Tropical Medicine and Infectious Disease

Mexico has not only successfully eliminated dog-mediated human rabies in recent years, but also the last rabies case in a dog infected with the canine variant of the rabies virus was reported in 2016. Mass dog vaccination campaigns were the cornerstone of these achievements. Unfortunately, the rabies virus still circulates in wildlife and, thus, spill-over infections in humans, livestock, and pets, including dogs, still occurs. Especially dogs that cohabit at interfaces shared with wildlife, like shepherd dogs, are at risk. These dogs are often free-roaming and difficult to restrain for vaccination purposes. Oral rabies vaccination (ORV) as an alternative vaccination strategy was tested in several rural villages in Querétaro State, Mexico. Bait acceptance and immunogenicity studies were conducted to test a licensed vaccine bait in terms of attractiveness and if the oral rabies vaccine strain, SPBN GASGAS, was able to induce an adequate immune response in local dogs, respectively. Although the egg(-flavored) bait was less well accepted (68.4%) by the dogs than the two other bait types included in the study, a bait made from boiled intestine segments (71.2%) and a bait with fish meal as an attractant (72.3%), dogs offered the egg bait were more often considered successfully vaccinated. 83.3% of the dogs offered an egg bait seroconverted during the immunogenicity study. Hence, ORV can be a suitable alternative by increasing the overall vaccination coverage of dogs that cannot be easily restrained and handled for vaccination. Full article

Dengue fever has significantly increased globally, extending into non-endemic regions. This study aims to describe the epidemiological and clinical characteristics of pediatric dengue cases diagnosed in Madrid, Spain, over ten years. We conducted a retrospective observational study across four tertiary hospitals, including all confirmed dengue cases in children under 16 between 2015 and 2024. Epidemiological data, clinical presentation, laboratory findings, and outcomes were collected, with severity assessed according to the 2009 WHO criteria. Forty-six cases were identified, with 72% diagnosed in the last three years and a peak incidence in 2024. Children visiting friends and relatives (VFR) constituted the majority of cases (56%). The most frequent clinical features were fever (100%) and gastrointestinal symptoms (78%), while laboratory findings included leukopenia (72%), thrombocytopenia (70%), and hypertransaminasemia (74%). Five cases (10%) met the criteria for severe dengue, one being fatal in a patient with pre-existing oncological disease. We identified no autochthonous cases. These results highlight the growing impact of imported pediatric dengue in non-endemic regions, the particular vulnerability of VFR travelers, and the need for clinical awareness, improved diagnostic availability and prevention strategies, especially in climate-influenced vector expansion. Full article

Until recently, Stenotrophomonas maltophilia was considered a low-virulence pathogen, usually found as an environmental commensal and colonizer of moist abiotic surfaces. Lately, it has increasingly been implicated in invasive infections with high associated morbidity and mortality. Most epidemiological studies involving patients with S. maltophilia infections have recorded risk factors and their associations with outcomes in critically ill patients. The aim of this study was to investigate its epidemiology as a pathogen in patients hospitalized in medical wards and potential factors associated with mortality. For this purpose, S. maltophilia-positive cultures from patients admitted to medical wards from 1 January 2023 to 30 June 2025 were collected, demographics and patient characteristics were recorded and analyzed and associated with clinical outcome. Twenty-nine patients and their first positive S. maltophilia positive culture were included in the study with a direct attributable mortality of 27.6%. Patients with cardiovascular and chronic obstructive pulmonary disease more commonly developed respiratory tract infections. Among the recorded comorbidities, only diabetes was associated with worse outcome. Most of the strains retained sensitivity to co-trimoxazole and levofloxacin and treatment outcome was not affected by the choice of regimen. This study highlights the rise of S. maltophilia to a true pathogen affecting immunocompetent patients; in combination with its antimicrobial resistance, this justifies its recognition as an emerging pathogen of public health concern. Full article

As wastewater monitoring networks continue to expand the monitoring of various targets, it is important to ensure these networks remain both representative of their monitored populations and flexible enough to accurately predict shifts in an expanding list of targets. In this study, we analyzed the levels of SARS-CoV-2, influenza A (InfA), and influenza B (InfB) detected in untreated wastewater during the 2023–2024 respiratory season at 70 locations participating in the Ohio Wastewater Monitoring Network. Locations with the first detection that are seasonal hotspots and sites reaching peak concentration for each target were compared and analyzed for dependence on healthcare access and population characteristics, such as population size and density, county traffic, and demographic and socioeconomic factors. The trends in these three respiratory viruses were found to closely mirror trends in clinical indicators including the number of cases and positive tests with wastewater levels providing a two-week lead for SARS-CoV-2 and no lead for influenza on these clinical indicators. InfA was first detected in more affluent sewersheds that were less racially and ethnically diverse and had higher traffic counts, while none of the parameters tested had an effect on InfB first detects. The seasonal hotspots varied for all three respiratory viruses, where InfA hotspots were exclusively in the northeast, InfB was in the southeast and east border areas, and SARS-CoV-2 wastewater hotspots concentrated around central and northwestern Ohio. While wastewater monitoring networks may not offer full coverage of all populous areas, we have shown that a spatially distributed and highly diverse network is needed for early detection of various respiratory targets. Full article

Background: Namibia is experiencing a generalized HIV epidemic, with 7.5% of the population living with HIV. Adolescent girls and young women (AGYW) aged 15–24 account for 28.6% of new infections annually. Various factors increase AGYW’s vulnerability to HIV. To address this, Project HOPE Namibia (PHN)-led consortium implemented the PEPFAR/USAID-funded DREAMS project in Khomas, Oshikoto, and Zambezi regions from 2018 to 2023. This study estimated the AGYW population most in need of HIV prevention and assessed geographic and age-specific gaps to improve program effectiveness and efficiency. Methods: This secondary data analysis utilized the Namibia Population-Based HIV Impact Assessment (NamPHIA) 2017, the Namibia census, and service data from the DREAMS project, which includes entry points for recruitment, screening, and enrolment. We used Python to conduct unadjusted and adjusted Poisson regression and UpSet plots for data visualization. Results: Analysis of NamPHIA data revealed low HIV prevalence in 10–14-year-olds, with only Oshikoto showing a detectable rate of 2.76%, mostly attributed to perinatal HIV transmission. Of the 12 DREAMS eligibility criteria, three could be mapped to 10–14-year-olds, while all except sexually transmitted infections could be mapped for 15–19 and 20–24-year-olds. Nationally, 17.3% of 10–14-year-old AGYW, 48.0% of 15–19-year-olds, and 50% of 20–24-year-olds met at least one DREAMS eligibility criterion. Among 15–19-year-olds, a history of pregnancy, no/irregular condom use, and out-of-school status were positively associated with HIV status. For 20–24-year-olds, transactional sex was positively associated with HIV status. Overall, 62% of screened individuals were eligible, and 62% of eligible individuals enrolled. PHN screened 134% of the estimated 37,965 10–14-year-olds, 95% of the estimated 35,585 15–19-year-olds, and 57% of the 24,011 20–24-year-olds residing in the five districts where DREAMS was implemented. Conclusions: We recommend the refinement of the DREAMS eligibility criteria, particularly for AGYW 10–14, to better identify and engage those at risk of HIV acquisition through sexual transmission. For 15–19-year-olds, PHN efforts should interrogate geographic variability in entry points for recruitment and screening practices. PHN should enhance the recruitment and engagement of AGYW 20–24, with a particular focus on those engaged in transactional sex. Full article

Increasing antimicrobial resistance (AMR) levels in Enterobacterales from pigs in Ghana prompted us to investigate farm feed, pig slurry, and farm water for Enterobacterales isolates, their antimicrobial resistance patterns, and antimicrobial residues. Between August and November 2024, we collected one sample each of feed, slurry, and water from 14 pig farms for microbiological analysis. Out of 42 samples, Enterobacterales (E. coli and Enterobacter spp.) were isolated from 30 (71.4%) samples, with the highest prevalence found in feed (85.7%), followed by slurry (78.6%) and water (50.0%). The prevalence of AMR to tetracyclines, trimethoprim-sulfamethoxazole, and ampicillin was high, with over 50% of isolates from slurry and water and 40% from feed exhibiting tetracycline resistance. Multi-drug resistance (MDR) was identified in nine (27.3%) isolates of Enterobacterales, with the highest prevalence found in feed (38.5%), then slurry (23.1%), and water (14.3%). Among 42 farm samples screened for colistin-resistant Enterobacterales, 10 (23.8%) exhibited phenotypic colistin resistance. No antimicrobial residues were detected. Risk factors associated with MDR included large farms with high pig turnover (p < 0.05) and the channelling of slurry into both covered and uncovered pits on the farm (p < 0.05). These high resistance levels underscore the urgent need for improved hygiene in feed, water, and slurry management, stricter antibiotic stewardship with veterinary oversight, and better enforcement of existing antibiotic use regulations on pig farms. Full article

Tick-borne diseases (TBDs) are a growing public health concern in the United States. This study analyzed 261,630 weighted hospitalizations from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database between 2002 and 2021 to evaluate trends, coinfections, demographic disparities, and financial impacts. Lyme disease was the most common cause, accounting for 65% of hospitalizations (171,328 admissions), followed by ehrlichiosis/anaplasmosis (46,446), babesiosis (18,057), rickettsial diseases (16,412), tularemia (2428), and other TBDs (19,435). Hospitalizations increased 2.5-fold over the study period, with the Northeast region bearing 52.9% of the burden and peaking in July. Males (53.9%), Caucasians (81.4%), and residents of higher-income zip codes were predominant, though rickettsial diseases showed elevated Hispanic representation (18.4%). Coinfections were common, with 35.8% of babesiosis and 15.6% of ehrlichiosis/anaplasmosis cases involving another TBD, suggesting that routine testing may be warranted. Median hospital charges rose from USD 9433 in 2002 to USD 35,161 in 2021, totaling USD 1.265 billion in 2021. In-hospital mortality was 1.1%, with the highest cause of mortality being babesiosis (2.06%). Future areas for research include characterizing the burden of disease in an outpatient setting, understanding the causes of racial disparities in hospitalizations, and testing strategies to identify coinfection. Full article

In 2024, the Americas experienced the largest dengue outbreak on record and Brazil was among the worst affected countries, reporting 6.6 million cases and 6200 deaths. We report the long-term entomological and epidemiological effectiveness of city-wide deployment of wMel-strain Wolbachia-infected Aedes aegypti in Niterói, a city of half a million people in Rio de Janeiro state, where Wolbachia releases across three-quarters of the urban population in 2017–2019 were expanded to remaining populated areas in 2023. wMel was durably established at ≥95% prevalence in Ae. aegypti populations throughout Niterói four years post-release, and up to seven years in the earliest release sites. Notified dengue case incidence in Niterói was 89% lower following Wolbachia releases, compared to the 10-year pre-intervention period of 2007–2016. Dengue incidence in Niterói in 2024, during a period of record high incidence in Brazil and the region, was 374 per 100,000 population, substantially lower than overall in Rio de Janeiro state (1884 per 100,000) and nationwide in Brazil (3157 per 100,000). Our findings show that city-wide Wolbachia coverage in Niterói provided sustained population-level reduction in dengue incidence throughout the five years post-intervention, including during the 2024 epidemic surge, averting an estimated three-quarters of the dengue case burden that may otherwise have been expected in Niterói in 2024. Full article

Streptococcus pneumoniae remains a leading cause of invasive diseases, particularly affecting young children and the elderly. Currently, two main types of pneumococcal vaccines are commercially available: polysaccharide vaccine (PPSV23) and conjugate vaccines (e.g., PCV20). Of over 100 identified pneumococcal serotypes, vaccines targeting 24 serotypes covered by PPSV23 and PCV20 (19 serotypes overlap between the two vaccines) have been developed, with serotype distribution varying by geography, age, and time. The immune response to pneumococcal vaccines differs across serotypes, vaccine types (polysaccharide vs. conjugate), and host factors. Quantitative methods for antibody assessment—particularly newer high-throughput assays—have emerged since 2000 to address limitations in conventional approaches. However, these methods have not been comprehensively reviewed. This scoping review aimed to systematically map the existing literature on quantitative methods used to assess antibody responses to pneumococcal vaccines. Specific objectives included the following: 1. summarizing conventional and novel quantitative immunoassays; 2. evaluating the current state of validation and application of these methods; 3. identifying knowledge gaps and methodological challenges. We followed the PRISMA-ScR guidelines. We included the following: 1. peer-reviewed, open-access papers related to immunoassays used for pneumococcal antibody assessment; 2. articles written in English; 3. Studies published between 2000 and 2023. We excluded the following: 4. studies focusing on other pathogens, employing different analytical methods, or using animal models. Articles meeting the eligibility criteria were primarily retrieved from PubMed and Scopus. If free full-text versions were unavailable there, Google Scholar or the original journal databases were consulted. All references were exported to EndNote 20 for further management. At the beginning of the review, a data-charting form was developed based on prior studies and commonly addressed themes. Additional charts were created to accommodate newly identified variables during the review. All charting tools were reviewed and finalized through discussion among all research team members. The included studies were classified into five thematic groups: 1. general descriptions of quantitative assessment methods, 2. assay development and validation, 3. comparative studies, 4. technical details of assay development, 5. interpretation of assay application findings. Of 1469 articles from PubMed and 2946 articles from Scopus initially identified, 55 articles met the inclusion criteria. The earliest methods included radioimmunoassays, later replaced by WHO-standardized ELISA. While ELISA remains the gold standard, it is limited by labor, cost, and throughput. Multiplex immunoassays (MIAs), including Luminex-based platforms, have demonstrated advantages in efficiency and scalability. However, many MIAs did not initially meet WHO validation criteria. More recent assays show an improved performance, yet interlaboratory variability and lack of standardized protective thresholds remain major limitations. This review provides the first comprehensive mapping of quantitative antibody assessment methods for pneumococcal vaccines. Although ELISA continues to serve as the benchmark, MIAs represent a promising next-generation approach. Continued efforts are needed to harmonize assay validation protocols and establish global standards for protective thresholds, which will enhance the reliability of vaccine efficacy monitoring across diverse populations. Full article

Background: Latent tuberculosis infection (LTBI) is a major global health concern, particularly among individuals with chronic kidney disease (CKD), who are at increased risk of reactivation due to impaired immunity and frequent exposure to immunosuppressive therapies. Despite growing reliance on interferon-gamma release assays (IGRAs) such as QuantiFERON-TB Gold In-Tube (QFT-GIT) in BCG-vaccinated populations, data on IGRA performance across CKD stages remain limited in resource-limited settings. Objective: To determine the prevalence of LTBI and indeterminate IGRA results across CKD stages in a Thai population and assess the clinical utility of IGRA in this context. Materials and Methods: We conducted a cross-sectional study among 785 Thai adults receiving care at a national infectious disease institute, including diabetes clinic patients, hospital staff, and individuals on hemodialysis. Each participant underwent QFT-GIT testing, and the CKD stage was classified using the estimated glomerular filtration rate (eGFR) closest prior to testing. Results: Overall IGRA positivity was 22.2%, peaking in CKD stage G3 (31.6%) and declining in stage G5 (11.0%), where indeterminate results were also highest (6.8%). Limitations: Single-center design and lack of confirmatory testing may limit generalizability. Conclusions: IGRA performance is reliable in early-to-moderate CKD but less so in advanced stages. LTBI is prevalent in CKD stages G2–G4, supporting stage-specific approaches to LTBI screening and caution against overreliance on IGRA in advanced renal impairment. Full article

Background: The microscopic examination of stool samples remains the reference method for the diagnosis of intestinal protozoal infections; however, this technique is time consuming and requires experienced and well-trained operators. Therefore, there is a growing interest in molecular diagnostic techniques, including commercial PCR assays. The aim of this multicentric study was to evaluate a commercial real-time PCR for the detection of intestinal protozoa in fecal samples. Methods: The samples were routinely examined using conventional techniques, such as macro- and microscopic examination after concentration, Giemsa or Trichromic stain, Giardia duodenalis, Entamoeba histolytica/dispar or Cryptosporidium spp. antigens research, and amoebae culture. The samples were frozen by the participating laboratories, retrospectively extracted and examined with one-step real-time PCR multiplex using the Allplex™ GI-Parasite Assay (Seegene Inc., Seoul, Korea). Results: A total of 368 samples were analyzed from 12 Italian laboratories. Compared to traditional techniques, the sensibility and specificity of the real-time PCR kit were as follows: 100% and 100% for Entamoeba histolytica, 100% and 99.2% for Giardia duodenalis, 97.2% and 100% for Dientamoeba fragilis, and 100% and 99.7% for Cryptosporidium spp., respectively. Conclusions: The Allplex™ GI-Parasite Assay exhibited excellent performance in the detection of the most common enteric protozoa. Full article

Background: Dengue infection is a spreading vector borne disease with most severe infection-related fatalities occurring in adults. This study was conducted to explore prognostic indicators of dengue infection severity. Methods: This study included patients aged over 15 years who were diagnosed with dengue viral infection. Data were collected from nine hospitals across all regions of Thailand between January 2019 and December 2022. Diagnosis of dengue infection was confirmed by a positive result for the NS-1 antigen via RT–PCR, IgM antibody, or IgG antibody tests. Data including gender, age, BMI, underlying disease, clinical characteristics and laboratory findings were collected. Multivariable logistic regression with backward elimination was used to identify a set of prognostic factors. Results: The prognostic indicators of severe dengue were age < 55 years (OR = 6.13, p = 0.054), severe bleeding (bleeding from the gastrointestinal tract, hematemesis, melena, menorrhagia, or hematuria) (OR = 20.75, p < 0.001), pleural effusion (OR = 10.23, p < 0.001), and platelet ≤ 100,000 (/µL) (OR = 3.62, p = 0.035). These predictors were able to accurately estimate the severity of dengue infection with an area under the receiver operating curve (AuROC) of 0.836. Conclusions: The proposed four prognostic factors can be applied to predict severe dengue infections. These findings may inform the development of a risk scoring system to forecast severe dengue infection, early detection, and appropriate treatment during sickness. Full article

Cutaneous Leishmaniasis (CL) is a tropical disease endemic in many regions of Latin America. Its clinical diagnosis is often supported by histopathological analysis of skin biopsies; however, parasite detection by microscopy can be challenging, particularly in chronic or pauciparasitic lesions, leading to inconclusive results. Objective: This study aimed to evaluate the utility of polymerase chain reaction (PCR) as a confirmatory diagnostic tool for CL in formalin-fixed, paraffin-embedded (FFPE) biopsies with inconclusive histopathology. Methods: We analyzed 16 FFPE skin biopsy samples from patients with clinical suspicion of CL. All cases underwent routine histopathological evaluation using hematoxylin and eosin staining and were classified as inconclusive. DNA was extracted and PCR was performed, targeting the ITS1 and miniexon regions of Leishmania spp. Results: PCR successfully amplified Leishmania DNA in 8 (50%) out of 16 samples when both targets were utilized, confirming infection. These findings highlight the additional benefits of molecular tools in cases with inconclusive histopathology, thereby enhancing diagnostic accuracy and enabling species-level identification in certain instances. Conclusions: PCR proved to be a valuable diagnostic complement to histopathology in clinically and histologically suspected cases of CL without visible parasites. Its implementation may improve diagnostic accuracy and timely treatment in endemic areas. Full article

We analysed the socioeconomic, behavioural, and protection factors (PFs) influences on the HIV combined prevention (CP) strategy among Brazilian Amazonian men who have sex with men (MSMs). PFs are resources that reduce the effect of adversity and help people maintain their well-being. Methods: Cross-sectional study employing a convenient sample of MSMs living in the metropolitan region of Belém. A questionnaire containing socioeconomic, behavioural, PFs, and behaviour/knowledge concerning CP questions was used. “Behaviour/knowledge concerning CP” was defined as a dependent variable and received a maximum score of 16 points. The Mann–Whitney and Kruskal–Wallis tests and multiple linear regression were employed. Results: Our sample comprised 384 MSMs scoring an average of 7.83 points (±1.9). Contributing to lower scores were “not talking about sex life with confidants”, “not talking with work colleagues about personal life and sexually transmissible infections”, and “not participating in non-governmental organisations.” On the other hand, “not being happy in the neighbourhood of residency” contributed to higher scores. Conclusion: Peer support and social inclusion are essential for increasing MSMs’ access to CP. Full article

The accurate identification of mosquito species is critical for effective mosquito surveillance and control, especially when presented with morphologically similar species like Aedes aegypti and Aedes sierrensis. Damaged specimens and morphologically similar life stages such as eggs and larvae make it difficult to distinguish Aedes aegypti from Aedes sierrensis using microscopy and taxonomic keys. To address this, the AegySierr.ID-qPCR assay, a multiplex quantitative PCR assay that utilizes single-nucleotide polymorphisms within the mitochondrial cytochrome oxidase subunit I gene, was developed to distinguish between these two species. The assay was tested on DNA extracted from the eggs, larvae, and adults of both species, as well as from environmental DNA (eDNA) collected from natural mosquito reproduction sites. It demonstrated a high diagnostic accuracy across multiple life stages, with a sensitivity exceeding 95% for most groups and specificity exceeding 90%, except for field-collected adult Ae. sierrensis (75%). For eDNA samples, the assay achieved 100% sensitivity and 94% specificity for samples classified as Ae. sierrensis and 91% sensitivity and 86% specificity for Ae. aegypti. A two-graph receiver operating characteristic analysis was also used as an alternate method with which to establish Ct thresholds for interpreting results from unknown samples. The AegySierr.ID-qPCR assay enables the rapid and sensitive identification of Ae. aegypti and Ae. sierrensis from specimens and eDNA, and may be of use in mosquito surveillance programs. Full article

The genus Orthoflavivirus includes several mosquito-borne pathogenic viruses, notably West Nile virus (WNV), which is endemic to the Mediterranean region. In Portugal, WNV circulation has been documented in equines, birds and mosquitoes, however human cases remain rare and no recent human seroprevalence studies have been conducted. This study aimed to estimate the national and regional seroprevalence of WNV among blood donors in mainland Portugal and explore associations with sociodemographic factors. A cross-sectional study conducted in 2022 included 3593 blood donors from across mainland Portugal. Serum samples were tested for WNV immunoglobulin G (IgG) by enzyme-linked immunosorbent assay (ELISA) and positive and borderline samples were confirmed using a virus neutralization test. Sociodemographic data were collected through a structured paper questionnaire. Statistical analyses, including multivariate logistic regression, identified factors associated with seropositivity. A total of 55 samples (1.5%) tested positive, and 21 samples (0.6%) were classified as borderline for WNV antibodies by ELISA. Of these, 47 were confirmed by viral neutralization, giving an estimated national seroprevalence of 1.4%. Significant regional variation was noted, with higher seroprevalence observed in the Beira Baixa, Grande Lisboa and Médio Tejo regions. Some seropositive individuals were identified in northern coastal regions such as Ave, Cávado and Área Metropolitana do Porto. In multivariate analysis, geographical area of residence was the only factor associated with seropositivity. This study highlights regions at potential higher risk for human WNV exposure, primarily in the southern half of Portugal. Continued and integrated surveillance is crucial to inform public health strategies to mitigate WNV transmission risks in these regions, as well as in other regions where WNV may be emerging as a relevant One Health concern. Implementing preventive measures for both animals and humans is critical to minimizing exposure and infection, and further confirmatory studies using virus neutralization tests will be important for refining these estimates. Full article

The World Health Organization (WHO) declared snakebite envenoming (SBE) as a neglected tropical disease in 2017. Antivenom is the gold standard of treatment, but many healthcare barriers exist, and hence, affected populations are often unable to access it. The challenge is further perpetuated by the lack of attention from national health authorities, poor regulatory systems and policies, and mismanagement of antivenom. This study aims to map the evidence regarding snake antivenom regulations globally and identify gaps in the literature to inform future research and policy. This review was conducted using the original Arksey and O’Malley framework by three independent reviewers, and the results were reported using the Preferred Reporting Items for Systematic reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR). A search strategy was developed with assistance from a librarian, and six databases were searched: PubMed, SCOPUS, ProQuest Central, Africa Wide Web, Academic Search Output, and Web of Science. Screening was conducted independently by the reviewers, using Rayyan, and conflicts were resolved with discussions. A total of 84 articles were included for data extraction. The major themes that emerged from the included studies were regarding antivenom availability, accessibility, manufacturing, and regulations. The study revealed massive gaps in terms of policies governing antivenom management, especially in Asia and Africa. The literature does not offer sufficient evidence on management guidelines for antivenom in the endemic regions, despite identifying the challenges in supply. However, significant information from Latin America revealed self-sufficient production, involvement of national health bodies in establishing efficient regulations, effective distribution nationally and regionally, and technology sharing to reduce SBE-related mortality. Full article

Human brucellosis is a zoonotic, bacterial infection caused by the intracellular, Gram-negative Brucella spp., which is common globally but rare in the United Kingdom, with approximately 20 imported cases per annum following travel to countries with high endemicity. Transmission typically occurs via the ingestion of infected animal products, including unpasteurised dairy products. Human-to-human transmission is rare, and routes include postpartum vertical transmission through breastfeeding. We report here on a familial cluster of three cases within a single UK-based Kurdish household of four, including a 11-month-old infant infected through the consumption of breast milk. Four months prior to presentation, the family had travelled together to northern Iraq for a 5-week holiday and all consumed local dairy products except for the children, including the 11-month-old, who was exclusively breastfed at the time. All three patients, including one adult male with complicated brucellosis, had a favourable outcome with medical therapy.: Brucellosis is an important differential diagnosis in returning travellers and specialist advice should be obtained early to prevent sequelae. It is also important for active case-finding, especially in family units with shared exposure. Paediatricians and adult physicians who may manage brucellosis should consider the possibility of vertical transmission in breastfeeding mothers. Full article

Adherence to the 6-month tuberculosis (TB) treatment regimen is challenging due to its duration and side effects, with various factors influencing patient compliance. A retrospective cross-sectional study was conducted among newly diagnosed pulmonary TB (pTB) patients in Selangor, Malaysia, undergoing treatment in government primary care clinics and hospitals. Patients who were lost to follow-up (LTFU) within the first six months were determined by reviewing patient records and the national TB registry. Logistic regression analysis identified sociodemographic and clinical factors associated with LTFU. Of the 699 pTB patients, 55 (7.9%) were lost to follow-up. Factors significantly associated with LTFU included age (higher in 25–44-year-olds, adjusted odds ratio (aOR): 2.83), unmarried status (aOR: 2.17), lower education level (aOR: 6.13), being a smoker (aOR: 2.65), and unawareness of TB diagnosis (aOR: 38.14). A significant interaction was found between education level and awareness of diagnosis, with unawareness having a stronger association with LTFU among higher-educated patients. Young adults, those with a lower education level, unmarried individuals, smokers, and those unaware of their TB diagnosis are at higher risk of LTFU. These factors can be used for rapid risk assessment. Intensive counselling and health education at treatment initiation, particularly for at-risk patients, are crucial for preventing LTFU. Full article