JORGE AUGUSTO DE OLIVEIRA GUERRA

@fmt.am.gov.br

Gerencia de Leishmaniose
FUNDAÇÃO DE MEDICINA TROPICAL DOUTOR HEITOR VIEIRA DOURADO

JORGE AUGUSTO DE OLIVEIRA GUERRA


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https://researchid.co/jorgeguerra

EDUCATION

Universidade Federal do Amazonas Manaus Amazonas Brasil
Medicina 1978 a 19183

RESEARCH, TEACHING, or OTHER INTERESTS

Infectious Diseases, Health Professions, Parasitology, Epidemiology
22

Scopus Publications

Scopus Publications

  • Evaluation of the autonomic nervous system in autochthonous patients from Amazon with acute Chagas disease treated with benznidazole
    Mônica Regina Hosannah da Silva e Silva, Débora Raysa Teixeira de Sousa, Jessica Vanina Ortiz, Matheus Martins Monteiro, Alba Regina Jorge Brandão, Marcia Regina Silva e Silva, Susan Smith-Doria, Melissa de Sousa Melo Cavalcante, Katia do Nascimento Couceiro, Guilherme Peixoto Tinoco Arêas, Jorge Augusto de Oliveira Guerra, Maria das Graças Vale Barbosa Guerra, João Marcos Bemfica Barbosa Ferreira
    Plos Neglected Tropical Diseases, 2026
    Chagas disease, a neglected tropical disease, is endemic in the Amazon region, where oral transmission predominates. Autonomic nervous system (ANS) impairment is a recognized pathophysiological mechanism contributing to disease progression, including Chagas cardiomyopathy. This study aimed to assess ANS function in patients with acute Chagas disease from the Amazon, evaluating responses pre- and post-benznidazole treatment. We included 28 acute-phase patients and 20 healthy controls. Participants underwent comprehensive cardiac evaluations, including 12-lead ECG, echocardiogram, 24-hour Holter monitoring, treadmill stress testing, and 5-minute heart rate variability (HRV) assessment. HRV was analyzed across time, frequency, and nonlinear domains, with statistical comparisons performed between groups and within the patient cohort. The study population predominantly comprised individuals from rural Amazonian municipalities (89.3%), with oral transmission accounting for 85.7% of infections. While resting ECGs were normal in 60.7%, diffuse ventricular repolarization was the most common abnormality (21.4%). Before treatment, 24-hour HRV showed significant reductions in SDANN and SDNN, indicating sympathovagal imbalance. For 5-minute HRV, significant alterations were observed across time (rMSSD, SDNN), frequency (LF, HF, LF/HF ratio), and nonlinear domains, reflecting reduced parasympathetic tone. Intragroup comparisons (pre- vs. post-treatment) further reinforced the sustained sympathovagal imbalance and parasympathetic inhibition. These findings highlight persistent autonomic modulation alterations, characterized by sympathovagal imbalance and reduced parasympathetic activity, in acute Chagas disease patients from the Amazon. Such dysfunction may predispose individuals to long-term structural cardiac changes and arrhythmias, underscoring the critical need for continued monitoring and potential targeted interventions to address autonomic imbalance in this vulnerable population.
  • Chronic Chagas Disease in the Brazilian Amazon: Serological Survey, Clinical Follow-Up, and Associated Risk Factors
    Susan Smith-Doria, Laise Kelma Costa Magalhães, Laylah Kelre Costa Magalhães, Suzane Ribeiro Prestes, Alba Regina Jorge Brandão, Emily de Sousa Moura, Elsa Isela Guevara Moctezuma, Monica Regina Hosanahh da Silva e Silva, Katia do Nascimento Couceiro, Yuliana Padrón-Antonio, Victor Irungu Mwangi, Jessica Vanina Ortiz, Leíla Ines Aguiar Raposo Câmara Coelho, Adriano Gomes-Silva, Henrique Silveira, João Marcos Bemfica Barbosa Ferreira, Jorge Augusto de Oliveira Guerra, Maria das Graças Vale Barbosa Guerra
    American Journal of Tropical Medicine and Hygiene, 2025
    The prevalence and characteristics of chronic Chagas disease (CCD) in the Amazon Region remain underexplored. This study aimed to describe the challenges encountered during a serological survey and follow-up of CCD, while also highlighting potential risk factors in the Amazon Region. The serological survey involved residents of periurban and rural areas of Manaus in the Brazilian Amazon. All participants were invited to complete a clinical, epidemiological, and demographic questionnaire and provide a blood sample for anti-Trypanosoma cruzi (T. cruzi) IgG tests. A total of 1,845 participants were included, of whom 43 were identified as having presumed CCD, based on having at least two positive serological tests. Only 35 underwent complementary tests, and five had cardiac alterations not consistent with CCD. The main risk factors associated with CCD were age ≥20 years, living in periurban areas, reporting the presence of the insect vector inside the household, entering the forest, consumption of bushmeat, and having undergone blood transfusion. In the Amazon, the population is exposed to the sylvatic T. cruzi life cycle and is unaware of the associated risk factors. The divergent serology results raise doubts about the reliability of the commercial serological tests used for CCD screening in the region. Surveillance for CCD is important in the Amazon.
  • Chagas Disease and Brazil’s Unified Health System (SUS): The Challenge of Confronting Historical Gaps
    Memorias do Instituto Oswaldo Cruz, 2025
  • Reactivation of cutaneous leishmaniasis after kidney transplantation in the Brazilian Amazon: a case report
    Alba R. J. Brandão, Elsa I. G. Moctezuma, Edival F. de Oliveira Júnior, Jessica V. Ortiz, Débora R. T. de Sousa, Kátia do N. Couceiro, João M. B. B. Ferreira, Mônica R. H. da S. e Silva, Susan S. Doria, Lucely P. R. da Silva, Karla C. S. Petruccelli, Márcia R. S. da Silva, Francisco M. João, Jorge A. de Guerra, Maria das G. V. B. Guerra
    International Journal of Dermatology, 2024
  • Treatment of cutaneous leishmaniasis with a sequential scheme of pentamidine and tamoxifen in an area with a predominance of Leishmania (Viannia) guyanensis: A randomised, non-inferiority clinical trial
    Silmara Navarro Pennini, Jorge Augusto de Oliveira Guerra, Paula Frassinetti Bessa Rebello, Marília Rosa Abtibol‐Bernardino, Luigui Lima de Castro, Antonio Alcirley da Silva Balieiro, Cynthia de Oliveira Ferreira, Ariani Batista Noronha, Camila Gurgel dos Santos da Silva, André Luiz Leturiondo, Denison Vital de Jesus, Felipe Jules de Araújo Santos, Anette Chrusciak‐Talhari, Maria Das Graças Vale Barbosa Guerra, Sinésio Talhari
    Tropical Medicine and International Health, 2023
    ObjectiveTo determine whether a combination of a single intramuscular (IM) dose of pentamidine (7 mg/kg) followed by oral tamoxifen 40 mg/day for 20 days is non‐inferior to three IM doses of pentamidine 7 mg/kg in the treatment of cutaneous leishmaniasis with a margin of 15%.MethodsPhase II, randomised, controlled, open‐label, non‐inferiority clinical trial. Primary outcome was the complete healing of the lesions 6 months after starting treatment. Secondary outcomes were healing 3 months after starting treatment and determining the presence and severity of adverse effects (AE).ResultsThe research was concluded with 49 patients; Leishmania (Viannia) guyanensis was the most frequent species isolated. In the primary outcome, 18 (72%) (95% CI: 52.4%–85.7%) of the 25 patients allocated to the intervention group and 24 (100%) (95% CI: 86.2%–100%) of the control group (p = 0.015) met the established criteria of cure. There was no AE with tamoxifen.ConclusionAlthough a 72% cure rate presented by the combination of tamoxifen and pentamidine was lower than in the control group that achieved a 100% cure, it is still a safe and is a clinically relevant result. It indicates that the therapeutic scheme evaluated may be a promising option for populations in remote areas, however it should be further studied, in order to include a larger number of patients.
  • Epidemiological clinical profile and closure of chronic plantar ulcers in patients with leprosy sequelae undergoing orthopedic surgery in a municipality in western Amazon
    Francisco Mateus João, Silmara Navarro Peninni, Zanair Soares Vasconcelos, Arineia Soares da Silva, Katia do Nascimento Couceiro, Alba Regina Jorge Brandão, Mônica Regina Hosannah da Silva e Silva, Marcello Facundo do Vale Filho, Guilherme Miranda Silva de Oliveira, Lucas Silva Ferreira, Victor Irungu Mwangi, Bernardo Maia da Silva, Maria das Graças Vale Barbosa Guerra, Jorge Augusto de Oliveira Guerra
    Plos One, 2023
    IntroductionChronic plantar ulcers in leprosy are lesions resulting from motor and sensory alterations caused by Mycobacterium leprae. They are lesions refractory to conventional dressings and present high recurrence rates.ObjectiveTo evaluate the epidemiological clinical profile of patients with chronic plantar ulcers associated with bony prominences in the lesion bed and to evaluate the efficacy of orthopedic surgical treatment of these lesions.MethodsThis is a descriptive and analytical retrospective study with the evaluation of medical records of patients undergoing surgical treatment of chronic plantar ulcers from 2008 to 2018. The surgical technique applied consisted of corrective resection of bone prominences and the primary closure of the lesion with bipediculated local flap.Results234 patients were submitted to surgery, 55.1% male with an average age of 69.5 years old. Of these, 82.9% were illiterate; and 88.5% with open lesions over 10 years. After surgical treatment, total wound healing occurred in an average time of 12 weeks. The variables that contributed to shorter healing time were: Patients’ lower age group; regular use of orthopedic shoes and insoles and dressings performed by nurse aides in health units before surgery. Obesity was the factor that correlated with the delay of healing time.ConclusionA higher incidence was observed in males and male and female illiterate patients. The regular use of shoes and insoles and dressings performed by nurse aides in health units contributed to shorter postoperative healing time. Orthopedic surgical treatment with corrective resection of bony prominences proved to be an efficient therapeutic method for the closure of chronic plantar ulcers. It is a reproducible method, justifying the importance of the orthopedic surgeon in the context of the multidisciplinary team to cope with these complex lesions.
  • Acute Chagas disease associated with ingestion of contaminated food in Brazilian western Amazon
    Débora Raysa Teixeira de Sousa, Jorge Augusto de Oliveira Guerra, Jessica Vanina Ortiz, Katia do Nascimento Couceiro, Monica Regina Hosanahh da Silva e Silva, Alba Regina Jorge Brandão, Elsa Guevara, Ana Ruth Lima Arcanjo, Edival Ferreira de Oliveira Júnior, Susan Smith‐Doria, Victor Irungu Mwangi, Rômulo Freire Morais, George Allan Villarouco Silva, Israel Molina, Henrique Silveira, João Marcos Bemfica Barbosa Ferreira, Maria das Graças Vale Barbosa Guerra
    Tropical Medicine and International Health, 2023
    ObjectiveTo describe clinical, epidemiological and management information on cases of acute Chagas disease (ACD) by oral transmission in the state of Amazonas in western Amazon.MethodsManual and electronic medical records of patients diagnosed with ACD at the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT‐HVD) were included.ResultsThere were 147 cases of acute CD registered from 10 outbreaks that occurred in the state of Amazonas between 2004 and 2022. The transmission pathway was through oral route, with probable contaminated palm fruit juice (açaí and/or papatuá), and involved people from the same family, friends or neighbours. Of 147 identified cases, 87 (59%) were males; cases were aged 10 months to 82 years. The most common symptom was the febrile syndrome (123/147; 91.8%); cardiac alterations were present in 33/100 (33%), (2/147; 1.4%) had severe ACD with meningoencephalitis, and 12 (8.2%) were asymptomatic. Most cases were diagnosed through thick blood smear (132/147; 89.8%), a few (14/147; 9.5%) were diagnosed by serology and (1/147; 0.7%) by polymerase chain reaction (PCR) and blood culture. In all these outbreaks, 74.1% of the patients were analysed by PCR, and Trypanosoma cruzi TcIV was detected in all of them. No deaths were recorded. The incidence of these foci coincided with the fruit harvest period in the state of Amazonas.ConclusionThe occurrence of ACD outbreaks in the Amazon affected individuals of both sexes, young adults, living in rural and peri‐urban areas and related to the consumption of regional foods. Early diagnosis is an important factor in surveillance. There was a low frequency of cardiac alterations. Continuous follow‐up of most patients was not carried out due to difficulty in getting to specialised centres; therefore, little is known about post‐treatment.
  • Immunogenicity Characterization of COVID-19 Vaccines: A Systematic Review and Meta-analysis
    Zanair Soares Vasconcelos, Hany Abdulateif Salem, Sâmia Pimenta Veiga, Fabiola Estefany Botelho de Lima, César Rogério da Silva Gonçalves, Eliane Carvalho dos Santos, Alba Regina Jorge Brandão, Kátia Nascimento Couceiro, Jorge Augusto de Oliveira Guerra, Maria das Graças Vale Barbosa Guerra
    Revista Da Sociedade Brasileira De Medicina Tropical, 2023
    Introduction: Immunogenicity has emerged as a challenge in the development of vaccines against coronavirus disease of 2019 (COVID-19). Immunogenicity is a determinant of the efficacy and safety of vaccines. This systematic review and associated meta-analysis summarized and characterized the immunogenicity of COVID-19 vaccines in randomized controlled trials (RCTs). Methods: Relevant RCTs were systematically sourced from different medical databases in August 2021. The risk ratios and mean differences with 95% confidence intervals were calculated. Results: Of 2,310 papers, 16 RCTs were eligible for review. These RCTs involved a total of 26,698 participants (15,292 males and 11,231 females). The pooled results showed a significant difference in the geometric mean titer between the vaccinated and control groups in favor of the vaccine group after 1 and 2 months of follow-up, for the young age group (18 - < 55y), and with different doses (P < 0.001). The difference in the older age group (>55y) was insignificant (P = 0.24). The seroconversion rate of spike neutralizing antibodies favored the vaccine groups 1 or 2 months after vaccination (P < 0.001). The seroconversion rate of the vaccine group was significantly different (P < 0.001) from that of the control group. Conclusions: Vaccination elicits immunogenicity in the follow-up period for all age groups and at low and large doses. Therefore, people should be encouraged to receive vaccines currently being offered. A boost dose has been asserted for the elderly.
  • The Selvester QRS score as an estimative of myocardial injury in acute chagasic patients from the Brazilian Amazon
    Katia do Nascimento Couceiro, Jessica Vanina Ortiz, Michael do Nascimento Correia, Mônica Regina Hosannah da Silva e Silva, Alba Regina Brandão, Paula Rita Leite da Silva, Susan Smith Doria, Reinaldo Bulgarelli Bestetti, Débora Raysa Teixeira de Sousa, Rubens Celso Andrade da Silva Junior, Maria das Graças Vale Barbosa Guerra, João Marcos Bemfica Barbosa Ferreira, Jorge Augusto de Oliveira Guerra
    BMC Infectious Diseases, 2021
    Background In the Brazilian Amazon, a new epidemiological profile of Chagas disease transmission, the oral route, has been detected and cited as being responsible for the increase in acute cases in Brazil. The clinical evaluation of acute Chagas disease (ACD) has been a challenge since it can progress to a chronic phase with cardiac alterations, and the follow-up by modern diagnostic methods is very difficult due to the socio-geographical characteristics of the Brazilian Amazon. Thus, alternatives should be sought to alleviate this problem. We conducted a study to evaluate subjects with ACD using the 12-lead ECG QRS score (Selvester score) as an estimative of myocardial injury progression before and after ACD treatment. Methods The study included indigenous subjects from the Amazon region with ACD in clinical follow-up at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD) Chagas Disease outpatient clinic in the state of Amazonas, Brazil. The control group consisted of 31 healthy volunteers with no history of heart disease and no reactive serology for Chagas disease. Baseline ECG was performed in all subjects. The Selvester scoring method was performed according to the standardized guide (&lt; 3 points: no myocardial injury,&gt; 3: points × 3% = % of the predicted LV infarction). Results A total of 62 subjects were included, 31 as cases and 31 as controls. The mean follow-up of the case group was 17 months. The control group presented normal ECG. The case group presented 13 alterations before treatment and 11 after. Nineteen individuals presented scores &gt; 3 points, 6 before and 13 after. In 19.36% of subjects, myocardial injury was found before treatment and in 41.94% after treatment. Conclusion This is the first study that uses the Selvester score (SS) to predict myocardial injury in subjects with ACD. The results of this study suggest the significant presence of myocardial injury from the beginning of treatment to the period post treatment of ACD, which demonstrates that the SS can be applied for stratification and follow-up of Chagas disease in the Amazon region.
  • Socioenvironmental aspects of the Purus Region - Brazilian Amazon: Why relate them to the occurrence of American Tegumentary Leishmaniasis?
    Jorge Augusto de Oliveira Guerra, Maria das Graças Vale Barbosa Guerra, Zanair Soares Vasconcelos, Nayra da Silva Freitas, Fernanda Rodrigues Fonseca, Rubens Celso Andrade da Silva Júnior, Arineia Soares da Silva, Vanderson Sampaio, Marcel Gonçalves Maciel, Melissa de Sousa Melo Cavalcante, Bernardino Cláudio de Albuquerque, Gilton Mendes dos Santos, Luiza Garnelo
    Plos One, 2019
    This study aims to analyze factors related to the occurrence of American Tegumentary Leishmaniasis in the Purus Region, based on the reporting of cases between 2001 and 2013, correlating them with livelihoods and subsistence farming in the region, and analyzing them in regards to sex, age, clinical form, occupation, diagnostic methods and seasonality. The analysis parameter which was used included all cases of American Tegumentary Leishmaniasis in each sub-region by municipality. The Purus Region, between the states of Amazonas and Acre, consists of three sub-regions: Upper, Middle, and Lower Purus. We observed that socio-environmental impacts influenced the livelihoods of the human population and that the interaction with extractive activities, especially latex and Brazil nut collecting, where the labor regime implies a long stay in the jungle, leads to socio-environmental conditions that are favorable to the contraction of American Tegumentary Leishmaniasis. During the referred period, there were 13,971 cases of American Tegumentary Leishmaniasis distributed among the sub-regions: High (12611 cases = 90.27%), Middle (1225 cases = 8.77%) and Lower (135 cases = 0.96%). Among the 22 municipalities that were studied, Rio Branco stands out with 31.6% of cases, followed by Xapuri with 12.6% and Sena Madureira with 12.5%. In the results, we highlight the high percentage (20.8%) of mucous forms; the age group from 11 to 50 (70.2%), however, 20.2% were in the age group of 1 month to 10 years of age; cases in males were 69.8%, and, in the reports examined, 43.7%. cited their occupation as extractivism. A statistically significant negative association was demonstrated between cutaneous leishmaniasis and rainfall between Purus municipalities. However, in regards to the association of cutaneous leishmaniasis for both, temperature and Municipal Human Development Index-MHDI, no significant associations were found in Purus. We concluded that American Tegumentary Leishmaniasis occurring in the Purus Region is related to two distinct aspects: the development of enterprises that extend the agricultural frontier, and a change in lifestyle, namely the extraction of wood as an occupation, which has, as a consequence, an environmental impact and creates difficulties in accessing treatment.
  • An open label randomized clinical trial comparing the safety and effectiveness of one, two or three weekly pentamidine isethionate doses (seven milligrams per kilogram) in the treatment of cutaneous leishmaniasis in the Amazon Region
    Ellen Priscilla Nunes Gadelha, Rajendranath Ramasawmy, Bruna da Costa Oliveira, Nágila Morais Rocha, Jorge Augusto de Oliveira Guerra, George Allan Villa Rouco da Silva, Tirza Gabrielle Ramos de Mesquita, Carolina Chrusciak Talhari Cortez, Anette Chrusciak Talhari
    Plos Neglected Tropical Diseases, 2018
  • Extranodal nasal Natural Killer/T-Cell lymphoma affecting oral mucosa of a patient with history of Leishmaniasis
    Marcos Antonio Fernandes, Satiko Takano Peixoto, Nayra da Silva Freitas, Tatiana Nayara Libório‐Kimura, Luiz Carlos de Lima Ferreira, Jorge Augusto de Oliveira Guerra
    Revista Portuguesa De Estomatologia Medicina Dentaria E Cirurgia Maxilofacial, 2015
  • Leishmania (Viannia) naiffi: Rare enough to be neglected?
    Giselle Aparecida Fagundes-Silva, Gustavo Adolfo Sierra Romero, Elisa Cupolillo, Ellen Priscila Gadelha Yamashita, Adriano Gomes-Silva, Jorge Augusto de Oliveira Guerra, Alda Maria Da-Cruz
    Memorias do Instituto Oswaldo Cruz, 2015
  • Polymorphisms in the TOLLIP gene influence susceptibility to cutaneous leishmaniasis caused by leishmania guyanensis in the amazonas state of Brazil
    Felipe Jules de Araujo, Luan Diego Oliveira da Silva, Tirza Gabrielle Mesquita, Suzana Kanawati Pinheiro, Wonei de Seixas Vital, Anette Chrusciak-Talhari, Jorge Augusto de Oliveira Guerra, Sinésio Talhari, Rajendranath Ramasawmy
    Plos Neglected Tropical Diseases, 2015
  • Home-based counseling and testing for HIV and syphilis - An evaluation of acceptability and quality control, in remote Amazonas State, Brazil
    Luciana Viana da Costa Ribeiro, Meritxell Sabidó, Enrique Galbán, Jorge Augusto de Oliveira Guerra, David Mabey, Rosanna W Peeling, Adele Schwartz Benzaken
    Sexually Transmitted Infections, 2015
  • Chagas disease in the state of amazonas: History, epidemiological evolution, risks of endemicity and future perspectives
    Maria das Graças Vale Barbosa, João Marcos Bemfica Barbosa Ferreira, Ana Ruth Lima Arcanjo, Rosa Amélia Gonçalves Santana, Laylah Kelre Costa Magalhães, Laise Kelma Costa Magalhães, Daniel Testa Mota, Nelson Ferreira Fé, Wuelton Marcelo Monteiro, Henrique Silveira, Jorge Augusto de Oliveira Guerra
    Revista Da Sociedade Brasileira De Medicina Tropical, 2015
  • Tegumentary leishmaniasis in the state of amazonas: What have we learned and what do we need?
    Jorge Augusto de Oliveira Guerra, Marcel Gonçalves Maciel, Marcus Vinítius de Farias Guerra, Anette Chursciack Talhari, Suzane Ribeiro Prestes, Marcos Antonio Fernandes, Alda Maria Da-Cruz, Alessandra Martins, Leíla Ines de Aguiar Raposo Camara Coelho, Gustavo Adolfo Sierra Romero, Maria das Graças Vale Barbosa
    Revista Da Sociedade Brasileira De Medicina Tropical, 2015
  • Trypanosoma cruzi I and IV Stocks from Brazilian Amazon Are Divergent in Terms of Biological and Medical Properties in Mice
    Wuelton Marcelo Monteiro, Ana Paula Margioto Teston, Ana Paula Gruendling, Daniele dos Reis, Mônica Lúcia Gomes, Silvana Marques de Araújo, Maria Terezinha Bahia, Laylah Kelre Costa Magalhães, Jorge Augusto de Oliveira Guerra, Henrique Silveira, Max Jean de Ornelas Toledo, Maria das Graças Vale Barbosa
    Plos Neglected Tropical Diseases, 2013
  • American Tegumentary Leishmaniasis
    Carolina Talhari, Jorge Augusto de Oliveira Guerra, Anette Chrusciak‐Talhari, Paulo Roberto Lima Machado, Sinésio Talhari
    Imported Skin Diseases Second Edition, 2012
  • Mucosal leishmaniasis caused by leishmania (Viannia) braziliensis and Leishmania (Viannia) guyanensis in the Brazilian Amazon
    Jorge Augusto de Oliveira Guerra, Suzane Ribeiro Prestes, Henrique Silveira, Leila Inês de Aguiar Raposo Câmara Coelho, Pricila Gama, Aristoteles Moura, Valdir Amato, Maria das Graças Vale Barbosa, Luiz Carlos de Lima Ferreira
    Plos Neglected Tropical Diseases, 2011
  • Chronic chagasic cardiopathy in Amazon Region: An etiology to remember
    Arquivos Brasileiros De Cardiologia, 2009
  • Clinical and diagnostic aspects of American tegumentary leishmaniosis in soldiers simultaneously exposed to the infection in the Amazon region
    Jorge Augusto de Oliveira Guerra, Sinésio Talhari, Marcilene Gomes Paes, Marlúcia Garrido, Joana Maria Talhari
    Revista Da Sociedade Brasileira De Medicina Tropical, 2003