Tropical Medicine and Infectious Disease

13 pages, 536 KB

Open AccessArticle

Enablers of Post-Validation Surveillance for Lymphatic Filariasis in the Pacific Islands: A Nominal Group Technique and Expert Elicitation

by Adam T. Craig, Clement Couteaux, Ken Jetton, Roger Nehemia, Oliver Sokana, Tanebu Tong, Temea Bauro, Taulanga Baratio, Ofa Tukai, Joe Takai, Satupaitea Viali, Noel Gama Soares, Maria Ome-Kaius, Mary Yohogu, Litiana Volavola, Patricia Tatui, Fasihah Taleo, Salanieta Saketa, Andie Tucker, Charles Mackenzie, Katherine Gass, Holly Jian, Colleen L. Lau and Harriet L. S. Lawford Show full author list Hide full author list

Trop. Med. Infect. Dis. 2026, 11(2), 62; https://doi.org/10.3390/tropicalmed11020062 - 23 Feb 2026

Cited by 1 | Viewed by 604

Abstract

Lymphatic filariasis (LF) is a mosquito-borne neglected tropical disease that causes substantial morbidity and social exclusion. Global efforts under the World Health Organization’s Global Programme to Eliminate Lymphatic Filariasis have markedly reduced prevalence, and several Pacific Island Countries and Territories (PICTs) have achieved [...] Read more.

Lymphatic filariasis (LF) is a mosquito-borne neglected tropical disease that causes substantial morbidity and social exclusion. Global efforts under the World Health Organization’s Global Programme to Eliminate Lymphatic Filariasis have markedly reduced prevalence, and several Pacific Island Countries and Territories (PICTs) have achieved elimination of the disease as a public health problem. However, post-validation surveillance (PVS), essential for detecting resurgence and enabling early response, has rarely been implemented, and barriers to its delivery remain poorly understood. We used two complementary qualitative approaches to identify systemic barriers and enablers to LF PVS in PICTs. First, we conducted a Nominal Group Technique followed by a structured expert elicitation involving program managers and technical staff. Data were analysed thematically and triangulated across sources. Participants identified 70 challenges which were consolidated into ten thematic domains. Pertinent barriers relate to limited leadership understanding of LF and surveillance options, inconsistent technical and financial support, and a lack of context-appropriate operational guidance. Additional challenges included limited field-ready diagnostics, procurement delays, the absence of formal mandates, and low community engagement. Enablers included embedding PVS within existing health services, leveraging trusted community networks, strengthening regional frameworks, and co-developing practical tools with countries. Sustaining LF elimination in the Pacific will require political commitment, regional collaboration, and integrated, programmatic approaches informed by recent PVS experience. Full article

(This article belongs to the Section Infectious Diseases)

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31 pages, 1422 KB

Open AccessReview

Three Decades of Use of the Minimum Basic Data Set in Infectious Disease Research in Spain: A Scoping Review with an Evidence-Mapping Approach

by Beatriz Rodríguez-Alonso, Hugo Almeida, Montserrat Alonso-Sardón, Inmaculada Izquierdo, Ángela Romero-Alegría, Amparo López-Bernús, Virginia Velasco-Tirado, Josué Pendones Ulerio, Javier Pardo Lledías and Moncef Belhassen-García

Trop. Med. Infect. Dis. 2026, 11(2), 61; https://doi.org/10.3390/tropicalmed11020061 - 20 Feb 2026

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Abstract

Nationwide hospital discharge databases are increasingly used in infectious disease research, yet their methodological strengths and limitations are rarely synthesised. In Spain, the Minimum Basic Data Set (Conjunto Mínimo Básico de Datos, CMBD) was implemented in 1987 and provides near-universal coverage of acute-care [...] Read more.

Nationwide hospital discharge databases are increasingly used in infectious disease research, yet their methodological strengths and limitations are rarely synthesised. In Spain, the Minimum Basic Data Set (Conjunto Mínimo Básico de Datos, CMBD) was implemented in 1987 and provides near-universal coverage of acute-care hospitalisations and has been widely applied in infectious disease epidemiology. However, its overall contribution and intrinsic constraints have not been comprehensively mapped. Given the breadth of infections, study designs, populations and outcome definitions in CMBD-based research, effect-size synthesis was not feasible; therefore, we conducted a scoping review with an evidence-mapping approach. We aimed to synthesise the scope, applications and methodological limitations of CMBD-based infectious disease research since its implementation. We conducted a scoping review following JBI guidance and reported according to PRISMA-ScR. PubMed, Embase, Web of Science and Scopus were searched from inception to 25 November 2024 for peer-reviewed journal articles in English or Spanish using CMBD data to investigate infectious diseases in Spain (no restrictions were applied by study design; grey literature was excluded). Screening, data charting and synthesis were completed during 2025. Four reviewers independently screened records and charted data. Studies were classified by infectious disease focus, syndromic category, study design and geographical scope. A total of 359 studies published between 1996 and 2024 were included, mostly retrospective observational analyses. Infectious diseases were the primary focus in 225 studies (62.7%), most commonly respiratory, gastrointestinal/liver and vaccine-preventable infections. Subnational analyses were concentrated in a limited number of regions. Over 80% of reported limitations reflected intrinsic CMBD features. Over three decades, the CMBD has become a cornerstone of hospital-based infectious disease research in Spain, enabling robust national analyses. However, limitations in clinical detail, microbiological confirmation and coding consistency constrain aetiological specificity and causal inference, highlighting the need for data validation and linkage with complementary sources. Full article

(This article belongs to the Section Infectious Diseases)

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14 pages, 2001 KB

Open AccessArticle

Emergence of Human and Animal Melioidosis in Southern Africa, 2018–2021

by Jennifer Rossouw, Hermanus D. W. Geyer, Monica Birkhead, Douglas Wilson, Jeremy Nel, Alan S. Karstaedt, Carel E. Haumann, Annelize Jonker, Jason W. Sahl, David M. Wagner and John A. Frean

Trop. Med. Infect. Dis. 2026, 11(2), 60; https://doi.org/10.3390/tropicalmed11020060 - 19 Feb 2026

Cited by 1 | Viewed by 645

Abstract

Melioidosis is increasingly recognised in tropical and subtropical regions worldwide as a serious and potentially fatal bacterial infection affecting humans and animals, acquired from the environment. Until now, human cases of melioidosis had not been reported in Southern Africa. Over a four-year period, [...] Read more.

Melioidosis is increasingly recognised in tropical and subtropical regions worldwide as a serious and potentially fatal bacterial infection affecting humans and animals, acquired from the environment. Until now, human cases of melioidosis had not been reported in Southern Africa. Over a four-year period, we identified three human and two animal cases of melioidosis in South Africa and Namibia. Burkholderia pseudomallei isolates were investigated by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS) and whole-genome sequencing (WGS). Phylogenetic analysis demonstrated substantial diversity, suggesting long-term cryptic persistence of the bacterium in the Southern African region. Limited awareness of the disease and inadequate diagnostic capacity likely contribute to its apparent rarity in the region. These findings underscore the urgent need for increased surveillance, improved diagnostics, and greater awareness of melioidosis in Southern Africa to better understand its true epidemiological burden and prevent future cases. Full article

(This article belongs to the Section Infectious Diseases)

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19 pages, 1407 KB

Open AccessArticle

Long-Term Parasitological Clearance and Cardiac Progression in Trypanosoma cruzi TcI: A Phase-Stratified Cohort from Colombia

by Mario J. Olivera, Adriana Arévalo and Alejandro Marcel Hasslocher-Moreno

Trop. Med. Infect. Dis. 2026, 11(2), 59; https://doi.org/10.3390/tropicalmed11020059 - 19 Feb 2026

Cited by 1 | Viewed by 654

Abstract

Clinical trajectories following Trypanosoma cruzi infection are heterogeneous, and the determinants of post-treatment parasitological dynamics and cardiac progression remain incompletely characterized, particularly in TcI-predominant regions. This study assessed, in both the acute phase and the indeterminate chronic form, the association between TcI infection [...] Read more.

Clinical trajectories following Trypanosoma cruzi infection are heterogeneous, and the determinants of post-treatment parasitological dynamics and cardiac progression remain incompletely characterized, particularly in TcI-predominant regions. This study assessed, in both the acute phase and the indeterminate chronic form, the association between TcI infection and molecular clearance kinetics, cardiac progression, and the prognostic value of early molecular response. An ambispective cohort in Colombia included patients with acute or indeterminate chronic infection followed between 2000 and 2023. Sustained clearance was defined as two consecutive negative quantitative polymerase chain reaction results obtained at separate visits. Time-to-event analyses were conducted using Kaplan–Meier curves and Cox proportional hazards models. TcI infection was consistently associated with delayed molecular clearance in both clinical presentations. Although long-term clearance was achieved in most patients, TcI infection was independently associated with a higher risk of cardiac progression. In contrast, quantitative polymerase chain reaction negativity at 12 months was associated with reduced subsequent progression risk, indicating that sustained molecular response is a clinically meaningful prognostic marker. Collectively, these findings support the incorporation of early molecular monitoring into risk-stratified follow-up strategies in TcI-predominant settings and reinforce the need for phase-specific clinical management approaches. Full article

(This article belongs to the Topic Vector-Borne Disease Spatial Epidemiology, Disease Ecology, and Zoonoses)

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15 pages, 413 KB

Open AccessReview

Series 1: Behind the Spread: A Scoping Review of Risk Factors for Exposure to Mycobacterium tuberculosis

by Sonia Menon, Anthony D. Harries, Riitta A. Dlodlo, Gisèle Badoum, Mohammed F. Dogo, Olivia B. Mbitikon, Pranay Sinha, Yan Lin, Jyoti Jaju, Aung Naing Soe, Anisha Singh, Bharati Kalottee and Kobto G. Koura

Trop. Med. Infect. Dis. 2026, 11(2), 58; https://doi.org/10.3390/tropicalmed11020058 - 19 Feb 2026

Viewed by 1257

Abstract

Background: Tuberculosis (TB) remains a major global health challenge, with transmission influenced by the incidence of contagious people with TB, the duration of infectivity, and the probability of contact with susceptible individuals. This review synthesizes recent evidence on established and emerging risk factors [...] Read more.

Background: Tuberculosis (TB) remains a major global health challenge, with transmission influenced by the incidence of contagious people with TB, the duration of infectivity, and the probability of contact with susceptible individuals. This review synthesizes recent evidence on established and emerging risk factors influencing TB transmission, particularly in light of global trends such as migration, urbanization, and demographic shifts, to guide future prevention and control strategies. This scoping review maps and synthesizes evidence from systematic reviews on risk factors for Mycobacterium tuberculosis exposure. Methods: A preliminary general literature search was conducted in PubMed on 25 August 2024, using the keywords “tuberculosis,” “risk factors,” and “systematic review.” A subsequent targeted search focused on systematic reviews published since 2000 that examined social and environmental determinants of exposure to M. tuberculosis identified in the general search. Original research and reviews spanning pre-2000 were excluded. Data extraction and synthesis followed PRISMA-ScR guidelines. Results: Of the 344 systematic reviews identified, 14 met the eligibility criteria, reporting on key risk factors contributing to the incidence of contagious people with TB, the duration of infectivity, and the probability of contact. These risk factors included homelessness, migration, occupational exposure, urbanization, climate change, and air pollution. The findings emphasize the complex interrelated role of social and environmental determinants in driving TB transmission. Conclusion: This review highlights the need for a multi-sectoral approach to TB, as climate change, air pollution, overcrowding, stigma, and limited healthcare access exacerbate established risks related to poverty. Effective prevention and control require targeted interventions that address these interconnected factors. Full article

(This article belongs to the Section Infectious Diseases)

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17 pages, 3802 KB

Open AccessArticle

Spatial Epidemiological Approach to Tuberculosis Treatment Outcomes in a Tertiary-Level Hospital: A Retrospective Analysis

by Luis Eduardo Del Moral Trinidad, Gilberto Silva Bañuelos, Esteban Gonzalez-Diaz and Melva Guadalupe Herrera Godina

Trop. Med. Infect. Dis. 2026, 11(2), 57; https://doi.org/10.3390/tropicalmed11020057 - 18 Feb 2026

Cited by 1 | Viewed by 687 | Correction

Abstract

Tuberculosis (TB) remains a persistent public health challenge in Mexico, particularly in large urban settings marked by social heterogeneity. We conducted a retrospective cohort study of patients diagnosed with tuberculosis and treated at a tertiary-level hospital in Guadalajara, Mexico, between 2020 and 2023. [...] Read more.

Tuberculosis (TB) remains a persistent public health challenge in Mexico, particularly in large urban settings marked by social heterogeneity. We conducted a retrospective cohort study of patients diagnosed with tuberculosis and treated at a tertiary-level hospital in Guadalajara, Mexico, between 2020 and 2023. Unfavorable treatment outcomes were defined as treatment failure, loss to follow-up, or death. Multivariable logistic regression was used to identify factors independently associated with unfavorable outcomes. Spatial analyses, including Kernel Density Estimation, Global Moran’s I, Local Indicators of Spatial Association (LISA), and Getis–Ord Gi*, were applied to explore the geographic distribution of unfavorable outcomes. Unfavorable tuberculosis treatment outcomes among patients treated at a tertiary-level hospital were not randomly distributed in space. Spatial epidemiological methods provided complementary, exploratory insights beyond individual-level clinical factors, highlighting geographic patterns that may inform place-sensitive public health interventions and strengthen routine tuberculosis surveillance, without implying causal inference. Full article

(This article belongs to the Special Issue Innovative Approaches to Combat Infectious Diseases in Low and Middle Income Countries (LMICs): Epidemiology, Diagnosis, and Interventions)

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17 pages, 1618 KB

Open AccessProtocol

Developing an Integrated Municipal Environmental Health Framework for Communicable Disease Surveillance and Prevention in South Africa: A Mixed-Methods Study Protocol

by Ledile Francina Malebana, Maasago Mercy Sepadi and Matlou Ingrid Mokgobu

Trop. Med. Infect. Dis. 2026, 11(2), 56; https://doi.org/10.3390/tropicalmed11020056 - 17 Feb 2026

Viewed by 593

Abstract

Communicable diseases remain a significant public health burden in South Africa, particularly where environmental determinants of health intersect with fragmented surveillance systems. Environmental Health Practitioners (EHPs) are legally mandated to implement the surveillance and prevention of communicable disease services at the municipal level. [...] Read more.

Communicable diseases remain a significant public health burden in South Africa, particularly where environmental determinants of health intersect with fragmented surveillance systems. Environmental Health Practitioners (EHPs) are legally mandated to implement the surveillance and prevention of communicable disease services at the municipal level. However, this function is inconsistently operationalised and often remains reactive (outbreak-driven), with limited integration into broader national surveillance systems. This study protocol outlines a mixed-methods investigation to develop a practical framework to strengthen the communicable disease surveillance and prevention function within Environmental Health Services in South Africa. The study will assess existing guiding tools, operational practices, and intersectoral collaboration mechanisms supporting surveillance across metropolitan and district municipalities. Quantitative data will be collected through a national survey of EHPs, while qualitative data will be generated through key informant interviews with national stakeholders, focus group discussions with municipal health managers, and a targeted review of municipal documents. Quantitative data will be analysed using descriptive and inferential statistics, while qualitative data will be thematically analysed and triangulated across data sources. The expected outcome is an integrated framework that clarifies roles, strengthens data flow, and promotes proactive, coordinated surveillance and prevention of communicable diseases within environmental health. The developed framework is anticipated to inform policy discussions and may contribute to efforts aligned with Sustainable Development Goal 3, Target 3.3, on reducing communicable disease burdens, by strengthening municipal communicable disease surveillance and prevention. Full article

(This article belongs to the Special Issue Emerging Infectious Diseases and Strategies for Their Prevention and Control)

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17 pages, 718 KB

Open AccessArticle

A Nationwide Cross-Sectional Survey of Knowledge, Attitudes, and Practices on Rabies in Saudi Arabia

by Ebtisam Bakhsh, Rasha Doumi, Najd Alqahtani, Shahad Althubiti, Jana Hagr, Abeer Alnujide, Shouq Alobaid, Jana Allaboon, Shatha Alotaibi, Duaa Aljuhaymi, Maha Alotaibi and Abdullah Assiri

Trop. Med. Infect. Dis. 2026, 11(2), 55; https://doi.org/10.3390/tropicalmed11020055 - 17 Feb 2026

Viewed by 810

Abstract

Rabies remains a fatal yet preventable zoonotic disease, and understanding population-level knowledge, attitudes, and practices (KAP) is essential to guide national elimination strategies. This nationwide cross-sectional study assessed rabies-related KAP among 2116 residents across all major regions of Saudi Arabia. An online validated [...] Read more.

Rabies remains a fatal yet preventable zoonotic disease, and understanding population-level knowledge, attitudes, and practices (KAP) is essential to guide national elimination strategies. This nationwide cross-sectional study assessed rabies-related KAP among 2116 residents across all major regions of Saudi Arabia. An online validated questionnaire measured sociodemographic characteristics and KAP indicators. Descriptive and inferential statistics, including logistic regression, were used to identify predictors of good KAP outcomes. Overall, more than half of participants demonstrated poor knowledge (54.9%), particularly regarding rabies etiology, transmission, and essential post-exposure wound care, while attitudes toward prevention were overwhelmingly positive (92%). Despite this, several unsafe practices persisted, including interaction with stray animals and use of traditional remedies. Good knowledge was significantly associated with higher income, pet ownership, and residency in the Central region, whereas younger age and Northern residency predicted poorer practices. Mediation analysis suggested that knowledge may partly explain (mediate) the association between sociodemographic characteristics and reported preventive practices; however, causal inference is limited by the cross-sectional design. These findings demonstrate substantial knowledge and behavioral gaps despite favorable attitudes and highlight the need for culturally tailored educational interventions, improved access to post-exposure prophylaxis, and strengthened One Health strategies to support rabies elimination in Saudi Arabia. Full article

(This article belongs to the Special Issue Rabies—Global Challenges, Societal Perspectives, and Case Studies)

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14 pages, 836 KB

Open AccessProject Report

Integrated Approaches to Surveillance of Lymphatic Filariasis and Other Infectious Diseases in the Pacific Islands

by Adam T. Craig, Harriet L. S. Lawford, Temea Bauro, Clement Couteaux, Litiana Volavala, Myrielle Dupont-Rouzeyrol, Noel Gama Soares, Roger Nehemia, Maria Ome-Kaius, Prudence Rymill, Fasihah Taleo, Patricia Tatui, ‘Ofa Sanft Tukia, Satupaitea Viali, Mary Yohogu, Fiona Angrisano, Leanne J. Robinson, Salanieta Saketa, Andie Tucker, Charles Mackenzie, Susana Vaz Nery, Venkatachalam Udhayakumar, Katherine Gass, Patrick Lammie and Colleen L. Lau Show full author list Hide full author list

Trop. Med. Infect. Dis. 2026, 11(2), 54; https://doi.org/10.3390/tropicalmed11020054 - 14 Feb 2026

Viewed by 986

Abstract

Lymphatic filariasis (LF) is a mosquito-borne neglected tropical disease targeted by the World Health Organization (WHO) for global elimination as a public health problem. Sixteen Pacific Island countries and territories were historically endemic, and eight have now met the WHO criteria for elimination [...] Read more.

Lymphatic filariasis (LF) is a mosquito-borne neglected tropical disease targeted by the World Health Organization (WHO) for global elimination as a public health problem. Sixteen Pacific Island countries and territories were historically endemic, and eight have now met the WHO criteria for elimination as a public health problem. Elimination as a public health problem does not imply zero transmission. Rather, it denotes that LF prevalence has been reduced below a defined threshold at which community transmission can be sustained. Following validation of elimination, the WHO recommends post-validation surveillance (PVS) to detect potential re-emergence of LF as a public health problem. However, implementing PVS is challenging in Small Island Developing States with dispersed populations, limited workforce capacity, resource constraints, and competing health priorities. The ‘Voices and Visions: Building Partnerships for Integrated Serosurveillance of LF and Other Infectious Diseases in the Pacific Islands’ meeting was held in Brisbane, Australia, from 8–10 July 2025. Fifty-one delegates, including Pacific LF programme managers, WHO representatives, global health partners, and academic researchers, reviewed regional PVS progress, discussed the newly released WHO guidelines for the implementation, monitoring, and evaluation of PVS, planned for PVS implementation, and explored novel multiplex bead assay (MBA) serological analysis methods to strengthen regional coordination for its development as a public health tool. Five broad themes emerged. First, the new WHO Monitoring and Epidemiological Assessment of Mass Drug Administration in the Global Programme to Eliminate Lymphatic Filariasis: A Manual for National Elimination Programmes, 2nd edn needs to be operationalised to meet decision-making needs across diverse Pacific settings. Second, integrating LF-PVS with existing surveys and health service activities could improve efficiency and long-term sustainability. Third, regional coordination and alignment of funding cycles will require high-level collaboration. Fourth, community engagement is essential to strengthen demand for PVS. Finally, while at an early stage and with further evidence needed, MBA laboratory methods hold promise for cost-effective, feasible integrated multi-pathogen serosurveillance. Full article

(This article belongs to the Special Issue Innovative Approaches to Combat Infectious Diseases in Low and Middle Income Countries (LMICs): Epidemiology, Diagnosis, and Interventions)

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9 pages, 482 KB

Open AccessBrief Report

The Effect of Increased Temperature on Dengue Virus in the Vector Aedes aegypti from New Caledonia

by Méryl Delrieu, Olivia O’Connor, Nicolas Pocquet, Kenny Teraiharoa, Anne-Fleur Griffon, Christophe Menkes, Morgan Mangeas, Elvina Viennet, Valérie Burtet-Sarramegna, Myrielle Dupont-Rouzeyrol and Francesca D. Frentiu

Trop. Med. Infect. Dis. 2026, 11(2), 53; https://doi.org/10.3390/tropicalmed11020053 - 14 Feb 2026

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Abstract

Dengue virus (DENV) is a major public health concern in tropical and subtropical regions, including the Pacific. Temperature is recognised as a major driver of transmission under climate change. Understanding how higher temperatures may alter DENV transmission is essential to anticipate future dengue [...] Read more.

Dengue virus (DENV) is a major public health concern in tropical and subtropical regions, including the Pacific. Temperature is recognised as a major driver of transmission under climate change. Understanding how higher temperatures may alter DENV transmission is essential to anticipate future dengue risk. Therefore, we assessed the effect of temperature on DENV-1 in Aedes aegypti from New Caledonia. Mosquitoes were orally infected and maintained for 14 days at 26.6 °C (average temperatures during recent outbreaks) or 31.1 °C (SSP5-8.5 scenario projected temperatures). Mosquito bodies, heads, and saliva were analysed separately to determine infection, dissemination, and transmission rates as well as transmission efficiencies. Infectious virus was detected by using a fluorescent focus assay, and viral titres were quantified via TCID₅₀ assays. No significant differences were observed in infection, dissemination, and transmission rates or transmission efficiencies between the two temperatures. However, DENV titres in mosquito bodies and heads were significantly higher at 31.1 °C than 26.6 °C. Our results indicate that elevated temperature increases viral loads within the insect but not the proportion of infectious mosquitoes, highlighting the importance of considering temperature as a key parameter in assessing dengue risk under climate change. Further studies are needed to investigate the effects of temperature on virus–mosquito interactions. Full article

(This article belongs to the Special Issue Surveillance of Eliminated and Near-Eliminated Infectious Disease in the Western Pacific Region)

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13 pages, 1118 KB

Open AccessArticle

Optimizing Quality of Care for Elderly Tuberculosis Patients in Shanghai, China: Insights from Patient Cascade of Care and Patient Pathway Analysis

by Yutong Han, Lixin Rao, Yu Huang, Qi Zhao, Xin Shen and Biao Xu

Trop. Med. Infect. Dis. 2026, 11(2), 52; https://doi.org/10.3390/tropicalmed11020052 - 12 Feb 2026

Viewed by 646

Abstract

With population aging, the burden of tuberculosis (TB) among the elderly is rising. Older adults are at high risk of TB but susceptible to poor TB care. In this study, we enrolled TB patients aged over 60 years registered in Shanghai during 2019–2021. [...] Read more.

With population aging, the burden of tuberculosis (TB) among the elderly is rising. Older adults are at high risk of TB but susceptible to poor TB care. In this study, we enrolled TB patients aged over 60 years registered in Shanghai during 2019–2021. A seven-step care cascade from estimated TB burden in the community to treatment outcomes was constructed to quantify retention and attrition at each step of TB health service. Patient pathway analysis was carried out in two districts of Shanghai to describe patients’ care-seeking behaviors, service coverage, and diagnosis delays. Across the care cascade, the largest gaps occurred from symptom onset to care seeking (11.3%) and from treatment initiation to completion (10.7%). Male sex, older age, and mycobacterium tuberculosis positivity were associated with treatment discontinuation and unfavorable outcomes. The patient pathway analysis revealed that first contact at lower-level or non-TB-designated hospitals was associated with more complex pathways and may contribute to diagnostic delays. These findings highlight the need to promote proactive care seeking upon symptoms, strengthen targeted adherence support for older people, and improve diagnostic capacity and referral efficiency at lower-level health facilities. Full article

(This article belongs to the Special Issue Burden of Tuberculosis in Different Countries, 2nd Edition)

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15 pages, 1281 KB

Open AccessArticle

Immunoendocrine Profiles in Neurocysticercosis Patients: A Case-Control Study in Honduras

by Nicholas Zugno-Gadea, Lázaro Molina, Mariangela Hernandez-González, María Mercedes Rueda, Francis Bejarano, Nelson Alexander Betancourt and Ana Sanchez

Trop. Med. Infect. Dis. 2026, 11(2), 51; https://doi.org/10.3390/tropicalmed11020051 - 12 Feb 2026

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Abstract

Emerging evidence suggests that certain cestodes, including Taenia solium, may actively modulate the host’s hormonal and immune environment to facilitate their survival. This study aimed to determine whether patients diagnosed with neurocysticercosis (NCC) exhibit immunoendocrine alterations associated with infection. A clinical study [...] Read more.

Emerging evidence suggests that certain cestodes, including Taenia solium, may actively modulate the host’s hormonal and immune environment to facilitate their survival. This study aimed to determine whether patients diagnosed with neurocysticercosis (NCC) exhibit immunoendocrine alterations associated with infection. A clinical study was conducted in Honduras, enrolling 11 adult NCC patients (9 female, 2 male) and 11 age- and sex-matched healthy controls. Serum concentrations of seven hormones and two cytokines were evaluated. Compared to controls, NCC patients showed significantly elevated levels of 17β-Estradiol (E2), Progesterone (P4), Androstenedione (A4), Luteinizing Hormone (LH), Follicle-Stimulating Hormone (FSH), Interleukin-6 (IL-6), and Interleukin-10 (IL-10). Conversely, Free testosterone (FT) and Dihydrotestosterone (DHT) levels were significantly reduced. These findings support the hypothesis that T. solium may manipulate host immunoendocrine pathways to promote its establishment and persistence within the central nervous system. Full article

(This article belongs to the Section Neglected and Emerging Tropical Diseases)

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15 pages, 293 KB

Open AccessArticle

Factors Associated with the Prevalence of Dengue–Leptospirosis Coinfection in Patients Hospitalized for Febrile Syndrome

by Dina I. Bance-Anicama, María M. Diaz-Orihuela, Luz M. Diaz-Orihuela and Wilter C. Morales-García

Trop. Med. Infect. Dis. 2026, 11(2), 50; https://doi.org/10.3390/tropicalmed11020050 - 12 Feb 2026

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Abstract

Background: In tropical regions, dengue and leptospirosis coexist and share a nonspecific clinical onset that hinders timely diagnosis. Coinfection may worsen the clinical course and increase mortality. Objective: To estimate the prevalence of dengue, leptospirosis, and coinfection among patients with febrile syndrome in [...] Read more.

Background: In tropical regions, dengue and leptospirosis coexist and share a nonspecific clinical onset that hinders timely diagnosis. Coinfection may worsen the clinical course and increase mortality. Objective: To estimate the prevalence of dengue, leptospirosis, and coinfection among patients with febrile syndrome in Madre de Dios (Peru) and to identify associated clinical factors. Methods: Observational, analytical, cross-sectional, retrospective study conducted at a primary-level health facility. Clinical and laboratory records of patients with febrile syndrome seen in 2024 were analyzed. Categorical variables were summarized as frequencies (%) and numeric variables as mean ± SD or median [IQR]. Comparisons used chi-square or Fisher’s exact test, Student’s t test, or the Mann–Whitney U test, as appropriate. Associations were estimated using Poisson regression models with robust variance, adjusted for sex, reporting prevalence ratios (PRs) and 95% CIs. Analyses were performed in R 4.0.2. Results: A total of 226 patients were included. Positivity was 19.0% for dengue (43/226), 66.8% for leptospirosis (151/226), and 5.8% for coinfection (13/226). In the bivariate analysis, dengue was associated with higher temperature (p < 0.001), lower mean arterial pressure (p = 0.007), mucosal bleeding/ecchymosis (p = 0.049), and lower fluid intake (p = 0.021); temperature was also higher in coinfection (p = 0.021). In Poisson models, dengue was associated with tachycardia (PR = 5.69; 95% CI: 1.95–13.07; p < 0.001), temperature (PR = 1.61 per °C; 1.23–2.12; p = 0.001), bilateral polyarthralgia (PR = 2.55; 1.14–5.04; p = 0.012), and mucosal bleeding/ecchymosis (PR = 3.31; 0.94–8.37; p = 0.027). Leptospirosis was associated with male sex (PR = 0.78 vs. female; 0.65–0.94; p = 0.010) and fever (PR = 2.38; 1.17–6.03; p = 0.035). Leptospira–dengue coinfection was related to higher temperature (PR = 1.75 per °C; 1.05–3.01; p = 0.036). Conclusions: Simple clinical signs such as fever/elevated temperature, tachycardia, bilateral polyarthralgia, and mucosal bleeding can help prioritize suspicion of dengue, leptospirosis, or coinfection; guide requests for dual testing (dengue–Leptospira), early hydration in dengue, and timely initiation of antibiotic therapy in leptospirosis. These findings support the development of integrated triage algorithms and strengthening access to molecular diagnostics in high-burden febrile syndrome settings. Full article

(This article belongs to the Section Infectious Diseases)

11 pages, 230 KB

Open AccessArticle

Prognostic Value of Charlson Comorbidity Index in Patients with COVID-19

by Iliyan Todorov, Margarita Gospodinova and Kalina Stoyanova

Trop. Med. Infect. Dis. 2026, 11(2), 49; https://doi.org/10.3390/tropicalmed11020049 - 10 Feb 2026

Cited by 1 | Viewed by 807

Abstract

COVID-19, caused by SARS-CoV-2, is a highly contagious disease with variable clinical presentation. Severe forms are more common in patients with pre-existing chronic conditions. The objective of this study is to evaluate the prognostic value of the Charlson Comorbidity Index (CCI) in relation [...] Read more.

COVID-19, caused by SARS-CoV-2, is a highly contagious disease with variable clinical presentation. Severe forms are more common in patients with pre-existing chronic conditions. The objective of this study is to evaluate the prognostic value of the Charlson Comorbidity Index (CCI) in relation to disease severity and outcome in hospitalized COVID-19 patients with comorbidities. A retrospective analysis was conducted on 558 patients, hospitalized at the Infectious Diseases Clinic of “St. Marina” University Hospital, Varna, Bulgaria, between March 2020 and March 2021. CCI score was calculated to estimate 10-year survival probabilities. Prevalent comorbidities were arterial hypertension (78.55%), type 2 diabetes (16.09%), and ischemic heart disease (5.82%). A higher number of comorbidities was associated with increased rates of bilateral pulmonary consolidation (χ² = 6.63, p = 0.010), oxygen therapy needs (χ² = 5.41, p = 0.020), and mortality (χ² = 7.88, p = 0.005). Patients with higher CCI scores had worse outcomes. A CCI score above 5 was common among non-survivors and those with pulmonary consolidation and respiratory failure. The findings confirm that advanced age and multiple comorbidities are strong predictors of poor COVID-19 prognosis. Early CCI calculation at hospital admission would help identify high-risk patients and support timely, targeted medical interventions. Full article

(This article belongs to the Special Issue Post-Pandemic Challenges: Endemic COVID-19, Vaccine Hesitancy, and Viral Resurgence)

14 pages, 1545 KB

Open AccessArticle

Hospitalization Free-Survival, Adverse Drug Reactions, and Retention in Care Outcomes of an Outpatient Treatment Model for Cryptococcal Meningitis in PLWH in Maputo, Mozambique

by Maria Ruano Camps, Aleny Couto, Irénio Gaspar, Eudoxia Filipe, Idilia Nhamtumbo, Luis Armando, Gil Muvale, Ana Gabriela Gutierrez Zamudio, Rosa Bene, Jeff Lane, Florindo Mudender and Edy Nacarapa

Trop. Med. Infect. Dis. 2026, 11(2), 48; https://doi.org/10.3390/tropicalmed11020048 - 10 Feb 2026

Viewed by 556

Abstract

Background: Cryptococcal meningitis (CM) remains a leading cause of mortality among people with advanced HIV disease (AHD) in sub-Saharan Africa. Current guidelines recommend induction therapy with amphotericin B and flucytosine, typically administered in an inpatient setting due to concerns over severe clinical presentation [...] Read more.

Background: Cryptococcal meningitis (CM) remains a leading cause of mortality among people with advanced HIV disease (AHD) in sub-Saharan Africa. Current guidelines recommend induction therapy with amphotericin B and flucytosine, typically administered in an inpatient setting due to concerns over severe clinical presentation and drug-related toxicities. This requirement poses a significant burden on resource-limited health systems. We evaluated the real-world outcomes of a fully outpatient model for CM therapy in Maputo, Mozambique. Methods: A longitudinal retrospective cohort study was conducted at the Centro de Referência de Alto-Maé (CRAM), a specialized AHD outpatient clinic. We included 83 PLWH with laboratory-confirmed CM treated between October 2020 and December 2024. The primary outcome was hospitalization-free survival (HFS) within the first 10 weeks of treatment. Secondary outcomes included the frequency and severity of adverse drug reactions (ADRs), analysed by tracking haemoglobin (Hgb), potassium (K+), and creatinine (Creat) levels on days 1, 3, and 7 of induction therapy, and retention in care (RIC) at 6, 12, and 24 months. Statistical analyses included Kaplan–Meier survival estimates and paired t-tests. Results: The median age was 37 years (IQR: 27–42), 63.9% were male, and the median CD4 count was 62 cells/µL (IQR: 27–105). Most patients (95.2%) were symptomatic at presentation, and 56.6% had concurrent tuberculosis. For the 52 patients who completed the full induction protocol at CRAM, the HFS rate at 10 weeks was 84.6% (44/52), with an overall survival of 90.4% (47/52). ADR analysis (n = 52) showed a predictable pattern of mild, manageable toxicity: a significant decline in Hgb (11.2 ± 1.8 to 10.6 ± 2.0 g/dL, p < 0.001) and K+ (4.27 ± 0.66 to 3.86 ± 0.78 mmol/L, p = 0.008), and a transient increase in Creat (0.83 ± 0.42 to 1.13 ± 0.64 mg/dL, p = 0.001) from day 1 to day 3, with stabilization or a trend toward recovery by day 7. No significant differences in ADRs were found between single-dose (47%) and multiple-dose (53%) L-AmB regimens. RIC for the entire cohort (n = 83) was high at 81.9% at 6 months, declining to 74.0% at 12 months and 70.4% at 24 months. Conclusions: An ambulatory model for CM therapy is feasible and effective in a resource-limited setting, demonstrating high hospitalization-free survival, manageable and reversible adverse drug reactions, and excellent medium-term retention in care. These findings suggest potential benefits and provide support for re-evaluating the standard of inpatient care. They indicate that integrating outpatient CM management into advanced HIV disease (AHD) care packages could help alleviate health system burdens and may contribute to improved patient outcomes. Full article

(This article belongs to the Special Issue Innovative Approaches to Combat Infectious Diseases in Low and Middle Income Countries (LMICs): Epidemiology, Diagnosis, and Interventions)

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17 pages, 788 KB

Open AccessArticle

A Randomised, Parallel-Group Study to Compare the Efficacy of 3% Phenothrin-Containing Jigger Lotion Versus Potassium Permanganate for Treatment of Tungiasis in Vihiga County, Kenya

by Kana Suzuki, Asiko Ongaya, Evans Amukoye and Yasuhiko Kamiya

Trop. Med. Infect. Dis. 2026, 11(2), 47; https://doi.org/10.3390/tropicalmed11020047 - 9 Feb 2026

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Abstract

Tungiasis, caused by the sand flea Tunga penetrans, results in itching and pain. Effective treatments, such as dimeticones, are often unaffordable. A 3% phenothrin lotion has shown safety and efficacy in Kenyan trials. This study compared the cure rate and safety of [...] Read more.

Tungiasis, caused by the sand flea Tunga penetrans, results in itching and pain. Effective treatments, such as dimeticones, are often unaffordable. A 3% phenothrin lotion has shown safety and efficacy in Kenyan trials. This study compared the cure rate and safety of 3% phenothrin lotion (as the intervention) and 0.05% potassium permanganate (KMnO₄; as the standard-care comparator) over 14 days. This parallel-group, three-arm, non-blinded, randomised comparative trial was conducted in Vihiga County, Kenya. Participants aged ≥2 years with ≥1 viable flea on each foot were allocated (2:1:1) to KMnO₄, single-dose 3% phenothrin, or two-dose 3% phenothrin groups. Overall, 415 fleas from 79 participants were followed up to day 14 (KMnO₄, 213; single-dose, 129; two-dose, 73). On days 4 and 7, the single-dose phenothrin showed significantly higher cure rates (11.6% and 21.7%) than KMnO₄ (0.9% and 11.7%) (p < 0.001 and p = 0.013). The differences diminished by days 10 and 14 because of spontaneous flea death. The cure rate of the two-dose group on day-7 (8.2%) was lower than that of the single-dose group. Single-dose 3% phenothrin improved early cure rates compared to KMnO₄, but not by days 10–14; two-dose phenothrin showed no benefit compared with single dose from day 7 onwards. Full article

(This article belongs to the Special Issue Global Perspectives on Neglected Tropical Diseases: Burden, Science, and Policy Interventions)

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8 pages, 217 KB

Open AccessArticle

There Is No Association Between Loiasis and Malaria: Findings from a Secondary Analysis of a Cross-Sectional Survey in Rural Gabon

by Jacob Werner, Rella Zoleko-Manego, Ghyslain Mombo-Ngoma, Michael Ramharter and Johannes Mischlinger

Trop. Med. Infect. Dis. 2026, 11(2), 46; https://doi.org/10.3390/tropicalmed11020046 - 7 Feb 2026

Viewed by 453

Abstract

Loiasis exists in regions where malaria is highly endemic, yet few studies have investigated their association as concomitant infectious diseases. Secondary data analysis from a cross-sectional survey conducted in Gabon (2015–2016) was performed to assess the association between malaria and loiasis. A total [...] Read more.

Loiasis exists in regions where malaria is highly endemic, yet few studies have investigated their association as concomitant infectious diseases. Secondary data analysis from a cross-sectional survey conducted in Gabon (2015–2016) was performed to assess the association between malaria and loiasis. A total of 947 participants of all ages were enrolled in the original study. In crude analyses, malaria showed a seemingly protective association with loiasis, manifesting in an odds ratio (OR) of 0.67 (95% CI: 0.45 to 1.01; p = 0.0521). This borderline association disappeared completely after adjustment for confounders (adjusted OR: 1.31; 95% CI: 0.81 to 2.11; p = 0.276), particularly age. The apparent crude protective association is therefore likely explained by the different epidemiological distribution of both diseases according to age rather than a true biological interaction. Malaria predominantly occurred in children and loiasis mainly in older individuals. Findings of this study do not support an association between malaria and loiasis in this setting. Full article

(This article belongs to the Special Issue Innovative Approaches to Combat Infectious Diseases in Low and Middle Income Countries (LMICs): Epidemiology, Diagnosis, and Interventions)

14 pages, 7437 KB

Open AccessArticle

Spatial Dynamics and Sterilization Range of Incompatible Aedes albopictus Males: Advancing Toward an Optimized IIT Approach

by Elena Lampazzi, Chiara Virgillito, Beniamino Caputo, Giulia Lombardi, Greta Santarelli, Riccardo Moretti and Maurizio Calvitti

Trop. Med. Infect. Dis. 2026, 11(2), 45; https://doi.org/10.3390/tropicalmed11020045 - 6 Feb 2026

Cited by 1 | Viewed by 714

Abstract

The Incompatible Insect Technique (IIT) is a species-specific, eco-friendly mosquito control method that relies on releasing Wolbachia-infected males, which induce cytoplasmic incompatibility (CI), rendering eggs inviable when mating with wild females. Aiming at optimizing IIT protocols in terms of cost-effectiveness, data on [...] Read more.

The Incompatible Insect Technique (IIT) is a species-specific, eco-friendly mosquito control method that relies on releasing Wolbachia-infected males, which induce cytoplasmic incompatibility (CI), rendering eggs inviable when mating with wild females. Aiming at optimizing IIT protocols in terms of cost-effectiveness, data on incompatible male dispersal and survival and the distance- and time-related impact of induced sterility are fundamental. This study plans to fill this gap and reports findings from a two-year field trial (2022–2023) at the ENEA-Casaccia Research Center, based on single-spot releases of incompatible Aedes albopictus males (ARwP strain). Male releases were carried out in late September 2022 (~15,000 released males) and the early Ae. albopictus season (at the end of June 2023; ~24,000 released males). Fifty-eight ovitraps were located at a 20–900 m distance from the ARwP release spot and were monitored weekly from May to November to assess egg hatching rates and measure CI effects in relation to both distance and time. Following the 2023 release, samples of adults were collected at increasing distances from the release site and at multiple post-release time points to assess, individually, wild female fertility and ARwP male dispersal and survival using Wolbachia as a genetic marker. Statistical analyses revealed that: (a) the highest reduction in the egg hatching was found within 100 m from the release spot (46.5% and 19.9%, respectively, in 2022 and 2023) but remained significant even at greater distances (29.9% and 7.7% at 300 m, respectively, in 2022 and 2023); (b) accordingly, the highest reduction in the wild female fertility occurred within 100 m from the release spot (47.3%), but similar effects were recognizable up to 600 m; (c) the overflooding ratio of the ARwP males did not significantly differ between 3 and 11 days after the release, with ARwP males remaining active up to 18 days and dispersing as far as 400 m. These results demonstrate the potential of localized, non-inundative IIT trials to furnish clues for the setup of spatially optimized release strategies, especially in scaled-up applications. The study also emphasizes the need for standardized assessment tools and further research regarding environmental and behavioral factors influencing long-term suppression outcomes. Full article

(This article belongs to the Section Vector-Borne Diseases)

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18 pages, 5321 KB

Open AccessArticle

Comparative Analysis of Next- and Third-Generation Sequencing Platforms for Chikungunya Virus Whole-Genome Sequencing Using a Lineage-Inclusive Primer Set During the 2025 Foshan Outbreak

by Penghui Jia, Xiao Cong, Chang Zhang, Zhe Liu, Xiaofang Peng, Juan Su, Qiqi Tan, Shen Huang, Changyun Sun, Xin Zhang and Baisheng Li

Trop. Med. Infect. Dis. 2026, 11(2), 44; https://doi.org/10.3390/tropicalmed11020044 - 5 Feb 2026

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Abstract

Chikungunya virus (CHIKV) poses an increasing global public health threat, as evidenced by the significant 2025 Foshan outbreak in China. Rapid, whole-genome sequencing (WGS) is critical for outbreak response but is challenged by primer mismatches across diverse lineages and a lack of direct [...] Read more.

Chikungunya virus (CHIKV) poses an increasing global public health threat, as evidenced by the significant 2025 Foshan outbreak in China. Rapid, whole-genome sequencing (WGS) is critical for outbreak response but is challenged by primer mismatches across diverse lineages and a lack of direct sequencing platform comparisons. To address this, we developed a novel lineage-inclusive primer set and performed parallel WGS on 24 clinical samples from the outbreak using both Illumina (NGS) and Oxford Nanopore Technologies (TGS) platforms. Our lineage-inclusive primer set successfully amplified full-length CHIKV genomes across all samples. Comparisons revealed that Illumina NGS provided higher raw read accuracy, while Nanopore TGS achieved more complete coverage of terminal UTRs with a faster turnaround time. Crucially, after polishing, variant calls between the two platforms were 100% concordant. Phylogenetic analysis was consistent with a single introduction event, with all outbreak isolates forming a monophyletic clade within the ECSA lineage most closely related to contemporaneous strains from Réunion Island. This study validates a lineage-inclusive amplicon-based sequencing strategy and demonstrates that NGS and TGS offer complementary advantages. When integrated, they provide a robust framework for real-time genomic surveillance, enhancing preparedness and guiding public health interventions against CHIKV. Full article

(This article belongs to the Section Infectious Diseases)

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16 pages, 2763 KB

Open AccessArticle

Global, Regional, and National Burden of Tuberculosis Among Children: A Population-Based Study

by Leiwen Fu, Ke Liu, Yuxian Sun, Wei Shu, Yujia Ning, Yang Liu, Jian Du and Liang Li

Trop. Med. Infect. Dis. 2026, 11(2), 43; https://doi.org/10.3390/tropicalmed11020043 - 5 Feb 2026

Viewed by 1438

Abstract

Background: Tuberculosis remains a major global public health challenge, particularly among children. This study aims to provide a comprehensive assessment of the global, regional, and national burden of tuberculosis among children (0–14 years) using data from the Global Burden of Disease (GBD) 2021 [...] Read more.

Background: Tuberculosis remains a major global public health challenge, particularly among children. This study aims to provide a comprehensive assessment of the global, regional, and national burden of tuberculosis among children (0–14 years) using data from the Global Burden of Disease (GBD) 2021 study. Methods: Data on the incidence of tuberculosis (drug-susceptible, MDR-TB, and XDR-TB), as well as disability-adjusted life years (DALYs), among children aged 0–14 years in 204 countries and territories from 1990 to 2021 were obtained from the GBD 2021 study. Estimated annual percentage changes (EAPCs) in age-standardised incidence rates (ASIRs) and DALY rate were calculated overall and stratified by age, sex, and sociodemographic index (SDI) to quantify temporal trends. Spearman correlation analyses were performed to assess associations between tuberculosis burden and SDI. Results: In 2021, there were an estimated 759,300 new tuberculosis cases (ASIR: 37.7 per 100,000 population) among children globally, including 32,515 cases of MDR-TB (ASIR: 1.6) and 1193 cases of XDR-TB (ASIR: 0.1). Both global ASIR and DALY rate exhibited a declining trend from 1990 to 2021, with EAPC of −2.61% (95%CI: −2.74 to −2.47) and −4.38% (−4.61 to −4.14), respectively. From 1990 to 2021, High-income North America was the only GBD region with an increasing ASIR for tuberculosis (EAPC = 1.12, 95% CI: 0.61 to 1.64). From 1990 to 2021, there was no significant change in ASIR of MDR-TB (EAPC = 1.18, 95% CI: −0.16 to 2.54). However, eight of the 21 GBD regions exhibited increasing trends in the ASIR of MDR-TB, with the largest increase observed in Oceania (11.99, 10.49 to 13.52), followed by Central Asia (9.76, 6.48 to 13.13) and South Asia (5.71, 3.10 to 8.38). A strong negative correlation was observed between tuberculosis burden and SDI, with the highest disease burden concentrated in low-SDI regions. Conclusions: Achieving elimination targets will require stronger diagnostics and treatment for childhood tuberculosis, alongside reduced transmission, improved infection detection, and preventive therapy for exposed children, especially those under 5 years. Full article

(This article belongs to the Special Issue Tuberculosis in Special Populations: Epidemiology and Evidence-Based Interventions)

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11 pages, 5584 KB

Open AccessArticle

Physicochemical Properties of Anopheles Mosquito Larval Habitats in Nouakchott, Mauritania

by Mohamed Haidy Massa, Osman Abdillahi Guedi, Nicolas Gomez, Ali Ould Mohamed Salem Boukhary, Sébastien Briolant and Mohamed Aly Ould Lemrabott

Trop. Med. Infect. Dis. 2026, 11(2), 42; https://doi.org/10.3390/tropicalmed11020042 - 3 Feb 2026

Viewed by 710

Abstract

Malaria remains one of the main public health problems in Mauritania, and it is essential to identify the factors that determine the distribution and productivity of Anopheles breeding sites in order to develop more effective control strategies. A longitudinal survey with repeated measurements [...] Read more.

Malaria remains one of the main public health problems in Mauritania, and it is essential to identify the factors that determine the distribution and productivity of Anopheles breeding sites in order to develop more effective control strategies. A longitudinal survey with repeated measurements was conducted in Nouakchott between May 2023 and April 2024, in order to examine the factors influencing the distribution and productivity of Anopheles larval habitats. The larvae were collected by immersion in 60 water points, once a month during the dry season and twice a month during the rainy season, for a total of 294 observations. The physical and chemical characteristics of the sites were also measured. Logistic regression analyses with random effects showed that the presence of Culex and Aedes larvae, pH, and temperature were statistically significantly associated with positive water collection for Anopheles larvae (aOR = 3.03, 95%CI [1.14–8.07], p-value = 0.026; aOR = 0.18, 95%CI [0.05–0.60], p-value = 0.006; aOR = 3.17, 95%CI [1.32–7.61], p-value = 0.010 and aOR = 5.95, 95%CI [2.09–16.92], p-value < 0.001, respectively). Only Anopheles multicolor and An. arabiensis were present in Nouakchott. Our results could help health authorities by guiding the destruction of breeding sites with biological larvicides or physical elimination of peridomestic habitats. Full article

(This article belongs to the Section Vector-Borne Diseases)

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16 pages, 1782 KB

Open AccessArticle

In Vitro Antiviral Activity of Red Algae Extracts from Chondracanthus teedei var. lusitanicus and Osmundea pinnatifida Against Coxsackievirus A12 and a Lentiviral Vector

by Nanci Santos-Ferreira, Clévio Nóbrega, Marta Mota, Luís Pereira de Almeida, Leonel Pereira, Teresa Gonçalves and Célia Nogueira

Trop. Med. Infect. Dis. 2026, 11(2), 41; https://doi.org/10.3390/tropicalmed11020041 - 31 Jan 2026

Viewed by 1038

Abstract

Infectious diseases remain a major global health challenge, underscoring the need for safe and accessible antiviral therapies. Natural products, particularly marine macroalgae, are promising sources of bioactive compounds with antiviral properties. This study evaluated the antiviral activity of extracts from two red algae [...] Read more.

Infectious diseases remain a major global health challenge, underscoring the need for safe and accessible antiviral therapies. Natural products, particularly marine macroalgae, are promising sources of bioactive compounds with antiviral properties. This study evaluated the antiviral activity of extracts from two red algae collected along the Portuguese coast: two life stages (tetrasporophyte and female gametophyte) of Chondracanthus teedei var. lusitanicus and the algae Osmundea pinnatifida. Antiviral effects were assessed against Coxsackievirus A12 (CVA12) and a lentivirus (LV) vector model. Extracts from both algae inhibited viral replication in vitro at non-cytotoxic concentrations. The tetrasporophyte extract of C. teedei exhibited virucidal activity against CVA12, and the results are consistent with interference with multiple stages of the viral life cycle, while also inducing an antiviral state in HEK-293T cells against LV infection. The female gametophyte extract affected early stages of CVA12 and LV infection and showed potential virucidal activity. O. pinnatifida demonstrated the strongest antiviral effects against both viruses. These findings highlight the antiviral potential of these red algal extracts and warrant further in vivo evaluation. Full article

(This article belongs to the Section Infectious Diseases)

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14 pages, 1011 KB

Open AccessArticle

AI-Assisted Differentiation of Dengue and Chikungunya Using Big, Imbalanced Epidemiological Data

by Thanh Huy Nguyen and Nguyen Quoc Khanh Le

Trop. Med. Infect. Dis. 2026, 11(2), 40; https://doi.org/10.3390/tropicalmed11020040 - 30 Jan 2026

Viewed by 1019

Abstract

Dengue and chikungunya are endemic arboviral diseases in many low- and middle-income countries, often co-circulating and presenting with overlapping symptoms that hinder early diagnosis. Timely differentiation is critical, especially in resource-limited settings where laboratory testing is unavailable. We developed and evaluated machine-learning (ML)- [...] Read more.

Dengue and chikungunya are endemic arboviral diseases in many low- and middle-income countries, often co-circulating and presenting with overlapping symptoms that hinder early diagnosis. Timely differentiation is critical, especially in resource-limited settings where laboratory testing is unavailable. We developed and evaluated machine-learning (ML)- and deep-learning (DL) models to classify dengue, chikungunya, and discarded cases using a large-scale, real-world dataset of over 6.7 million entries from Brazil (2013–2020). After applying the Synthetic Minority Oversampling Technique (SMOTE) to address class imbalance, we trained six ML models and one artificial neural network (ANN) using only demographic, clinical, and comorbidity features. The Random Forest model achieved strong multi-class classification performance (Recall: 0.9288, the Area Under the Curve (AUC): 0.9865). The ANN model excelled in identifying chikungunya cases (Recall: 0.9986, AUC: 0.9283), suggesting its suitability for rapid screening. External validation confirmed the generalizability of our models, particularly for distinguishing discarded cases. Our models demonstrate high-accuracy in differentiating dengue and chikungunya using routinely collected clinical and epidemiological data. This work supports the development of Artificial Intelligence-powered decision-support tools to assist frontline healthcare workers in under-resourced settings and aligns with the One Health approach to improving surveillance and diagnosis of neglected tropical diseases. Full article

(This article belongs to the Special Issue Surveillance, Modelling, and Risk Mapping of Tropical Infectious Diseases)

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14 pages, 3636 KB

Open AccessArticle

Seasonal Dynamics Versus Vertical Stratification of Mosquitoes (Diptera: Culicidae) in an Atlantic Forest Remnant, Brazil: A Focus on the Mansoniini Tribe

by Cecília Ferreira de Mello, Wellington Thadeu de Alcantara Azevedo, Shayenne Olsson Freitas Silva, Samara Campos Alves and Jeronimo Alencar

Trop. Med. Infect. Dis. 2026, 11(2), 39; https://doi.org/10.3390/tropicalmed11020039 - 30 Jan 2026

Viewed by 587

Abstract

Mosquitoes (Diptera: Culicidae) exhibit vertical stratification patterns in forest environments, a fundamental ecological aspect for understanding niche occupation patterns, host-seeking behavior, and consequently arbovirus transmission mechanisms. Despite the relevance of this topic, available studies mostly focus on genera such as Aedes, Haemagogus [...] Read more.

Mosquitoes (Diptera: Culicidae) exhibit vertical stratification patterns in forest environments, a fundamental ecological aspect for understanding niche occupation patterns, host-seeking behavior, and consequently arbovirus transmission mechanisms. Despite the relevance of this topic, available studies mostly focus on genera such as Aedes, Haemagogus, and Sabethes which are traditionally associated with arbovirus transmission. There are still important gaps regarding stratification and seasonality in the Mansoniini tribe, whose biology and epidemiological role remain underexplored, especially in highly biodiverse ecosystems such as the Atlantic Forest. This study evaluated the influence of seasonality and vertical stratification on the mosquito community, with a detailed focus on the Mansoniini tribe, in an Atlantic Forest fragment in Brazil, between May 2023 and December 2024. Captures were performed monthly using CDC light traps positioned at 1.5 m and 10 m heights, and specimens were morphologically identified. A total of 880 mosquitoes from nine genera and 24 species were captured, of which 91 (10.3%) belonged to the Mansoniini tribe. The most abundant species were Coquillettidia fasciolata and Mansonia titillans, recorded in both strata. Our results indicate no marked vertical segregation for the studied mosquito community in this specific location, but a strong influence of seasonality, particularly for the Mansoniini tribe, reinforcing the role of meteorological data on the population structure of these species. These site-specific findings offer a foundational ecological portrait and a robust methodological template for a neglected taxon. They generate critical, testable hypotheses about niche partitioning in fragmented forests and underscore the necessity for broader spatial replication to disentangle the relative influence of seasonal versus vertical drivers in similar ecosystems. Full article

(This article belongs to the Special Issue Emerging Vector-Borne Diseases and Public Health Challenges)

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14 pages, 509 KB

Open AccessArticle

Low Bone Mineral Density in Men Living with HIV on Tenofovir Antiretroviral Therapy: A Cross-Sectional Exploratory Study from a Malaysian Tertiary Hospital

by Muhamad Riduan Daud, Petrick Periyasamy, Kok-Yong Chin, Najma Kori, Ummu Afeera Zainulabid, Sheng Qian Yew, Nur Ezzaty Mohammad Kazmin and Xiong Khee Cheong

Trop. Med. Infect. Dis. 2026, 11(2), 38; https://doi.org/10.3390/tropicalmed11020038 - 29 Jan 2026

Viewed by 885

Abstract

Background and objectives: Low bone mineral density (BMD) is a recognized complication in people living with HIV (PLHIV) that remains under-addressed, particularly in Malaysia. Known contributing factors for low BMD include advanced age, HIV infection itself, and prolonged use of anti-retroviral therapy (ART), [...] Read more.

Background and objectives: Low bone mineral density (BMD) is a recognized complication in people living with HIV (PLHIV) that remains under-addressed, particularly in Malaysia. Known contributing factors for low BMD include advanced age, HIV infection itself, and prolonged use of anti-retroviral therapy (ART), particularly tenofovir-based regimens. There are limited data on the burden of low BMD in the HIV population in Malaysia. This study aimed to determine the prevalence of low BMD among men living with HIV on tenofovir disoproxil fumarate (TDF) and to identify the possible associated factors compared to a group of healthy individuals matched for age and ethnicity. Methods: This is single-center cross-sectional study involved 112 men (56 HIV-positive individuals and 56 uninfected individuals matched for age and ethnicity) who underwent dual-energy X-ray absorptiometry (DXA) scans of the femoral neck and lumbar spine. Sociodemographic, clinical lifestyle, and laboratory data, including FRAX scores for those aged more than 40 years old, were collected. Results: The prevalence of low BMD at the femoral neck in HIV-infected men on tenofovir disoproxil fumarate was significantly higher compared to healthy individuals (32.1% vs. 16.1%; p < 0.05). Low BMD prevalence at the lumbar spine was higher in the HIV group (8.9% vs. 3.6%; p = 0.463) but was not statistically significant. Older age and low body mass index (BMI) were found to be significantly associated with reduced BMD in HIV patients. Chronic kidney disease stage 2 and 3a was linked with low femoral neck BMD. HIV-related factors (duration of illness, duration of ART exposure, and CD4+ counts) showed no significant associations to low BMD. The 10-year risk of major osteoporotic and hip fractures estimated by the FRAX tool was low in both groups, and no participant exceeded the recommended intervention threshold. Conclusions: Men with HIV on tenofovir disoproxil fumarate have a higher prevalence of low BMD, particularly at the femoral neck. Traditional risk factors were more closely associated with low BMD compared to HIV-related factors and specific markers, supporting the need for routine bone health screening and preventive strategies in this population. Full article

(This article belongs to the Special Issue HIV Testing and Antiretroviral Therapy)

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12 pages, 732 KB

Open AccessPerspective

Reframing TB Care: A Perspective on Multimorbidity-Centered Care for People with TB

by Alexa Tabackman, Sadie Cowan, Claire Calderwood and Pranay Sinha

Trop. Med. Infect. Dis. 2026, 11(2), 37; https://doi.org/10.3390/tropicalmed11020037 - 29 Jan 2026

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Abstract

Tuberculosis (TB) rarely occurs in isolation; most people with TB experience multiple coexisting conditions, including HIV, diabetes, undernutrition, depression, and substance use disorders, which worsen disease severity and compromise treatment outcomes. Although the World Health Organization has issued disease-specific guidance for managing key [...] Read more.

Tuberculosis (TB) rarely occurs in isolation; most people with TB experience multiple coexisting conditions, including HIV, diabetes, undernutrition, depression, and substance use disorders, which worsen disease severity and compromise treatment outcomes. Although the World Health Organization has issued disease-specific guidance for managing key comorbidities, TB care remains largely siloed and poorly equipped to address the growing burden of multimorbidity, particularly in African health systems. In this perspective article, we propose a phased framework for multimorbidity-centered TB care. The first phase emphasizes systematic screening for common comorbidities and establishment of basic referral pathways. The second phase focuses on strengthening coordination between TB programs and existing health and social services, including task sharing and longitudinal follow-up. The third phase advances toward fully integrated, co-located, multidisciplinary models of care that embed TB services within broader multimorbidity platforms. Together, this framework offers a pragmatic roadmap for TB programs to deliver more person-centered, equitable, and efficient care, strengthen primary care systems, and accelerate progress toward ending TB as a public health threat in Africa. Full article

(This article belongs to the Special Issue Tuberculosis Control in Africa and Asia)

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13 pages, 1058 KB

Open AccessArticle

AI-Driven Tuberculosis Hotspot Mapping to Optimize Active Case-Finding: Implementing the Epi-Control Platform in Uganda

by Geofrey Amanya, Sumbul Hashmi, Jessica Sarah Stow, Philip Tumwesigye, Bernadette Nkhata, Kelvin Roland Mubiru, Anne-Laure Budts, Matthys Gerhardus Potgieter, Seyoum Dejene Balcha, Muzamiru Bamuloba, Andiswa Zitho, Luzze Henry, Mary G. Nabukenya-Mudiope and Caroline Van Cauwelaert

Trop. Med. Infect. Dis. 2026, 11(2), 36; https://doi.org/10.3390/tropicalmed11020036 - 28 Jan 2026

Viewed by 990

Abstract

Tuberculosis remains a major public health concern in Uganda, one among the thirty high TB burden countries globally. Despite national progress, gaps persist due to asymptomatic disease, diagnostic limitations, and uneven access to healthcare within the country. This study implemented the Epi-control platform, [...] Read more.

Tuberculosis remains a major public health concern in Uganda, one among the thirty high TB burden countries globally. Despite national progress, gaps persist due to asymptomatic disease, diagnostic limitations, and uneven access to healthcare within the country. This study implemented the Epi-control platform, an AI-driven predictive modelling tool, to predict community-level hotspots and support data-driven active case-finding (ACF). Using retrospective chest X-ray screening data, we integrated demographic, environmental, and human development indicators from open-source databases to model TB risk at sub-parish level. A proprietary Bayesian modelling framework was deployed and validated by comparing TB yields between predicted hotspots and non-hotspot locations. Across Uganda, the model identified significantly higher TB yields in hotspot areas (risk ratio = 1.69, 95% CI 1.41–2.02; p < 0.001). The Central and Western regions showed the highest concentrations of hotspots, consistent with their population density and urbanization patterns. The results show that the model prioritized areas with higher observed ACF yield in this retrospective dataset, supporting its potential operational use for screening prioritization under similar implementation conditions. The results demonstrate that AI-based predictive modelling can enhance the efficiency of ACF by targeting high-risk areas for screening. Integrating such predictive tools within national TB programmes may support screening planning and resource prioritization; prospective evaluation and external validation are needed to assess generalisability and incremental impact. Full article

(This article belongs to the Special Issue Integrating Data-Driven Insights into Mathematical Modeling of Infectious Diseases)

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12 pages, 598 KB

Open AccessArticle

Laboratory-Based Surveillance and Genetic Diversity of Enteric Adenovirus Among Children in Argentina, 2022–2024

by Juan Ignacio Degiuseppe, Paula Mabel Moron, Christian Barrios Mathieur and Argentinean Surveillance Network for Viral Gastroenteritis

Trop. Med. Infect. Dis. 2026, 11(2), 35; https://doi.org/10.3390/tropicalmed11020035 - 25 Jan 2026

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Abstract

Enteric adenoviruses are recognized causes of pediatric acute gastroenteritis, yet national-level data on their epidemiology and genetic diversity in Argentina remain limited. This study aimed to describe the laboratory-based surveillance of enteric adenoviruses and to characterize the circulating genotypes among children during the [...] Read more.

Enteric adenoviruses are recognized causes of pediatric acute gastroenteritis, yet national-level data on their epidemiology and genetic diversity in Argentina remain limited. This study aimed to describe the laboratory-based surveillance of enteric adenoviruses and to characterize the circulating genotypes among children during the 2022–2024 period. Data were obtained from the Argentine National Health Surveillance System, including weekly aggregated reports of adenovirus testing results from clinical laboratories nationwide. Detection frequencies were analyzed by year, age group, clinical setting, geographic region, and epidemiological week. Molecular characterization was performed using partial hexon gene sequencing. A total of 22,826 stool samples were tested, of which 1530 (6.7%) were positive for adenovirus, with no significant differences in positivity across years. Detection rates were highest among children under 1 year of age and were consistently greater in outpatient and emergency department settings compared with hospitalized patients. No clear seasonal pattern was observed. Genotyping revealed a predominance of HAdV-F41, with sporadic detection of non-enteric adenovirus types. These findings provide the first nationwide overview of enteric adenovirus circulation and genetic diversity in Argentina, highlighting stable transmission patterns and supporting the value of sustained laboratory surveillance to better characterize viral gastroenteritis etiology in the post-rotavirus vaccination era. Full article

(This article belongs to the Special Issue Viral Enteropathogens in Pediatric Populations)

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Open AccessArticle

Development of a TaqMan qPCR Method for Detecting Angiostrongylus cantonensis (Rhabditida: Angiostrongylidae) Infection in Snails from Hainan Province, China

by Kun Wang, Tian Tian, Yunhai Guo, Muxin Chen, Xiaonen Wu, Zhiying Hou, Binbin Xie, Fanna Wei, Zhiheng Qi, Zhisheng Dang, Dingwei Sun, Yang Hong, Jun-Hu Chen and Yue Wang

Trop. Med. Infect. Dis. 2026, 11(2), 34; https://doi.org/10.3390/tropicalmed11020034 - 23 Jan 2026

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Abstract

Angiostrongylus cantonensis (A. cantonensis) is the primary causative agent of human angiostrongyliasis and is widely distributed in Southeast Asia and China, with increasing reports from the Americas. Achatina fulica (A. fulica), Pomacea canaliculata (P. canaliculata), and slugs [...] Read more.

Angiostrongylus cantonensis (A. cantonensis) is the primary causative agent of human angiostrongyliasis and is widely distributed in Southeast Asia and China, with increasing reports from the Americas. Achatina fulica (A. fulica), Pomacea canaliculata (P. canaliculata), and slugs constitute established intermediate hosts of A. cantonensis, whereas Camaena hainanensis (C. hainanensis) has been newly reported as a host species in Hainan. A TaqMan quantitative PCR (qPCR) method assay targeting a novel genomic region of A. cantonensis was developed to detect infection in 150 snails collected from Hainan Province, China. The assay was employed to detect the parasite larvae across various snail tissues (lung sac, mucus, and foot), and its performance was compared with conventional lung sac microscopy. Out of the 120 A. fulica examined, 75 tested positive using the qPCR assay, yielding a significantly higher detection rate than lung-sac examination (p < 0.05). Significant differences were also observed in the positivity rates across the three snail tissues (lung sac, mucus, and foot) (p < 0.05), with the lung sac showing the highest rate of infection. Importantly, the detection of A. cantonensis DNA in snail mucus highlights its potential for development as a non-invasive diagnostic sample. Additionally, C. hainanensis was identified as a new host of A. cantonensis in Hainan, suggesting its possible contribution to parasite transmission. The newly developed qPCR assay demonstrated superior sensitivity (reflected by lower Ct values) compared with previously published TaqMan qPCR methods. The established qPCR method provides a sensitive and non-invasive tool for detecting A. cantonensis in snails, and can be applied for monitoring and early warning of parasite prevalence and transmission. Full article

(This article belongs to the Special Issue Emerging Vector-Borne Diseases and Public Health Challenges)

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Trop. Med. Infect. Dis., Volume 11, Issue 2 (February 2026) – 29 articles

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