Trop. Med. Infect. Dis., Volume 10, Issue 5 (May 2025) – 29 articles

A male in his 60s presented with a four-month history of dysuria and lower urinary tract symptoms (LUTS). He had a history of elevated PSA and benign prostatic hyperplasia (BPH), previously treated with transurethral resection of the prostate (TURP). Multiparametric MRI (MP-MRI) revealed a PI-RADS 5 lesion, raising suspicion of malignancy. However, histopathological analysis from MRI fusion-targeted biopsies confirmed tuberculous prostatitis. The patient was treated with antituberculosis drugs, resulting in symptomatic improvement and a significant PSA decline. This case highlights the diagnostic challenge of distinguishing tuberculous prostatitis from prostate cancer, particularly in tuberculosis-endemic regions. Our literature review reveals that patients with tuberculous prostatitis undergoing MRI are at least 50 years old, originate from endemic areas, and exhibit PI-RADS scores ranging from 2 to 5, indicating inter-rater variability. Histopathological confirmation remains essential in cases with ambiguous imaging and clinical findings. Full article

Strongyloidiasis is a common intestinal infection that may persist in humans for decades without symptoms or can present as a potentially fatal, broadly disseminated infection in an immunocompromised host. This report describes a rare case of concomitant strongyloidiasis and E. coli meningitis that was successfully recognized and treated in a patient 20 years post-renal transplantation. Full article

Parasitic diseases represent a severe global burden, with current treatments often limited by toxicity, drug resistance, and suboptimal efficacy in chronic infections. This review examines the emerging role of triazole-based compounds, originally developed as antifungals, in advanced antiparasitic therapy. Their unique structural properties, particularly those of 1,2,3- and 1,2,4-triazole isomers, facilitate diverse binding interactions and favorable pharmacokinetics. By leveraging innovative synthetic approaches, such as click chemistry (copper-catalyzed azide–alkyne cycloaddition) and structure-based design, researchers have repurposed and optimized triazole scaffolds to target essential parasite pathways, including sterol biosynthesis via CYP51 and other novel enzymatic routes. Preclinical studies in models of Chagas disease, leishmaniasis, malaria, and helminth infections demonstrate that derivatives like posaconazole, ravuconazole, and DSM265 exhibit potent in vitro and in vivo activity, although their primarily static effects have limited their success as monotherapies in chronic cases. Combination strategies and hybrid molecules have demonstrated the potential to enhance efficacy and mitigate drug resistance. Despite challenges in achieving complete parasite clearance and managing potential toxicity, interdisciplinary efforts across medicinal chemistry, parasitology, and clinical research highlight the significant potential of triazoles as components of next-generation, patient-friendly antiparasitic regimens. These findings support the further optimization and clinical evaluation of triazole-based agents to improve treatments for neglected parasitic diseases. Full article

Healthcare workers (HCWs) face an increased risk of tuberculosis (TB) due to occupational exposure. This study aimed to estimate the point prevalence of TB infection (TBI) from the initial test performed, while the reversion and conversion were done by subsequent testing at one year among HCWs in Puducherry, India. A prospective cohort study was conducted among a sample of proportionately chosen HCWs based on their occupational strata of a tertiary hospital in 2022. TBI was assessed using IGRA (4th generation QuantiFeron—TB gold plus kits) after TB symptom screening. The IGRA test was repeated at the end of one year. Reversion was defined as a positive IGRA test at the baseline and had values < 0.2 IU/L in TB1 or TB2 tubes during follow-up. Conversion was defined as a negative IGRA result at the baseline and had values of >0.7 IU/L in TB1 or TB2 tubes during follow-up. Of the 400 HCWs included, the mean (SD) age was 37 (7) years. Median (IQR) work experience was 15.7 (10–21) years. TBI was seen in 150 HCWs (37.7%, 95% CI: 33.0–42.7), and one had active TB. A total of 128/150 HCWs with TBI at baseline were followed up, and 15 had TBI reversion (11.7 per 100 person-years; 95% CI: 6.7–18.5). Thirteen HCWs (5.6 per 100 person-years; 95% CI: 3.3–9.8) had TBI conversion. Full article

Oncomelania hupensis quadrasi is the intermediate host of S. japonicum, the causative species of schistosomiasis in the Philippines. Conventionally, risk areas are identified by procedures requiring highly skilled personnel and constant surveillance efforts. Recent developments in disease diagnostics explore the utilization of environmental DNA as targets for polymerase chain reactions in disease surveillance. In this study, a low-cost, specific, and efficient SYBR Green-based real-time PCR assay to detect O. h. quadrasi DNA from water samples was developed, optimized, and validated. Primers were designed based on the A18 microsatellite region of O. h. quadrasi. The assay exhibited a detection limit of one copy number per microliter at 99.4% efficiency and R² = 0.999, which specifically amplified O. h. quadrasi DNA only. Validation of this assay in environmental water samples demonstrated 100% PPV and NPV values, suggesting its potential as a tool for identifying risk areas, pathogen-directed surveillance, policy making, and disease control. Full article

Background: We aimed to describe trends in M. genitalium prevalence and associated resistance in Canada between 1980 and 2022. Methods: Ecological study and a scoping review. We collected publicly available data published by the governments of all Canadian provinces and territories. We also systematically searched PubMed, Medline, Embase, and grey literature using the keywords ‘M. genitalium’, ‘Canada’, and all provinces and territories. We reported M. genitalium prevalence, age, sex, gender, symptoms, coinfections, sample types used for diagnosis, and macrolide and fluoroquinolone resistance rates. Results: National or provincial surveillance systems for M. genitalium are absent. Eight studies reported the epidemiology of M. genitalium. The prevalence ranged between 3% in Quebec and 30.3% in Ontario. Half of the patients reported symptoms. The most collected sample for M. genitalium diagnosis was urine, followed by cervical and urethral swabs. Co-infection with Chlamydia trachomatis was reported in 3.3% to 16.4% of cases and with Neisseria gonorrhoeae in 0.0% to 24.0%. Macrolide resistance ranged between 25% and 82.1%, and fluoroquinolone resistance between 0.0% and 29.1%. Conclusions: M. genitalium prevalence and resistance rates varied by sex, gender, province, and specimen type. In the absence of routine surveillance, incomplete data hinders understanding the bacterium’s natural history, its impact on some key groups, and the tracking of antibiotic resistance. Full article

Background: Recent setbacks in malaria control in Comoros demand a reassessment of its evolving epidemiology. Methods: Using the Global Burden of Disease (GBD) Study 2021 data, we analyzed malaria trends from 2010 to 2021, stratified by sex. We quantified the contributions of demographic and epidemiological factors to these trends and identified risk factors for malaria-related disability-adjusted life years (DALYs). Results: From 2010 to 2021, malaria cases, deaths, and DALYs in Comoros fell by −90.22%, −94.44%, and −94.88%; and the corresponding age-standardized rates declined with EAPCs of −18.70% (95% CI: −33.77 to −0.20), −23.89% (95% CI: −36.58 to −8.66), and −24.49% (95% CI: −36.88 to −9.66), with steeper declines in males. Nevertheless, all indicators increased in 2018 and again in 2021. In sub-Saharan Africa, only cases increased, while other metrics declined slightly. In Comoros, incidence shifted mainly to adults ≥25 years, unlike sub-Saharan Africa, where children < 5 years were most affected. Population growth drove increases in cases, deaths and DALYs, whereas epidemiological shifts had the opposite effect. Child underweight was the leading risk factor for malaria DALYs. Conclusions: Existing interventions can achieve malaria control in Comoros; however, rebounds in 2018 and 2021 highlight the need to identify and address drivers of resurgence. Full article

The iCARE Nigeria study is evaluating a daily text message medication reminder intervention (TXTXT) to improve viral suppression and medication adherence among youth living with HIV (YLH), aged 15–24 years. In this sub-study, we evaluated text message responsiveness (text-back) at 24 weeks of the intervention as an indicator of engagement, as well as barriers and facilitators at one of six clinical study sites. Differences in responses by age group, birth sex, schooling status, education, mode of infection, and weekend/weekday and holiday/non-holiday periods were analyzed using t-test and multiple linear regression. Focus group discussions were conducted among three groups (low, average, and high text message responsiveness) and analyzed using a rapid content analysis approach. Overall, TXTXT responsiveness was 26.5% (4606/17,367); older age (18–24 years) and weekdays (versus weekends) were significantly associated with higher responsiveness. Facilitators included being comfortable receiving personalized text messages. Barriers included a lack of airtime and messages received late. Overall, text-back responsiveness to daily medication adherence messages among YLH was low, better among older participants, and higher on weekdays. Addressing barriers and promoting facilitators may improve responsiveness. Full article

Visceral leishmaniasis (VL) is a severe parasitic disease caused by Leishmania spp., with a significant impact on pediatric populations, particularly in endemic regions. The diagnosis of VL in children requires a high index of suspicion, as clinical manifestations—such as prolonged fever, hepatosplenomegaly, and pancytopenia—overlap with other infectious and hematologic diseases. While serological and molecular tests aid in detection, bone marrow aspiration remains the gold standard for definitive diagnosis. In this case series, we describe five pediatric patients diagnosed with VL in Italy, emphasizing the importance of a timely and accurate diagnostic approach. Liposomal amphotericin B (LAmB) is the first-line treatment in Southern Europe due to its high efficacy and reduced toxicity. Our patients received a standard regimen of 3 mg/kg daily for five days, plus an additional dose on day 10, leading to rapid clinical improvement. However, some cases required supportive care, such as red blood cell transfusions, particularly in patients with co-infections. Despite being a neglected disease, VL is re-emerging in Europe, influenced by climate change, increased pet ownership, and migration from endemic regions. Prevention strategies focus on vector control, canine vaccination, and public health awareness. The global rise in pediatric VL highlights the need for improved surveillance, access to affordable treatments, and the development of effective vaccines to mitigate the disease burden in both endemic and non-endemic areas. Full article

Scabies and tungiasis are skin-related neglected tropical diseases (NTDs) associated with poverty and poor living conditions. We performed an ecological study covering a state in northeast Brazil to identify socio-economic and environmental factors associated with the occurrence of severe scabies and severe tungiasis, respectively. Data on disease occurrence on the municipality level were derived from a previous study based on online questionnaires. A total of 47 (26.0%) of the 181 state’s municipalities reported severe tungiasis, and 113 (62.4%) severe scabies. Municipalities with occurrence of severe tungiasis were characterized by higher annual rainfalls (median = 883 mm vs. 741 mm; p = 0.037), higher minimum temperatures (median = 23.4 °C vs. 22.7 °C; p = 0.002), higher aridity indices indicating more humid climates (median = 45.1 vs. 50.6; p = 0.019), lower altitudes (median = 88.8 m vs. 201 m; p < 0.001), higher mean air humidity (66.5% vs. 63%; p = 0.018), and better socioeconomic indices (Municipal Human Development Index [MHDI]—median = 0.616 vs. 0.611; p = 0.048/MHDI Longevity—mean = 0.769 vs. 0.759; p = 0.007/Municipal Development Index [MDI]—median = 27.5 vs. 21.8; p < 0.001). Municipalities with predominant luvisol soil characteristics had a lower risk for severe tungiasis (RR = 0.46; 95% CI = 0.27–0.79; p = 0.003), whereas municipalities with predominant gleysols had a significantly higher risk (RR = 2.44; 95% CI = 1.43–4.15; p = 0.010). Municipalities with occurrence of severe scabies were characterized by significantly higher annual rainfalls (median = 804 mm vs. 708 mm; p = 0.001), higher minimum temperatures (23.1 °C vs. 22.3 °C; p < 0.001), higher aridity index (median = 48.2 vs. 41.9; p = 0.014), higher air humidity (65.9% vs. 61%; p = 0.001), lower altitudes (median = 153 m vs. 246 m; p = 0.003), and better socio-economic indicators (MHDI—median = 0.616 vs. 608; p= 0.012/MHDI Education—mean = 0.559 vs. 0.541; p = 0.014/MDI—median = 24.3 vs. 21.1; p = 0.005). In multivariate regression analysis, MDI remained significantly associated with the presence of severe tungiasis in the final model (RR = 1.04; 95% CI: 1.02–1.05; p < 0.001) and the presence of severe scabies with minimum temperature (RR = 1.13; 95% CI: 1.04–1.24; p = 0.003) and aridity index (RR = 1.01; 95% CI: 1.00–1.01; p = 0.004). Our study underscores the importance of environmental and socioeconomic factors for the occurrence of severe scabies and tungiasis in a semi-arid climatic context, offering a perspective for identification of high-risk areas, and providing evidence for the control of skin NTDs withina One Health approach. Full article

Altered lipid profiles have been observed in acute malaria, though mechanisms remain unclear. The impact of asymptomatic submicroscopic malaria infection (AMI) on lipids is unexploredAn observational, comparative, retrospective study was conducted of 1278 asymptomatic Sub-Saharan African migrants (ASSAMs) screened for malaria and lipid profiles during health exams (2010–2022). A systematic screening protocol for infectious disease was performed, including screening for Plasmodium spp. infection by polymerase chain reaction (PCR).Among 800 ASSAMs screened for malaria, 104 (13%) were PCR-positive: P. falciparum (68.72%), P. malariae (18.27%), P. ovale (9.62%), and mixed infections (3.8%). Participants with AMIs exhibited lower baseline lipid levels: total cholesterol (146 vs. 163 mg/dL; p < 0.001), HDL (43 vs. 47 mg/dL; p < 0.001), and LDL (87.5 vs. 98 mg/dL; p < 0.001), with no differences in triglycerides. After treatment, lipid levels partially equalized: total cholesterol (156 vs. 166; p = 0.01), HDL (44 vs. 47.5; p = 0.05), LDL (102 vs. 108.5; p = 0.31), with no changes in triglycerides. Patients with AMI showed higher rates of co-infections (Strongyloides 20.61% vs. 14.35%; p < 0.001; filariae 7.69% vs. 1.91%; p = 0.02) and lower mean corpuscular volume (87.2 vs. 85; p < 0.001). Conclusions: These findings suggest that cholesterol reductions in AMI are not solely due to acute inflammation but may reflect chronic inflammatory processes triggered by asymptomatic malaria. This supports a potential link between AMI and lipid profile changes, underscoring its role in subclinical chronic inflammation. Full article

Snakebite envenoming remains a critical yet underrecognized public health issue, particularly in tropical and subtropical regions, with India bearing nearly half of the global burden of snakebite-related deaths. Despite its significant impact, underreporting, delayed medical intervention, and insufficiently trained healthcare professionals continue to exacerbate the problem. In response, the Government of India launched the National Action Plan for Prevention and Control of Snakebite Envenoming (NAPSE) in March 2024, aiming to halve snakebite-related deaths by 2030. Key challenges during the development and implementation of NAPSE included the limited multisectoral engagement initially, variations in state-level capacities, and logistical barriers in reaching remote populations. Lessons learned include the value of early stakeholder consultations, the importance of inter-ministerial collaboration, and the need for continuous community engagement. This comprehensive strategy emphasizes strengthening surveillance systems, enhancing anti-snake venom (ASV) distribution and quality, improving healthcare infrastructure, and promoting community awareness through a One Health approach. The plan also addresses critical challenges such as inadequate training at primary healthcare levels, inconsistent ASV supply, and inefficient emergency referral systems. By fostering multisectoral collaboration and targeted interventions, such as strengthening Regional Venom Centres and establishing Poison Information Centre, targeted training, and awareness campaigns, NAPSE aims to reduce mortality and disability associated with snakebite envenoming, aligning with global health objectives and setting an example for regional efforts in Southeast Asia. Full article

The severity of physical disability at leprosy diagnosis reflects the timeliness of case detection and the effectiveness of disease surveillance. This study evaluates machine learning models to predict factors associated with late leprosy diagnosis—defined as grade 2 physical disability (G2D)—in Brazil from 2018 to 2022. Using an observational cross-sectional design, we analyzed data from the Notifiable Diseases Information System and trained four machine learning models: Random Forest, LightGBM, CatBoost, XGBoost, and an Ensemble model. Model performance was assessed through accuracy, area under the receiver operating characteristic curve (AUC-ROC), recall, precision, F1 score, specificity, and Matthew’s correlation coefficient (MCC). An increasing trend in G2D prevalence was observed, averaging 11.6% over the study period and rising to 13.1% in 2022. The Ensemble model and LightGBM demonstrated the highest predictive performance, particularly in the north and northeast regions (accuracy: 0.85, AUC-ROC: 0.93, recall: 0.90, F1 score: 0.83, MCC: 0.70), with similar results in other regions. Key predictors of G2D included the number of nerves affected, clinical form, education level, and case detection mode. These findings underscore the potential of machine learning to enhance early detection strategies and reduce the burden of disability in leprosy, particularly in regions with persistent health disparities. Full article

The novel coronavirus pandemic, SARS-CoV-2, has a variable clinical spectrum, ranging from asymptomatic to critical forms. High mortality and morbidity rates have been associated with risk factors such as comorbidities, age, sex, and virulence factors specific to viral variants. Material and Methods: We retrospectively evaluated imaging characteristics using the Brixia radiological score in relation to favorable or unfavorable outcomes in adult patients. We included COVID-19 cases, admitted between 2020 and 2022, in a specialized pulmonology hospital with no intensive care unit. We analyzed 380 virologically confirmed COVID-19 cases, with a mean age of 52.8 ± 13.02 years. The mean Brixia radiological score at admission was 5.13 ± 3.56, reflecting predominantly mild-to-moderate pulmonary involvement. Multivariate analysis highlighted the utility of this score as a predictive marker for COVID-19 prognosis, with values >5 correlating with other severity biomarkers, NEWS-2 scores, and a lack of vaccination and hospitalization delay of more than 6 days from symptom onset. Summarizing, the Brixia score is itself an effective tool for screening COVID-19 cases at risk of death for early recognition of clinical deterioration and for decisions regarding appropriate care settings. Promoting vaccination can reduce the severity of radiological lesions, thereby decreasing the risk of death. Technologies based on artificial intelligence could optimize diagnosis and management decisions. Full article

Sub-Saharan Africa has made remarkable strides in genomic surveillance, with more than 50% of countries now equipped with an in-country sequencing capacity and 98% actively contributing data to public genomic repositories. Catalyzed by the momentum of the COVID-19 pandemic, these advancements have extended far beyond SARS-CoV-2 to address a broader spectrum of public health threats, including antimicrobial resistance (AMR) and other emerging infectious diseases. This review explores these transformative achievements, identifies remaining gaps, and outlines strategic priorities for embedding genomics into the continent’s health systems. With a focus on sustainability, equity, and cross-sector collaboration, it positions Africa as a driver of global innovation in pathogen surveillance, uniquely leveraging its genetic and epidemiological diversity. Full article

The growing threat of antimicrobial resistance (AMR) is a critical issue for both civilians and the military. With each successive conflict, pathogens become more resistant, making the management of infections in casualties increasingly challenging. To better understand the scope and characteristics of conflict-related AMR, a comprehensive literature search was conducted in the PubMed database in April 2025, using defined search terms related to war casualties and antimicrobial resistance. We screened and included 117 relevant publications, comprising original research articles, reviews, case series, case reports, editorials, and commentaries, published in English or French, with no date restriction. This narrative review synthesizes current evidence on multidrug-resistant bacteria most commonly isolated from war casualties, their associated resistance mechanisms, and the microbiological diagnostic tools available at various levels of the military continuum of care (Roles 1–4). It also presents strategies for preventing cross-contamination and infection in resource-limited combat settings and provides practical, field-adapted recommendations for clinicians, from first responders to specialized care providers, aiming to improve infection management in armed conflict zones and mitigate the spread of AMR. Full article

Tuberculous meningitis (TBM) is a very severe form of childhood tuberculosis (TB), requiring hospitalisation for diagnosis. We investigated trends in admission, disease spectrum, outcomes, and healthcare system factors in children with TBM managed at a tertiary referral hospital in Cape Town, South Africa. We conducted a retrospective cohort study of children (<13 years) with TBM admitted from 2017 to 2021. An innovative surveillance algorithm was used to identify all possible TBM episodes using integrated electronic health data. Episodes were clinically verified and data were extracted using medical records. A total of 263 children (median age 2.2 years; IQR: 1.1–5.1), 17 (6.5%) living with HIV were admitted with TBM during 2017 to 2021. There was a significant reduction in TBM admissions during the COVID-19 pandemic (IRR: 0.57, 95% CI:0.39–0.84), particularly in children < 2 years (IRR: 0.31, 95% CI: 0.15–0.62). BCG vaccination was documented in 137/263 (52.1%) and 10/87 (11.5%) eligible children who initiated TB preventive therapy. During the pandemic, children with TBM were significantly more likely to be living with HIV (aOR: 4.01, 95% CI: 1.39–11.62). COVID-19 was associated with a significant reduction in the number of young children admitted with TBM. Many missed opportunities to prevent TBM were identified regardless of COVID-19. Paediatric TBM surveillance is a useful marker to monitor epidemiological trends. Full article

Adolescents living with HIV (ALHIV) (10–19 years) make up approximately 4.2% (320,000) of people living with HIV in South Africa. Adolescence is a developmental period characterized by pervasive biological, social and psychological changes, which challenges adherence and retention in care for ALHIV on antiretroviral therapy (ART). Further, as ALHIV grow “older”, they are expected to transition to the adult HIV treatment programme, where they should assume greater responsibility for managing their chronic condition and healthcare pathway. Whereas it is imperative that ALHIV are transitioned when they are ready, little is known about the challenges and experiences of ALHIV before and during transition. The aim of this paper was to report on the experiences and challenges of transition for ALHIV who received ART at an adolescent-friendly service that is adjunct to a public primary healthcare facility in the Western Cape province of South Africa. Methods: Photovoice methods were employed to explore the transition experiences of ALHIV on ART at a “supportive transition” public health facility in the Cape Town Metro in South Africa. Participants took pictures that depict their experience pre- and during transition to adult care and discussed these in groups with peers. Audio data were digitally recorded and transcribed verbatim and subjected to thematic analysis using Atlas.Ti version 24. Results: The emergent themes described their apprehension to transitioning to adult care; self-management; challenges to adherence; the need for psychosocial support; and how adolescent-friendly services were filling the gap. Conclusions: We illuminate the “I-We-I” configuration, to reflect (the first “I”) individual ALHIV experiences as isolated before being transferred to the supportive facility; how they experience a sense of belonging and family (“we”) in the supportive facility; but face apprehension about transitioning to adult care in the local clinic, where they have to self-manage (final “I”). Full article

Parasitic infections remain a significant public health challenge in West Africa, contributing to high morbidity and mortality rates, economic burdens, and healthcare system strain. Malaria, soil-transmitted helminths, schistosomiasis, and other parasitic diseases persist due to environmental, socio-economic, and healthcare barriers. A systematic literature search was conducted using databases such as PubMed, Scopus, Web of Science, and Science Direct. Studies published between 2014 and 2024 were screened using predefined eligibility criteria. Cross-sectional and case–control studies reporting on prevalence, diagnostic techniques, and treatment of parasitic infections in West Africa were included. The Rayyan online platform was used for screening, and data extraction focused on study location, prevalence rates, diagnostic methods, and treatment regimens. This review identified the high prevalence rates of malaria, schistosomiasis, and soil-transmitted helminths across various West African countries. Co-infections were frequently reported, particularly among children and pregnant women. Diagnostic methods ranged from traditional microscopy to advanced molecular techniques, though accessibility remained a challenge in resource-limited settings. Treatment strategies, including artemisinin-based combination therapies for malaria and mass drug administration for helminths, showed varying efficacy due to reinfection risks and emerging drug resistance. Factors influencing transmission included environmental conditions, sanitation practices, socio-economic status, and healthcare access. Parasitic infections in West Africa continue to pose significant health and economic challenges. Integrated control programs, enhanced surveillance systems, improved access to diagnostics and treatment, and targeted public health interventions are essential for reducing disease burden. Further research is needed to evaluate the long-term impact of existing interventions and explore innovative solutions for parasite control and elimination. Full article

COVID-19-associated invasive fungal infections (CAIFIs) contribute to increased mortality and morbidity rates. This study explores the epidemiology, laboratory parameters, radiological characteristics, treatments, and 30-day mortality risks of CAIFI in critically ill intubated patients while also evaluating factors associated with prolonged mechanical ventilation (PMV) in this population. Adults admitted to a tertiary hospital from 1 April 2021 to 31 March 2022 who were diagnosed with severe COVID-19, required invasive mechanical ventilation, and developed invasive fungal infection (IFI) during hospitalization were analyzed in this retrospective cohort study. Among 150 patients, 65 (43.3%) required PMV, with an in-hospital mortality rate of 64%. Candida albicans (47%) and Aspergillus fumigatus (27%) were the most prevalent pathogens. Multivariate analysis revealed that COVID-19 vaccination (adjusted odds ratio, aOR = 0.155, 95% confidence interval, 95% CI = 0.029–0.835, p = 0.030) and higher serum protein levels (aOR = 0.900, 95% CI = 0.819–0.989, p = 0.028) were significantly associated with a reduced risk of PMV. Meanwhile, elevated glucose levels (hazard ratio, HR = 1.047, 95% CI = 1.003–1.093, p = 0.036) and an increased neutrophil-to-lymphocyte ratio (HR = 1.024, 95% CI = 1.009–1.039, p = 0.002) were correlated with a greater 30-day mortality risk. Tracheostomy emerged as a protective factor, significantly reducing the risk of 30-day mortality (HR = 0.273, 95% CI = 0.127–0.589, p = 0.001). In this single-center study, patients with CAIFI exhibit a high mortality rate. Clinicians should maintain vigilance for IFI in critically ill COVID-19 patients with mechanical ventilation. Full article

The trematodes Fasciola hepatica and F. gigantica are transmitted by lymnaeid snails and cause fascioliasis in livestock and humans. Human infection is emerging in southern and southeastern Asia. In India, the number of case reports has increased since 1993. This multidisciplinary study analyzes the epidemiological scenario of human infection. The study reviews the total of 55 fascioliasis patients, their characteristics, and geographical distribution. Causes underlying this emergence are assessed by analyzing (i) the climate change suffered by India based on 40-year-data from meteorological stations, and (ii) the geographical fascioliasis hotspots according to archeological–historical records about thousands of years of pack animal movements. The review suggests frequent misdiagnosis of the wide lowland-distributed F. gigantica with F. hepatica and emphasizes the need to obtain anamnesic information about the locality of residence and the infection source. Prevalence appears to be higher in females and in the 30–40-year age group. The time elapsed between symptom onset and diagnosis varied from 10 days to 5 years (mean 9.2 months). Infection was diagnosed by egg finding (in 12 cases), adult finding (28), serology (3), and clinics and image techniques (12). Climate diagrams and the Wb-bs forecast index show higher temperatures favoring the warm condition-preferring main snail vector Radix luteola and a precipitation increase due to fewer rainy days but more days of extreme rainfall, leading to increasing surface water availability and favoring fascioliasis transmission. Climate trends indicate a risk of future increasing fascioliasis emergence, including a seasonal infection risk from June–July to October–November. Geographical zones of high human infection risk defined by archeological–historical analyses concern: (i) the Indo-Gangetic Plains and corridors used by the old Grand Trunk Road and Daksinapatha Road, (ii) northern mountainous areas by connections with the Silk Road and Tea-Horse Road, and (iii) the hinterlands of western and eastern seaport cities involved in the past Maritime Silk Road. Routes and nodes are illustrated, all transhumant–nomadic–pastoralist groups are detailed, and livestock prevalences per state are given. A baseline defining areas and seasons of high infection risk is established for the first time in India. This is henceforth expected to be helpful for physicians, prevention measures, control initiatives, and recommendations for health administration officers. Full article

Trypanosoma cruzi, the causal agent of Chagas disease, exhibits great genetic diversity, which has been related to its biological properties. However, these are poorly known in strains from the endemic area of Hidalgo. To assess the parasite’s virulence, we evaluated parasitemia, mortality, and tropism in thirteen organs of CD1 mice during the acute phase of infection. For genotyping, we amplified the mini-exon gene from T. cruzi DNA using PCR. All five isolates were identified as belonging to DTU TcI. The peak of parasitemia occurred between 25 and 29 days post-infection. The Tultitlán and Olma isolates did not cause any mouse deaths, whereas Ixcatépec produced 100% mortality. Mice infected with the Barrio Hondo isolate exhibited the highest parasitemia, while those infected with Cuatecomaco had the lowest. The five isolates generated varying degrees of infection and chronic inflammation; only two isolates triggered acute pancreatitis and myocarditis. No amastigote nests were found in the hearts of mice infected with the Ixcatépec isolate. Our findings suggest that the damage caused by T. cruzi strains from Hidalgo may extend beyond cardiac lesions in the acute phase of Chagas disease regardless of their classification as TcI and variability in parasitemia levels. Full article

Leishmaniasis is a complex neglected tropical disease that impacts public health, particularly in resource-limited populations where access to accurate and timely diagnosis is often limited. Current diagnostic methods, primarily relying on microscopy, suffer from low sensitivity and specificity, hindering effective case management and disease control. The objective of this study was to validate a novel real-time PCR assay targeting the conserved Hsp20 gene for the detection of Leishmania spp. We evaluated the performance of the method using two distinct detection systems, such as SYBR Green and TaqMan probes, against a diverse panel of 225 clinical samples confirmed to have the disease. The real-time PCR targeting Hsp20 using SYBR Green demonstrated a sensitivity of 88% (95% CI: 83.53–92.47) and 100% specificity. Meanwhile, the TaqMan probe demonstrated a lower sensitivity of 47% (95% CI: 29.53–64.92). The high sensitivity and robust performance of the real-time PCR using SYBR Green establish its potential as a valuable diagnostic tool, particularly useful in endemic regions where rapid and accurate diagnosis is critical for timely treatment and effective disease control. Full article

Background: We describe a community-based outbreak of multidrug-resistant Shigella flexneri serotype 2a among people experiencing homelessness (PEH) in Vancouver’s Downtown Eastside during the COVID-19 pandemic. Methods: In this observational cohort study, we followed the Outbreak Reports and Intervention Studies of Nosocomial Infection (ORION) reporting guidelines. We identified cases by laboratory surveillance and collected demographic and clinical data from the medical charts or patient interviews. We implemented enhanced surveillance and disseminated testing and management guidelines. Shigella flexneri isolates were serotyped, and whole-genome sequencing was performed. Results: We identified 101 confirmed cases of Shigella flexneri 2a (80% male; median age 43) between 31 January and 16 December 2021. All the affected individuals experienced homelessness, and substance use disorder was the most common comorbidity (88%). Five patients required ICU hospitalization, and one death occurred within 30 days. Core-genome multilocus sequence typing analysis confirmed a clonal outbreak. All S. flexneri isolates were phenotypically and genotypically multidrug-resistant. Conclusions: COVID-19 exacerbated longstanding public health concerns around the dearth of hygiene and sanitation resources available to PEH. Preventing similar outbreaks will require addressing these risks and finding solutions to the crisis of homelessness in Canada. Full article

New intervention methods and product formulations are needed to better control pyrethroid-resistant Aedes aegypti populations and mitigate the risk of mosquito-borne disease. ReMoa Tri is a novel adulticidal space spray that utilizes a different mode of action than the commonly used adulticides: pyrethroids and organophosphates. As a triple-action space spray, ReMoa Tri combines three components: Fenpropathrin, a mixed-type I/II pyrethroid; abamectin, a macrocyclic lactone; and C8910, a patented fatty acid chain. Prior studies performed by Collier Mosquito Control District showed that ReMoa Tri is effective at controlling type I pyrethroid-resistant Ae. aegypti mosquitoes. To further validate these results and the performance of ReMoa Tri, we conducted a semi-field evaluation using ground and aerial ULV (ultra-low volume) applications with field-caught deltamethrin-resistant Ae. aegypti and a susceptible Ae. aegypti laboratory strain. Ground evaluations tested ReMoa Tri and a type II pyrethroid-based product, DeltaGard. While ReMoa Tri was equally effective against Collier’s deltamethrin-resistant Ae. aegypti and the susceptible laboratory strain, DeltaGard was effective against both strains, with reduced efficacy at farther distances. Similarly, aerial evaluations also showed that ReMoa Tri was equally effective against Collier’s deltamethrin-resistant Ae. aegypti strain and susceptible laboratory strain. This study further confirms ReMoa Tri’s potential as an effective alternative to pyrethroid-based adulticides, both in ground and aerial applications, for managing pyrethroid-resistant Ae. aegypti. Full article

Yellow fever virus (YFV) is an endemic arbovirus in parts of Africa and the Americas. In Brazil, following the eradication of the urban transmission cycle, YFV is maintained in a sylvatic cycle involving several species of neotropical primates and mosquitoes of the genera Haemagogus and Sabethes, which serve as primary and secondary vectors, respectively. During the 2016–2019 outbreak in São Paulo State, a total of 3731 mosquito pools were collected from sites with ongoing epizootic events in 192 municipalities. The RT-qPCR analysis detected YFV in 46 pools (1.4%) across nine mosquito species, including both primary and secondary vectors, as well as species from the genera Aedes and Psorophora. Differences in viral loads were observed among species. While Aedes aegypti was not found to be positive, the detection of natural YFV infection in other Aedes species raises concerns about potential virus reurbanization. Further studies are needed to clarify the role of additional mosquito species in YFV transmission in Brazil. Full article

The long regimen of drug therapy, the emergence of drug-resistance (DR), and infections with non-tuberculous mycobacteria (NTMs) are alarming challenges in controlling tuberculosis (TB), a disease caused by Mycobacterium tuberculosis (M.tb), necessitating the pursuit of new, broad-spectrum anti-mycobacterials. With more than two-thirds of the clinically useful antibiotics originating from the bacterial phylum Actinomycetota, and their enormous diversity in India, we explored atypical environments for new bacterial strains with potential anti-M.tb activity. In this study, we the examined the secondary metabolites of soil and endophytic bacterial isolates from the wetland niches of Manipur, India, and determined their anti-mycobacterial properties using viability assays. The ethyl acetate culture filtrate extracts of one of the isolates, named Streptomyces sp. SbAr007, showed broad-spectrum anti-mycobacterial activity against laboratory M.tb strains H37Ra and H37Rv, a clinical drug-resistant M.tb and non-tuberculous mycobacteria (NTM). The isolate was characterized for its phenotype and genetic identity, which indicated its closeness to Streptomyces samsunensis, Streptomyces malaysiensis, and Streptomyces solisilvae. Further, macrophage infection assays showed that the extracts could effectively control the intracellular mycobacterial growth but had negligible cytotoxicity to PBMCs from healthy donors. LC-MS identified an unusual combination of antibiotics in these culture filtrate extracts, which can be further explored for specific active molecules or as a formulation against DR-TB. Full article