshmanía (L.) chagasí. / Mestre

In the absence of an effective vaccine, vector control and surveillance of dengue fever (DF) and dengue hemorrhagic fever (DHF) are the most important strategies currently used to reduce the impact of these diseases in affected population. The objectives of this study were to estimate the incidence of symptomatic and asymptomatic dengue cases, the prevalence of antidengue antibodies, and to evaluate the laboratory and clinical aspects related to an active surveillance of dengue cases. In this study, active surveillance was incorporated as a part of the study design. At total of 3,255 people from four high risk neighborhoods were followed in a two years prospective study whereby the participants' houses were visited three times a week. During these visits, dengue cases were characterized by identifying patients with fever as well as other symptoms that were compatible with dengue disease. In addition, a biannual blood sample was taken for each study participants, to establish the prevalence and six month incidence of dengue infection. We found a crude incidence density (ID) of 3.24 by 100,000 person/days (p/d) which changed from 5.69 by 100,000 p/d for the first year of the study to 1.45 by 100.000 p/d in the second year. In both years, the months from July through September had the highest ID of 8.81 by 100,000 p/d. Children displayed higher ID when compared to adults, RR: 3.92 (2.38 - 6.48). The Plaque Reduction Neutralization Test was used to assay for the presence of antidengue antibody in 2,125 study participants (65.3% of total). The prevalence of anti dengue antibodies was found to be 86.6% (1,840 positives). The prevalence of anti DENV-1 was 74%, while 65.2 % of the participants had anti- DENV-1 and anti- DENV-2 simultaneously. The cumulative incidence of anti IgG dengue antibody in the negative participants (283 at the start of the study) was 30% in the first 6 months period, 29.6% in the second 6 months, and 23.8 in the third one. The difference between the numbers of participants detected in the active surveillance, (270 confirmed and non confirmed dengue cases) with the numbers of people who showed sero-conversion to anti-IgG dengue antibody within a relatively short period of time suggested that there was a high number of asymptomatic dengue infections present in the population. Transmissibility of the virus, the surveillance of dengue, and vaccine implementation in the near future would all be affected by the large number of asymptomatic people in hyperendemic countries.

Evidence-based dentistry (EBD), an evolving educational tool that started its rise in the late 1990’s and early 2000’s, is being used more every year in dentistry. EBD combines the most current scientific and clinical evidence with the dentists’ expertise and the patients’ needs and preferences to formulate the best option to treat the patient. Since patients are taking more time to research their oral health issues before seeing their dentists, the dentists and the dental team must be prepared for all types of questions. Having the tools necessary to understand the latest and most significant research allows dental professionals to consistently educate themselves. However, there is no independent committee that handles the current issues facing dentistry. Using the topic of asymptomatic removal of third molars as a framework for EBD education, it can be used to help improve how schools educate their students. It is important that both the dental community and the public understand the scientific literature behind the removal of third molars because the existing practice of removing third molars without adverse symptoms is not statistically supported. Unfortunately, there is not enough evidence in favor of either side of the situation. Major databases, like PubMed, contain very little research on the asymptomatic removal of third molars, and those studies were not done recently. For EBD to be successful in dentistry, it must function in the clinical environment, but initial training in the concepts of EBD must start during pre-doctoral education. The dental practitioner still must rely on his or her own experience, but the patient must also trust his or her dentist. EBD is based on trust because it is based on the trust you have demonstrated through your skills and your usage of all available resources. If the dentist can compile pertinent scientific data and information to share with the patient and make the best decision together, then the use of EBD will be beneficial to the field of dentistry.

Objective: The aims of this prospective clinical cohort study were to determine the prevalence of asymptomatic bacteriuria in dogs with cranial cruciate ligament disease and to determine which clinical parameters and clinicopathologic data are associated with asymptomatic bacteriuria. Another aim was to determine the incidence of surgical site infections in dogs with and without asymptomatic bacteriuria. Results: In 156 dogs with cruciate ligament disease, the prevalence of asymptomatic bacteriuria was 7.1%. Furthermore, the prevalence was 12.4% in female dogs and 0% in male dogs. The most common bacterial isolate was Escherichia coli. Patient sex, urine white blood cells/ high-powered field, and microscopic bacteriuria were significantly different between dogs with and without asymptomatic bacteriuria. Only 60% of dogs with microscopic bacteriuria had growth on urine aerobic culture. No significant difference was found in age, body weight, body condition score, duration of lameness, limb affected, or other urinalysis values between dogs with and without asymptomatic bacteriuria. Of the dogs that had 8-week repeat cultures, 2/3 dogs with asymptomatic bacteriuria had negative urine cultures and 3/43 without asymptomatic bacteriuria had positive urine cultures. Of 57 dogs that received surgery and had sufficient follow-up, 15 developed surgical site infection. All surgical site infections occurred in dogs without AB. The incidence of surgical site infection in this population was 26.3% (15/57). Conclusions: Prevalence of asymptomatic bacteriuria in dogs presenting with cranial cruciate ligament disease was similar to previously reported values in male and female dogs. This suggests that dogs with cranial cruciate ligament disease are not more prone to asymptomatic bacteriuria than dogs in previously studied populations. Preliminary data suggests that AB does not predispose dogs to SSI however further research and continued data collection is warranted. / Master of Science / Asymptomatic bacteriuria is defined as having bacteria in the urine without signs of lower urinary tract disease. The aim of this study was to determine the prevalence asymptomatic bacteriuria in dogs with cranial cruciate ligament disease. Additionally, another aim was to determine the incidence of surgical site infections after cranial cruciate ligament surgery in dogs with and without asymptomatic bacteriuria. Prevalence of asymptomatic bacteriuria in dogs presenting with cranial cruciate ligament disease was found to be similar to previously reported values in male and female dogs. This suggests that dogs with cranial cruciate ligament disease are not more prone to asymptomatic bacteriuria than dogs in previously studied populations. Preliminary data suggests that dogs with bacteria in the urine does not predispose dogs to SSI however further research and continued data collection is warranted.

theresa.j.ochoa@uth.tmc.edu / Article / BACKGROUND: Enteropathogenic Escherichia coli (EPEC) strains are pediatric pathogens commonly isolated from both healthy and sick children with diarrhea in areas of endemicity. The aim of this study was to compare the bacterial load of EPEC isolated from stool samples from children with and without diarrhea to determine whether bacterial load might be a useful tool for further study of this phenomenon. METHODS: EPEC was detected by polymerase chain reaction (PCR) of colonies isolated on MacConkey plates from 53 diarrheal and 90 healthy children aged <2 years. DNA was isolated from stool samples by cetyltrimethylammonium bromide extraction. To standardize quantification by quantitative real-time PCR (qRT-PCR), the correlation between fluorescence threshold cycle and copy number of the intimin gene of EPEC E2348/69 was determined. RESULTS: The detection limit of qRT-PCR was 5 bacteria/mg stool. The geometric mean load in diarrhea was 299 bacteria/mg (95% confidence interval [CI], 77-1164 bacteria/mg), compared with 29 bacteria/mg (95% CI, 10-87 bacteria/mg) in control subjects (P = .016). Bacterial load was significantly higher in children with diarrhea than in control subjects among children <12 months of age (178 vs 5 bacteria/mg; P = .006) and among children with EPEC as the sole pathogen (463 vs 24 bacteria/mg; P = .006). CONCLUSIONS: EPEC load measured by qRT-PCR is higher in diarrheal than in healthy children. qRT-PCR may be useful to study the relationship between disease and colonization in settings of endemicity.

A lombalgia e a cervicalgia possui grande incidência em toda a população mundial. Segundo a Organização Mundial de Saúde (OMS), em média, cerca de 80% da população adulta apresenta, em algum momento da vida, pelo menos uma queixa de dor na coluna, onde a degeneração da articulação do processo articular é frequentemente apontada como a etiologia. Diversos estudos vêm sendo realizados, na tentativa de se compreender como ocorre o processo degenerativo patológico dessas articulações, onde, frequentemente são usados indivíduos sintomáticos. Deste modo, avaliou-se, com o uso de técnicas macroscópicas, de microscopia de luz e de microscopia eletrônica, a organização estrutural da cartilagem dos processos articulares (CPas) das vértebras cervicais (C) e lombares (L) de indivíduos jovens (GJ) e idosos (GI), presumivelmente assintomáticos. Foram utilizados blocos vertebrais obtidos de cadáveres necropsiados no Serviço de Verificação de Óbitos da Capital do Estado de São Paulo, onde familiares de todos os indivíduos forneceram informações que permitiram incluir ou excluí-los da pesquisa. Os resultados mostram que ocorrem alterações na superfície da CPa do segmento L no GJ. A degeneração da CPa ocorre de forma heterogênea entre os indivíduos do GI e as característica do grau 2 podem ser admitidas como decorrentes do processo de envelhecimento normal, não havendo diferenças entre os segmentos C e L. / Back pain and neck pain have a high occurrence in populations worldwide. According to the World Health Organization (WHO), approximately 80% of adults have at some instance in life pain in the spine with an etiology frequently indicated to be the degeneration of the articular process. Several studies have been undertaken to understand how the pathological degenerative process occurs and symptomatic subjects are frequently used for this end. Macroscopic and light and electron microscopy techniques have been employed to assess the structural organization of the cartilage of the articulation processes (CAP) of the cervical (C) and lumbar (L) vertebrae of presumably asymptomatic young (Y) and elderly (E) people. Samples, retrieved from routinely necropsied corpses by the Death Verification Service of the Capital City of the State of São Paulo (SVOC/SP) and the family of all individuals provided information that enabled include or exclude them from search. Results show that changes in the CAP surface of segment L of Y occur. CAP degradation occurs heterogeneously among elderly people, whereas second degree characteristics are caused by normal aging without any difference between the C and L segments.

Leptospirosis is a zoonotic disease of global importance caused by pathogenic Leptospira species. Dogs are reservoir hosts for pathogenic Leptospira and can act as potential transmission sources of the disease. Identification of such individuals and characterization of leptospires involved in chronic infections may promote a better understanding of the role of dogs in the epidemiology of particular leptospiral strains and the overall contribution of dogs to environmental contamination in urban and rural scenarios. The present work describes the identification of dogs presenting asymptomatic urinary shedding of different pathogenic Leptospira species among stray and sheltered dog populations, as well as the characterization of leptospiral strains isolated from chronic carriers. Blood and urine samples were taken from three different populations: (I) 92 dogs kept in a public shelter at the University of São Paulo campus; (II) seven stray dogs living inside the University of São Paulo campus; and (III) 24 dogs kept in a public shelter from the city of Mogi das Cruzes. Dogs identified as urinary shedders by PCR-based DNA detection were prospectively evaluated in order to confirm persistent renal carriage of the pathogen and to recover viable leptospires for proper characterization. Leptospiruric dogs were identified in all populations studied. Quantitative PCR targeting the lipL32 gene and the 16S rRNA detected urinary shedding in 10 dogs (10,87%) from population I: two of these dogs were recently admitted at the facility and one dog was adopted immediately after presenting large quantities of leptospires in urine. Prospective evaluation of nine leptospiruric dogs enabled the identification of two chronic carriers, allowing the recovery of leptospires from both dogs. The strains were further characterized by MLST analysis and serogrouping, thus confirming infection caused by L. interrogans serogroup Canicola and L. santarosai serogroup Sejroe. Two leptospiruric dogs (28,5%) were detected in population II by 16S and secY PCR amplification; one dog presented persistent urinary shedding of L. interrogans, but no isolates could be recovered. The other leptospiruric dog presented asymptomatic infection caused by L. santarosai and could not be reevaluated. Only one dog from population III (4,1%) presented leptospiruria detected by PCR; the dog could not be reevaluated, however sequence analysis revealed infection caused by L. santarosai. The results indicate the first report of L. santarosai infection in dogs. Asymptomatic infection caused by this leptospiral species was observed in all populations studied, thus indicating a possible role of dogs in the chain of transmission of this particular pathogen. The results also suggest a possible genetic distinction between lineages of Brazilian L. santarosai maintained by dogs and other animal hosts. Isolation and persistent chronic carriage of L. santarosai found shows that dogs can persistently harbor leptospires other than L. interrogans. This study also points out that dogs can be inadvertently admitted and adopted in dog shelters, potentially increasing the risks of occupational and zoonotic transmission by bringing infected animals closer to shelter workers, adopters and their households. / A leptospirose é uma doença zoonótica de importância global causada por espécies patogênicas do gênero Leptospira. Cães são hospedeiros de manutenção de leptospiras patogênicas e podem atuar como potenciais fontes de infecção da doença. A identificação de tais indivíduos e a caracterização de leptospiras envolvidas na infecção crônica podem ajudar a compreender o papel dos cães na epidemiologia da doença tanto em ambientes rurais quanto urbanos. O presente trabalho descreve a identificação de cães errantes e mantidos em abrigos coletivos com eliminação assintomática de leptospiras patogênicas, além de descrever também a caracterização das diferentes estirpes obtidas de cães cronicamente infectados. Amostras de sangue e urina foram coletadas de 3 populações distintas: (I) 92 cães mantidos em um abrigo coletivo localizado dentro da Universidade de São Paulo; (II) sete cães errantes capturados dentro do campus da Universidade de São Paulo; e (III) 24 cães mantidos em um abrigo coletivo localizado na cidade de Mogi das Cruzes. Cães identificados como leptospirúricos por técnicas moleculares (PCR) foram prospectivamente avaliados para confirmar a persistência da eliminação bacteriana e para obter isolamento da cepa infectante e sua subsequente caracterização. A amplificação de fragmentos dos genes 16S rRNA e lipL32 permitiu a identificação de 10 cães (10,87%) leptospirúricos na população I. Dois dos 10 cães haviam sido recentemente admitidos no local, e outro cão foi adotado logo após apresentar grandes quantidades de leptospiras na urina. A avaliação prospectiva de nove animais leptospirúricos permitiu a caracterização da infecção crônica e assintomática em dois cães, o que possibilitou o isolamento de leptospiras de ambos os animais. As cepas foram tipificadas pelas técnicas de MLST e sorogrupagem, caracterizando duas cepas distintas, sendo elas L. interrogans sorogrupo Canicola e L. santarosai sorogrupo Sejroe. Dois cães leptospirúricos (28,5%) foram identificados na população II pela amplificação por PCR dos genes 16S rRNA e secY; um deles apresentou eliminação persistente de L. interrogans, no entanto não foi possível o isolamento do patógeno. O outro cão leptospirúrico não pôde ser reavaliado, entretanto a análise filogenética permitiu identificar infecção causada por L. santarosai. Apenas um cão da população III (4,1%) apresentou eliminação de leptospiras na urina, que foi confirmada pela amplificação de fragmento dos genes 16S rRNA e secY; o cão não pôde ser reavaliado, no entanto a análise filogenética dos fragmentos amplificados confirmou infecção causada por L. santarosai. Os resultados indicam o primeiro registro de infecção causada por L. santarosai em cães. A ocorrência da infecção assintomática causada por essa espécie nas três populações avaliadas indica um possível papel dos cães na cadeia de transmissão desse patógeno em centros urbanos, além de demonstrar que cães podem se tornar portadores de diferentes espécies de leptospiras. Os resultados sugerem uma possível distinção genotípica de cepas de L. santarosai mantidas por cães quando comparadas com estirpes desta espécie isoladas de outros hospedeiros. O presente estudo também foi capaz de demonstrar que cães leptospirúricos podem ser inadvertidamente admitidos ou adotados em abrigos coletivos, aumentando potencialmente os riscos de transmissão ocupacional e zoonótica da doença.