Tropical Medicine and Infectious Disease

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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