Trop. Med. Infect. Dis., Volume 10, Issue 6 (June 2025) – 30 articles

The private sector in Tanzania has played an essential role in improving coverage and access to mosquito nets. This follow-up study assessed the overall market share for untreated and insecticide-treated nets (ITNs) and misleading or counterfeit ITN products in commercial markets. This study was conducted from March to April 2024 in ten regions in Tanzania. The study used mixed methods: (1) a quantitative survey among sampled outlets supported by photographic documentation of all net products and (2) key informant interviews of retailers and wholesalers. We assessed the relationship between market share and population access using ANOVA and Pearson correlation. No counterfeit or misleading nets were found, consistent with results from 2017, 2021, and 2022 surveys. Untreated nets dominated all markets, comprising 99% of all products observed and 99% of estimated net sales 3 months before the survey. Legitimate ITNs were crowded out from the studied markets. Leaked nets from free distributions were present but extremely limited (1%) and at their lowest level of the survey rounds. Untreated nets were more expensive than leaked ITNs for both regular- and queen-size nets. Despite ongoing efforts, increasing the share of legitimate ITNs remains a significant challenge in a context of large-scale public sector distributions. Full article

Anopheles darlingi is a major malaria vector in South America. Understanding its population dynamics is critical for designing effective vector control strategies. While various Anopheles collection methods exist, they may sample distinct populations. Microsatellite genotyping across nine loci was performed to characterize An. darlingi populations, which were collected in French Guiana between 6:30 p.m. and 7:00 a.m. using human landing catch (HLC) or Mosquito Magnet^® (MM) traps. Traps were arranged in a 3 × 3 Latin square design to minimize possible effects of geographical position. Pairwise F_ST index and discriminant analyses of principal components (DAPC) were used to make comparisons. A total of 431 An. darlingi were analyzed. No significant genetic differentiation was observed between collection methods or time slots (F_ST values non-significant, p > 0.25), with DAPC revealing a single genetic cluster. Despite documented phenotypic variations, no significant population structure was detected among An. darlingi sampled in a rural village in French Guiana via collection methods or time slots. These findings confirm that mosquitoes collected with these various methods or time slots are suitable for the molecular studies of An. darlingi in French Guiana. In this context, Mosquito Magnet^® traps could also represent an alternative to the now controversial human landing catch. Full article

Dengue, an acute infectious disease caused by the dengue virus, remains a major public health problem in the 21st century. This study investigated the global dengue burden, identified high-risk regions, evaluated the long-term incidence trends, and can inform evidence-based control strategies. Using GBD 2021 data, we analysed the dengue incidence from 1992 to 2021 using age–period–cohort models. We determined the net drift (overall annual percentage change), local drift (annual percentage change for each age group), longitudinal age curves (expected longitudinal age-specific rates), and periods’ (cohorts’) relative risks. In 2021, the global age-standardised incidence rate reached 752.04/100,000 (95% UI: 196.33–1363.35), a 47.26% increase since 1992. High-risk regions included eastern sub-Saharan Africa, Southeast Asia, South Asia, and Latin America and the Caribbean. Southeast Asia experienced the largest rise (65.43%), with a net drift of 2.47% (1992–2021). While individuals aged 5–39 years bore the highest burden, those over 80 faced an elevated risk. Dengue remains a critical public health threat, disproportionately affecting younger populations but increasingly endangering older adults. Targeted interventions in high-risk regions and age groups, coupled with precision public health strategies, are essential to enhance prevention and control efforts. Full article

Democratic Republic of the Congo (DRC) is among the countries that have a high malaria incidence. In an effort to combat this public health challenge, innovative tools and strategies are being developed and evaluated. Among the new generation of nets with improved effectiveness of insecticides, those treated with a combination of piperonyl butoxide (PBO) and pyrethroids appear to be a promising malaria control tool. This study evaluated the effectiveness of this combination under community conditions of use in the DRC. A quasi-experimental study was carried out from January to December 2018, in Kisantu Health Zone. Thirty villages were randomly allocated as clusters (1:1) to receive one of two types of long-lasting insecticidal nets (LLIN) treated with deltamethrin alone, or PBO with deltamethrin. After the intervention, the assessments were conducted monthly, quarterly, and every six months for malaria infection, mosquito density, and LLIN durability, respectively. Comparison of changes in different indices between the two groups was made using generalized linear models to correct for non-linear effects. A total of 1790 children were included. There was a significant non-linear effect of time (months) on the malaria infection incidence. The malaria infection incidence was higher in January–March, May–June, and November. It remained higher in the control group compared to the intervention group over time. Similarly, there was a significant non-linear effect of time on the density of both Anopheles funestus s.l. and Anopheles gambiae s.l. These densities decreased after the first month following the intervention and increased after 6 months. Twelve months later, a cohort follow-up showed that the bio-efficacy of LLINs was better in the intervention group. The nets treated with the combination of PBO and deltamethrin appear to be more effective for malaria control under community conditions in the DRC, but a loss of chemical durability is noted after the first year of use. Full article

The rapid global expansion of Aedes aegypti-borne diseases such as dengue, chikungunya, and Zika has positioned this mosquito as a key target for vector control programs. These programs rely heavily on insecticide use, leading to the widespread emergence of insecticide resistance. Understanding the molecular basis of resistance is essential for developing effective management strategies. In this study, we employed a whole-transcriptome (RNA-seq) approach to analyze gene expression in three Ae. aegypti populations from Mexico that underwent four generations of laboratory selection with deltamethrin. Several cytochrome P450 genes (CYP6AG4, CYP6M5, CYP307A1) and a chitin-binding peritrophin-like gene (Ae-Aper50) were significantly overexpressed following selection, supporting roles for both detoxification and midgut protection. We also observed a consistent downregulation of cuticular protein genes in deltamethrin-selected groups relative to the baseline populations, suggesting their involvement in baseline tolerance rather than induced resistance. Additionally, the overexpression of immune- and stress-related genes, including the RNA helicase MOV-10, indicates that insecticide selection may trigger broader physiological responses. These findings highlight complex, multi-pathway transcriptomic changes associated with resistance development in Ae. aegypti. Full article

As COVID-19 transitions from pandemic to endemic, our prevention and control policies have shifted from broad, strict community interventions to focusing on the prevention of cluster outbreaks. Currently, information on the characteristics of cluster outbreaks remains limited. This study describes the features of COVID-19 clusters in Shanghai. It aims to provide valuable insights for managing localized outbreaks. We conducted a retrospective analysis of clusters of confirmed COVID-19 cases. Epidemiological descriptions, the transmission characteristics of clusters, and individual risk factors for contagiousness were analyzed. A total of 381 cases of COVID-19 were confirmed and 67 clusters were identified. Most clusters (58.21%, 39/67) only had two cases, with a declining proportion held by clusters of more cases. Familial transmission was predominant, accounting for 79.10% (53/67) of clusters. Although other types of cluster outbreaks, such as those in workplaces (1.49%, 1/67), occur less frequently compared to household clusters, they tend to involve larger scales and more cases. Workplaces and similar venues are more likely to experience large-scale cluster outbreaks. Contagiousness was higher among cases with runny nose (risk ratio [RR]: 4.8, 95% CI: 1.40–16.44, p-value = 0.01) and those with diabetes (RR: 3.8, 95% CI: 1.01–14.60, p-value = 0.05). In conclusion, household cluster outbreaks, in particular, are both a key priority and a foundational issue. Establishing an indicator system based on the transmissibility of cases holds significant practical value for infectious disease prevention and control. By enhancing household hygiene and developing a case classification and management system based on transmissibility, it is possible to better prevent and control regional COVID-19 outbreaks. Full article

Background: Newly arrived migrants are at increased risk for vaccine-preventable and communicable diseases due to low immunization coverage, poor access to healthcare, and challenging migration trajectories. This study describes the implementation and outcomes of a one-stop public health intervention focused on serological screening and accelerated vaccination in recently arrived migrants in Galicia, Spain. Methods: We conducted a cross-sectional descriptive study in July and August 2024 involving 335 adult migrants from sub-Saharan Africa with irregular administrative status and asylum applications. A centralized mobile health unit provided point-of-care screening for immunity against measles, mumps, rubella, varicella, and hepatitis A, alongside testing for active infections, including hepatitis B and syphilis. Sociodemographic and clinical data were collected, and individuals were offered vaccination according to an accelerated immunization schedule. Results: Of 336 migrant adults invited to participate in the study, only 1 individual declined to participate (participation rate: 99.7%). Therefore, 335 migrants were assessed. A significant proportion of participants were susceptible to at least one vaccine-preventable disease, particularly hepatitis B (36.4%, 95% CI 31.3–41.6), measles (22.7%, 95% CI 18.2–27.2), and varicella (16.4%, 95% CI 12.5–20.4). Active infections were detected in 12.9% (95% CI 9.3–16.4) of individuals, including hepatitis B (9.9%, 95% CI 6.7–13.0) and syphilis (3.0%, 95% CI 1.2–4.8). The intervention allowed for timely vaccination and linkage to care, minimizing dependence on passive healthcare access. Conclusions: This study highlights substantial immunization gaps and the presence of undiagnosed infections in vulnerable migrant populations. Centralized and culturally adapted screening programs, combined with accelerated vaccination strategies, are feasible and effective. These findings support the integration of structured protocols into national health systems to ensure equity, reduce transmission risk, and align with WHO and ECDC public health frameworks. Full article

Severe Acute Respiratory Syndrome (SARS) represents a significant cause of morbidity and mortality in children under one year of age, a particularly vulnerable population due to immunological and respiratory immaturity. The diverse etiology includes multiple respiratory viruses such as Respiratory Syncytial Virus (RSV), influenza, rhinovirus, and SARS-CoV-2, each with distinct potential to cause severe illness and death. Understanding the specific incidence and lethality by etiological agents in the recent Brazilian context (2024), after the COVID-19 pandemic, is essential to guide surveillance and public health strategies. This study aimed to analyze the risk of incidence and lethality by specific etiology of SARS in children under one year of age hospitalized in Brazil during the year 2024. A descriptive cross-sectional study was performed using secondary data from the 2024 Influenza Epidemiological Surveillance Information System (SIVEP-Gripe), obtained via OpenDataSUS. Reported cases of SARS hospitalized in children <1 year of age in Brazil were included. Distribution by final classification and epidemiological week (EW) was analyzed; the incidence rate by Federative Unit (FU) (cases/100,000 < 1 year) with risk classification (Low/Moderate/High) was assessed; and, for cases with positive viral RT-PCR, the etiological frequency and virus-specific lethality rate (deaths/total cases of etiology ×100), also with risk classification, were extracted. A multivariate logistic regression model was performed for the risk factors of death. A total of 66,170 cases of SARS were reported in children under 1 year old (national incidence: 2663/100,000), with a seasonal peak between April and May. The majority of cases were classified as “SARS due to another respiratory virus” (49.06%) or “unspecified” (37.46%). Among 36,009 cases with positive RT-PCR, RSV (50.06%) and rhinovirus (26.97%) were the most frequent. The overall lethality in RT-PCR-positive cases was 1.28%. Viruses such as parainfluenza 4 (8.57%), influenza B (2.86%), parainfluenza 3 (2.49%), and SARS-CoV-2 (2.47%) had higher lethality. The multivariate model identified parainfluenza 4 (OR = 6.806), chronic kidney disease (OR = 3.820), immunodeficiency (OR = 3.680), Down Syndrome (OR = 3.590), heart disease (OR = 3.129), neurological disease (OR = 2.250), low O₂ saturation (OR = 1.758), SARS-CoV-2 (OR = 1.569) and respiratory distress (OR = 1.390) as risk factors for death. Cough (OR = 0.477) and RSV (OR = 0.736) were associated with a lower chance of death. The model had good calibration (Hosmer–Lemeshow p = 0.693) and overall significance (p < 0.001). SARS represented a substantial burden of hospitalizations, with marked seasonal and geographic patterns. RSV and rhinovirus were the main agents responsible for the volume of confirmed cases but had a relatively low to moderate risk of lethality. In contrast, less frequent viruses such as parainfluenza 4, influenza B, parainfluenza 3, and SARS-CoV-2 were associated with a significantly higher risk of death. These findings highlight the importance of dissociating frequency from lethality and reinforce the need to strengthen etiological surveillance, improve diagnosis, and direct preventive strategies (such as immunizations) considering the specific risk of each pathogen for this vulnerable population. Full article

There is a significant portion of the South African population with unknown HIV status, which slows down epidemic control despite the progress made in HIV testing. Machine learning (ML) has been effective in identifying individuals at higher risk of HIV infection, for whom testing is strongly recommended. However, there are insufficient predictive models to inform targeted HIV testing interventions in South Africa. By harnessing the power of supervised ML (SML) algorithms, this study aimed to identify the most consistent predictors of HIV testing in repeated adult population-based surveys in South Africa. The study employed four SML algorithms, namely, decision trees, random forest, support vector machines (SVM), and logistic regression, across the five cross-sectional cycles of the South African National HIV Prevalence, Incidence, and Behavior and Communication Survey (SABSSM) datasets. The Human Science Research Council (HSRC) conducted the SABSSM surveys and made the datasets available for this study. Each dataset was split into 80% training and 20% testing sets with a 5-fold cross-validation technique. The random forest outperformed the other models across all five datasets with the highest accuracy (80.98%), precision (81.51%), F₁-score (80.30%), area under the curve (AUC) (88.31%), and cross-validation average (79.10%) in the 2002 data. Random forest achieved the highest classification performance across all the dates, especially in the 2017 survey. SVM had a high recall (89.12% in 2005, 86.28% in 2008) but lower precision, leading to a suboptimal F₁-score in the initial analysis. We applied a soft margin to the SVM to improve its classification robustness and generalization, but the accuracy and precision were still low in most surveys, increasing the chances of misclassifying individuals who tested for HIV. Logistic regression performed well in terms of accuracy = 72.75, precision = 73.64, and AUC = 81.41 in 2002, and the F₁-score = 73.83 in 2017, but its performance was somewhat lower than that of the random forest. Decision trees demonstrated moderate accuracy (73.80% in 2002) but were prone to overfitting. The topmost consistent predictors of HIV testing are knowledge of HIV testing sites, being a female, being a younger adult, having high socioeconomic status, and being well-informed about HIV through digital platforms. Random forest’s ability to analyze complex datasets makes it a valuable tool for informing data-driven policy initiatives, such as raising awareness, engaging the media, improving employment outcomes, enhancing accessibility, and targeting high-risk individuals. By addressing the identified gaps in the existing healthcare framework, South Africa can enhance the efficacy of HIV testing and progress towards achieving the UNAIDS 2030 goal of eradicating AIDS. Full article

Infections with the Hepatitis B (HBV) and Hepatitis C (HCV) viruses share some transmission routes, which is why coinfection with these viruses becomes common, especially in endemic areas. This study evaluated the immunological response profile, viral load, and liver damage in groups monoinfected with HBV or HCV and in those co-infected with HBV/HCV. The groups were composed of 22 patients monoinfected by HCV, 22 patients monoinfected by HBV, and 34 co-infected by HBV/HCV, according to serological markers and molecular biology tests. The study was carried out from December 2017 to October 2019. Virus detection employed enzyme immunoassay, Enzyme-Linked Immunosorbent Assay (ELISA), and real-time PCR, while liver function and fibrosis were assessed using biochemical tests and Fibroscan. To research the immunological profile, cytokines were quantified using the BIO-Plex Pro Human Cytokine. Comparing the groups, both mono- and co-infected patients exhibited a Th1 immune response profile. HCV monoinfection notably showed significantly elevated serum levels of INF-γ (p < 0.01) and TNF-α (p < 0.01). The viral load was significantly higher in the HCV monoinfected group when compared to the other groups. Regarding liver damage, patients with a high level of fibrosis (F4) presented significant levels of cytokines INF-γ (p < 0.001), IL-17 (p < 0.0001), and TNF-α (p < 0.0001). Full article

Campylobacter jejuni is a leading cause of bacterial gastroenteritis worldwide which usually presents as mild, and self-limiting disease in immunocompetent individuals. However, in immunocompromised patients, such as those with common variable immunodeficiency, C. jejuni can cause severe recurrent infections requiring antibiotic treatment. Our study reports a case of a 37-year-old male patient with CVID, who had multiple episodes of C. jejuni intestinal infections over a 3.5-year period. A total of 27 stool samples were collected and analyzed between December 2020 and July 2024 during acute febrile diarrheal episodes, with C. jejuni isolated in 15 samples. Antimicrobial susceptibility testing (AST) during the course of the disease revealed three different antimicrobial resistance profiles including multi-drug-resistant phenotype. Whole genome sequencing was performed on three representative isolates, all identified as MLST type 367, ST-257 complex, with minimal genetic divergence, indicating a clonal origin. Genes and point mutations conferring resistance to macrolides, fluoroquinolones, beta-lactams, and tetracycline were identified in different C. jejuni isolates, along with key virulence factors linked to adherence, invasion, motility, and immune evasion. The genetic analysis of macrolide phenotypic resistance revealed different resistance mechanisms. Genotypic and phenotypic analyses of the same C. jejuni clone from single patient, and identified multidrug resistance pattern, present the first documented case of in vivo resistance development of C. jejuni in Croatia. This case highlights the role of prolonged antibiotic pressure in driving resistance evolution and underscores the need for careful antimicrobial stewardship and genomic monitoring in immunocompromised patients. Further research is needed to correlate phenotypic resistance with genetic determinants in Campylobacter spp. Full article

The antimicrobial resistance (AMR) surveillance network has been monitoring bloodstream bacterial pathogens and their resistance since 1999 in Tunisia. We report the long-term trends in the distribution of bloodstream bacterial pathogens and their resistance patterns from this surveillance database. We analyzed antibiotic resistance rates in 11 tertiary teaching hospital laboratories under the AMR surveillance network during 2011–2023, focusing on six priority bacterial pathogens, using the Cochrane–Armitage test for trend analysis. Of 22,795 isolates, K. pneumoniae (38.5%) was the most common, followed by S. aureus (20.4%), E. coli (13.6%), and A. baumannii (10.3%). Carbapenem resistance was highest in A. baumannii (77%), followed by Pseudomonas aeruginosa (29.3%), K. pneumoniae (19.4%), and Enterobacter cloacae (6.8%). Carbapenem-resistant Enterobacterales and third-generation cephalosporin-resistant Enterobacterales (3GCREB) increased from 10.6% to 26.3% (p-value < 0.001), and from 39% to 50.2%, respectively, during 2011–2023 (p-value < 0.001). Vancomycin resistance (38.3%) and the emergence of linezolid resistance in 2019 (2.4%) were reported in E. faecium isolates. Resistance to carbapenems and 3GC is a major challenge to controlling BSI in Tunisia. The national AMR surveillance network helps monitor annual patterns and guides empirical therapy. An integrated database combining clinical profiles and resistance data via real-time data-sharing platforms could improve clinical decision-making. Full article

Cutaneous larva migrans (CLM) is attributed to zoonotic infection with animal hookworm larvae penetrating the human skin, usually the feet and legs. There is, however, a broad range of differential diagnoses, with the implicated hookworm species usually remaining speculative. Single-dose ivermectin is the most recommended current therapy, with repeat ivermectin doses sometimes required. With the massive global expansion of macrocytic lactone use in both livestock and companion animals, ivermectin resistance is being increasingly described in both helminths and ectoparasites. A case of CLM involving the foot of a healthy 37-year-old is described, with the failure of two doses of ivermectin 15 mg (240 μg/kg) a week apart. This occurred in the context of a remote work environment in tropical Australia with both companion animals (dogs and cats) and wildlife exposed to antiparasitic agents including ivermectin. A combination regimen of multiple doses of albendazole and ivermectin was curative. Parasites with multidrug resistance being described from animals now include hookworms in dogs which are resistant to pyrantel, benzimidazoles such as mebendazole and ivermectin. For relapsed CLM we now recommend a combination of ivermectin and albendazole therapy. This report supports the critical role for a One Health/Planetary Health approach to surveillance and response for emerging zoonoses and antimicrobial resistance in human and animal pathogens. This requires support for systematic approaches to foster and normalize communications and collaborations between human and animal health professionals, environmental scientists and ecologists and First Nations scientists who are the holders of Indigenous knowledge. Full article

Hand hygiene reduces healthcare-associated infections. The World Health Organization (WHO) recommends the multimodal hand hygiene strategy to improve hand hygiene. To compare hand hygiene knowledge and compliance of healthcare practitioners (HCPs) before and after the implementation of the WHO multimodal strategy, a before-and-after cross-sectional study was conducted in two Tunisian University Hospitals (2019–2023). Hand hygiene knowledge and compliance were assessed using the WHO questionnaire and observation tool. In 2019, 42 of 246 HCPs (17%) correctly answered ≥80% of 25 questions on hand hygiene knowledge. By 2023, this increased to 47 HCPs (19%). Knowledge on hand hygiene significantly improved for 10 out of 25 questions (12–38% increases) but declined for eight questions (5–40% decreases). Seven questions showed no significant changes in knowledge. Overall hand hygiene compliance increased from 21% in 2019 to 40% in 2023 (p < 0.001). Improvements were observed across the hospital departments (p < 0.001) and staff categories (p < 0.001). In 2023, the lowest hand hygiene compliance was for/before touching a patient (29%), and before clean/aseptic procedures (37%). Hand hygiene compliance was improved, but progress fell short of the WHO’s desired 80% target. Sustained efforts and complementary interventions are needed to accelerate progress and achieve the desired outcomes. Full article

This retrospective cohort study aimed to assess clinical and epidemiological characteristics, treatment outcomes, and predictors of serological cure in patients with chronic Chagas disease in a non-endemic setting. All individuals aged ≥16 years with confirmed infection and evaluated at a tertiary hospital in Spain from 2008 to 2023 were included. Most of the 107 participants were women (78.5%) and Bolivian-born (99.1%). Digestive and cardiac involvement were identified in 32.7% and 17.8% of cases, respectively. Cardiac symptoms were significantly associated with the diagnostic findings of cardiac involvement (odds ratio [OR] 3.0, 95% confidence interval [CI] 1.1–8.2), whereas digestive symptoms did not correlate with imaging abnormalities (OR 0.7, 95% CI 0.3–1.6). Antiparasitic treatment, usually benznidazole, was initiated in 69% of patients and led to adverse events in 66.2%, with treatment discontinuation in 25.7%. Only 8.1% of treated patients achieved serological cure after a median 26 months, with obesity emerging as the only independent predictor (adjusted OR 31.0, 95% CI 3.7–261.2). Cardiac progression occurred in 9.3% of patients despite treatment. Although 59.8% were lost to follow-up, the cohort maintained a median follow-up of 27 months. These findings underscore the need for improved treatment strategies and sustained clinical monitoring in non-endemic settings. Full article

In Cabo Verde, Acute Respiratory Infection caused by various pathogens was the most reported condition in children under 5 years old between 2014–2020, and the fourth leading cause of mortality in this age group, with Human Respiratory Syncytial Virus (HRSV) being one of the main etiological agents. However, limited literature on the subject hinders the study of its epidemiology and the evaluation of potential implications for public health. In this work, we developed and validated a primer collection for the amplification and sequencing of the G and F genes of HRSV, using a sequential workflow including conventional and semi-nested PCR, followed by Sanger sequencing. This strategy not only allowed for the identification of HRSV linages but also facilitated the detection of mutants in the HRSV F protein, a critical step towards evaluating and ensuring the continued efficacy of Nirsevimab or Palivizumab as prophylactic therapies. Our analysis revealed the presence of the HRSV lineages A.D.2.2.1, A.D.3, B.D.4.1.1, and B.D.E.1, corresponding to the globally circulating lineages during the study period (years 2019 and 2022). No previously described mutations in the F protein that confer resistance to Palivizumab and Nirsevimab were found. However, continuous monitoring of HRSV genotypes is crucial to promptly identifying resistant viruses, considering their potential impact on public health. Full article

This study aimed to analyze the epidemiological characteristics and incidence trends of zoonotic diseases in China from 2015 to 2022, providing evidence for zoonotic disease prevention and control strategies. Individual case data for nationally reported zoonotic diseases from the Chinese Disease Prevention and Control Information System were collected. Descriptive epidemiology and statistical methods were employed to analyze trends along with changes in their spatial, temporal, and demographic distributions. From 2015 to 2022, the annual incidence rates of leishmaniasis, Japanese encephalitis, rabies, echinococcosis, hemorrhagic fever with renal syndrome (HFRS), and schistosomiasis showed a fluctuating downward trend. The incidence rates of anthrax and leptospirosis remained relatively stable. The incidence of brucellosis declined from 2015 to 2018 but subsequently increased through 2022. Western provinces, such as Gansu, Ningxia, Qinghai, Xinjiang, and Yunnan, remain high-incidence areas for multiple zoonotic diseases, with farmers being the population at the highest risk. These findings indicate it is essential to strengthen cross-sectoral cooperation and develop region- and population-specific prevention and control strategies based on the ‘One Health’ concept, particularly in areas with high incidence rates and among high-risk populations. Full article

Background: The case confirmation of CL relies on the direct demonstration of the parasite in clinical specimens from skin tissues. Despite most research efforts focusing on biopsy samples as the preferred diagnostic specimen for the detection of Leishmania spp., the use of non-invasive sampling, such as cutaneous swabs, combined with the use of molecular assays, has shown promising results. Methods: We conducted a retrospective study aimed at comparing the performance of different invasive and non-invasive diagnostic techniques, employed for the diagnosis of CL, in an Italian tertiary care center. Results: We observed 29 cases of CL between 2008 and June 2024. Considering the demonstration of Leishmania spp. on culture, biopsy PCR, histology, or smear microscopy as the reference diagnostic test for CL, molecular assays on cutaneous swabs showed a sensitivity of 100% (95% C.I. 73.5–100). Overall, PCR performed on swab specimens allowed for the detection of three cases that biopsy histology (in two cases) and microscopic examination of cutaneous smear (in three cases) would have failed to identify. Conclusion: Non-invasive swab sampling, combined with molecular analysis, can be a valuable tool for a more accessible and patient-friendly diagnostic approach for CL. Should our preliminary results be confirmed, this test could become the first-line diagnostic tool for CL, reserving biopsy as a second-level test or for cases in which the differential diagnosis includes malignancy or other concerning diseases. Further studies aimed at defining the efficiency of this diagnostic method and providing standardized diagnostic protocols would be needed to provide stronger evidence supporting its recommendation. Full article

Background: Female sex workers (FSWs) in sub-Saharan Africa bear a disproportionate burden of sexually transmitted infections, including HIV, high-risk HPV (HR-HPV), and herpes simplex virus type 2 (HSV-2). This study evaluated possible association between HR-HPV, HIV, and HSV-2 among FSWs in the Democratic Republic of the Congo. Methods: A cross-sectional study was conducted among 432 FSWs (mean age, 28.1 years) recruited via respondent-driven sampling. Genital self-sampling using the V-Veil UP2™ device was performed, followed by HPV genotyping and quantification by multiplex PCR, and HSV-2 DNA detection by PCR. Results: Among 415 participants, HR-HPV prevalence was 36.9%, with HPV-52 (14.9%), HPV-58 (10.1%), and HPV-16 (6.5%) as leading genotypes. Overall, 89% of HR-HPV-positive women harbored genotypes covered by Gardasil-9^®. Co-infection with HIV and HSV-2 significantly increased HPV prevalence, genotype diversity, and viral load. Notably, HSV-2 positivity was the sole independent predictor of elevated replication of HR-HPV (p < 0.001), vaccine HR-HPV (p < 0.001), and non-vaccine HR-HPV (p < 0.021). Conclusions: FSWs exhibit a high burden of HR-HPV, shaped by co-infections with HIV and HSV-2. HSV-2 independently drives HR-HPV replication, highlighting its role in HPV persistence and cervical cancer risk. Integrated HSV-2 detection and Gardasil-9^® vaccination should be prioritized in cervical cancer elimination strategies targeting high-risk populations in sub-Saharan Africa. Full article

Baylisascariasis is a debilitating and potentially lethal zoonotic disease caused by a nematode parasite that has a worldwide distribution. Baylisascaris spp. are carried by a variety of mammalian definitive hosts, and their larvae can infect a large diversity of paratenic hosts including birds and mammals, and even humans. Herein, the potential exposure risk of this zoonotic parasite is demonstrated through the study of a suburban American community with a population of Baylisascaris procyonis—infected raccoons (Procyon lotor) as a case study for any location with Baylisascaris spp., definitive hosts, and proximity to humans. Soil from 100 properties within neighborhoods of southern Corpus Christi, TX, USA, was surveyed to determine if viable B. procyonis eggs were present. In total, 27% of the residential properties were contaminated. Positive soil samples, on average, contained 31,287 B. procyonis eggs/gram of soil; of these samples, 92% of the B. procyonis eggs had motile larvae. Sites with contaminated soils appeared random within residential properties; frequency of contaminated sites was similar between known raccoon defecation sites and random sites. Suggestions for the reduction in risks of exposure to this potentially debilitating parasite are offered to residents of Baylisascaris-contaminated properties. Full article

Candida auris possesses distinctive features that facilitate its persistence and transmission in healthcare settings, causing outbreaks of infection that are difficult to treat. So, emphasis has been placed on implementing measures for controlling, eliminating, and preventing fungal transmission, such as environmental disinfection and patient decolonization. This review aimed to understand and analyze the agents for environmental disinfection and patient decolonization reported in the last 5 years. The PubMed database was reviewed, using the terms “Candida auris”, “disinfection”, and “decolonization”. Only original papers, published between 2020–2025, in English or Spanish, that included relevant information on the topic, were selected. After the selection process, 52 articles were chosen to analyze the agents for environmental disinfection and decolonization of C. auris. Natural and synthetic disinfectants and ultraviolet radiation were reported for the environmental disinfection, with variable efficacy, depending on factors such as concentration and exposure time. Natural and synthetic antiseptics were also reported for decolonization, with varying efficacy. For example, 2% chlorhexidine shows a 0.5 log reduction, while at concentrations >10% it is >4 log. However, most have only been tested in animal models. Based on the review, Far-UV-C radiation (222 nm) is safe and appropriate to mitigate (up to 1 log reduction) the spread of C. auris in the hospital setting. However, it is important to consider that the cost and limited availability of the device present a barrier to its implementation. Patient decolonization is still challenging nowadays due to the absence of agents with proven high efficacy in humans. Full article

Background and Objectives: Abnormal blood and biochemical indicators could increase the risk of infectious diseases. However, the association between blood together with biochemical indicators and latent tuberculosis infection (LTBI) has not been well confirmed. Materials and Methods: Our aim was to assess the role of blood and biochemical indicators in the risk of LTBI. We enrolled 965 freshmen who were originating from tuberculosis key areas of a college in Nanjing. We used logistic regression models, restricted cubic spline (RCS), and nomograms to evaluate the association between blood and biochemical indicators and LTBI. In addition, calibration curves were performed to evaluate the quality of the model. Results: Among these 965 participants, 311 were diagnosed as LTBI according to TST. Multivariate models showed that the population with an eosinophils percentage around <0.5% (OR: 2.82, 95% CI: 1.39–5.74, p = 0.004) and 0.5–5% (OR: 2.78, 95% CI: 1.07–7.23, p = 0.036) were positively associated with LTBI. Elevated uric acid levels (OR: 1.01, 95% CI: 1.00–1.02, p = 0.047) were significantly associated with LTBI. In addition, participants with a history of tuberculosis exposure (OR: 3.26, 95% CI: 1.39–7.66) and a history of tuberculosis (OR: 10.92, 95% CI: 1.24–96.08) were also positively correlated with LTBI. Conclusions: Eosinophils percentage and uric acid are associated with LTBIs. Participants who have tuberculosis exposure history and tuberculosis history are the critical target population. Full article

Background: The availability of laboratory tests to screen and diagnose migrants and travellers for neglected and tropical parasitic diseases significantly impacts individual and public health. Italian scientific societies for parasitology, tropical diseases, and global health developed a survey to assess number and geographical localisation of laboratories able to carry out adequate diagnostics. Methods: An open-ended and multiple-choice questionnaire was constructed and sent to 752 members working in Italian microbiology laboratories via scientific societies’ mailing lists. Data concerning malaria, cystic echinococcosis, leishmaniasis, schistosomiasis, strongyloidiasis, and Chagas disease were included. Results: Members from 96 laboratories replied. At least one laboratory responded from 18 out of 20 Italian regions. Serological tests for Schistosoma spp., Strongyloides stercoralis, Trypanosoma cruzi, Echinococcus spp., and Leishmania spp. are performed in <50% of responding laboratories. Only 56.6% of labs provide all three recommended tests for malaria diagnosis in the emergency room. Direct identification methods availability varies for Schistosoma eggs (75–95.8%), S. stercoralis larvae (53.1%), trypomastigotes (59.4%), and Leishmania amastigotes (53.1%). Geographical differences (mainly northern versus southern regions) were evident. Conclusions: The survey underlines the need to improve diagnosis for neglected and tropical diseases, to define a network of reference laboratories for testing less prevalent diseases, and to share information, education, and training for both clinicians and microbiologists/parasitologists. Full article

Influenza poses a significant global health burden due to its high transmissibility, antigenic variability, and substantial morbidity. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has further complicated influenza dynamics, highlighting the need for rapid, accurate, and accessible diagnostics. This review comprehensively summarized the advancements in influenza virus (IFV) detection, from conventional methods like viral culture and serology to modern molecular techniques, including CRISPR-based systems, next-generation sequencing (NGS), and biosensors. We analyze the sensitivity, specificity, and applicability of these methods and emphasize their roles in clinical and public health settings. While traditional techniques remain valuable for strain characterization, novel technologies like CRISPR and portable biosensors offer rapid, low-resource solutions. This review provides a comprehensive insight into the development of integrated diagnostic strategies for seasonal IFV epidemics and future pandemics. Full article

Scrub typhus is an acute febrile vector-borne infectious disease caused by Orientia tsutsugamushi (O. tsutsugamushi) and transmitted through the bite of infected chigger mite larvae. Transmission involves complex ecological interactions among vectors, hosts, and environmental factors. Accumulating evidence indicates complex interactions between the scrub typhus incidence and multilevel environmental determinants, encompassing meteorological factors (e.g., temperature, humidity, precipitation, wind speed, sunshine duration, and atmospheric pressure), geographical conditions (e.g., topography, elevation, and landcover), and socioeconomic factors (e.g., economic level, cultural practices, residential conditions, and human behaviors). However, significant discrepancies persist among studies regarding the effect sizes and temporal associations, and the precise mechanisms remain incompletely elucidated. This review synthesizes the evidence on environment–disease relationships, clarifies the methodological inconsistencies, analyzes the potential sources of heterogeneity, and highlights the critical knowledge gaps to inform targeted prevention and control strategies and guide future research priorities. Full article

Tennessee’s ecological diversity, spanning forests, farmland, and urban areas, provides an ideal foundation for applying the One Health approach, which integrates human, animal, and environmental health. This review examines Tennessee’s current One Health landscape, highlighting active initiatives, ongoing challenges, and future directions. Key efforts involve workforce development, disease surveillance, outbreak response, environmental conservation, and public education, led by a coalition of state agencies, universities, and the Tennessee One Health Committee. These programs promote cross-sector collaboration to address issues such as zoonotic diseases, climate change, land use shifts, and environmental contaminants. Notably, climate-driven changes, including rising temperatures and altered species distributions, pose increasing threats to health and ecological stability. Tennessee has responded with targeted monitoring programs and climate partnerships. Education is also a priority, with the growing integration of One Health into K–12 and higher education to build a transdisciplinary workforce. However, the state faces barriers, including limited funding for the One Health workforce, undefined workforce roles, and informal inter-agency data sharing. Despite these obstacles, Tennessee’s successful responses to outbreaks like avian influenza and rabies demonstrate the power of coordinated action. To strengthen its One Health strategy, the state must expand funding, formalize roles, improve data systems, and enhance biodiversity and climate resilience efforts positioning itself as a national leader in interdisciplinary collaborative solutions. Full article

Studies have indicated that there was a disease interaction of pandemic influenza with respiratory tuberculosis (TB) in Malta, which could explain the heightened mortality recorded in young adults. We revisit the 1918/19 influenza and TB syndemic potential on the island of Malta. Borrowing from crisis studies that explore the harvesting effect, we used the method of assessing changes in pre-pandemic, pandemic, fallow, and post-pandemic mortality/life expectancy to reveal the syndemic experience. Pre-pandemic (1914–1917) life expectancy at birth was significantly higher, at 37.91 years, than during the pandemic (1918), when life expectancy dropped to 33.26 years (Z = 10.56, p < 0.0001). Post-pandemic (1919) life expectancy rose to 43.49 years, which was an even longer life expectancy than pre-pandemic (Z = 17.61, p < 0.0001). There were significant changes in TB mortality death rates during the four periods in those of reproductive age. Augmenting our framework for studies of syndemics involving short-term events, we proposed the identification of contributing, driving, and limiting factors. Underlying living conditions contributed to the syndemic. The exacerbation of housing conditions, the economy associated with the First World War, and meteorological measures—temperature, relative humidity, and rainfall—were driving factors. The early implementation of mitigation strategies, such as restrictions on mass gatherings, were limiting factors of the syndemic. Full article

Bacillus Calmette–Guérin (BCG)-related immune reconstitution inflammatory syndrome (IRIS) is a recognised complication following antiretroviral therapy (ART) initiation in HIV-infected infants. We report the case of a 19-month-old child with undiagnosed perinatally acquired HIV due to maternal nondisclosure. The child developed ipsilateral axillary lymphadenitis at the BCG vaccination site shortly after starting ART. The clinical features and temporal association with ART supported a diagnosis of BCG-IRIS. The child was successfully managed with conservative pharmacological treatment alone—rifampicin, isoniazid, and macrolide therapy—without surgical incision or corticosteroids. Progressive improvement of the lesion was observed, and complete clinical resolution occurred over the following months, alongside immune recovery. This case underscores the importance of recognising BCG-IRIS, even in settings where HIV diagnosis may be delayed, and supports the feasibility of conservative management in paediatric patients, potentially avoiding surgical intervention in settings of localised disease. Full article

Aedes aegypti, the main urban vector of dengue fever, represents a growing public health problem in Nouakchott, the capital of Mauritania. Identifying the factors influencing the distribution and productivity of its breeding sites is essential for the development of effective control strategies. From May 2023 to April 2024, physico-chemical characteristics were recorded and mosquito larvae were collected, using a standard dipping method, from 60 water collections each month during the dry season and twice a month during the rainy season, totaling 294 observations. The larval positivity of water collections and larval abundance of breeding sites over the time were modeled using a random-effect logistic regression model and a negative binomial regression model, respectively. The depth, distance from habitat, type of water collection and exposure to sunlight were statistically significant and independently associated with water collection positivity for Ae. aegypti larvae (aOR = 5.18, 95%CI [1.66–16.18], p-value = 0.005; aOR = 0.00, 95%CI [0.00–0.02], p-value < 0.001; aOR = 252.88, 95%CI [4.05–15,786.84], p-value = 0.009 and aOR = 0.04, 95%CI [0.01–0.26], p-value < 0.001, respectively). Aedes aegypti larval habitats were mainly artificial (90%), temporary (n = 217 observations), close to dwellings (n = 114) and shaded (n = 96). Plastic water tanks (n = 17, 48.6%), wells (n = 6, 17.1%) and barrels (n = 4, 11.4%) were the most common breeding sites. Larval abundance was negatively associated with containers of increasing pH and surface area (aOR = 0.50, 95%CI [0.33–0.75] p-value = 0.001 and aOR = 0.48, 95%CI [0.27–0.87], p-value = 0.016, respectively). As Ae. aegypti mosquitoes are multi-resistant to adult insecticides and dengue has become endemo-epidemic since 2014, vector control should give the priority to the physical removal or treatment of shaded, peridomestic containers—particularly plastic water tanks and barrels—and consider the use of biological larvicides to target breeding sites with low pH and small surface areas. Full article

Studies on the burden of COVID-19 cases in Colombia have focused on specific populations and short timeframes. A retrospective observational study was conducted on adult patients aged 18 diagnosed with COVID-19 who received inpatient and/or outpatient medical care at a large health maintenance organization, to evaluate the burden of COVID-19 cases in Colombia (from March 2020 to January 2023) and associations with demographic and clinical characteristics. COVID-19 cases were identified with ICD-10 codes and confirmed by a laboratory test. The statistical analysis focused on descriptors of the frequency of events. A multivariate regression model was used to identify factors associated with severe conditions and death. Of the 953,661 cases detected, most cases (~79%) were mild or moderate (handled as outpatients). There were 20.1% (N = 191,260) severe cases and 0.9% (N = 8841) critical cases. Most COVID patients were unvaccinated (94.6%) and had, on average, one comorbidity. Hypertension (19.1%), immunocompromised condition (23.8%), mental health conditions (15%), obesity (10.8%), and cancer (11.2%) were the common prevalent comorbidities. The presence of comorbidity increased the risk of severe or critical COVID-19. COVID-19 cases were associated with the lack of vaccination and comorbidities. Effective vaccination strategies are needed to reduce the burden of COVID-19 in Colombia and, considering budgetary constraints, it is advisable to prioritize the elderly or populations with underlying conditions. Full article