Tropical Medicine and Infectious Disease

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.

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.

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.