Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090259

Authors: Yuxia Yu Huarui Liu Huan Yang Dan Ye Lu Xia Xiaoqing Ma Jiayi Wang Yuchong Sun Feng Li Yuanyuan Chen

Introduction: This study investigated independent factors associated with neurological prognosis at discharge in patients with tuberculous meningitis (TBM) and evaluated the impact of intensified treatment regimens. Methods: A retrospective analysis was conducted in 518 TBM patients from two Chinese medical centers. LASSO and multivariable logistic regression were used to identify independent risk factors for poor neurological outcomes. A 1:1 PSM based on intensified treatment exposure was performed to assess its association with neurological outcomes, with an exploratory outcome-based matched comparison conducted for other prognostic factors. Results: Among 518 patients, 123 (23.75%) had poor neurological outcomes. The poor-prognosis group had higher proportions of MRC stage III (30.08% vs. 8.35%, p < 0.001), linezolid use (58.54% vs. 40.76%, |SMD| = 0.361), and fluoroquinolone use (87.8% vs. 75.19%, |SMD| = 0.386). Multivariable analysis identified decreased muscle strength, MRC stage II/III, albumin < 30 g/L, and hydrocephalus as independent risk factors for poor neurological outcomes. After treatment-exposure-based PSM, intensified treatment was not significantly associated with neurological outcomes, while an exploratory matched analysis suggested a potential association between diabetes mellitus and unfavorable neurological outcomes. Conclusion: Neurological prognosis in TBM is influenced by both disease severity and host baseline status. Intensified therapy was not significantly associated with neurological outcome at discharge after adjustment, highlighting the importance of individualized risk management.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090258

Authors: Tatiana J. Marrufo Genito A. Maúre Américo F. José Osvaldo F. Inlamea Bettencourt P. S. Capece Maria-Raquel G. Silva

Transmission of water, vector, and foodborne diseases tends to increase with climate variability, disproportionately affecting vulnerable communities. Globally, this dynamic contributes to adverse health outcomes in low- and middle-income countries such as Mozambique. Nevertheless, the influence of climate variability on disease patterns remains unclear. We assessed the potential relationship between climate variables and diseases, including diarrheal diseases, malaria, and malnutrition, in four districts around the Revuè sub-basin. An ecological, longitudinal, retrospective study conducted from 2016 to 2024 used secondary weekly disease data and annual malnutrition records. We applied a Generalized Additive Model framework to evaluate non-linear associations between climate factors and disease case counts. Our main findings showed that while higher maximum temperature was associated with increased cumulative malaria case counts, cumulative and heavy rainfall (~100 mm/week) was associated with decreased diarrheal disease case counts. Higher prevalence of moderate acute malnutrition is associated with a decrease in annual mean total precipitation (p = 0.0062). In contrast, higher prevalence of severe acute malnutrition is associated with a decrease in annual mean temperature (p = 0.0312). This study contributes to understanding climate variables associated with water, vector, and foodborne diseases, enhancing our understanding of factors contributing to overall food insecurity and affecting public health.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090257

Authors: Kornkanok Nakudom Amornrat Geadkaew-Krenc Wansika Phadungsil Rudi Grams

Helminth infections continue to present a substantial public health challenge worldwide, particularly in tropical and developing areas. Despite the widespread use of anthelmintic drugs for treatment and control, their effects on host cells remain poorly understood. In this study, the three commonly used anthelmintics albendazole, ivermectin, and praziquantel were investigated by transcriptome analysis for their effects on gene activity in the human intestinal cell line FHs 74 Int after 24-h exposure. The drug concentrations used were substantially higher than in the treatment of helminthiases but did not affect cell viability after 24 h and less than 50% after 72 h. Praziquantel had negligible toxic effects on the intestinal cells at the highest achievable concentration of 1 mM whereas albendazole and ivermectin were already effective at low micromolar concentrations and were tested at 1 µM and 15 µM concentrations. Consistent with the observed cytotoxicity, transcriptome analysis showed no transcriptional changes for 1 mM praziquantel at low cutoff criteria of adjusted p-value (padj) ≤ 0.05, log2 fold change ≥ 0. At the same padj but with log2 fold change ≥ 2, 17 upregulated and 2 downregulated genes were found after treatment with 1 µM albendazole and 106 upregulated and 65 downregulated genes with 15 µM ivermectin. Analysis of these genes showed that albendazole caused a modest upregulation of cell cycle related processes, especially mitotic spindle formation, and chromosome segregation. The cells showed a stronger response to ivermectin and the data suggested inhibition of cell proliferation through downregulated transcription factors and nuclear receptors and stimulation of cell growth and cell survival mechanisms through upregulated metabolic enzymes.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090256

Authors: María A. Occhionero Daniela A. Gaspar Daniela E. Barraza María Elisa Vázquez Brenda A. Zabala Rita A. Sandoval Lucila Saavedra Cecilia Pérez Brandán Natalia S. Corbalán Leonardo Acuña

American tegumentary leishmaniasis (ATL) remains a therapeutic challenge due to the toxicity and limited effectiveness of conventional agents. This study evaluated Enterococcus mundtii CRL35, a food-grade lactic acid bacterium, as a dual-mechanism therapeutic platform against Leishmania (L.) amazonensis. Initial screening identified E. mundtii CRL35 as the most active strain among four enterococci tested, demonstrating high selectivity against promastigotes (SI = 95) and intracellular amastigotes (SI = 25). In a BALB/c murine model of cutaneous leishmaniasis, three treatment modalities were evaluated: topical application of cell-free supernatant (CFS-T), oral viable bacteria (LB-O), and their combination (CFS-T+LB-O). All three treatments achieved significant reductions in lesion parasite burden (approximately 2–3 orders of magnitude versus untreated controls), substantially exceeding the parasitological efficacy of amphotericin B under identical experimental conditions. CFS-T and CFS-T+LB-O additionally produced significant macroscopic lesion improvement. Importantly, no treatment was associated with adverse changes in organ indices or serum biochemical parameters. E. mundtii CRL35-based treatments promoted higher IgG2a/IgG1 antibody ratios compared to untreated controls and amphotericin B, generating an immune profile more favorable for intracellular parasite control. Taken together, these findings support the therapeutic potential of these modalities as safe, effective, and affordable alternatives for ATL, particularly in resource-limited endemic regions where toxicity and logistical barriers limit access to conventional therapy.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090255

Authors: Serdar Karakullukçu İrem Dilaver Murat Topbaş Merve Erdoğan Hüsniye Ebru Çolak Meral Fidan Uçan

Co-endemic zoonoses may occur in the same broad geographic settings but not necessarily the same communities or time periods. This study investigated whether Crimean–Congo hemorrhagic fever (CCHF) and brucellosis exhibit convergent or divergent spatiotemporal patterns across geographic scales in a livestock-dependent, CCHF-endemic province of Türkiye. This retrospective study analyzed confirmed human CCHF and brucellosis cases reported to the national infectious disease surveillance system between 2011 and 2024. Temporal analyses, kernel density estimation, settlement-level random labeling, and within- and cross-disease Knox tests were performed. Among the 611 eligible cases, CCHF (n = 442; 72.3%) and brucellosis (n = 116; 19.0%) accounted for 91.3%. CCHF was strongly seasonal, with 99.3% of cases occurring between April and September, whereas brucellosis occurred throughout the year. Although broad density surfaces partially overlapped, same-settlement co-occurrence was substantially lower than expected (O/E = 0.37; p < 0.001) and remained so in the sensitivity analysis (O/E = 0.74; p = 0.001). Cross-disease analysis showed no evidence that CCHF and brucellosis occurred closer together in both space and time than expected. Annualized CCHF concentration peaked in 2020–2021, whereas brucellosis peaked in 2022–2024. Integrated surveillance may use shared regional infrastructure, but interventions should be tailored to disease-specific settlements, transmission pathways, and periods of risk.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090254

Authors: Victor Feitosa de Freitas Liliane Lins-Kusterer Karen Valadares Trippo Herman Henrique Silva Santana Fernando Martins Carvalho

Background: Multidrug therapy (MDT) is the cornerstone of treatment for Hansen’s disease. We aimed to identify factors associated with health-related quality of life (HRQoL) of people with Hansen’s disease undergoing MDT. Methods: Sixty-six people of any sex, aged 18 and older, undergoing MDT, without adverse reactions, were enrolled as outpatients at a public health service in Salvador, Brazil. A physical examination was performed, during which the Simplified Neurological Evaluation Form was used to determine the Degree of Physical Disability. The HRQoL was evaluated using the RAND-36 questionnaire and its Physical Component Summary (PCS) and Mental Component Summary (MCS). Results: The PCS and MCS were negatively associated with pain and positively associated with the Degree of Physical Disability after controlling for MDT duration, bacilloscopy, schooling, race/color, age, sex, and monthly income; the PCS was negatively associated with smoking. Patients who reported pain had a PCS 14.282 percent units lower than those who did not report it, and patients that reported pain had an MCS 6.762 units lower. Differences in such magnitude are clinically important for patients with Hansen’s disease being treated with MDT. Conclusion: Pain and the Degree of Physical Disability are strongly associated with the HRQoL of patients with Hansen’s disease undergoing MDT.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090253

Authors: Nandini Sharma Saurav Basu Shivani Rao Mrunali Zode Himanshu Bachawandia Meenakshi Bakshi Mongjam Meghachandra Singh

Objectives: The aim of this study was to ascertain the seroprevalence and determinants of dengue virus (DENV) and chikungunya virus (CHIKV) seropositivity in Delhi, India. Methods: This cross-sectional serosurvey with a nested longitudinal immunological sub-study was conducted in an urban resettlement and slum settlement in the North-East district of Delhi in individuals aged ≥2 years. Dengue and Chikungunya virus IgG antibodies were screened using indirect enzyme-linked immunosorbent assay (ELISA), and a longitudinal subset of 100 paired IgG-seropositive samples was further characterized via a plaque reduction neutralization test (µPRNT50) to evaluate changes in functional neutralization over time. Results: A total of 752 participants, including 56.65% female participants, were included in the study. Of the participants studied, 81.91% (95% CI: 78.97, 84.60; n = 616) were positive for IgG antibodies against DENV, and 28.32% (95% CI: 25.13, 31.69; n = 213) were positive for CHIKV IgG antibodies. µPRNT50 confirmed stable, near-universal CHIKV neutralization (97% baseline, 98% endline). However, DENV neutralizing antibody showed a significant contraction for DENV-3 (79% baseline, 60% endline) and DENV-4 (69% baseline, 60% endline), while DENV-1 (76%) and DENV-2 (77% to 80%) antibodies remained stable. Individuals living in households with screened windows had significantly lower odds of contracting DENV infection (AOR: 0.36; 95% CI: 0.21, 0.61) and CHIKV infection (AOR: 0.63; 95% CI: 0.43, 0.90) compared with those living in households without screened windows. Further, individuals from households with uncovered containers with stagnant water had 50% higher odds of CHIKV infection than those without such containers (AOR: 1.55; 95% CI: 1.05, 2.29). Conclusions: This study revealed a high burden of DENV and CHIKV exposure in this high-risk urban population. While neutralization remained stable for CHIKV, DENV-1, and DENV-2, waning DENV-3 and DENV-4 antibodies suggest differential serotype-specific immunity in the participants.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090252

Authors: Hsien-Yi Wang Shih-Bin Su Chung-Yi Li Kow-Tong Chen

Severe dengue remains an important cause of pediatric hospitalization, morbidity, and mortality in tropical and subtropical regions, particularly where rapid triage and pediatric critical-care capacity are limited. This structured narrative review synthesizes the evidence on the epidemiology, pathogenesis, early recognition, diagnosis, management, and prevention of severe dengue in children. Severe disease reflects interactions among viral factors, pre-existing immunity, dysregulated host responses, and microvascular endothelial injury. Antibody-dependent enhancement, inflammatory mediators, dengue nonstructural protein 1, and endothelial glycocalyx disruption contribute to vascular hyperpermeability, plasma leakage, shock, severe bleeding, and organ impairment. Because deterioration often occurs abruptly around defervescence, serial clinical assessment, hematocrit trends, urine-output monitoring, and timely recognition of warning signs are central to risk stratification. Molecular assays and NS1 antigen testing are most useful during the early febrile phase, although diagnostic performance varies with illness timing and immune status. Carefully titrated isotonic crystalloid therapy remains the cornerstone of treatment; both delayed resuscitation and excessive fluid administration may worsen outcomes. Reducing mortality requires integrated clinical and public-health strategies combining standardized pediatric management, accessible diagnostics, effective referral systems, vaccination where appropriate, surveillance, and vector control.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090251

Authors: Callum Lowe Tony Arjuna Mubasysyir Hasanbasri Haribondhu Sarma I Nyoman Sutarsa Severine Navarro Darren Gray Matthew Kelly

Objective: To investigate the burden of environmental enteric dysfunction (EED) and its association with water, sanitation, and hygiene (WASH) and linear growth amongst infants in rural Central Java, Indonesia. Study design: A longitudinal study of 119 infants aged from 5–19 months was conducted in five villages of Wonosobo District, Central Java, Indonesia. Infant length and weight were measured at baseline and 5-month follow-up and stool samples were collected for the investigation of alpha-1-antitrypsin (AAT), neopterin (NEO), and myeloperoxidase (MPO) levels. Linear mixed-effects regression (LMER) models estimated the associations between WASH and height-for-age z-score (HAZ) on biomarker concentrations. Results: Biomarkers increased from baseline to follow-up where AAT, NEO, and MPO were elevated in 68.7%, 79.0%, and 71.4% of infants. Breastfed infants and infants with recent diarrhoea had higher biomarker levels than non-breastfed infants. After correction for multiple testing, few significant associations between EED biomarkers and WASH variables or HAZ were detected. EED biomarkers measured at baseline or follow-up were not significantly associated with growth faltering over the follow-up period. In cross-sectional analysis, compared to infants at risk of stunting (−2 < HAZ ≤ −1), infants with HAZ > −1 had lower AAT at baseline (β = −0.43, 95% CI = −0.82 to −0.05, padj < 0.05). Conclusions: Elevated EED biomarker levels were frequently observed and had mixed associations with WASH and HAZ, highlighting the complexity of EED and need to understand EED etiology through intervention studies.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090250

Authors: Paolo Fusco Francesco De Maria Alessandro Russo

West Nile virus (WNV) is an expanding mosquito-borne orthoflavivirus and an important cause of arboviral neuroinvasive disease. Whether HIV infection modifies WNV susceptibility, severity, or diagnostic performance remains uncertain. This narrative review was supported by structured PubMed/MEDLINE and Scopus searches updated to 22 August 2026 and a supplementary targeted citation search, identifying 23 peer-reviewed reports providing direct clinical or seroepidemiological evidence on WNV in people with HIV (PWH). The evidence remains heterogeneous, but recent data clarify several conclusions. A Northern Italian sero-repository study of 2843 PWH found neutralization-confirmed WNV antibodies in 3.0%, with no neuroinvasive disease and no association with HIV-related immunological variables. Comparative US cohorts likewise do not demonstrate that HIV status alone confers a uniform excess risk of WNV neuroinvasive disease. Conversely, individual reports of advanced HIV disease describe severe neuroinvasive presentations with delayed or absent WNV-specific antibody responses and molecular confirmation. HIV status alone should therefore not be considered a uniform WNV risk marker; the individual immune phenotype may be more clinically informative. In PWH with profound immunosuppression, negative early serology should not prematurely exclude WNV, and molecular testing should be considered when clinical suspicion remains high. Prevention, seasonal vigilance, and prospective HIV-specific studies remain priorities.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090249

Authors: Jurairat Jongthawin Aongart Mahittikorn Kinley Wangdi Frederick Ramirez Masangkay Manas Kotepui

Intestinal parasitic infections, particularly soil-transmitted helminths (STHs), remain a major public health concern in low- and middle-income countries. As control programs reduce infection intensity, accurate diagnosis becomes increasingly challenging. The McMaster technique has been proposed as an alternative diagnostic method for detecting human intestinal parasites; however, its diagnostic performance in human populations remains unclear. This study aimed to evaluate the diagnostic sensitivity of the McMaster technique for detecting intestinal parasites, particularly STHs. A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines and registered in PROSPERO (CRD420261298952). Electronic databases (PubMed, Scopus, Web of Science, Ovid, Nursing & Allied Health Premium, and Google Scholar) were searched up to January 2026. Studies assessing the McMaster technique in human populations and reporting sufficient data to calculate sensitivity were included. A random-effects model was used to estimate pooled sensitivity, with subgroup analyses by parasite species, geographic region, and population characteristics. Risk of bias was assessed using the the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Among the 1514 records identified through database searching, 10 studies were included in the final analysis. The pooled sensitivity of the McMaster technique was 73% (95% confidence interval [CI]: 67–78%; I2 = 91.0%) for detecting any intestinal parasites and 72% (95% CI: 65–78%; I2 = 93.5%) for STHs. Species-specific sensitivities were 67% (95% CI: 61–72%; I2 = 80.7%) for Ascaris lumbricoides, 79% (95% CI: 57–91%; I2 = 96.9%) for Trichuris trichiura, and 71% (95% CI: 61–80%; I2 = 89.9%) for hookworms. The McMaster technique demonstrates moderate sensitivity for detecting intestinal parasites in humans. While it offers practical advantages for field applications, its reduced sensitivity in low-intensity infections limits its utility as a standalone diagnostic tool in control and elimination settings. Further research should focus on methodological standardization and integration with more sensitive diagnostic approaches.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090248

Authors: Priscilla Nkonde Gardner Victor Daka Paul Simusika Walter Azibadighi Charles Chileshe Leah Kamulaza Davie Simwaba Roma Chilengi

Measles remains a public-health concern where immunity gaps and incomplete vaccination coverage persist. This study assessed household and geographic factors associated with laboratory-confirmed measles among suspected cases in three Zambian provinces. A prospective cross-sectional study was conducted during measles outbreaks in five selected districts across Luapula, Northern and Northwestern provinces. Suspected cases meeting the IDSR case definition were consecutively enrolled. Blood samples were collected, transported to the UTH Virology Laboratory, and tested using procured IgG test kits. Participant characteristics were summarised descriptively. Bayesian logistic regression estimated associations between laboratory-confirmed (IgG positive) measles and age, sex, vaccination status, household size and previous measles history, with province added in a second model. Results were reported as posterior odds ratios with 95% credible intervals. Among the 172 suspected cases, 45 (26.2%) were laboratory confirmed (IgG positive). Vaccination status was verified using caregiver-provided immunization cards; status was unknown for 110 (64.0%) participants (all of whom tested negative), reflecting missing vaccination documentation. Vaccinated participants had 93% lower adjusted odds of laboratory-confirmed measles than unvaccinated participants (adjusted posterior OR: 0.07, 95% CrI: 0.02–0.18). Adjusted posterior probabilities were consistently lower among vaccinated participants across all three provinces (34% to 49%) than among unvaccinated participants (86% to 92%). Age, sex and household size were not clearly associated with measles positivity. All four participants reporting a previous measles history tested positive, and the unadjusted association was significant using Fisher’s exact test (p = 0.004). Vaccination status was most strongly associated with laboratory-confirmed measles, with substantially lower adjusted odds among vaccinated participants. These findings reinforce the importance of measles vaccination in outbreak prevention and control.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090247

Authors: Sara Manzi Martina Micocci Luca Tassoni Stefano Vettore Davide Bonetto Simone Martini Francesco Gradoni Federica Toniolo Giulia Iandiorio Lidia Iustina Danca Giulia Chiarello Patrizia Visentin Matteo Cecconello Sara Carlin Federica Gobbo Matteo Mazzucato Francesca Russo Chiara Ziprani Barbra Bucci Sergio Iavicoli Vincenzo Severino Fabrizio Montarsi

Aedes invasive mosquito (AIM) species are expanding worldwide, increasing the risk of arbovirus introduction and transmission. Points of Entry (PoEs), including airports and seaports, represent critical gateways for the introduction and spread of invasive vectors through international passenger and cargo traffic. This study evaluated the AIM long-term dynamics at three major PoEs (Treviso Airport, Venice Airport, and Venice Port) in northeastern Italy (Veneto region) between 2018 and 2024 through an integrated entomological surveillance programme designed to collect AIMs (adults and eggs) throughout the seasonal activity (June–October). Mosquitoes were identified morphologically and, where required, by molecular analyses. Aedes albopictus was the dominant AIM throughout the study period (eggs N = 96,192, adults N = 14,231), being detected at all three study sites and showing consistent interannual and seasonal dynamics, with peak abundance during summer despite routine vector control interventions. Aedes koreicus was detected at two of the three study sites, namely Venice and Treviso airports (eggs N = 1, adults N = 3). Phylogenetic analyses based on COI indicated that these specimens belonged to a distinct European lineage, revealing genetic diversity among European populations of Ae. koreicus. No evidence of newly established AIMs was found during the surveillance period. These findings highlight the importance of long-term surveillance at PoEs for the early detection of AIMs, monitoring temporal changes in established vector populations, and supporting integrated control and surveillance strategies to reduce the risk of vector establishment and mosquito-borne disease transmission.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090246

Authors: Miguel Hueda-Zavaleta Exequiel Federico Espeche Francisco Zea Gamboa Mady Canelu Ramos Rojas Enrique Lanchipa Valencia Juan Carlos Gómez de la Torre Pretell

Background: Intestinal parasitic infections caused by Giardia lamblia and Ascaris lumbricoides remain a public-health problem in resource-limited settings, where conventional microscopy depends on expert personnel and shows variable sensitivity. Artificial intelligence (AI) could standardize and decentralize diagnosis. This study aimed to design and validate FenoParasite, an AI object-detection software (Azure Custom Vision) for the microscopic identification of G. lamblia cysts and trophozoites and A. lumbricoides eggs in stool samples. Methods: Diagnostic-accuracy study. The reference standard was consensus microscopy by two expert readers, with a third reader for discordant cases. An internal validation set (n = 159) and a prospective pilot validation set (n = 31) were analyzed. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy (95% Clopper–Pearson CI), AUC-ROC (bootstrap), and Cohen’s kappa were computed; the confidence threshold was 90%. Results: The model achieved a mAP@0.30 of 98.3% (precision 98.2%; recall 96.4%). In internal validation, G. lamblia showed 100% sensitivity, 98.9% specificity, 99.4% accuracy, and AUC 0.98; A. lumbricoides reached 100% across all indices (AUC 1.00). In the prospective pilot validation, sensitivity and specificity were 100% for both taxa; however, the confidence intervals were very wide (lower sensitivity bounds of 39.8% and 75.3%, based on only 4 and 13 reference-positive specimens, respectively), and these estimates are correspondingly imprecise. Conclusions: FenoParasite showed high agreement with consensus expert microscopy for both a protozoan and a helminth. Because the reference standard was expert microscopy rather than a molecular assay, the reported performance estimates quantify agreement with microscopic reading rather than absolute diagnostic accuracy. These findings remain preliminary. Multicenter validation against molecular reference standards is required before clinical implementation can be considered.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090245

Authors: Hugo O. Valdivia Maria Silva Cristopher D. Cruz Paul Rios Marisa E. Lozano Julia S. Ampuero Yeny Tinoco Jeffrey Spiro Yuliya S. Johnson Alden S. Estep Steev Loyola Carmen Flores-Mendoza Gissella M. Vasquez Jose A. Garcia-Rivera Henju Marjuki

Endemic and (re)emerging infectious diseases pose a major threat to public health and military readiness in Central and South America. The high biodiversity and the differing transmission pathways require the use of highly sensitive methods to track the emergence and spread of these diseases. High-throughput sequencing technologies have become a critical resource for the field of infectious disease monitoring, specifically for tracking pathogen evolution, antimicrobial resistance, and transmission. This review provides an overview of the implementation of genomics-informed infectious disease surveillance conducted by the U.S. Naval Medical Research Unit SOUTH, focusing on operational, infrastructural, and logistical challenges in resource-limited settings and outlining strategies for building sustainable regional capacity. Selected case studies focused on prominent biothreats including dengue, Oropouche, malaria, and antimicrobial resistance demonstrate the significance and applicability of targeted and agnostic sequencing approaches to elucidate transmission pathways, pathogen discovery, and guide public health responses and field-deployable applications.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090244

Authors: Yithenthrathevinair K Paramasivam Nur Syafiqah Mohamad Nasir Mohd Zulkifli Salleh

Mpox has emerged as a global public health concern, highlighting the limitations of traditional vaccinia-based vaccination strategies and the urgent need for precision vaccinology approaches. Advances in structural virology and immunoinformatics have enabled the identification of conserved immunodominant antigens from both mature virion and extracellular virion forms, supporting the development of multivalent antigen combinations capable of inducing broad neutralizing antibody (nAb) responses. Emerging delivery technologies including mRNA-lipid nanoparticles, viral vectors, and self-assembling protein nanoparticles offer rapid scalability, enhanced immunogenicity, and improved safety compared with conventional live-attenuated vaccines. Addressing antigenic evolution, vaccine supply limitations, and population-specific immune variability will be crucial for optimizing vaccine effectiveness. This review synthesizes current evidence on antigen design, vaccine delivery platforms, and immunological correlates of protection to outline a framework for next-generation mpox vaccines. Precision vaccinology therefore represents a transformative strategy for developing durable, clade-specific mpox vaccines and strengthening preparedness against future orthopoxvirus outbreaks worldwide.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090243

Authors: Elodie Monchatre-Leroy Diana Isabela Costescu Strachinaru Oula Itani Sophie Wensierski Alexandre Servat Patrick Soentjens

For deployed military personnel, a single exposure from a rabies-infected animal can become a death sentence. With a case fatality rate approaching 100%, rabies remains a serious, yet insufficiently acknowledged hazard for service members, for whom prevention in operational environments poses unique challenges. We conducted a systematic literature search to identify relevant studies on rabies risk in armed forces personnel. By analysing rabies-related fatalities in the military, this review highlights the operational challenges posed by animal bites during deployment, including underreporting and delayed access to care, which compromise timely post-exposure prophylaxis (PEP) administration. Special emphasis is placed on prevention strategies, including pre-exposure prophylaxis (PrEP) and animal control protocols tailored to military settings. Its aim is to provide a comprehensive, evidence-based resource for healthcare professionals involved in the protection of deployed forces against this ancient yet still deadly infectious disease.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090242

Authors: João Gustavo Mendes Rodrigues Guilherme Silva Miranda Genil Mororó Araújo Camelo Caio Brandão Goes Gouveia Deborah Aparecida Negrão-Corrêa

Strongyloidiasis is a neglected, potentially lifelong disease caused by Strongyloides stercoralis that can lead to a high mortality rate in immunocompromised hosts; therefore, it is necessary to increase the accuracy of infection diagnosis. In the current study, we used Wistar rats experimentally infected with different burdens of Strongyloides venezuelensis to characterize circulating leukocytes and IgM, IgG, IgG1, IgG2a, and IgA reactivity before and after anthelmintic treatment or immunosuppression. Infection, especially with 500 L3, induced an increase in circulating leukocytes, particularly during the acute phase. Animals treated with ivermectin showed complete elimination of the parasite and an early reduction in circulating eosinophils. The production of IgM, IgG, and IgG1 anti-L3 (infective larvae) and anti-Sv (adult worm) antigens was significantly elevated in all infected groups but did not allow differentiation between cured and infected animals. Treatment with dexamethasone delayed worm elimination and temporarily reduced cellular response and parasite-specific IgG production but did not alter IgM reactivity. IgG2a anti-L3 and anti-Sv reactivity showed a progressive reduction, returning to baseline levels in ivermectin-treated rats. IgA anti-ES/L3 (excretory and secretory larval antigens) reactivity significantly decreased in intestinal wash after parasitological cure. These data would help the development of more efficient immunodiagnostic alternatives for human strongyloidiasis based on antibody isotype reactivity.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090241

Authors: Jurairat Jongthawin Aongart Mahittikorn Kinley Wangdi Frederick Ramirez Masangkay Manas Kotepui

Human sarcocystosis is a neglected zoonotic infection caused by protozoa of the genus Sarcocystis. Although sporadic cases and outbreaks have been reported worldwide, the global burden of human infections has not been comprehensively synthesized. This study aimed to estimate the pooled prevalence and global distribution of Sarcocystis infections in humans. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420251159944). PubMed, Scopus, Web of Science, Ovid, Nursing & Allied Health Premium, and Google Scholar were used for retrieving relevant studies. Observational studies published from 2000 onward reporting human Sarcocystis infections confirmed by microscopic and/or molecular methods were included. A random-effects model was used to estimate pooled prevalence. Heterogeneity was assessed using the I2 statistic. Subgroup analyses and meta-regression were performed to explore sources of heterogeneity. Seventeen studies comprising 66,329 participants met the inclusion criteria. The pooled prevalence of human Sarcocystis infection was 0.85% (95% confidence interval [CI]: 0.33–2.19), with substantial heterogeneity (I2 = 98.2%). Prevalence estimates showed marked variation across continents, countries, participant groups, diagnostic methods, Sarcocystis species, and clinical forms of sarcocystosis. Although human Sarcocystis infection appears relatively rare, its prevalence is geographically heterogeneous across studies published between 2000 and 2024. The robustness of the pooled prevalence estimate is limited by the small number of studies, uneven geographical coverage, and substantial heterogeneity. Differences in diagnostic approaches, study populations, infecting species, and disease phenotypes likely contributed to this variability. Enhanced surveillance and standardized application of sensitive molecular diagnostics are essential to better define the epidemiology, burden, and public health significance of human sarcocystosis.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090240

Authors: Qi Yuan Han Shu Yizhi Pan Tianshuo Li Hangyi Shen Weiqi Jiang Zidan Zhu Pengpeng Zhang Ningli Xi Junyi Xin Kai Li Guanqun Sun

Spatio-temporal epidemic forecasting aims to predict future outbreak trajectories across interconnected regions from historical epidemiological observations and meteorological covariates. However, existing approaches often fail to preserve historically salient epidemic states or to fully exploit delayed and region-varying meteorological associations, leading to unstable temporal representations and insufficient meteorological-context-aware spatio-temporal context for prediction at later forecast horizons. In this paper, we propose CASRL, a Climate-Aware Self-Retrospective Representation Learning network for stable and meteorological-context-aware spatio-temporal epidemic forecasting. CASRL first employs a Self-Retrospective Epidemic Encoder (SREE) to retrospectively aggregate historically salient epidemic states through query-guided weighting and adaptive gating, thereby preserving informative historical epidemic states within the look-back window. It then introduces a Climate-Adaptive Graph Message Passing (CAGMP) module that breaks away from traditional passive feature concatenation. Instead, it constructs a separate meteorological-view predictive graph conditioned on the static spatial prior and adaptively fuses it with the incidence-associated topology to model complex cross-regional predictive associations. By integrating self-retrospective epidemic representations with meteorological-view spatio-temporal interactions, CASRL produces forecasts with improved predictive stability at later forecast horizons. Extensive experiments on two public influenza benchmarks show that CASRL is competitive at shorter forecast horizons and provides clearer advantages at later forecast horizons, particularly in phase-alignment-related evaluation and 15-week-ahead forecasting.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090239

Authors: Jalil Nejati Abedin Saghafipour Rubén Bueno-Marí

We thank Asgarian et al [...]

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090238

Authors: Qisheng Hou Xiaoliang Xu Si Liu Chen Sun Fengfeng Zhu Yang Yang Jianchao Shao Yifan Wang Yanqiang Feng Yingxiang Liu Yan Yan Song Wang Yan Wang Cheng Liu

Background: Rabies is an almost universally fatal disease for which post-exposure prophylaxis (PEP), including passive immunization (PI) with rabies immunoglobulin or monoclonal antibodies, remains the only effective intervention. Despite established clinical guidelines, real-world PI utilization remains suboptimal. This study aimed to investigate the prevalence and determinants of PI hesitancy among previously unvaccinated patients with Category III rabies exposure in China. Methods: This multicenter cross-sectional questionnaire study was conducted at 12 rabies PEP clinics or emergency departments in 12 provinces of mainland China. The analysis included 585 previously unvaccinated adults with Category III rabies exposure who initially hesitated to receive or declined PI. The questionnaire collected sociodemographic characteristics, exposure profiles, awareness of the early protection gap, reasons for initial PI hesitancy or refusal, the decision to receive PI during the same clinical encounter, and PI product selection. Multivariable logistic regression identified factors associated with PI treatment decisions, with results reported as adjusted odds ratios (aORs); reason-specific models used the Benjamini–Hochberg false discovery rate correction. All inferential analyses were restricted to adults. Results: Among 5068 eligible previously unvaccinated patients with Category III rabies exposure, 2866 (57%) initially hesitated to receive or declined recommended PI. Of 617 questionnaire respondents, 32 minors were excluded, leaving 585 adults for all inferential analyses. The leading reasons for initial hesitancy were lack of understanding of the immediate protective role of PI (199/585, 34%), belief that vaccination alone was sufficient (194/585, 33%), and high cost (178/585, 30%). During the same clinical encounter, 320/585 adults (55%) chose to receive PI. Awareness of the early protection gap (aOR 2.63, 95% CI 1.75–3.98, p < 0.001) and bachelor’s degree or higher (aOR 1.61, 95% CI 1.07–2.43, p = 0.023) were positively associated with the decision to receive PI, whereas head/face wounds were negatively associated (aOR 0.53, 95% CI 0.30–0.92, p = 0.026). In reason-specific models, lack of knowledge about immediate protection was associated with higher odds of choosing PI (aOR 2.43, 95% CI 1.62–3.68, BH-FDR p < 0.001), whereas high cost was associated with lower odds (aOR 0.41, 95% CI 0.27–0.62, BH-FDR p < 0.001). Conclusion: Hesitancy toward and refusal of PI were observed among previously unvaccinated adults with Category III rabies exposure, yet initial hesitation or refusal is not irreversible. Early protection gap awareness was positively associated with PI choice, whereas cost-related concern was negatively associated. Clear explanation of protection timing and attention to cost-related barriers may support informed PI treatment decisions.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11090237

Authors: Hayley Stratton Callum Pownell Megan Sandeman Patrick Rosengren Cody Price Alexandra G. A. Stewart Roderick Gavey Toni Kinneally Kathy Petoumenos Simon Smith Josh Hanson

Background: The “doxycycline deficiency syndrome” is a colloquial term used in tropical Australia to describe the overlapping, non-specific findings seen in leptospirosis, Q fever, and the rickettsial diseases scrub typhus and Queensland tick typhus (QTT). A laboratory confirmed diagnosis is frequently delayed, however, early differentiation of these potentially life-threatening infections has important implications for clinical management. Methods: We examined consecutive laboratory-confirmed cases of leptospirosis, Q fever, and rickettsial diseases managed at a referral centre in tropical Australia. The patients’ symptoms, clinical signs and simple laboratory and radiology investigations at presentation were compared. Results: There were 111 cases of leptospirosis, 59 cases of Q fever, and 34 cases of rickettsial disease (17 cases of QTT and 17 of scrub typhus). Patients with leptospirosis had a shorter duration of symptoms and were more likely to have gastrointestinal symptoms, arthralgia, haemoptysis, hypotension, conjunctival suffusion and abnormal chest auscultation at presentation than patients with the other infections. They were more likely to have renal impairment and an elevated creatine kinase but less likely to have an elevated serum ferritin and serum lactate dehydrogenase. Patients with leptospirosis were more likely to have alveolar and multilobar changes on chest imaging. Patients with Q fever were more likely to have abnormal liver function tests at presentation but were more likely to have preserved renal function and normal chest imaging. Patients with rickettsial disease were more likely to have a rash, an eschar, lymphadenopathy and splenomegaly. Overall, 76/204 (37%) required ICU admission, of whom 56 (74%) had leptospirosis, but all 204 patients survived to hospital discharge. Conclusions: Leptospirosis, Q fever, and rickettsial diseases can have a similar presentation, but simple clinical, laboratory and imaging findings can help distinguish these infections and expedite their optimal management.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080236

Authors: Tahereh Sadat Asgarian Mohammad Mehdi Sedaghat

In this paper, we critically review the article entitled “Spatiotemporal Patterns and Historical Overview of Aedes Mosquitoes in Iran: A Systematic Review” published in Tropical Medicine and Infectious Disease (2026, 11, 131) [...]

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080235

Authors: Diego Gayoso-Cantero Begoña Monge-Maillo Jose A. Perez-Molina

Autochthonous mucocutaneous leishmaniasis caused by Leishmania infantum is an under-recognised but established manifestation of endemic leishmaniasis in Spain. This review identified 65 confirmed autochthonous cases reported since 1990, showing a relatively consistent clinical pattern. Most patients were adults, predominantly men in the fifth or sixth decade of life. Nearly half were immunosuppressed, mainly due to HIV infection, corticosteroid use, biologic therapy, autoimmune diseases, or solid organ transplantation, although immunocompetent individuals were also affected. The laryngeal, nasal, and oral mucosa were the most commonly involved sites, with occasional tracheal and bronchial disease. Clinical presentation was typically chronic and non-specific, including ulcerative, nodular, polypoid, or tumour-like lesions that frequently mimicked malignancy or inflammatory disorders, often delaying diagnosis. Unlike classical New World mucocutaneous leishmaniasis, Spanish cases generally lacked a preceding cutaneous lesion, supporting recognition as a distinct form of L. infantum infection. Diagnosis required microbiological confirmation, ideally with species identification through culture or molecular methods, while serology showed limited reliability. Treatment approaches varied considerably, reflecting the absence of standardised protocols, although systemic therapy (particularly liposomal amphotericin B) was most commonly used. Improved recognition, surveillance, and inclusion in clinical guidelines are needed to reduce diagnostic delay and therapeutic variability.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080234

Authors: Fernando de la Calle-Prieto Lucía Platero Jorge Ligero-López Marta Díaz-Menéndez Guillermo Ruiz-Carrascoso

This case report highlights how neglected tropical diseases (NTDs) may remain underdiagnosed in high-resource settings despite advanced healthcare systems. We describe an 18-year-old woman from Equatorial Guinea living in Spain who presented with chronic pruritus and episodic ocular symptoms and was ultimately diagnosed with ocular loiasis after the incidental extraction of a conjunctival filaria. Diagnostic evaluation included microscopy, serology, and molecular techniques, confirming Loa loa and Mansonella perstans co-infection alongside evidence of exposure to other parasitic infections. Management involved staged antiparasitic therapy with albendazole, ivermectin, praziquantel, and diethylcarbamazine, combined with corticosteroids to mitigate treatment-related reactions. The patient showed clinical improvement, although follow-up was irregular and microfilaremia persisted. This case illustrates key challenges in non-endemic settings, including low clinical suspicion, fragmented care pathways, and barriers to healthcare access among migrant populations. Despite the availability of sensitive diagnostic tools, delayed recognition remains common when tropical diseases are not considered in the differential diagnosis. Comprehensive, multidisciplinary approaches are essential, particularly in patients from endemic regions who may harbor multiple co-infections. Strengthening clinical awareness, referral pathways, and appropriate screening for NTDs may help reduce diagnostic delays and improve patient outcomes in increasingly globalized healthcare settings.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080233

Authors: Soukaina Khourcha Ines Hilal Iatimad Elbejjaj Mehdi Karkouri Amal Safi Abdelaziz Hmyene Naoual Oukkache

There was an error in the original publication [...]

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080232

Authors: Noumouké Kante Abdoulaye Kuan Traore Lanceï Kaba Nafissatou Ouédraogo Nicolas Barro

Background: Dog-mediated rabies remains a fatal but preventable zoonosis. Its elimination requires sufficient canine vaccination coverage, informed communities, and spatially targeted surveillance. In Guinea, human knowledge, attitudes, and practices (KAP) data and canine serological data had previously been analyzed separately, limiting their translation into operational priorities. Objective: To build an integrated One Health assessment of rabies risk by combining KAP indicators, canine immunity, and spatial analysis. Methods: A secondary integrated analysis was conducted using a KAP survey of 2733 respondents and canine rabies serology from 419 vaccinated dogs tested with the Platelia™ Rabies II ELISA, with a protection threshold set at 0.5 IU/mL. Indicators were regionalized, compared, and incorporated into a vulnerability index. Associations were estimated by logistic regression with 95% confidence intervals, and spatial findings were displayed on a real map of Guinea. Results: Knowledge was insufficient or intermediate among most respondents, unfavorable attitudes reached 88.84%, and poor practices reached 73.80%. Declared canine vaccination coverage remained below the 70% programmatic threshold in all regions. Overall canine seroprotection was high (88.78%), but 11.22% of dogs remained insufficiently protected. Among dog owners, knowledge of rabies was associated with dog vaccination (OR = 2.77; 95% CI: 1.49–6.29). The integrated One Health assessment ranked Kindia as priority 1, Siguiri as priority 2, Boké and Labé as priority 3, and N’Zérékoré as priority 4. Conclusions: The integrated analysis shows that a strong immune response among vaccinated dogs is not sufficient when coverage, human practices, and the spatial distribution of risk remain heterogeneous. The recommended strategy is a regionally differentiated intervention combining post-exposure education, proximity-based dog vaccination, and targeted surveillance.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080231

Authors: Sarbhan Singh Nuur Hafizah Md. Iderus Lonny Chen Rong Qi Ahmad Sumarni Mohd Ghazali Nur’ain Mohd Ghazali Mohd Nadzmi Md Nadzri Asrul Anuar Mohd Kamarulariffin Kamarudin Lim Mei Cheng Teh Chien Huey Chong Zhuo Lin Wan Ming Keong Chew Cheng Hoon

Endemic channels are widely used in dengue surveillance to detect unusual increases in case counts. However, conventional approaches that rely on historical averages with fixed standard deviation (SD)-based multipliers may produce unstable thresholds and false alerts. This study compared a conventional SD-based endemic channel with a log-scale SD-based endemic channel incorporating an enhanced alert rule to identify the optimal approach for routine dengue surveillance in Malaysia. Weekly national dengue case data from 2014 to 2024 were analyzed. A rolling validation approach was used to evaluate outbreak detection performance from 2017 to 2023 using three-year historical baselines. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and the Youden Index were calculated and pooled across the validation years. The optimal multiplier was selected based on the highest pooled Youden Index using the rolling validation period (2017–2023). The selected approach was then applied independently to the 2024 surveillance data as an operational demonstration of its potential use in routine dengue surveillance. A total of 260 epidemiological weeks were analyzed, of which 42 (16.2%) were classified as outbreak weeks. The log-scale SD-based endemic channel incorporating an enhanced alert rule achieved the highest pooled Youden Index of 0.43 at the optimal multiplier of 0.50. At this multiplier, sensitivity was 0.60, specificity 0.82, positive predictive value 0.35, negative predictive value 0.93, and overall accuracy 0.79. Compared with the conventional SD-based endemic channel at its optimal multiplier (1.00), the proposed approach demonstrated improved sensitivity (0.60 vs. 0.56), specificity (0.82 vs. 0.70), positive predictive value (0.35 vs. 0.23), negative predictive value (0.93 vs. 0.91), accuracy (0.79 vs. 0.68), and Youden Index (0.43 vs. 0.26). The log-scale SD-based endemic channel incorporating an enhanced alert rule demonstrated superior overall outbreak detection performance and was selected as the optimal approach for routine dengue surveillance.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080230

Authors: Zanele Bennedict Nomatshila Guillermo Alfredo Pulido Estrada Sibusiso Cyprian Nomatshila Teke Ruffin Apalata

Background: Alcohol and tobacco use remain important public health concerns among people living with HIV (PLWH), even after achieving viral load suppression. This study examined the socio-demographic factors associated with alcohol and tobacco use among virally suppressed PLWH in the Eastern Cape Province, South Africa. Methods: A cross-sectional study was conducted among 244 adults receiving antiretroviral therapy with suppressed viral loads at public healthcare facilities in the Eastern Cape Province. Data were collected using the Alcohol Use Disorders Identification Test (AUDIT) and the WHO STEPwise questionnaire. Alcohol use was classified according to the AUDIT, and participants were further categorised into low-risk (AUDIT score < 8) and risky drinking (AUDIT score ≥ 8) for regression analyses. Associations between socio-demographic characteristics and alcohol use were initially examined using cross-tabulations and exact tests where appropriate. Univariable and multivariable binary logistic regression analyses were subsequently performed to identify factors independently associated with risky alcohol use and smoking. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, with statistical significance set at p < 0.05. Results: Of the 244 participants, 57.0% were female, and 61.5% were employed. Based on the total AUDIT score, 60.2% of participants were classified as risky drinkers, while 44.3% were current smokers. In the multivariable analysis, employment was independently associated with risky alcohol use (AOR = 2.03, 95% CI: 1.11–3.73) and current smoking (AOR = 3.75, 95% CI: 1.98–7.08). Compared with single participants, married (AOR = 2.61, 95% CI: 1.25–5.45), separated (AOR = 5.19, 95% CI: 1.98–13.60), and divorced participants (AOR = 3.32, 95% CI: 1.05–10.49) had higher odds of risky alcohol use. Conclusion: Alcohol use and tobacco smoking remain common among virally suppressed PLWH in the Eastern Cape Province. Although viral load suppression is an important treatment outcome, it does not fully reflect broader health behaviours that may compromise long-term health. Integrating routine screening for alcohol and tobacco use, together with targeted behavioural interventions and harm reduction strategies, into comprehensive HIV care may improve long-term health outcomes.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080229

Authors: Darrel Ornelle Elion Assiana Hugues Check Asken Traoré Franck Hardain Okemba-Okombi Emmanuel Fonfon Ebata-Mboussa Freisnel Hermeland Mouzinga Erudit Beny Elenga Asta-Wabi Fozia Hamed Belo Mary Vincent Pabie Passy Mambou Juliette Burchelle Ayessa Ondzie Alain Disu Kamalandua Tanou Joseph Kalivogui Romeance Juvick Lepoupou Bermeland Ewuinh Tsiobinda Edrene Likoyo Mampouyath Rachel Laure Nguela Viviane Gisele Lompo Ouedraogo Prudence Théoline Ovoulaka Jessica Jeielle Ayande Jacques Ndion Ngandzien Baurel Arnaud Akiera Salomon Tchuandom Bonsi Jean Akiana

Background: Limited access to rapid molecular diagnostics remains a major barrier to timely tuberculosis (TB) detection and drug-resistance surveillance in resource-constrained settings. In the Republic of Congo, GeneXpert MTB/RIF platforms remain concentrated in a few laboratories, while peripheral facilities rely predominantly on smear microscopy, highlighting the need for a structured sample referral system. Methods: We conducted a three-year mixed-methods operational study comprising a six-month pilot phase (January–June 2023), initially enrolling 29 TB diagnostic and treatment centers in urban and rural settings followed by a 30-month national roll-out phase (July 2023–December 2025), evaluated retrospectively using routine programmatic surveillance data. Results: During the pilot phase, 962 sputum samples were transported. 294 (30.6%) were TB cases, including 12 (4.1%) RR-TB. Median total turnaround time was 53 h (19–168) in urban and 62 h (26–204) in rural, with 86% overall site participation (92% urban vs. 60% rural). During scale-up, samples increased from 2154 (2023) to 5160 (2024), achieving full national coverage (12/12 departments). Over three years, 2587 TB and 84 RR-TB cases were detected. The system’s contribution to national TB detection grew from 9.2% to 16.0%, and RR-TB detection from 10.4% to 18.7%. Conclusions: Implementation of the structured sample referral system was associated with improved equitable access to molecular TB diagnosis, turnaround times within national targets, and strengthened the RR-TB surveillance. Scalable transport networks integrated into national guidelines may enhance diagnostic equity and drug-resistance detection in centralized laboratory systems.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080228

Authors: Kim Dianne B. Ligue-Sabio Yoni Nazarathy Kien Quoc Do Luis Furuya-Kanamori Yusuf A. Sucol Benn Sartorius Colleen L. Lau

African swine fever (ASF) is a viral disease of domestic and wild pigs that has re-emerged as a major transboundary disease. Modelling using mechanistic, statistical, and machine learning (ML) approaches plays a key role in understanding ASF transmission and informing disease control, but the literature remains fragmented. To synthesise global ASF modelling efforts, we systematically reviewed studies applying these three approaches. We examined temporal and geographic trends, modelling objectives, explanatory variables, and model evaluation practices. A total of 151 papers published through 2024 met the inclusion criteria. Mechanistic (54.3%) and statistical (40.4%) approaches predominated, whereas ML (9.3%) was increasingly applied in recent years. Mechanistic models were primarily used to assess control strategies (48.8%) and transmission drivers (41.5%), statistical models to identify risk factors (63.9%) and spatiotemporal spread (32.8%), and ML for environmental suitability modelling (64.3%). Most were published from 2011 (99.3%) and focused on Europe (43.0%) and Asia (26.5%). Model evaluation remained inconsistent, with mechanistic papers frequently lacking model output uncertainty quantification (47.0%) and statistical papers often omitting model adequacy assessment (49.2%) and assumption checking (50.8%). Overall, ASF modelling approaches have developed complementary methodological roles, while geographic underrepresentation, limited representation of some transmission pathways, and inconsistent model evaluation remain important gaps.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080227

Authors: Mohammad Reza Mahmoudi Zahra Naemi Meysam Sharifdini Nozhat Zebardast Somayeh Abbaszadeh Panagiotis Karanis

Background: Blastocystis sp. is an anaerobic intestinal protozoan with extensive genetic diversity and controversial pathogenicity. The distribution and molecular subtypes of this entity in Guilan province, northern Iran, remain under-investigated. Objective: This study aimed to determine the prevalence and molecular subtypes of Blastocystis sp. in Rasht, Guilan Province, Iran. Methods: In this cross-sectional study (2023–2024), 300 stool samples were collected from patients referred to the medical laboratory at Razi Hospital. Microscopic examination and PCR amplification targeting the SSU rDNA gene were performed. Sequencing was performed on the positive isolates, and subtyping was achieved through BLAST alignment and subsequent phylogenetic analysis. Results: The overall prevalence of Blastocystis sp. was 12.3% (n = 37). No significant associations were found between infection and age, sex, or place of residence (p > 0.05). Molecular characterisation (23.08%). No statistically significant correlation was observed between subtypes and clinical symptoms, although ST1 and ST7 were more frequently detected in symptomatic individuals. Conclusions: Blastocystis sp. showed notable subtype diversity in the studied population, including the potentially zoonotic ST7. However, no significant association was found between subtypes and clinical manifestations. These findings support sustained molecular epidemiological surveillance and larger-scale studies to clarify subtype-specific pathogenesis and transmission dynamics.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080226

Authors: Ahmad Y. Alqassim

Rift Valley fever (RVF) is a climate-sensitive mosquito-borne zoonosis long regarded as a rural, pastoral disease, yet accelerating tropical urbanization and intensifying climate variability may be reshaping its epidemiology at the urban–peri-urban interface. This narrative review examines how global climate change and urban-specific climatic conditions jointly shape RVF virus (RVFV) vector habitats, transmission, and burden in tropical and subtropical cities, synthesizing 51 of 412 English-language records identified by a structured, non-systematic search of PubMed, Scopus, Web of Science, and Google Scholar (2009–2026) and selected for relevance to urban and peri-urban RVF. This research draws on human, livestock, and vector evidence from Sub-Saharan Africa, the Arabian Peninsula, and Indian Ocean islands across epidemic and inter-epidemic periods. The synthesis indicates that impervious surfaces, poor drainage, and open water storage can recreate the water-retaining function of rural dambos, sustaining a year-round larval habitat, and that Culex quinquefasciatus dominance together with peri-urban cattle may form an amplification bridge to humans. Direct evidence remains scarce, anchored by a single peri-urban serosurvey and limited urban slaughterhouse entomology. Critical gaps include urban primary-vector ecology, infection-rate data, urban-heat effects, city-specific exposure studies, and coupled climate–urban burden models. We conclude that RVF is a plausible emerging urban threat warranting proactive inter-epidemic surveillance and integration of RVF into urban planning and One Health systems.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080225

Authors: Tawanda Mapuranga Collins Timire Ronald T. Ncube Sithabiso Dube Nqobile Mlilo Cynthia Chiteve Owen Mugurungi Tsitsi Mutasa-Apollo Fungai Kavenga Clorata Gwanzura Manners Ncube Nicholas Siziba Selma Dar Berger Talent Maphosa Macarthur Charles Riitta A. Dlodlo Julia Ershova

People living with HIV (PLHIV) are at an increased risk of progressing from Mycobacterium tuberculosis (TB) infection to TB disease. Tuberculosis preventive treatment (TPT) is recommended for PLHIV; however, its uptake remains suboptimal. In Zimbabwe, three months of weekly rifapentine and isoniazid (3HP) and six months of daily isoniazid (6H) are the most commonly prescribed TPT regimens. We explored barriers to TPT uptake among PLHIV from the perspective of healthcare workers (HCWs) in Zimbabwe. Facility nurses who had been implementing TPT for at least six months were invited to participate in in-depth interviews and/or focus group discussions conducted in March 2023. Audio recordings were transcribed into English, coded using NVivo 12 (QSR International), and analyzed thematically. Eleven HCWs participated in in-depth interviews and 15 in focus group discussions. Barriers were categorized as person- and health system-related. Person-related barriers included misconceptions about TPT, fear of adverse events, and pill burden. Health system barriers included stock-outs of TPT medications, limited HCW knowledge and skills to promote TPT, limited expertise in initiating TPT among children under five years of age, and limited access to chest radiography. Barriers to TPT uptake and completion remain in Zimbabwe and contribute to missed opportunities for TB prevention among PLHIV. TPT implementation could be strengthened through an uninterrupted supply of TPT medications, continuous training and mentorship of HCWs, and community engagement to improve awareness of the benefits and risks of TPT.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080224

Authors: Aldo Rodrigues da Silva Ana Cláudia Rodrigues da Silva Eladio Flores Sanchez Gabriel Alves Souto de Aquino Vitor Francisco Ferreira Sabrina Baptista Ferreira André Lopes Fuly

(1) Background: Snake bite envenomation is a neglected disease that affects impoverished and rural areas, causing deaths and physical sequelae. (2) Objective: A novel series of eight 1,2,3-triazole compounds, AM50, AM51, AM52, AM53, AM54, AM55, AM56, and AM57, were synthesized and assessed as inhibitors of toxic activities of B. jararacussu venom. Methods: B. jararacussu venom was pre-incubated with each of the compounds and after the coagulant, proteolytic, hemorrhagic, edematogenic, and lethal activities were assessed. The structure of compounds was analyzed by NMR and FT-IR spectroscopy techniques, and toxicity was predicted through OSIRIS and SwissADME. (3) Results: AM56 and AM57 inhibited the plasma coagulant and prevented hemorrhagic activity of the venom. Proteolysis and hemorrhage were inhibited by AM52, AM54, AM55, and AM56 (20–30%), as well as AM50, AM51, and AM57 (30–60%). AM57 fully protected the mice from death caused by venom, and AM50, AM53–AM57 inhibited edema of venom by 10–20%; AM51 and AM52 did not inhibit edema. In silico analysis of compounds revealed satisfactory parameters for drug discovery. (4) Conclusions: 1,2,3–triazole compounds inhibited the major toxic activities of B. jararacussu venom and should be considered as a lead for further investigation as adjunct of antivenom therapeutics.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080223

Authors: Paola Rey-Suárez Jonard David Echavarría-Rentería Jeisson Gómez-Robles Jaime Andrés Pereañez Mónica Saldarriaga-Córdoba Bruno Lomonte Julián Fernández Vitelbina Núñez

Coral snakes of the American continent are classified into two genera, Micruroides and Micrurus, with as many as 91 species recognized in the latter. Although envenomings caused by Micrurus are rare, they can be life-threatening due to neurotoxic effects leading to flaccid paralysis and potential respiratory failure. Micrurus ancoralis is found in the Pacific lowlands and along the western slope of the cordillera occidental Cordillera in Colombia. Although this species is relatively common within its distribution range, its phylogenetic position and the characterization of its venom have not been investigated. The results of phylogenetic analysis placed M. ancoralis within the triadal/bicolor clade of species with the characteristic triad pattern and group bicolor. Proteomic characterization of the venom showed predominance of phospholipase A2 (PLA2) enzymes in its composition, with 51.7% of the total protein content, followed by three-finger toxins (3FTxs; 23.2%) and lower proportions of proteins belonging to several other minor families. Out of 28 chromatographic venom fractions obtained, the seven most abundant were evaluated for toxicity, with three of them (F7, identified as a 3FTx, and F18 and F20 (both identified as PLA2s)) showing lethal activity by the intraperitoneal route in mice. The PLA2 activity of F20 was confirmed and its edema-inducing, myotoxic, and lethal effects in mice were demonstrated. A therapeutic equine anti-coral antivenom (INS, Colombia) against coral snake envenomings immunorecognized the whole venom and its fractions in ELISA tests and was able to neutralize 2 × LD50 (medial lethal dose) of M. ancoralis venom by preincubation, with an estimated potency of at least 0.2 mg venom/mL antivenom. This result suggests that envenomings by M. ancoralis could be effectively treated by this antivenom.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080222

Authors: Hongquan Chen Shiyi Wang Min Yuan Zhiguo Liu Zhenjun Li

Klebsiella pneumoniae (K. pneumoniae) is a leading cause of hospital- and community-acquired lower respiratory infections (LRI). The emergence of antimicrobial resistance (AMR), especially carbapenem-resistant strains (CRKP), poses a serious global health threat. Using Global Burden of Disease (GBD) 2021 data, we estimated AMR-related mortality for K. pneumoniae-associated LRI across regions from 1990 to 2021. Joinpoint regression analysis identified temporal trends. Global mortality declined overall, with a 70% reduction in under-5 deaths but a doubling among adults over 70 years. Deaths associated with and attributable to AMR decreased by 18.9% and 4.5%, respectively. The age-standardized mortality rate (ASMR) fell by nearly 50%. In contrast, the mortality burden associated with carbapenem resistance increased markedly, with AMR-associated deaths rising by 157% and disproportionately affecting high-burden regions such as Sub-Saharan Africa and South Asia. Despite overall progress, the increasing mortality burden associated with carbapenem resistance in K. pneumoniae-associated LRI poses a critical and persistent global health threat.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080221

Authors: Yann Hervigo Cornelia Staehelin Olivia Veit François Chappuis Gilles Eperon Stefano Musumeci

Background: Chikungunya virus (CHIKV) infection is an emerging disease of growing concern to international travelers due to the expanding geographic distribution of competent vectors, climate change, and frequent outbreaks in endemic and previously unaffected regions. Until recently, prevention relied exclusively on vector control and bite prevention; however, the recent approval of chikungunya vaccines has introduced a new preventive strategy. Methods: We conducted a narrative review of currently licensed chikungunya vaccines and candidates in clinical development, focusing on immunogenicity, safety, regulatory status, and implications for travel medicine practice. Results: Two vaccines have recently received regulatory approval: the live-attenuated vaccine IXCHIQ® and the virus-like particle vaccine Vimkunya®. Both demonstrated high immunogenicity based on neutralizing antibody thresholds accepted as surrogate markers of protection. Post-marketing safety signals associated with IXCHIQ®, particularly in older adults, have led to divergent regulatory decisions between authorities. The indication of vaccination in national recommendations varies somewhat depending on age, duration of travel, and individual risk factors. Several additional vaccine platforms remain under investigation, although some candidates have been discontinued. Conclusions: The recent approval of chikungunya vaccines marks a significant milestone in the field of travel medicine. However, uncertainties regarding long-term protection, safety in specific populations, and optimal targeting of travelers remain. Individualized risk–benefit assessment is essential, and further data are needed to refine vaccination strategies for travelers and populations at risk.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080220

Authors: Nelsensius Klau Fauk

Antiretroviral therapy (ART) is essential for preventing HIV transmission and improving the health outcomes of people living with HIV (PLHIV). However, many barriers limit PLHIV from starting and adhering to ART, which explains why HIV responses in many settings, including Indonesia, have produced limited gains. This qualitative phenomenological study explored multilevel barriers to ART adherence in urban Yogyakarta (locally known as Jogja) and rural Belu, Indonesia, from the perspectives of PLHIV and healthcare professionals (HCPs). Data were collected through one-on-one in-depth interviews with 92 PLHIV and 20 HCPs. Participants were recruited using the snowball sampling technique. Data were analysed using framework analysis informed by the Access to Healthcare Framework. The findings showed that PLHIV in Belu and Jogja had different experiences in terms of the provision of and ability to access and adhere to ART or HIV treatment. In rural Belu, ART was less available and visible, harder to approach, often unaffordable, less aligned with patients’ needs, and strongly influenced by the widespread use of traditional medicine. PLHIV in Belu also reported a more limited ability to perceive the need for ART, reach services, pay costs, engage in care, and seek ART than those in urban Jogja. Personal, psychological, and social barriers were also reported to hinder PLHIV’s ART adherence in both settings. These findings highlight the need for HIV policies that promote the equitable distribution of ART services and targeted interventions to improve understanding and acceptance of HIV care among PLHIV and the wider community.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080219

Authors: Elisa Alcántara-Henríquez Hugo O. Valdivia Gissella M. Vásquez Joel García Estela Guevara Juan F. Sanchez Adalid Palma Arnold Houghton Allan Iván Izaguirre González Marcia D. Laurenti Wilfredo Sosa-Ochoa

Integrated One Health studies are essential for assessing the risks of leishmaniasis transmission. In Honduras, the most prevalent clinical presentation of leishmaniasis is the non-ulcerated cutaneous form caused by Leishmania infantum; however, research on its transmission dynamics remains limited. This study aimed to characterize the eco-epidemiology of leishmaniasis and identify potential zoonotic risk factors in the municipality of Ojos de Agua, Department of Comayagua, central Honduras, using a One Health approach. We collected sand flies using CDC light traps placed in intra- and peridomestic settings of households with a history of leishmaniasis. Concurrently, we evaluated domestic dogs and collected blood samples for serological and molecular testing. We also conducted active surveillance among community residents to identify human infections. We collected a total of 644 phlebotomine sand flies, including 186 females. We identified eight sandfly species, with Lutzomyia (Lutzomyia) longipalpis as the predominant species, followed by Pintomyia (Pifanomyia) evansi. Among the 64 engorged females screened, the overall PCR positivity rate for Leishmania spp. was 14.1% (9/64). Blood meal analysis of PCR-positive sand flies identified humans and pigs as blood and meal sources. Additionally, 18.6% (8/43) of domestic dogs were seropositive for Leishmania spp., and 23.3% (10/43) tested positive by PCR. DNA sequencing identified the infecting species as Leishmania infantum. We detected no active human cases during the study period. These findings highlight the value of a One Health approach for improving transmission risk monitoring in newly emerging areas with a history of ulcerative cutaneous leishmaniasis in Honduras.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080218

Authors: Barry R. Davis John Dunn Lisette V. Alcantara Dennis G. Maki Timothy D. Dye Charles H. Hennekens

Guinea worm disease is approaching eradication, with only 10 human cases reported worldwide in 2025, the lowest annual total recorded. Yet the final phase of eradication presents complex clinical and public health challenges that differ from earlier stages of control. Persistent animal infections, particularly in dogs, civil conflict, fragile health systems, financing disruptions, and the need for prolonged surveillance threaten progress at the point when global attention may wane. Unlike smallpox, Guinea worm has been driven to near-eradication without a vaccine, curative drug, or rapid diagnostic test, relying instead on safe water, filtration, vector control, case containment, community education, reporting incentives, and sustained field operations. This Perspective argues that eradication remains achievable but requires a specific policy agenda: protected financing for surveillance, animal-source transmission control, safe-water measures, operational access, and certification through 2030. Completing the final mile would represent a permanent preventive achievement and a durable victory for neglected populations too often overlooked.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080217

Authors: Violeta Briciu Mihaela Lupşe Adrian Baican Bogdan Fetica Angela Monica Ionică Georgiana Coroiu Mirela Flonta Andreea Jodal Vladimir Filip Oana Stan Dana Marcu Andrada-Luciana Lazar Carmen Varodi Corina Baican

Although in Romania an increase in migrant population has been reported in the last years, there are no screening programs for infectious diseases implemented for migrants. We report the first two cases of leprosy (Hansen’s disease) since 1981 and the first imported ones in Romania, in two sisters originating from Indonesia, employed as massage therapists at a SPA center. Case one was diagnosed with multibacillary Hansen’s disease of mid-borderline type, and case two with paucibacillary Hansen’s disease borderline tuberculoid form based on epidemiological, clinical, histopathological and molecular diagnosis. Both patients have started multidrug therapy with dapsone, rifampicin and clofazimine provided by WHO. Both patients developed dapsone induced anemia under therapy, even though no G6PD deficiency was present, and dapsone was stopped. The clinical evolution of skin lesions was favorable under therapy, and the haemoglobin level started to increase after dapsone was stopped. This publication underlines the risk of importing rare diseases in Romania and in other European countries and the delay in diagnosis due to insufficient awareness among occupational medicine doctors. Improved strategies are needed at national level in order to increase awareness on rare imported infectious diseases and introduce screening programs in migrant population from high-risk areas.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080216

Authors: Fatalmoudou Tandina Safiatou Niare Doumbo Moussa Djimdé Sékou Sissoko Privat Agniwo Amagoron Mathias Dolo Abdrahamane S. Kamaté Amatigue Zeguime Salif Yirampo Boucary Ouologuem Aichata Dembélé Hawa Dembélé Mohamed Touré Abdoulaye Kaloga Francois Dao Siaka Goita Mamadou M. Tekete Mahamadou A. Thera Abdoulaye K. Koné Abdoulaye A. Djimdé Laurent Dembele

The widespread circulation of the Anopheles vector is observed during the rainy season and clearly decreases during the dry season, when only a few mosquitoes are able to survive. This study aimed to identify the major species sustaining continued malaria transmission across seasons. This cross-sectional study was conducted in a malaria-endemic area. Mosquitoes were captured in Faladie using pyrethroid spray catches during rainy and dry seasons. The collected mosquitoes were identified using morphological keys, combined with molecular techniques such as PCR-RFLP (IGS regions) for Anopheles (An.) gambiae s.l. identification. Plasmodium spp. positivity in each mosquito was characterized by qPCR using parasite 18 S genes. A total of 1082 and 1705 mosquitoes were captured inside the same houses in the rainy and dry seasons, respectively. In the rainy season, 454 (41.9%) were Anopheles, 624 (57.7%) Culex and 4 (0.4%) Aedes. During the dry season, 65 (3.81%) mosquitoes were Anopheles, while 1,640 (96.19%) were Culex. Morphologically, the anopheline population consisted of 100% An. gambiae s.l. The Anopheles species diversity in the rainy season comprised the sister taxa, An. gambiae s.s. and An. Coluzzii, followed by an An. gambiae/An. coluzzii hybrid and An. arabiensis. However, An. coluzzii was found as the only vector across the rainy and dry seasons that sustained malaria transmission. Plasmodium falciparum infection rates were 9.7% and 1.7%, respectively, for the rainy and dry seasons. An. coluzzii species can survive both the dry and the rainy seasons and sustain malaria through cross-seasonal transmission. This highlights the importance of tackling An. coluzzii species and residual malaria transmission to eradicate the disease in endemic areas.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080215

Authors: Wijitra Phaengkha Pornjarim Nilyanimit Nungruthai Suntronwong Jiratchaya Puenpa Duong Hoang Huy Le Saranya Ngamnimit Pattama Janpathip Lapasrada Kamput Kawin Thongnoi Wanalee Toomta Phatcha Wohanklong Jarunlak Saokeaw Niphapornt Thammajit Suwannee Rerngleum Ananyalak Yoisara Nitiya Srisuk Jidapa Suwannachat Anchalee Karagate Rujipat Wasitthankasem Yong Poovorawan

The World Health Organization targets hepatitis C virus (HCV) elimination as a public-health threat by 2030. Phetchabun province, in lower northern Thailand, has historically reported one of the country’s highest HCV seroprevalence rates. We describe a province-wide, decentralized test-to-treat micro-elimination program implemented within Thailand’s universal health-coverage system. Adults aged 35–64 years (2020–2024) and individuals born before 1992 (late 2023) across all 11 districts were screened using fingerstick anti-HCV rapid diagnostic tests at sub-district health-promoting hospitals. Reactive participants underwent confirmatory HCV-RNA testing at three regional nodes. Eligible patients received pangenotypic sofosbuvir/velpatasvir for 12 weeks, with ribavirin added for cirrhosis. Sustained virological response at 12 weeks post-treatment (SVR12) was the primary outcome. Of 400,567 targeted individuals, 389,547 (97.3%) were screened; 18,340 (4.71%) were anti-HCV reactive. Confirmatory HCV-RNA testing was completed in 14,845 (80.9%), of whom 10,996 (74.1%) had active infection. Of 8961 treatment-eligible patients, 8842 (98.7%) received DAA therapy. Among 6719 evaluable for SVR12, 6474 (96.4%) achieved cure. This simplified, domestically financed, decentralized test-to-treat model achieved WHO-target-level diagnosis, treatment, and cure rates at provincial scale, offering a scalable framework for HCV micro-elimination in low- and middle-income countries.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080214

Authors: Kannamkottapilly Chandrasekharan Prajitha Anam Anil Alwani Pruthu Thekkur

Tuberculosis (TB) remains a leading cause of infectious disease-related mortality worldwide despite major advances in diagnostics, treatment, and programmatic control. Achieving the goals of the World Health Organization End TB Strategy requires a greater emphasis on prevention alongside improvements in diagnosis and treatment. This viewpoint examines evolving priorities in TB prevention and highlights key insights from studies included in the Special Issue ‘New Perspectives in Tuberculosis Prevention and Control’. The articles published in the Special Issue highlight the importance of identifying populations at increased risk of infection, disease transmission, and disease progression; strengthening the implementation of tuberculosis preventive treatment among household contacts and people living with HIV; and addressing the behavioral, social, and structural determinants that influence access to TB prevention and care. They also demonstrate persistent challenges related to medicine availability, healthcare worker capacity, patient initiation and follow-up, program monitoring, and the implementation of preventive interventions in resource-constrained settings. Emerging developments in diagnostics, biomarkers, vaccines, and digital health may contribute to the longer-term TB prevention agenda but require further evaluation of their feasibility, affordability, and programmatic relevance. Collectively, the evidence indicates that effective TB prevention extends beyond individual biomedical interventions and requires coordinated approaches involving healthcare systems, communities, surveillance systems, and social support mechanisms. Continued investment in implementation research, health-system strengthening, program management, economic evaluation, and multisectoral action will be critical to translate existing evidence into sustainable, equitable, and context-specific strategies for reducing the global burden of TB.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080213

Authors: Guillermo Eduardo Cuéllar-Nevárez José Rafael Linares Morales Luis Arturo Camacho Silvas Sandra Guadalupe Chavarría Hidalgo Guadalupe Virginia Nevárez-Moorillón Karla Elva Loza Solano

Tuberculosis (TB) remains a leading cause of morbidity and mortality among people living with human immunodeficiency virus (HIV), in whom immunosuppression often results in atypical clinical manifestations, paucibacillary disease, extrapulmonary involvement, and disseminated forms that complicate timely diagnosis. This narrative review summarizes current and emerging diagnostic approaches for TB-HIV, with emphasis on their diagnostic performance, clinical applicability, implementation challenges, and potential integration into future algorithms. Conventional methods, including sputum smear microscopy, mycobacterial culture, and chest radiography, remain relevant but have important limitations in people living with HIV (PLHIV), particularly in advanced immunosuppression. Rapid molecular tests, especially Xpert MTB/RIF and Xpert MTB/RIF Ultra, have improved early detection of Mycobacterium tuberculosis and rifampicin resistance, although diagnostic gaps persist in sputum-scarce and extrapulmonary disease. Non-sputum-based tests, particularly WHO-recommended urine LF-LAM and emerging next-generation assays such as FujiLAM II, offer important opportunities for severely ill patients and those with advanced HIV disease. Host-derived biomarkers, transcriptomic signatures, and artificial intelligence-assisted chest imaging may further strengthen screening, triage, and diagnostic prioritization. Integrated, context-adapted diagnostic algorithms combining microbiological, molecular, urinary, imaging, and host-response tools are needed to improve early TB detection and reduce mortality in resource-limited settings.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080212

Authors: Zilian Cao Fang Xu Xiaoyan Huang Yifeng Shen Xin Xin Lin Ai Hao Pan Huanyu Wu

Introduction: Historically, human infections with clade Ia monkeypox virus (MPXV) primarily occurred through zoonotic transmission with limited secondary human-to-human transmission. Recent studies suggest increasing evidence of human-to-human transmission of some clade Ia lineages. This report documents the first imported clade Ia mpox case in Shanghai, representing the second documented case in China. Methods: Patient demographics, clinical profiles, epidemiological history, and close contacts were obtained through interviews with the patient and attending physicians. Clinical specimens were collected for real-time fluorescent quantitative polymerase chain reaction (qPCR) and whole-genome sequencing. Contact tracing was implemented, involving a 21-day health monitoring of close contacts. Results: The patient presented with moderate symptoms, including fever, rash, and respiratory manifestations. Genome sequencing identified the virus as clade Ia, showing 99.96% nucleotide identity to a strain from the Democratic Republic of Congo (DRC). Eight close contacts were identified with no secondary infection reported. Conclusions: This case was confirmed as an imported clade Ia mpox case originating in the DRC. The “four JOINTs” cross-agency collaborative mechanism between the CDC and customs played a significant role in effectively stopping local transmission. Challenges in remote investigation highlight the need for stronger international collaboration. Establishing an integrated “early warning-control-tracking” system, coupled with public health intervention, is crucial for reducing importation risks and safeguarding national health security.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080211

Authors: Gaetano Maffongelli Andrea Bongiovanni Alessandra D’Abramo Erica Binetti Laura Scorzolini Claudia Palazzolo Gabriella De Carli Alessandro Agresta Francesco Vairo Emanuele Nicastri

In 2025, Rome hosted the Catholic Jubilee, recording over 33 million cumulative pilgrim attendances while simultaneously facing the death of Pope Francis, the election of Pope Leo XIV, and a regional West Nile Virus (WNV) outbreak. This commentary describes the Lazio Region’s preparedness strategy, based on adapting an existing Hub-and-Spoke infectious diseases network integrating surveillance with Regional Service for Epidemiology, Surveillance and Control of Infectious Diseases (SERESMI) laboratory support, telemedicine, and clinical management. Preparatory measures included an additional Hub, updated syndromic pathways, multidisciplinary coordination, and enhanced surveillance. Emergency department visits increased by 14.8%, while the proportion of infectious syndromes remained stable. This experience highlights the potential value of strengthening existing healthcare networks for mass gathering preparedness.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080210

Authors: Júlia dos Santos Silva Cecilia Ferreira de Mello Shayenne Olsson Freitas Silva Amanda Queiroz Bastos Ana Laura Carbajal-de-la-Fuente Thamires Rezende Araújo Jeronimo Alencar

Understanding mosquito diversity in natural environments under anthropogenic influence or undergoing vegetation recovery is essential for comprehending potential behavioral changes and adaptations in the activity patterns of these populations. Within this context, this study aimed to investigate the oviposition activity, seasonal abundance, hatching dynamics, and sex ratio of medically important Culicidae species using ovitraps as an entomological surveillance tool, with special attention to Haemagogus leucocelaenus, Aedes terrens, and Aedes albopictus, and to analyze their distribution within an agroforestry area. The study was conducted at Sítio Terra Boa, a rural property managed under an agroforestry system, in the municipality of Silva Jardim, state of Rio de Janeiro, Brazil, between August 2021 and June 2025. Ten ovitraps were installed at a height of approximately 2 m above ground level and randomly distributed around an area cultivated with açaí (Euterpe oleracea) and peach palm (Bactris gasipaes). Collections were conducted monthly, and the paddles were replaced and subsequently sent to the laboratory for analysis. The 47-month study provided valuable data regarding the ecology of these species in an agroforestry environment. Haemagogus leucocelaenus was the dominant species throughout the study, and mosquito abundance peaked during the warmer months, particularly from December to April. The results revealed seasonal fluctuations in populations, species-specific oviposition patterns in response to environmental changes, displacement of sylvatic species such as Hg. leucocelaenus toward anthropized areas, and the expansion of urban vectors such as Ae. albopictus into forest matrices. The higher abundance of Hg. leucocelaenus in the ovitraps suggests that this species may persist in agroforestry areas; however, comparative studies across different landscape types are needed to evaluate its ecological adaptation. The coexistence of Haemagogus and Aedes species within the same forest fragment under anthropogenic interference reinforces the need for continuous entomological surveillance in these environments. These findings contribute to understanding vector ecology in recovering Atlantic Forest environments and provide support for future control programs.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080209

Authors: Enos Moyo Endalkachew Melese Hadrian Mangwana Simon Takawira Rosalia Indongo Bernadette Harases Perseverance Moyo Ntombizodwa Makurira Nyoni Kopano Robert Tafadzwa Dzinamarira

In the original publication [...]

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11080208

Authors: Mohamed Mukhtar Mohamed Rukia Abukar Abdi Mohamed Ahmed Ali Mohamed Abdirahman Jama Rahma Yusuf Haji Mohamud

Background: Tetanus remains a life-threatening yet preventable disease, with a disproportionate burden in low- and middle-income countries. Data on non-neonatal tetanus in Somalia, particularly from referral centres managing severe cases, are limited. This study aimed to describe the clinical characteristics, management, and outcomes of patients with non-neonatal tetanus in Mogadishu, Somalia. Methods: This retrospective observational study was conducted at Madina Hospital between July 2024 and January 2026. All patients with clinically diagnosed non-neonatal tetanus presenting to the Emergency Department were included. Data on demographics, clinical features, management, complications, and outcomes were extracted from medical records. Continuous variables were summarized as mean ± standard deviation or median (interquartile range), while categorical variables were presented as frequencies and percentages. Associations were assessed using Fisher’s exact test, with p < 0.05 considered statistically significant. Results: A total of 50 patients were included (mean age 22.24 ± 15.49 years; 84.0% male). Most patients were unvaccinated (80.0%), and severe or very severe disease was present in 64.0% of cases. Generalized muscle spasm was the most common presentation (50.0%). Dysautonomia (42.0%) and respiratory failure (18.0%) were the most frequent complications. The overall in-hospital mortality rate was 26.0%, with respiratory failure accounting for 69.2% of deaths. Mortality was significantly associated with disease severity (p < 0.001), complications (p = 0.006), antibiotic category (p = 0.043), and vaccination status (p = 0.0265). Conclusions: Non-neonatal tetanus in this referral-based setting is associated with high mortality, predominantly affecting young, unvaccinated individuals presenting with advanced disease. Disease severity and complications, particularly respiratory failure, are the main drivers of outcomes. Strengthening adult immunization, improving early recognition and referral, and expanding access to critical care are essential to reduce tetanus-related mortality.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070207

Authors: Elizabeth Cristina Araújo Ferreira Faulhaber Daniel Moreira de Avelar Liliane de F. Antonio Oliveira Luciana de F. Campos Miranda Cintia Xavier de Mello Gabrielle Baldan Stanciola Luanna da S. Ventura Marcelo Rosandiski Lyra Caio Thomaz de Lima e Silva Aline Fagundes da Silva Rosely Maria Zancope-Oliveira Maria Inês Fernandes Pimentel Andreza Pain Marcelino

Cutaneous leishmaniasis (CL) is a vector-borne disease caused by Leishmania spp. Molecular methods such as conventional PCR (cPCR) and real-time PCR (qPCR) show high accuracy but remain restricted to reference centers. Loop-mediated isothermal amplification (LAMP) enables rapid DNA amplification under isothermal conditions. LAMP targeting 18S rDNA using WarmStart® Colorimetric LAMP 2× Master Mix and Bst 2.0 DNA Polymerase with SYBR® Green I (BstSg) was evaluated in swab samples (extracted by kit—SW-kit and direct boil—SW-DB) and specimens collected through biopsy from ulcerated lesions of patients attending a reference center in Rio de Janeiro, Brazil. The reference standard was defined as at least one positive parasitological or molecular (cPCR) test plus clinical confirmation. Analytical sensitivity reached 10 fg with WS and 10 pg with BstSg. The diagnostic accuracy of LAMP ranged from 51.8% to 78.6%, with sensitivity from 52.5% to 81% and specificity from 39.6% to 89.4%. LAMP, particularly when applied to swab samples with DNA extracted using the SW-kit protocol and amplified with BstSg, showed promising diagnostic accuracy and operational feasibility as a less invasive approach for CL diagnosis, eliminating the need for skin biopsy and reducing patient discomfort during sample collection.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070206

Authors: Víctor Juan Vera-Ponce Jhosmer Ballena-Caicedo Holly E. Delgado-Toro Adriana Mishell Yoplac-Oyarce Lily Mabel Portal-Valqui Fiorella E. Zuzunaga-Montoya

Malaria coinfections with other infectious agents represent a clinically relevant epidemiological challenge, but evidence remains fragmented across individual systematic reviews. This umbrella systematic review synthesized review-level evidence on the prevalence and epidemiological patterns of concurrent malaria coinfections in human populations. PubMed/MEDLINE, Scopus, Web of Science, Embase, and LILACS/BVS were searched for systematic reviews published from 1 January 2000 to March 2026. Risk of bias, certainty of evidence, and primary-study overlap were assessed using ROBIS, an adapted GRADE framework for prevalence evidence, and citation-matrix/corrected-covered-area methods, respectively. Twenty-one systematic reviews were included, of which 16 contributed meta-analytical prevalence estimates. Among acute-pattern coinfections, review-level prevalence estimates ranged from 3.0% (95% CI: 2.0–5.0) for malaria–influenza to 21.7% (95% CI: 18.7–25.1) for malaria–Ebola virus disease. Among chronic or persistent-pattern coinfections, estimates ranged from 6.0% (95% CI: 4.0–7.0) for malaria–hepatitis B to 50.0% (95% CI: 28.0–72.0) for malaria–human African trypanosomiasis; the latter reflects Plasmodium positivity among patients with human African trypanosomiasis and should not be interpreted as a population-level prevalence. Sub-Saharan Africa was the most represented region. Certainty of evidence was generally low or very low, largely because of substantial heterogeneity, diagnostic variability, geographic concentration, and overlap among some source reviews. Malaria coinfections are clinically and epidemiologically relevant in endemic settings, but available prevalence estimates should be interpreted as context-dependent review-level summaries rather than globally comparable burden estimates.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070205

Authors: Tronic Sithole Ziphelele Peter Ayanda Princess Myeni

The Eastern Cape of South Africa carries the highest crude AIDS mortality rate nationally (135.86 per 100,000 in 2023), yet a province-specific, age-sex disaggregated analysis extending beyond 2012 does not exist. This study examined AIDS mortality trends in the Eastern Cape from 2000 to 2023. A quantitative ecological design was employed using secondary analysis of modelled estimates from the Thembisa Provincial HIV Model version 4.8. Annual AIDS deaths across nine age–sex subgroups and crude AIDS mortality rate were extracted from the Eastern Cape, 2000–2023, with provincial comparisons for 2023. Total AIDS deaths declined by 72.1% from 33,301 in 2005 to 9300 in 2023. Child deaths fell 96.1% from peak. Male youth deaths (15–24) plateaued after 2015. Adults aged 50 and older constituted 24.1% of deaths in 2023, with numbers increasing since 2019. Despite substantial gains, three unresolved gaps persist: a male youth mortality plateau, an ageing epidemic burden, and the highest provincial AIDS mortality rate nationally. Targeted differentiated interventions are urgently needed.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070203

Authors: 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 Kobto G. Koura

Background: Tuberculosis (TB) remains a leading cause of global morbidity and mortality, yet its impact extends far beyond microbiological cure. Many TB survivors experience persistent structural lung damage or functional impairment consistent with post-TB lung disease, while growing evidence highlights long-term non-respiratory health outcomes. Synthesizing evidence across lung and non- respiratory health outcomes, along with their risk factors, is critical to inform long-term TB care. Methods: We conducted a scoping review including systematic reviews reporting on post-TB long-term health outcomes. A search was performed in PubMed/MEDLINE on 27 July 2025, using terms related to “tuberculosis,” “systematic review,” “meta-analysis,” “sequelae” and “long-term health outcomes,” without language restrictions. Results: Nine systematic reviews met inclusion criteria. Most focused on pulmonary outcomes and consistently demonstrated that TB is associated with chronic airflow obstruction, reduced lung function, and an increased long-term risk of lung cancer, although residual confounding from environmental, clinical, and socioeconomic factors cannot be excluded. While younger adults are more prone to developing COPD after TB in high TB burden settings, older individuals face a higher risk of broader post-TB lung sequelae. Evidence suggested that TB survivors are at increased risk of non-respiratory complications. HIV co-infection, low CD4 counts, older age, pre-existing hepatitis, prior TB treatment, and hypoalbuminemia were associated with post-TB liver injury, while baseline hearing impairment and HIV co-infection increased the likelihood of post-TB hearing loss. TB was also linked to elevated risk of several non-pulmonary cancers, including oesophageal, cervical, hematological, pancreatic, and gastric malignancies, with the highest risk within the first year after TB diagnosis and persisting, though attenuated, in subsequent years. Conclusion: TB should be viewed as a chronic condition with enduring lung and non-respiratory health outcomes. TB survivors face increased risks of COPD, lung cancer, and a range of non-respiratory health outcomes, including hepatic and auditory complications, particularly among high-risk groups, such as those living with HIV infection, along with baseline hearing and hepatic impairment. Public health programmes must extend care beyond microbiological cure to include integrated, post-TB long-term monitoring of lung, hepatic and hearing across all ages, including malignancy surveillance, after baseline assessments to identify high-risk TB survivors. Future research should also elucidate risk factors for post-TB malignancy, and clarify the relationship between neurological, renal, and musculoskeletal sequelae and TB to inform evidence-based TB survivorship care.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070204

Authors: Bengthay Tep Sochetra Hak Nouv Sophorn Sin Grandy Ad Vos Dim Kanan Kinzang Dukpa

(1) Background: Dog-mediated human rabies remains a serious public health problem in Cambodia, partially due to the high abundance of dogs. As most dogs are free-roaming and cannot easily be handled and restrained, the rabies vaccination coverage is very low. Oral rabies vaccination (ORV) could increase the vaccination coverage to levels required for interrupting the transmission cycle. (2) Methods: In this study, the bait acceptance and immunogenicity of a commercially available vaccine bait were tested in local free-roaming dogs in the northern part of Takeo province in Cambodia. (3) Results: In total, 75.4% (515/683) of dogs initially showed interest when offered an egg-flavored bait containing the SPBN GASGAS rabies virus vaccine. Subsequently, 89.9% of these dogs consumed the bait, and almost all of them (98.3%) were considered successfully vaccinated. Blood samples were collected from 50 dogs prior to vaccination. Eight of these fifty dogs tested sero-positive for rabies antibodies (ELISA) and were excluded from follow-up samples. Thirty and ninety days post-vaccination, 91.4% and 68.2% of the relocated vaccinated dogs tested sero-positive, respectively. (4) Conclusions: Bait acceptance and immunogenicity showed similar results as observed in studies with the same vaccine bait conducted in other countries. Hence, ORV seems to be a very promising tool for dog rabies control in Cambodia, which has a large owned but free-roaming dog population.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070202

Authors: Joycelyn A. Dame Yemah Bockarie Adraina N. M. Asante Anthony Enimil

Sustained maternal HIV viral-load (VL) suppression during breastfeeding is essential for eliminating vertical HIV transmission in Sub-Saharan Africa. Although vertical transmission prevention programmes have improved antiretroviral therapy coverage and peripartum outcomes, viral control may deteriorate after delivery. This decline may result from psychosocial stressors, fragmented mother–infant services, and delayed return of results. This review examines post-delivery VL dynamics, breastfeeding-associated transmission risk, and the limitations of binary suppression thresholds. We suggest that post-delivery VL monitoring should be implemented as a rapid-action pathway. In this approach, detectable viraemia during breastfeeding should prompt a timely reassessment of adherence and repeat VL testing. Regimen review and additional measures to reduce the risks for both the mother and infant should be implemented where indicated. We also examine the individual, relational, structural, and health system determinants of post-delivery viraemia and lost to follow-up, including intimate partner violence. Finally, we highlight service delivery innovations that may improve maternal VL suppression and HIV-free infant survival rates.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070201

Authors: Yu Wang Qilan Wen Jinwei Chen Yikun Chang Na Cao Xin Sun Yuantao Hao Wangjian Zhang Zhicheng Du

This study aimed to compare the burden of malaria and dengue worldwide and to project future incidence trends. Incidence and disability-adjusted life-years (DALYs) were obtained from the Global Burden of Disease Study 2021 (GBD 2021). Temporal trends were quantified using estimated annual percentage change (EAPC), age–period–cohort analysis was used to assess age, period, and cohort effects, and Bayesian age–period–cohort models were applied to project incidence to 2036. From 1992 to 2021, the global age-standardized incidence rate (ASIR) of malaria decreased (EAPC= −0.55%), whereas that of dengue increased (EAPC = 1.83%); the corresponding age-standardized DALY rates showed EAPCs of −1.64% and 1.29%, respectively. Across 21 GBD regions, SDI was inversely correlated with ASIR for malaria (r = −0.848) and dengue (r = −0.521), and with age-standardized DALY rates for malaria (r = −0.849) and dengue (r = −0.497). Malaria burden remained concentrated in low-SDI regions, particularly sub-Saharan Africa and Oceania, whereas dengue burden was highest in middle-SDI regions, especially tropical Latin America. From 2021 to 2036, the global ASIR of malaria was projected to decrease slightly by 1.36% (3485.27 to 3437.72). Whereas that of dengue was projected to increase by 10.58% (752.04 to 831.63). In males, the projected ASIR of malaria and dengue increased by 4.18% (3193.24 to 3326.58) and 9.96% (704.83 to 775.06), respectively. In females, the corresponding increases were 4.87% (3379.82 to 3544.27) and 8.83% (819.74 to 892.13). These findings suggest divergent epidemiological trajectories for malaria and dengue. The projections further suggest a consistent upward trajectory for dengue, with sex-specific relative changes differing descriptively by disease: the projected relative increase was numerically greater in females for malaria and in males for dengue.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070200

Authors: Helena Lutchman Cannelle Michel Audrey Murat-Ringot Florence Carrouel

Despite significant biomedical advances in the prevention of mother-to-child transmission (MTCT) of HIV, residual transmission and suboptimal maternal outcomes persist across Europe. The challenge is no longer primarily virological but structural: aggregated ART coverage indicators mask important discontinuities across the perinatal care pathway. This scoping review maps evidence on clinical and psychosocial dimensions of the perinatal HIV pathway among adult women living with HIV (WLHIV) in Europe, and identifies key gaps in their integration across the continuum of care. Following PRISMA-ScR guidelines, five databases were searched for studies published between 2010 and 2026. Of 1881 records identified, 109 met inclusion criteria. Findings were synthesized thematically using an inductively developed framework spanning preconception through long-term postpartum outcomes. MTCT rates declined from approximately 1–1.2% in the mid-2000s to below 0.5% in recent data, and vaginal delivery rates increased markedly with sustained viral suppression. However, persistent inequalities remain among younger women, migrants, and those with histories of injecting drug use. Stigma, migration-related vulnerability, mental health difficulties, constrained disclosure, and socioeconomic insecurity shape engagement with care, influencing treatment continuity, retention, and virological outcomes, particularly during the postpartum period. Equitable perinatal HIV outcomes require integrated care models that combine clinical HIV and obstetric services with mental health support, social needs screening, and migration-sensitive services to address the structural conditions shaping care trajectories. A substantial proportion of WLHIV in Europe originate from high-prevalence regions, making perinatal HIV in this context a direct interface between global infectious disease burden and migration health. Addressing care in European settings therefore contributes to broader global health equity goals in HIV elimination. The protocol was pre-registered on Open Science Framework with registration number: 10.17605/OSF.IO/9BZGY.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070199

Authors: Neal Alexander Nurulhusna Ab Hamid Farah Diana Ariffin Muriel Rabilloud Tim W. R. Möhlmann Frédéric Schmitt Jason H. Richardson Mitra Saadatian-Elahi

For dengue, there is little evidence regarding community-level acceptance, facilitators and barriers for integrated vector management (IVM). We carried out a survey to measure these aspects in the context of a large cluster-randomized controlled trial of IVM against dengue vectors in urban Malaysia, in which the component control methods were (i) outdoor residual spraying, (ii) autodissemination devices (ADDs) and (iii) community engagement. The survey population comprised (i) members of the Joint Management Body (JMB) of building developments in both arms, and (ii) residents in the intervention arm. Members of both groups were requested to complete a structured questionnaire, through face-to-face interviews. Among JMB responders, 138 were the intervention clusters, and 94 from those receiving routine activities (control arm), and there were 604 responders among residents of intervention clusters. Among the JMB members, safety of the control methods (spraying and ADDs) was among the most important potential facilitators. Among barriers, the ones identified by over one-third of the participants were lack of information about the iDEM IVM methods, lack of communication and of involvement with the iDEM project personnel. Overall, the iDEM IVM methods were seen positively, and investment by the trial in community engagement may have contributed to this.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070198

Authors: Tronic Sithole Ziphelele Peter

Background: The Eastern Cape Province carries the second-highest antenatal HIV prevalence nationally (32.9%), yet province-level longitudinal data on HIV incidence among pregnant and breastfeeding women (PBW) remain limited. This study examined trends in HIV incidence, HIV prevalence, mother-to-child transmission (MTCT), and antiretroviral therapy (ART) coverage among PBW in the Eastern Cape from 2000 to 2023. Methods: A quantitative ecological design was employed using secondary analysis of modelled estimates from the Thembisa Provincial HIV Model, version 4.8. Annual HIV incidence in PBW, HIV prevalence in pregnant women (overall and by five-year maternal age group), MTCT rate, new MTCT cases, and ART coverage were extracted with 95% confidence intervals (CIs) for the Eastern Cape, 2000–2023. Descriptive analysis characterised temporal trends at seven reference years, and formal trend significance was assessed using the Mann–Kendall test and log-linear regression. Results: HIV incidence in PBW declined from 3.8% (95% CI: 3.7–3.9) in 2000 to 1.8% (95% CI: 1.3–2.4) in 2023, a relative reduction of approximately 53%. ART coverage rose from 0% to 71.6%, coinciding with an 88% reduction in MTCT rate from 31.3% to 3.6%. By 2023, the MTCT rate had crossed below the World Health Organization 5% elimination threshold. HIV prevalence among pregnant women remained high at 25.0% despite declining incidence. The age distribution of HIV burden shifted markedly toward older maternal cohorts: prevalence among women aged 40–49 years increased from 9.9% in 2000 to 46.5% in 2023, while prevalence in the 15–24 age group declined substantially. New MTCT cases fell from 9990 in 2000 to 1236 in 2023. Conclusions: Declining HIV incidence in PBW coincided with substantial ART scale-up in the Eastern Cape, while HIV prevalence among pregnant women remained persistently high, a divergence that reflects the accumulating, ART-sustained pool of women living with HIV who survive into older reproductive age rather than a reversal of programmatic progress; this divergence between declining incidence and persistent, ageing prevalence is the central epidemiological finding of this study. Targeted interventions, including age-responsive antenatal protocols and strengthened PMTCT retention, alongside more careful consideration of expanded pre-exposure prophylaxis (PrEP) access, are needed to achieve elimination of mother-to-child transmission.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070197

Authors: Hellen Njeri Maingi Maingi Ndichu James Ng’ang’a Chege Davis Njuguna Karanja Derrick Noah Sentamu Bruno Enagnon Lokonon Damaris Matoke-Muhia Helena Ngowi Bassirou Bonfoh

Leishmaniasis is an endemic zoonotic disease caused by the protozoan parasite Leishmania and transmitted by infected female phlebotomine sandflies. The World Health Organization (WHO) classifies it among the 20 neglected tropical diseases (NTDs), ranking eighth globally. The disease predominantly affects resource-limited populations in tropical regions. Kenya bears a significant global burden of leishmaniasis, with Baringo County identified as a major endemic area. A cross-sectional survey on knowledge, attitudes, and practices (KAP) was conducted from July 2025 to January 2026 among 135 residents of Baringo South Sub-County using a structured questionnaire. The study evaluated sociodemographic characteristics, disease awareness, perceptions, preventive practices, and treatment-seeking behaviors. Additionally, 12 healthcare professionals were interviewed regarding their diagnostic and treatment capacities. Associations between variables were analyzed using Chi-square tests and multivariate logistic regression. Overall awareness of leishmaniasis was high (94.8%), with KAP scores of 86.7%, 76%, and 77.7%, respectively. Despite this, critical knowledge gaps persisted regarding transmission dynamics, the role of dogs as reservoir hosts, and preventive measures. Significant associations were found for awareness of local cases, recognition of clinical signs, knowledge of vector activity, community control measures, and attitudes toward treatment preferences. Age and education level predicted KAP outcomes. Healthcare practitioners demonstrated technical capacity to diagnose and treat human Leishmania infections, whereas veterinarians lacked awareness of Leishmania infection in dogs, including its diagnosis and treatment. Integration of human, animal, and vector surveillance within a One Health framework is recommended to enhance disease monitoring and control in Baringo County.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070196

Authors: Guillermo Martínez-Carrión Leire Fernández-Ciriza Iosu Razquin María Ángeles del Río-Poza María Eugenia Portillo

Background: Dermatophilus congolensis, a Gram-positive actinomycete, is a well-known animal pathogen but a rare cause of human skin infections. Human dermatophilosis is an infection associated with tropical environments and animal contact that remains frequently underdiagnosed. Case Presentation: We report a case of recurrent folliculitis in a 34-year-old male Muay Thai fighter returning from Thailand to Spain. The patient presented with pustular lesions on his lower limbs following frequent leg shaving and close physical contact during training. Microbiological culture from skin swabs yielded beta-hemolytic colonies, identified as D. congolensis by MALDI-TOF MS. Identification was confirmed through Whole-Genome Sequencing (WGS), which also revealed an absence of antimicrobial resistance genes. Despite the lack of established EUCAST breakpoints, the isolate showed low MICs for most tested antibiotics. The patient was treated with doxycycline, although clinical follow-up was not possible due to travel. Conclusions: This case highlights D. congolensis as an emerging differential diagnosis for persistent folliculitis in travelers and athletes. Our findings suggest a potential horizontal transmission route through contact sports and fomites (e.g., mats) in high-humidity settings.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070195

Authors: Gabriel Bafunyembaka Christian Kinsiona Joody Mafema Emmanuel Irakoze Philbert Furero Christelle Samou Narcisse Elenga

Background: Intestinal parasitic infections are common in tropical settings and may influence immune regulation, allergic responses, and respiratory health. In children with sickle cell disease (SCD), respiratory morbidity is multifactorial, and the contribution of intestinal parasites remains uncertain. This study assessed whether documented intestinal parasitic infections, particularly helminth infections, were associated with asthma-like respiratory phenotypes and clinical morbidity in children with SCD in French Guiana. Methods: We conducted a multicenter cross-sectional analysis of children and adolescents younger than 18 years with confirmed SCD who were being followed by the pediatric SCD centers of Saint-Laurent-du-Maroni, Cayenne, and Kourou between January 2022 and December 2025. Clinical, respiratory, and parasitological data were extracted from routine-care medical records. Intestinal parasitic infection was defined as at least one documented stool parasitology result identifying Strongyloides stercoralis, hookworm, or Entamoeba histolytica, according to the variables consistently available in the database. Respiratory outcomes included physician-diagnosed asthma, bronchial obstruction, bronchodilator reversibility, and an asthma-like respiratory phenotype. Results: Among 233 included children, 105 (45.1%) had at least one documented intestinal parasitic infection and 82 (35.2%) had a helminth infection. Hookworm was the most common parasite (75/233, 32.2%), followed by Entamoeba histolytica (33/233, 14.2%) and Strongyloides stercoralis (24/233, 10.3%). An asthma-like respiratory phenotype was observed in 32/105 infected children (30.5%) versus 44/128 non-infected children (34.4%). Bronchial obstruction and bronchodilator reversibility were also similar between groups. After adjustment for age, sex, genotype, hydroxyurea treatment, rural residence, site of follow-up, and environmental tobacco smoke exposure, intestinal parasitic infection was not associated with asthma-like respiratory phenotype (adjusted OR: 0.94, 95% CI: 0.51–1.72; p = 0.844), recurrent hospitalization, or history of acute chest syndrome. Conclusions: In this routine-care multicenter pediatric SCD cohort from French Guiana, intestinal parasitic infections were common but were not associated with respiratory phenotype or selected morbidity outcomes. Because testing and respiratory assessment were not systematic, these findings should be interpreted as showing that routine parasitological status alone could not identify children with respiratory morbidity. Prospective studies with standardized repeated parasitological, immunological, environmental, and respiratory assessments are needed.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070194

Authors: Aqsa Mansoor Ghulam Narjis Imen Ben Abdelmalek Sabika Firasat Iffat Naz Kiran Afshan

Background: Malaria remains a major public health challenge in Pakistan, where persistent transmission, heterogeneous risk patterns, and evolving treatment practices continue to impede control and elimination efforts. Methods: A community-based cross-sectional study was conducted among 9211 symptomatic individuals in District Dera Ismail Khan, northwestern Pakistan, from January 2024 to December 2025. Malaria was diagnosed using rapid immunochromatographic assays for Plasmodium vivax (P. vivax) and Plasmodium falciparum (P. falciparum), and associated risk factors were assessed using multivariable logistic regression. Results: Overall malaria prevalence was 36.27% (3341/9211). P. vivax predominated, accounting for 93.8% (3133/3341) of infections, while P. falciparum represented 5.8% (195/3341) and mixed infections 0.4% (13/3341). Infection risk was significantly associated based on multivariate analysis with male sex, younger age, pregnancy (AOR = 4.69), and absence of mosquito net use (AOR = 6.17), whereas indoor residual spraying (AOR = 0.08) showed a strong protective effect. Malaria transmission showed two peaks: October–December (AOR = 3.78–4.97) and February–March (AOR = 2.25–2.31) and declined significantly based on unadjusted analysis from 39.5% in 2024 to 32.8% in 2025 (OR = 0.74; p < 0.001). Blood groups B+ (AOR = 0.77), B− (AOR = 0.78), and AB− (AOR = 0.86) were significantly associated with reduced odds of malaria infection. A notable shift toward artemisinin-based combination therapy was observed, with artemether–lumefantrine largely replacing chloroquine for malaria treatment. Conclusions: The persistence of P. vivax-dominated transmission alongside ongoing P. falciparum circulation highlights the need for targeted vector control, enhanced surveillance, and evidence-based treatment strategies to accelerate malaria elimination in Pakistan.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070193

Authors: Oh Beom Kwon Yeonjeong Heo Da Hye Moon Woo Jin Kim Seung-Joon Lee Seon-Sook Han

Tuberculosis (TB) remains a major infectious disease associated with substantial healthcare burdens. Although previous studies mainly focused on mortality and treatment outcomes, factors associated with TB-related hospitalization have not been sufficiently investigated. The aim of our study was to evaluate clinical factors associated with TB-related hospitalization in patients with TB. Patients diagnosed with TB at Kangwon National University Hospital between January 2024 and December 2025 were included in our study. The primary outcome was TB-related hospitalization during follow-up after TB diagnosis. Hospitalization-free probability was analyzed using Kaplan–Meier analysis, and Cox proportional hazards regression analysis was performed to identify factors associated with hospitalization risk. A total of 81 patients were included; 63 patients were in the outpatient group and 18 patients were in the hospitalization group. The median time to hospitalization was 36 days. The Charlson comorbidity index (CCI) was significantly higher in the hospitalization group (5.78 ± 2.88 vs. 4.16 ± 2.22, p = 0.038). Patients with CCI values ≥ 5 showed significantly lower hospitalization-free probability during the 180-day follow-up period (log-rank p = 0.013). In multivariable Cox hazards regression analysis, both serum creatinine (hazard ratio (HR), 1.599; 95% confidence interval (CI), 1.057–2.419; p = 0.026) and CCI (HR, 1.221; 95% CI, 1.018–1.466; p = 0.032) were significantly associated with TB-related hospitalization. A higher comorbidity burden may help identify patients at risk for TB-related hospitalization.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070192

Authors: Bayo Segun Fatunmbi Alexander Yabes Taruc Kazim Hizbullah Sanikullah Anna Marie Celina Garfin Jose Gerard Belimac Almira Cruz Gatchalian Ma. Regina De Jesus Valdez Carmel Angela Buado Kim Patrick Tejano Abelaine Venida-Tablizo Frederica Veronica Marquez-Protacio Belen L. Dofitas Arturo Cunanan Reginald Alain R. Santos Francesca Cando Gajete Concepcion P. Dumawat Eugene Caccam Eunyoung Ko Rui Paulo de Jesus

The Philippines achieved World Health Organization (WHO) certification for the elimination of leprosy as a public health problem in 1998. Despite this milestone, new cases continue to be reported each year, highlighting the need for sustained surveillance and interventions to achieve zero transmission. This paper provides an update on the country’s progress toward interruption of leprosy transmission using national surveillance data and programmatic reports from 2020–2024. Quantitative data were obtained from the Department of Health (DOH) Field Health Services Information System (FHSIS), while policy and programmatic information were drawn from national reports, WHO guidance, and implementation reviews. Descriptive analyses were conducted to examine trends in prevalence, case detection rates (CDRs), and age-sex distribution patterns to identify high-risk groups. Leprosy prevalence declined from 0.41 per 10,000 population in 2020 to 0.11 in 2024, remaining below the WHO elimination threshold. The CDR increased from 0.45 in 2022 to 1.17 per 100,000 in 2024, indicating recovery of active surveillance after COVID-19-related disruptions. Most newly detected cases occurred among adults aged 20–59 years (72%), although continued detection among children aged 0–14 years (6–7%) suggests ongoing transmission in selected endemic areas. Key program strengths include policy integration and WHO-supported surveillance initiatives, while major barriers include stigma, uneven local implementation, and limited access to rehabilitation. The Philippines has maintained low national prevalence while strengthening efforts toward transmission interruption. Continued investment in surveillance, contact tracing, stigma reduction, and integrated neglected tropical disease (NTD) services will be essential to achieving zero transmission, zero disability, and zero discrimination by 2030.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070191

Authors: Nalini Jayakody Catherine A. Gordon Anjana Silva Nuwan Wickramasinghe Susiji Wickramasinghe Natasha Collinson Asela Wijayasekara Chanaka Karunarathne Harshi Weerakoon Manjula Weerasinghe Nilanthi de Silva Kosala Weerakoon

Human intestinal nematode infections (HINIs) remain a public health concern despite reduced prevalence following mass drug administration (MDA) in low- and middle-income countries. Children continue to bear a substantial burden of infection, and caregiver knowledge and practices may influence their risk of acquiring infection. Sustaining control during the transition of prevention programmes to surveillance-based strategies requires an understanding of behavioural determinants of transmission. Therefore, we assessed caregiver knowledge, attitudes, and practices (KAP) and their associations with sociodemographic characteristics and child infection status. A community-based cross-sectional study was conducted among 945 caregivers of primary school children in Anuradhapura, a low-prevalence setting where school-based MDA ceased in 2019, to assess caregiver KAP and child HINI status. An interviewer-administered questionnaire assessed KAP, sociodemographic, water, sanitation, hygiene (WASH), and behavioural factors. Participants were predominantly mothers (89.5%). Good knowledge was observed in 61.7%, positive attitudes in 95.6% and good practices in 99.2%. Knowledge gaps persisted regarding transmission and complications. Higher caregiver knowledge (OR = 0.52; 95% CI: 0.36–0.72) and regular deworming (OR = 0.58, 95% CI: 0.40–0.83) were associated with lower odds of infection, whereas attitudes and practices were not independently associated. Caregiver knowledge remains a key determinant of infection risk. Gaps in knowledge, misconceptions, and practices may sustain transmission even in low-prevalence settings. Strengthening health education, school-based hygiene promotion, and community engagement remains essential to reinforce preventive behaviours and support long-term control as countries transition from routine MDA to elimination-oriented strategies.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070190

Authors: Benjamin Tetteh Mensah Hannah Otu Dorinda Naa Okailey Armah Comfort Teiko Abuanor Lucas Amenga-Etego Samuel Antwi-Baffour

Background: Malaria remains a major public health challenge in sub-Saharan Africa, where asymptomatic infections continue to hinder elimination efforts. Although the clinical and epidemiological consequences of microscopic infections are well documented, the health implications of submicroscopic Plasmodium falciparum infections remain poorly understood, particularly in Ghana. This study assessed the burden of submicroscopic P. falciparum infections and their association with antimalarial drug resistance markers among outpatients attending Korle Bu Teaching Hospital. Methods: A cross-sectional study involving 345 participants was conducted. Malaria infection was assessed using mRDT, blood smear microscopy, and LAMP-PCR for parasite detection and species identification. Antimalarial drug resistance markers were analyzed by multiplex PCR and Oxford Nanopore sequencing. Statistical analysis was performed using STATA version 14, applying Pearson’s chi-square test and logistic regression. Results: The overall prevalence of asymptomatic P. falciparum infection was 35.0% (117/334), with 18.9% microscopic and 16.1% submicroscopic infections. The wild-type pfcrt K76 allele, associated with chloroquine susceptibility, was highly prevalent (90.1%). Conclusions: Asymptomatic P. falciparum infections are common in this population, with a substantial proportion occurring at submicroscopic levels. The high prevalence of chloroquine-susceptible parasites and identified transmission hotspots underscore the need for sensitive diagnostics and targeted interventions to support malaria elimination efforts in Ghana.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070189

Authors: Dan Jiang Kun Wang Shenbo Chen Yang Hong Senping Yang Xiaoyuan Su Yongdong Hao Fei Luo Junhu Chen

This study aimed to project the current and future suitable habitats of three primary malaria vectors in China—An. lesteri, An. minimus, and An. sinensis—using an ensemble modeling approach. We simulated their geographical distributions under current and future climates (SSP126, SSP245, SSP585) using the Biomod2 platform with 19 bioclimatic variables and elevation. The ensemble models achieved high predictive performance, as reflected by AUC and TSS values. Environmental drivers were species-specific: An. lesteri was primarily influenced by elevation, temperature seasonality (Bio4), and seasonal precipitation (Bio18, Bio19); An. minimus by the mean temperature of the coldest quarter (Bio11); and An. sinensis by annual precipitation (Bio12), mean temperature of the wettest quarter (Bio8), and elevation. Future projections revealed divergent responses: the habitat of An. lesteri is projected to contract and shift northeastward; An. sinensis is expected to expand northward, potentially extending climatically suitable areas into new regions; and although the overall range of An. minimus remains stable, its internal suitability shifts toward higher classes under warming. These findings demonstrate that climate change will critically reshape the distribution of major malaria vectors across China, underscoring the need to integrate climate-informed projections into adaptive surveillance and vector control strategies in the post-elimination era.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070188

Authors: Carla Rodríguez González Susana Ávila Karina Cardone Mariana Fernández Favio Crudo Verónica Andreo M. Victoria Periago

Mother-to-child transmission (MTCT) of infectious diseases remains a public health challenge in socially vulnerable regions with limited healthcare access. This study assessed the epidemiological situation, spatial distribution, and socioeconomic context of MTCT infections—Chagas disease (ChD), syphilis, HIV, and hepatitis B (HB)—in the Gran Chaco region (Argentina–Paraguay), 2018–2024. Epidemiological data from 2877 patients enrolled in an MTCT Plus programme were analysed, alongside socioeconomic variables and spatio-temporal cluster analysis using SaTScan software. Maternal seroprevalence of ChD was 4.1%, the highest among the infections evaluated. Syphilis prevalence was 0.8%, while no HIV or HBV infections were detected among screened pregnant women. Two statistically significant spatiotemporal clusters of maternal Trypanosoma cruzi seropositivity were identified: a household-level cluster in 2018 and a regional cluster during 2019–2021. The highest prevalence of maternal ChD seropositivity was observed in census tracts with greater socioeconomic vulnerability, although this spatial overlap was assessed descriptively. These findings highlight the effectiveness of integrated maternal–child health services in ensuring coverage, timely diagnosis, and treatment in vulnerable populations. The identified spatial patterns provide evidence to support targeted surveillance and coordinated binational public health strategies in border regions affected by persistent social inequalities.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070187

Authors: Gregory D. Hawley Chu Sandy Wang Andrea K. Boggild

Marine envenomations are common non-infectious hazards for travelers. Lionfish, venomous fish native to Indo-Pacific waters, have become an invasive species in the Atlantic Ocean and threat to native marine ecosystems. Various control measures have been implemented in response to rapidly expanding lionfish populations, including licensed culling by recreational divers. We herein review lionfish envenomation through framing with a case that occurred during a diving trip to Curacao for the purpose of lionfish spearfishing. Following initial management in Curacao with hot water immersion, wound care, and antibiotic prophylaxis, the patient continued to have persistent swelling, bruising, and pain to the puncture site and was referred to our outpatient clinic for further evaluation. In addition to reviewing clinical syndromes and approach to management for common marine envenomations that may be encountered in the post-travel setting, we situate this case within the broader ecological context of expanding invasive species ranges with climate change and rising sea temperatures. Pre-travel providers should counsel patients at high risk for marine envenomations on preventative measures, along with how and when to seek care following exposure. Post-travel providers should be familiar with the immediate and long-term sequelae of non-infectious envenomations and intoxications, including marine exposures. Larger national and multinational collaborations are required to mitigate the effects of climate change and international marine movement on invasive species, especially those that incur risk to marine and human health alike.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070186

Authors: Haider Saddam Qasim Maree Donna Simpson

Background: Pre-travel health consultations require individualised risk assessment across itinerary, destination, traveller characteristics, vaccine and medication history, comorbidities, pregnancy and immune status, activities, and access to care. Artificial intelligence (AI), particularly large language models (LLMs), may support pre-consultation education, structured history collection, guideline retrieval, multilingual communication and post-consultation reinforcement, but unsafe use may introduce hallucinated, outdated or insufficiently personalised recommendations. Objectives: This scoping review maps the current evidence on AI tools relevant to pre-travel health consultations, characterises implementation gaps, identifies patient-safety risks and proposes a supervised implementation model for travel medicine clinics. Original contribution: Unlike previous reviews of clinical AI, patient-education LLMs or chatbots in chronic illness, this is the first scoping review focused specifically on AI in pre-travel consultations. It uniquely combines a five-tier evidence hierarchy that separates direct travel-medicine AI evidence from indirect clinical-AI safety and equity evidence, and provides a travel-medicine-specific clinical safety risk taxonomy and a supervised implementation framework anchored to authoritative travel-medicine guidance and current AI regulatory regimes. Methods: A scoping review was conducted following PRISMA-ScR reporting, using a Population–Concept–Context eligibility framework and a targeted retrieval in May 2026 covering January 2017 to May 2026. Sources were screened and charted by a single reviewer using a structured eligibility checklist. Quality and applicability were appraised conceptually using MMAT, AMSTAR 2 and JBI text-and-opinion criteria, with GRADE-informed certainty. Results: Of 70 records identified, 11 were included: four direct pre-travel AI sources, one adjacent travel-related decision-support study, four guideline and context sources and two clinical LLM safety sources. The only patient-level implementation involved 26 travellers using a GPT-4 Travel Clinic Assistant in Singapore, where physicians and travellers reported acceptability and workflow benefit but objective effectiveness outcomes were not measured. Broader clinical LLM evidence indicates heterogeneous evaluation methods, vulnerability to hallucinated guidelines, and accuracy that varies widely across model versions and specialties. Conclusions: Current evidence supports supervised AI augmentation of pre-travel consultations but does not support autonomous AI-led vaccine selection, malaria prophylaxis, contraindication screening or individualised travel-risk clearance. Near-term deployment should be restricted to clinician-supervised education, structured intake, source-grounded guideline retrieval, after-visit reinforcement and escalation-triggered workflow support. Priority research includes travel-medicine-specific hallucination audits; equity testing in visiting-friends-and-relatives, migrant, older-adult, First Nations Australian, and Pacific Islander travellers; and prospective trials reported under CONSORT-AI, SPIRIT-AI and TRIPOD + AI.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070185

Authors: Enes Dalmanoğlu İrem Sakarya Ali Osman Yıldız Muhammed Taha Özügüzel Çiğdem Işık Ahmet Enes Kaya Yasin Uslu Vedat Elgün Muhammed Enes Geylani

Background: Human brucellosis is a widespread zoonotic febrile illness in livestock-rearing endemic regions, including Türkiye (pooled human seroprevalence approximately 4.5%). Age-stratified item-level knowledge profiles paired with information-source patterns are rarely reported in adult populations. We aimed to describe age-stratified brucellosis knowledge and information-source ecosystems in a hospital-attending adult sample from an endemic Turkish province. Methods: A hospital-based cross-sectional survey enrolled 397 adults in Balıkesir, Türkiye. A 17-question instrument assessed demographics, prior awareness, a 26-item composite knowledge score among aware respondents, and information sources. Item-level recognition was compared across four age strata, with multivariable logistic regression identifying independent predictors. Results: Of 397 adults (mean age 36.1 years; 62.7% male), 233 (58.7%) reported prior awareness, increasing with age (51.8% in 18–29 vs. 74.5% in ≥60 years; p < 0.001). Among aware respondents, composite knowledge declined with age (mean 8.52 vs. 5.94; p < 0.001). Raw dairy transmission and treatment availability were uniformly recognized (>80% across all strata). Recognition of clinical symptoms (fever 68.9% vs. 34.3%; p = 0.005) and veterinary signs (decreased milk yield 36.9% vs. 8.6%; p = 0.001) was substantially lower in older respondents. Internet citation declined with age (41.7% to 17.1%), while older respondents relied more on interpersonal networks. Conclusions: Brucellosis knowledge was not uniformly distributed across the adult age spectrum. Dominant transmission and treatment messages were near-universally recognized, while clinical-symptom and veterinary-sign recognition showed substantial age-related deficits, accompanied by generational divergence in information-source ecosystems. These findings suggest that age-tailored, channel-specific reinforcement of less-recognized clinical and veterinary knowledge, delivered through trusted healthcare-worker channels, may strengthen brucellosis education in endemic Turkish settings. Community-based replication is required before broader policy translation.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070184

Authors: Yi-Jun Lim Gordon Xue-Zhen Chong Joo-Yie Chin Muhammed-Nur-Iman Mohammed-Syafiei Muhammad-Nasreen Suhaimi Siti-Nursyazziana Nordin Shin-Yee Fung Hazel Anne Tabo Polrat Wilairatana Tadesse Hailu Veeranoot Nissapatorn Wenn-Chyau Lee

Plasmodium knowlesi infections can progress rapidly to life-threatening complications, such as acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI), which are driven by the ability of the zoonotic parasite to rapidly replicate towards high parasitemia and the cytoadherence properties of the infected erythrocytes (IRBCs). This study evaluated the anti-parasitic and vasoprotective potential of Annona muricata (soursop) leaf ethanol extract against P. knowlesi. In vitro assays using the P. knowlesi A1-H.1 reference strain revealed significant blood stage schizogony inhibition (IC50: 9.65 µg/mL), specifically targeting the trophozoites. The anti-parasitic activity was concentrated in the <30 kDa subfraction of the extract. Washout assays confirmed that the effect was parasitostatic rather than parasiticidal, where the malaria parasites underwent developmental arrest but remained morphologically normal and resumed growth post-removal. Furthermore, priming human endothelial cell lines with the extract significantly reduced IRBC–endothelial binding. These results demonstrate that A. muricata extract exerts a dual-action effect by arresting P. knowlesi asexual replication and inhibiting IRBC–endothelial cytoadherence. While clinical translation would require exhaustive standardization and chemotypic profiling due to the natural variability of plant compositions, these findings provide a foundational academic framework for the potential of A. muricata leaf extract in mitigating severe knowlesi malaria complications.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070183

Authors: Ikhona Ntshobane Dominic Targema Abaver

Background: Opportunistic infections remain a significant cause of morbidity among people living with HIV (PLHIV) in sub-Saharan Africa despite expanded access to antiretroviral therapy (ART). This study evaluated the association between immune status, viral load suppression, ART adherence, and the risk of opportunistic infections among HIV-positive patients receiving ART in the rural Eastern Cape, South Africa. Methods: A retrospective cross-sectional study was conducted using clinical records of HIV-positive patients attending an HIV clinic in Mthatha between January 2021 and December 2024. Demographic characteristics, CD4 counts, viral load results, ART regimens, adherence status, and documented opportunistic infections were extracted. Viral load suppression was defined according to WHO guidelines as <1000 copies/mL. CD4 counts were categorized as <200, 200–499, and ≥500 cells/mm3. Multivariable logistic regression analysis was performed to identify independent predictors of opportunistic infections. Results: A total of 155 patients (105 females, 50 males) were included. Females demonstrated significantly higher mean CD4 counts than males (p = 0.037) and better ART adherence (p < 0.001). Tuberculosis, hepatitis B virus, and herpes simplex virus infections were more prevalent among males, whereas candidiasis was significantly more common among females (p = 0.034). In multivariable analysis, CD4 count < 200 cells/mm3, unsuppressed viral load, and poor ART adherence were independently associated with increased odds of opportunistic infections. Conclusions: Immune suppression and suboptimal ART adherence significantly increase the risk of opportunistic infections among HIV-positive patients in rural South Africa. Strengthening adherence interventions and early immune monitoring may reduce infection burden in high-prevalence settings.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070182

Authors: Maciej Grzybek Anna Bogacka

Climate change is reshaping the epidemiology of vector-borne diseases in Europe by altering the ecological conditions that determine vector survival, seasonal activity and pathogen transmission. Rising temperatures, milder winters, prolonged warm seasons and changing precipitation patterns are increasing the suitability of parts of Europe for competent mosquito, tick and sandfly vectors. These changes, combined with human mobility and land-use change, increase the probability that imported pathogens encounter permissive conditions for local transmission. This Opinion article examines autochthonous vector-borne disease transmission in Europe, using dengue as a sentinel example of a wider climate-sensitive transition. We discuss how imported viraemic cases, established competent vectors, vector–host contact and delayed clinical recognition can converge to enable local outbreaks. Beyond dengue, we consider West Nile virus, chikungunya, tick-borne encephalitis, leishmaniasis and Crimean–Congo haemorrhagic fever as examples of a broader and increasingly heterogeneous European risk landscape. We argue that the public-health impact of this transition is shaped not only by vector expansion, but also by gaps in surveillance integration, diagnostic readiness, workforce preparedness and One Health coordination. Strengthening climate-informed surveillance, rapid laboratory capacity, frontline clinical awareness and cross-sectoral response systems will be essential to prevent repeated introductions from becoming sustained public-health challenges.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070181

Authors: Immamul Muntasir Md. Omar Qayum Arifa Hasnat Ali Fahim Mohammad Sadique Srijon Mohammad Rashedul Hassan Mahbubur Rahman Tahmina Shirin

Early detection of infectious disease outbreaks is critical in densely populated, resource-limited settings. This study aimed to describe the community-based surveillance (CBS) system and its application of the Data–Information–Knowledge–Wisdom (DIKW) framework in Bangladesh. CBS was implemented in 12 urban wards across Dhaka South, Rajshahi, and Sylhet, where trained community volunteers conducted routine household visits to identify five priority syndromes. Data were collected through a mobile application integrated with an automated pipeline for cleaning, geocoding, cluster detection, and alert generation. Between January and June 2025, 38,489 households were visited, enrolling 128,626 individuals. The system generated 10,191 alerts and 577 clusters, predominantly for suspected dengue (58.7%), followed by acute watery diarrhea (24.1%) and influenza-like illness (10.7%). Rajshahi contributed the majority of alerts and clusters. Spatiotemporal analysis identified ward-level outbreak signals, including localized dengue peaks across all three cities. Over 98% of records were synchronized within 24 h, and more than 99% of data entry errors were automatically corrected, ensuring timely and high-quality analytics. These findings demonstrate that digital CBS can effectively transform community-level data into actionable public health intelligence, supporting early outbreak detection and response. This translation enabled timely public health actions, including targeted outbreak investigations and localized vector control measures in identified hotspots. Integration with national surveillance platforms may further strengthen health system responsiveness and epidemic preparedness.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070180

Authors: Messaoud Bouragba Samir Abdellaoui Sarah Saci Nasir A. Ibrahim Mohammed Saad Aleissa Nosiba S. Basher Nesrine Goumich Sundes Rabia Khelifa Meriem Aissou Abir Belakehal Hadjer Djaafer AbdElkarim Laatamna

Cystic echinococcosis (CE), a neglected zoonotic disease caused by Echinococcus granulosus sensu lato, poses a persistent public health burden in agro-pastoral regions worldwide. This study provides a large-scale epidemiological assessment of CE, highlighting sustained zoonotic transmission driven by agro-pastoral practices and human–animal interactions, and supporting the urgent implementation of One Health strategies. This ten-year retrospective study (2015–2024) analyzed 326 surgically confirmed cases from five hospitals in Djelfa. The cumulative surgical incidence was 2.04 cases per 100,000 person-years, classifying the region as hypoendemic. Females predominated (61.96%), and individuals aged 31–60 years represented 47.24% of cases. Rural residence (73.62%) and dog contact (94.17%) were major risk factors, with hepatic localization dominating (88.96%). Correlation analysis showed moderate associations between rural habitat and dog contact (V = 0.46, p < 0.001) and between sex and habitat (V = 0.34, p < 0.001), as well as weaker but significant associations for age and cyst location (V = 0.28, p < 0.001) and dog contact and cyst location (V = 0.20, p < 0.05). No postoperative mortality was recorded. These findings confirm active transmission linked to agro-pastoral practices and emphasize the need for coordinated One Health control strategies.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070179

Authors: Islam Karmokov Olga Freylikhman Regina Baimova Daria Grechishkina Gelena Lunina Ivan Lyzenko Ekaterina Riabiko Tatiana Arbuzova Anastasiia Bachevskaia Edward Ramsay Erik Khalilov Karina Kukleva Lyubov Bespyatova Sergey Bugmyrin Maxim Petrov Olga Neverova Ksenia Titarchuk Vera Agasoi Nikolai Kalinin Olga Vorobyeva Olga Mikheenko Tatiana Iakimenko Inna Druzhinina Olga Matina Daria Monastyrskaya-Nuzhina Anna Smirnova Nikolay Tokarevich

Rickettsia spp. are ubiquitous in nature and capable of causing diseases of varying severity. The most extensive group comprises the spotted fever group (SFG) Rickettsiae, the members of which are predominantly transmitted by ticks. The expansion of tick habitats observed in recent decades poses an increasing threat of dissemination of tick-borne infections into regions previously considered non-endemic. The aim of this study was to determine the prevalence of SFG Rickettsiae in ixodid ticks collected in Northwest Russia and to characterize the species diversity of these pathogens within the study area. Questing adult ixodid ticks (n = 4566) were collected from eight regions of Northwest Russia (Arkhangelsk, Kaliningrad, Leningrad, Novgorod, Pskov and Vologda Regions, as well as the Republic of Karelia and St. Petersburg) in 2023 to 2025 (from April to September). The species composition included Ixodes ricinus (n = 1683), Ixodes persulcatus (n = 2404), and Dermacentor reticulatus (n = 479). Genomic DNA was extracted from individual ticks and screened for SFG Rickettsiae using real-time PCR, followed by conventional PCR targeting the gltA, ompA, ompB, and sca4 (gene D) genes. Nucleotide sequences obtained for a subset of positive samples for the various genes were analyzed. The overall prevalence of SFG Rickettsiae was 12.6% (95% CI: 11.7–13.6). Circulation of the following species was detected: Rickettsia helvetica, Rickettsia conorii subsp. raoultii, Candidatus Rickettsia tarasevichiae, Rickettsia monacensis, and Rickettsia felis. The findings indicate considerable species diversity of SFG Rickettsiae in natural foci of Northwest Russia. Rickettsia monacensis was detected in ixodid ticks within the study area for the first time, and R. felis was identified in Russia for the first time.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070177

Authors: Mehmet Hakan Taskin Sule Ozturk Esra Tas Reyhan Caliskan Ergin Kariptas Ecem Dilara Aygun Seda Gozel Zafer Yazici Ahmed Eisa Elhag

Background: HIV has been a major global health issue since the 1980s. The proportions of diagnosed and undiagnosed infections are important indicators of HIV control. This study investigated the prevalence and characteristics of HIV based on blood samples from patients presenting for diagnosis and treatment at a tertiary healthcare hospital in the Central Black Sea Region over a four-year retrospective period. Methods: We retrospectively evaluated 271,367 samples submitted for anti-HIV serology testing for pre-operative screening or clinical suspicion between 2020 and 2023. HIV-1/2 antibodies and p24 antigen were screened using chemiluminescence microparticle immunoassay (CMIA), and reactive samples were confirmed by real-time RT-PCR. HIV RNA results and immunological parameters were also analyzed. Results: Among 271,367 samples, 694 were HIV-positive, yielding a prevalence of 0.25%. Of 2207 individuals tested for HIV RNA, 699 (31.7%) were positive. HIV RNA positivity was higher in men than women (35.5% vs. 18.6%). Absolute CD4+ T-cell counts were similar between genders, while the CD4/CD8 ratio was significantly higher in women. Both CD4+ T-cell counts and CD4/CD8 ratios increased significantly after three months of treatment. Conclusions: This study demonstrates a low but increasing HIV seroprevalence in the region, with a clear predominance among males and young adults. The findings also reflect effective viral suppression among treated patients and significant immunological recovery after therapy, providing important regional data to guide HIV monitoring and public health interventions.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070178

Authors: Naveed Ahmed Wardah Yusof Nurfadhlina Musa Kueh Yee Cheng Nurzulaikha Abdullah Rosline Hassan Muhammad Nashrul Farhan Samsudin Alwi Muhd Besari Hashim Manickam Ravichandran Chua Wei Chuan Chan Yean Yean

Neutralizing antibodies (NABs) play a critical role in assessing the immune response elicited by vaccines, providing insight into their protective efficacy. Despite their importance, there is a notable gap in research directly comparing NAB levels among individuals vaccinated with different vaccines, across diverse ethnicities, and between genders. The study aimed to compare NAB levels across variables such as vaccination status, vaccine type, age, gender, and ethnicity. The NAB levels among different study groups were measured using the Finecare RBD Antibody Test and the cPass kit (ELISA). The data was analyzed statistically using SPSS version 27. A total of 172 study subjects were analyzed. The mean age of participants was 45.03 ± 16.72 years, with 50.9% male and 77.3% of Malay ethnicity. Median NAB levels, assessed by both assays, were highest in females, vaccinated healthy participants, and those who received the Pfizer vaccine. Age-group comparisons revealed variations in median NAB levels across studied groups. Participants aged 10–25 years in the vaccinated healthy (VH) group exhibited the highest median antibody levels; on the other hand, the 26–45 year age group showed the highest median levels in the breakthrough infection (BI) and certain non-vaccinated categories. Ethnic group comparisons highlighted that Malays consistently had the highest median NAB levels. Significant differences in antibody levels were found across vaccination status, ethnicity, and vaccine type (p < 0.001). This study underscores the influence of vaccination status, demographic factors, and vaccine type on NAB levels. The Finecare RBD Antibody Test and cPass kit demonstrated comparable trends, highlighting their utility in evaluating vaccine-induced immunity. The findings of this study highlight the need for tailored immunization strategies to optimize protective immunity.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070176

Authors: Shewaye Belay Tessema Afework Mulugeta Bezabih Helen P. Price

Cutaneous leishmaniasis (CL) is highly prevalent in northern Ethiopia but data on community knowledge, attitudes, and health-seeking behaviours remain limited. A cross-sectional survey was conducted between November and December 2022 in CL-endemic areas of Tigray using mixed sampling and a structured questionnaire administered to 512 households. Knowledge of CL transmission was poor: only 1% correctly identified sand flies as the vector, while 25% believed the disease was genetically acquired. Approximately 67% of participants perceived CL as stigmatizing, and 63.3% reported a preference for traditional or local treatments over biomedical care. Knowledge levels were higher among rural residents and in households with prior CL experience. Gender and education were significantly associated with treatment-seeking and prevention practices, and participants from households with previous CL episodes reported better practices overall. Despite this, most participants demonstrated limited knowledge, unfavourable attitudes and suboptimal treatment-seeking and prevention behaviours. These findings highlight a disconnect between high disease burden, perceived seriousness and stigma, and limited understanding of transmission and prevention. Targeted, community-based health education interventions are needed to improve awareness of transmission, reduce stigma, and enhance access to effective treatment in CL-endemic settings.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070175

Authors: Mequanente Dagnaw Destaw Fetene Teshome Tilahun Bizuayehu Demass Abebaw Gebyehu Worku

Background: HIV-HBV co-infection remains a major public health challenge, particularly in sub-Saharan Africa. HBV co-infection worsens clinical outcomes among people living with HIV by accelerating liver disease and complicating treatment. Although antiretroviral therapy can effectively suppress both viruses, achieving optimal HIV viral suppression remains critical for reducing morbidity and transmission. While several factors influencing viral suppression among PLHIV are well documented, evidence on HIV viral suppression among HIV-HBV co-infected individuals is limited, especially in resource-limited settings like Ethiopia. Furthermore, data on the magnitude of viral suppression and its associated factors in this population are scarce. Therefore, this study aimed to assess the magnitude of HIV viral suppression and identify its associated factors among adult HIV-HBV co-infected patients in Northwest Ethiopia. Objective: This study aimed to assess the magnitude and factors associated with HIV viral suppression among adult people living with HIV-HBV Co-infection in Northwest Ethiopia. Methods: An institution-based cross-sectional study was conducted in Northwest Ethiopia among adults with HIV-HBV co-infection on antiretroviral therapy. A simple random sample of 402 participants was selected. Data were collected using a pretested structured interviewer-administered questionnaire and medical record review, covering sociodemographic, clinical, behavioral, treatment, follow-up, and adherence factors. HIV viral suppression was defined as a plasma viral load < 1000 copies/mL. Data were coded in EpiData 4.6 and analyzed using STATA 18. Descriptive statistics estimated suppression rates. Bivariable and multivariable logistic regression identified factors associated with suppression; variables with p < 0.25 in bivariable analysis were included in the multivariable model. Statistical significance was set at p < 0.05 with adjusted odds ratios and 95% confidence intervals reported. Model fit was assessed using the Hosmer–Lemeshow test, and multicollinearity was checked using variance inflation factors. Results: There were 423 participants in all. Among the 423 HIV-HBV co-infected adults on antiretroviral therapy included in this study, 138 (34, CI, 30–39%) achieved HIV viral suppression, while 264 (66%) had an unsuppressed viral load at the time of assessment. Viral suppression was found to be independently correlated with the ART TDF-3TC-LPV/r regimen, first-line medication adherence, bedridden functional level, missed clinic appointments, and length of therapy. While TDF-3TC-LPV/r usage (AOR 2.34; 95% CI: 1.40–3.90) and longer treatment duration (AOR 2.09; 95% CI: 1.30–3.34) were advantageous, good adherence significantly improved the likelihood of suppression (AOR 5.54; 95% CI: 3.27–9.38). Missed appointments and a bedridden state decreased the likelihood of suppression. Conclusions: HIV viral suppression was achieved in only 34% of participants. Adherence, ART regimen, treatment duration, functional status, and retention in care were significant predictors. Strengthening adherence support, patient retention, optimized ART regimens, routine viral load monitoring, and targeted care for high-risk patients could improve treatment outcomes and help Ethiopia achieve UNAIDS viral suppression targets.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070174

Authors: Suji Y. O’Connor Mary Lorraine Mationg Matthew J. Kelly Gail M. Williams Archie C. A. Clements Banchob Sripa Somphou Sayasone Virak Khieu Kinley Wangdi Donald E. Stewart Sirikachorn Tangkawattana Apiporn T. Suwannatrai Vanthanom Savathdy Visal Khieu Peter Odermatt Catherine A. Gordon Sangduan Wannachart Donald P. McManus Darren J. Gray

Opisthorchis viverrini (OV) is a liver fluke endemic to the Lower Mekong Basin. Infections often begin in childhood and are causally linked to cholangiocarcinoma, an often-fatal bile duct cancer. Anthelmintic treatment is the primary control strategy, but infection can recur. Therefore, additional strategies are needed. This study assessed the impact of “The Magic Glasses Opisthorchiasis” (MGO), a cartoon-based intervention, on schoolchildren’s OV-related knowledge, attitudes and practices (KAP). A cluster (school)-randomised controlled trial was conducted in Cambodia, Laos and Thailand. Clusters were randomised into either school health education only or with MGO. OV KAP was measured using a standardised questionnaire. FGDs and interviews were also conducted in intervention schools with schoolchildren, parents, and teachers. Cambodia intervention knowledge and attitude scores improved by 19.2 (p < 0.001) and 25.3 (p < 0.001) percentage points, respectively, relative to the control. Laos intervention knowledge and attitude scores improved by 19.0 (p < 0.001) and 14.2 (p < 0.001) percentage points. However, Thailand’s intervention knowledge and attitude scores declined by 23.3 (p < 0.001) and 15.8 percentage points (p < 0.001). There were no improvements in behaviour scores in any country, but parents and schoolchildren in Cambodia and Laos reported improved fish preparation practices, suggesting positive spillover effects from MGO. The findings support MGO as an effective tool for school-based health education.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070173

Authors: Thialao Sarr Mame Thierno Bakhoum Aminata Ba Gorgui Diouf Moussa Fall Mamadou Lamine Djiba Abdou Samath Thiall Modou Moustapha Lo Jessica Radzio Basu Assane Gueye Fall

Rift Valley fever virus (RVFV) and Crimean–Congo hemorrhagic fever virus (CCHFV) are endemic zoonotic pathogens in Senegal, transmitted by mosquitoes and ticks, respectively. Understanding the seasonal and spatial dynamics of their vectors is essential to improve targeted surveillance. This study investigated the abundance, diversity, and viral infection status of vector populations in a transboundary region (Matam) and a non-transboundary region (Thiès) over two seasons from September 2022 to March 2024. We collected mosquitoes using CO2-baited CDC light traps and sampled ticks directly from domestic small ruminants. A total of 6558 mosquitoes across 23 species and 1904 ticks representing seven species were morphologically identified. Mosquito abundance peaked significantly during the rainy season. Conversely, tick diversity increased during the dry season, with Hyalomma rufipes emerging as the predominant species. Crucially, RVFV was detected exclusively in Aedes vexans mosquito pools from the transboundary Matam region, emphasizing the epidemiological risk associated with cross-border livestock mobility. Viral RNA of CCHFV was detected in multiple tick species across both regions and seasons, confirming a sustained, multi-vector enzootic cycle. These findings demonstrate persistent RVFV and CCHFV circulation in Senegal and highlight the critical need for integrated, season-specific vector surveillance frameworks.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070172

Authors: Samiullah Sajjad Parnpen Viriyavejakul Dorn Watthanakulpanich Sant Muangnoicharoen Paron Dekumyoy Wirongrong Chierakul Chayasin Mansaguan Prakaykaew Charunwatthana

Background: Hydatid disease, caused by Echinococcus granulosus, remains a significant public health concern in endemic regions. This study aimed to evaluate the role of ultrasound in the diagnosis, staging, and clinical management of liver hydatid cysts in the eastern city of Jalalabad, Afghanistan. Method: A cross-sectional study was conducted between February and November 2024 among 159 patients diagnosed with liver hydatid cysts. Demographic, clinical, laboratory, and imaging data were collected. Cysts were classified according to the WHO Informal Working Group on Echinococcosis (WHO-IWGE) and Gharbi systems. Ultrasound findings were compared with computed tomography (CT), and their association with treatment decisions was assessed. Result: A total of 159 patients with liver hydatid cysts were included in the study. Among them, 91 (57.2%) were female, 80 (50.3%) were aged 20–39 years, and 128 (80.5%) resided in rural areas. Most patients presented with a single cyst (144/159, 90.6%), while multiple cysts were observed in 15 (9.4%). The majority of cysts measured 5–9.9 cm in diameter (43.4%), followed by 1–4.9 cm (42.1%) and ≥10 cm (14.5%). According to the WHO-IWGE classification, CE1 (25.8%) and CE4 (24.5%) were the most common stages, followed by CE2 (17.6%), CE3a (13.8%), CE3b (11.3%), and CE5 (7.0%). Common exposure-related factors included dog ownership, poor hygiene practices, and consumption of raw vegetables. Ultrasound accurately identified cyst stages and demonstrated a significant association between WHO-IWGE staging and treatment modality (χ2 = 63.56, p < 0.001). Almost perfect agreement was observed between ultrasound and CT for cyst classification (Cohen’s κ > 0.90), although CT provided additional anatomical information in selected complex cases. Conclusions: Ultrasound is an accessible, accurate, and reliable imaging modality for the diagnosis, staging, and management of liver hydatid cysts. In resource-limited settings, it serves as the primary imaging modality for guiding clinical decision-making, with CT reserved for complex or uncertain cases.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11070171

Authors: Indira Karibayeva Gulzar Shah Nikolay Lunchenkov Roza Kuanyshbekova Kuanysh Shonbay Botagoz Turdaliyeva

Background: HIV/AIDS remains a major global public health challenge, with persistent regional disparities in burden and progress toward the UNAIDS 95–95–95 targets. This study assessed temporal trends in the HIV/AIDS burden in Kazakhstan, compared them with Central Asia and global patterns, and projected trends through 2030. Methods: We conducted a population-level analysis using Global Burden of Disease 2023 data, examining age-standardized rates (per 100,000) of incidence, prevalence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) from 2010 to 2023. Trends were quantified using percent change and average annual percentage change, with projections based on log-linear models. Results: Between 2010 and 2023, prevalence in Kazakhstan increased by 332.1% and incidence by 111.0%, contrasting with the decline in global incidence (−24.7%). Mortality decreased (−32.7%), along with DALYs (−28.8%) and YLLs (−37.1%), while YLDs increased by 135.5%, indicating a shift toward a chronic disease burden. In 2023, Kazakhstan had a lower overall burden than global estimates but showed steeper increases in incidence and prevalence. Age-specific analyses indicated the largest increases among adults aged 30–69 years. Under current trend assumptions, projections suggest continued growth in prevalence and incidence, with modest mortality declines through 2030, though these trajectories do not account for future changes in prevention coverage, treatment access, or policy. Conclusions: Kazakhstan is undergoing a transition toward a chronic HIV epidemic, underscoring the need to strengthen prevention, expand PrEP and testing coverage, and address structural barriers to achieve epidemic control.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11060170

Authors: Solomon Monday Jacob Sophie Y. Akinbo Oluwaremilekun G. Ajakaye Uwem F. Ekpo Zainab Omoruyi Temitope Agbana Louise Makau-Barasa Moses O. Aderogba Jan-Carel Diehl David Bell Adedotun A. Bayegun Michael A. Okungbowa Juliana A-Enegela Frederick O. Akinbo

Schistosomiasis remains a major public health concern in Nigeria. We molecularly characterized Schistosoma eggs obtained from human urine to identify species and assess the presence of hybrid schistosomes in Abuja, Nigeria. Urine samples were collected from 1887 participants aged five years and above. Samples were examined for Schistosoma eggs using light microscopy. A total of 507 (26.9%) were positive for any form of Schistosoma while 91 (4.8%) had atypical Schistosoma eggs. DNA extracted from pooled ova was analyzed using metagenomic sequencing, read mapping, phylogenetic analysis, and BLASTn confirmation. Molecular analyses identified genetic signatures associated with both S. haematobium and S. bovis within pooled human urine samples, indicating the co-circulation of multiple schistosome species in the study area. Phylogenetic analyses based on trans-ITS and mitochondrial COX1 markers supported the presence of distinct nuclear and mitochondrial schistosome lineages. However, because sequencing was performed on pooled egg samples, the findings cannot distinguish between true recombinants and mixed infections involving co-circulating parental species. These findings highlight the potential complexity of schistosome transmission dynamics in endemic communities and underscore the need for enhanced molecular surveillance, especially single-parasite genomic approaches, and integrated One Health investigations to better understand schistosome transmission and its implications for control and elimination efforts in Nigeria.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11060169

Authors: Thomas Fotas Ioannis A. Giantsis Menelaos Lefkaditis Ioannis S. Pappas Mathis A. B. Christodoulopoulos Efterpi Zafiriou Electra Nicolaidou Alexander C. Katoulis Georgios Christodoulopoulos

Tungiasis is a cutaneous ectoparasitosis caused by the penetration of gravid female Tunga penetrans fleas into the epidermis. Although endemic in tropical and subtropical regions, it remains rare in Europe, where most cases are travel-associated and secondary household transmission is seldom documented. This study describes imported tungiasis in Greece and investigates possible secondary household transmission in a non-endemic setting. Seven Greek men residing in Attica developed tungiasis following occupational exposure in Tanzania, together with one secondary case in a non-travelling household contact who had never travelled outside Greece. Diagnosis was based on clinical and dermoscopic findings and confirmed by amplification and sequencing of the mitochondrial cytochrome oxidase I (COI) gene. Household investigations were also performed. Eight male patients presented with painful plantar and/or subungual nodular lesions. Sequence analysis of COI demonstrated 657/662 bp (99%) identity with the Tunga penetrans reference sequence, and identical sequences were identified in all samples. A representative sequence was deposited in GenBank (accession no. PZ336383). All patients exhibited mild-to-moderate elevations of hepatocellular and cholestatic liver enzymes, which resolved within two weeks following treatment. One probable secondary household case was identified, and no infestation was detected among additional cohabitants or companion animals. This report documents imported tungiasis with probable secondary household transmission in Greece and highlights the importance of clinical awareness and environmental assessment in non-endemic settings.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11060168

Authors: R Lia Kusumawati Mirzan Hasibuan Nisrina Tari Gema Nazri Yanni Laura Isa Ginting Cynthia Gozali Tryna Tania

(1) Background: Indonesia faces the dual challenge of a high tuberculosis (TB) burden and increasing drug resistance. Conventional molecular diagnostics frequently fail to detect isoniazid resistance and nontuberculous mycobacteria (NTM). This study evaluates a domestic multiplex Open PCR system in Medan, Indonesia. (2) Methods: From July to November 2025, 1569 sputum specimens from suspected TB patients were analysed using the Indigen MTB/NTM/DR-TB Real-time PCR Kit Gen 2. (3) Results: Mycobacterial DNA was detected in 421 specimens (26.8%). Among these, 396 (94.1%) were drug-susceptible TB, while 16 (3.8%) showed resistance, predominantly INH mono-resistance (n = 14; 0.89% of total). Additionally, 9 cases (2.1%) involved NTM or TB-NTM co-infections. Tertiary hospitals showed significantly higher positivity rates (33.5%) than primary care (18.9%; p < 0.001). TB status was significantly associated with male (p = 0.0052) and older age (p = 0.006), whereas resistance profiles and NTM distribution were consistent across all demographic groups (p > 0.80). (4) Conclusions: This study describes the implementation and diagnostic yield of a domestic multiplex Open PCR system in Medan, Indonesia. By bridging diagnostic gaps across a decentralized referral network, this facilitates rapid and targeted therapy. Integrating multiplex domestic innovations into national diagnostic algorithms is essential for achieving Indonesia’s TB elimination targets.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11060167

Authors: Andrea Ciammaruconi Anna Rocchetti Filippo Molinari Elisa Recchia Nathalie Totaro Chiara Pascolini Silvia Chimienti Giovanni Faggioni Riccardo De Santis Filippo Moramarco Alberto Autore Florigio Lista

Dengue virus infection remains a significant public health challenge in endemic regions, with growing evidence of autochthonous transmission in Europe. Assessing serological exposure in high-risk populations such as military personnel deployed to endemic areas is essential to quantify exposure risk and support operational decision-making, particularly regarding pre-deployment counselling and risks associated with secondary infection. We conducted a cross-sectional study involving 1355 members of the Italian Armed Forces, measuring anti-dengue IgG antibodies by ELISA and collecting data on deployment history and exposure risk. Overall, IgG seropositivity was 8.12%, with significantly higher prevalence among individuals reporting travel or deployment to endemic regions (24.71%) compared with non-exposed personnel (4.27%). Seropositivity increased with age and correlated with a CDC-derived cumulative dengue risk score (Spearman’s ρ = 0.299, p < 0.0001). A multivariable logistic regression model including age and exposure risk achieved an AUC of 0.75, while machine-learning models provided complementary predictive assessment, with random forest reaching an AUC of 0.79. These findings indicate substantial anti-dengue IgG seropositivity compatible with previous dengue exposure among Italian military personnel, particularly those deployed to endemic settings. The study highlights the need for targeted surveillance and risk-based preventive strategies, and supports the use of exposure-based models to improve epidemiological assessment and inform vaccination strategies in mobile populations.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11060166

Authors: Ivan Lyzenko Olga Stukolova Nikolay Tokarevich Marina Sokolova Regina Baimova Islam Karmokov Ekaterina Riabiko Daria Grechishkina Gelena Lunina Vladimir Dedkov

Background: Borrelia miyamotoi is an emerging tick-borne pathogen causing relapsing fever in humans. Although Saint Petersburg and the surrounding Leningrad Oblast harbor a high abundance of ixodid ticks (I. ricinus, I. persulcatus), no integrated assessment has yet simultaneously addressed pathogen circulation in vectors, reservoir hosts, and human populations in this specific northwestern region of Russia. Methods: During 2022–2024, we collected 1518 questing adult ticks and trapped 516 small mammals in Saint Petersburg and Leningrad Oblast. B. miyamotoi DNA was detected by real-time PCR. Sera from 3743 randomly selected volunteers (1553 from Saint Petersburg, 2190 from Leningrad Oblast) were tested for anti-B. miyamotoi IgG/IgM using a protein microarray (antigens: GlpQ, Vmps, flagellin). Infection rates and seroprevalence with 95% Wilson confidence intervals were compared using chi-square tests. Results: The overall tick infection rate was 3.78% (57/1506). I. ricinus had a significantly higher prevalence (4.94%; 95% CI: 3.67–6.60%) than I. persulcatus (2.29%; 95% CI: 1.39–3.74%; p = 0.011). Ticks from Leningrad Oblast also showed markedly elevated infection rates (4.98%; 95% CI: 3.75–6.58%) compared to those from Saint Petersburg (1.89%; 95% CI: 1.06–3.35%; p = 0.004). Small mammals exhibited substantially higher infection rates in Leningrad Oblast (39.44%; 95% CI: 31.78–47.65%) than in Saint Petersburg (13.90%; 95% CI: 10.76–17.78%; p < 0.001). Bank voles (Myodes glareolus) and yellow-necked mice (Apodemus flavicollis) were the main reservoirs; synanthropic rodents trapped within the city were found to be infected for the first time. No significant organotropism was detected, but positive correlations between infection in the heart, liver, and kidney suggested hematogenous dissemination. The overall human seroprevalence of B. miyamotoi was 1.71% (95% CI: 1.34–2.18%) and was significantly higher in Leningrad Oblast (2.19%; 95% CI: 1.66–2.89%) than in Saint Petersburg (1.03%; 95% CI: 0.64–1.67%; p = 0.010). In contrast, the seroprevalence of B. burgdorferi s. l. did not differ between the two regions (approximately 5.1%). Conclusions: This first comprehensive, multi-level investigation in Saint Petersburg and Leningrad Oblast reveals a stable epidemiological gradient: natural foci in Leningrad Oblast sustain higher B. miyamotoi circulation in ticks and rodents, which translates into a two-fold higher exposure of the rural population. The findings highlight the need to include B. miyamotoi in regional tick-borne infection surveillance programs and to adopt differentiated risk assessment strategies for urban and rural settings.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11060165

Authors: Sumon Ghosh Mohammad Nayeem Hasan Sukanta Chowdhury Narayan C. Paul Waqas Ahmad Jiangang Chen Thankam S. Sunil

Rabies remains a preventable yet fatal zoonotic disease and a major public health concern in Bangladesh, which aims to eliminate dog-mediated human rabies by 2030. Despite free availability of post-exposure prophylaxis (PEP), adherence to the WHO-recommended PEP regimen remains low. This study assessed PEP compliance and identified determinants of regimen completion among animal-exposed patients. We conducted a hospital-based observational study using secondary data from 457 patients who initiated PEP at the National Rabies Prevention and Control Centre (NRPCC) in Dhaka, from February 2023 to July 2023. Sociodemographic, clinical, and exposure-related factors were analyzed to identify predictors of compliance. Only 17.1% of patients completed the full PEP regimen, including rabies immunoglobulin (RIG) administration for WHO Category III exposures where indicated. Higher adherence was observed among females, individuals aged ≥15 years, lower-income groups, and those residing within 10 km of the treatment center. Exposure-related factors including dog bites, multiple exposures, unprovoked incidents, and appropriate exposure care were also associated with improved compliance. Despite free access, PEP completion remains critically low. Targeted strategies, including decentralized PEP delivery, improved public awareness, and strengthened follow-up systems, are essential to improve adherence and support progress toward rabies elimination by 2030.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11060164

Authors: Carlos Ramiro Silva-Ramos Peter C. Melby Patricia V. Aguilar Miguel M. Cabada Juan David Rodas Marylin Hidalgo Álvaro A. Faccini-Martínez

Spotted fever group (SFG) rickettsioses are emerging zoonotic diseases of increasing relevance in Latin America, yet the specific species involved in human infections remain poorly defined in many endemic regions. This study aimed to determine the most probable antigen among SFG-seroreactive febrile patients from Villeta, Colombia. A panel of 25 convalescent-phase serum samples previously identified as positive for SFG Rickettsia spp. antibodies was analyzed by indirect immunofluorescence assay using antigens of Rickettsia rickettsii, R. amblyommatis and R. parkeri. Antibody titers were compared to identify differential seroreactivity patterns. Overall, 44% (11/25) of the samples showed differential antibody titers against one of the tested antigens. Among these, nine (36%) exhibited higher titers to R. parkeri and two (8%) to R. amblyommatis, while none showed exclusive reactivity to R. rickettsii. The remaining 56% (14/25) presented similar titers across antigens, consistent with indeterminate or cross-reactive SFG responses. Antibody titers ranged from 1:128 to 1:4096, with R. parkeri showing the strongest reactivity. These findings suggest R. parkeri or a highly related Rickettsia species as the predominant probable antigen in Villeta, highlighting its potential role in mild rickettsial infections and emphasizing the need for eco-epidemiological studies to identify local vectors and reservoirs.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11060163

Authors: Basílio Felizardo Lima Neto Ana Caroline Dantas Amorim Maria Jessianny Diniz Alves Ana Maria Santos Lima Janielton Albuquerque Lima Celine Sousa Menezes Sá Emilly Henrique Silva João Luís Garcia Vinicius Longo Ribeiro Vilela Thais Ferreira Feitosa

This study aimed to determine the prevalence and risk factors associated with Toxoplasma gondii infection in blood donors from the Brazilian Semiarid region, and to explore its implications for transfusion safety. Samples were collected from 646 donors at blood donation centers in the states of Ceará and Paraíba. Serological diagnosis was performed using BIOLISA TOXOPLASMOSE ELISA kits for anti-T. gondii IgM and IgG antibodies, and molecular diagnosis was conducted by conventional PCR targeting a 529-bp noncoding repetitive fragment. Epidemiological questionnaires on variables associated with infection were administered, and statistical analysis was performed in univariate and multivariate stages, using multiple logistic regression. Among the 646 donors, 43.4% (281/646) were positive for anti-T. gondii IgG antibodies, 0.3% (2/646) for IgM antibodies, and none tested positive by PCR. In the univariate analysis, age, family income, educational level, salad washing practices, water source, raw milk consumption, and duration as a donor were significantly associated, whereas in the multivariate analysis only “age” and “salad washing practices” remained significant. A substantial IgG seroprevalence was observed among blood donors in the Brazilian Semiarid. The low IgM frequency, concurrent IgG positivity, and negative PCR results are consistent with a low transfusion risk in the region. However, these findings should be interpreted cautiously, as negative PCR results do not completely rule out the presence of circulating parasites. Age was identified as a risk factor, whereas proper salad washing showed a protective effect.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11060162

Authors: Paula A. Avilés-Vergara Dina Ricardo-Caldera Carlos Alberto Bolívar Pineda Eliud Daniel Pérez Vergara Ana Carolina Negrette Oquendo Luis Carlos Ruiz Garces Sara Cecilia Soto-De León Catalina Tovar-Acero

Background/Objectives: Arboviral diseases transmitted by Aedes mosquitoes, including Dengue (DENV), Zika (ZIKV), and Chikungunya (CHIKV), represent a major public health challenge in tropical regions. Their clinical similarity complicates differential diagnosis, particularly in settings of viral co-circulation, and may lead to underdiagnosis. The objective was to detect acute dengue infection and assess serological evidence of Chikungunya and Zika virus exposure among patients with acute febrile syndrome and clinical suspicion of dengue in the department of Córdoba, Colombia. Methods: A prospective descriptive study was conducted between 2023 and 2024 in healthcare institutions in Montería and Sahagún. Serum samples were analyzed by ELISA to detect DENV NS1 antigen, anti-CHIKV IgM, and anti-ZIKV IgG antibodies. Sociodemographic, clinical, and laboratory variables were described, and the association between prior ZIKV infection and dengue severity was assessed. Results: Ninety patients were included. Isolated laboratory marker detection was observed for DENV NS1 antigen in 36.7% (33/90), anti-ZIKV IgG in 30.0% (27/90), and anti-CHIKV IgM in 2.2% (2/90); combined arboviral markers were identified in 22.2% (20/90), and 8.9% (8/90) had no detectable markers. Among NS1-confirmed dengue cases (n = 47), 61.7% (29/47) were classified as dengue with warning signs. Anti-ZIKV IgG detection was not associated with dengue clinical classification (p = 0.989), although platelet counts were lower in IgG-positive cases (p = 0.037). Conclusions: The findings support laboratory-supported diagnosis and integrated acute febrile illness surveillance in Córdoba, including locally adapted vector control, in a setting of arbovirus co-circulation with overlapping laboratory markers.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11060161

Authors: Elichilia Robert Shao Jeremia J. Pyuza Tito Kibona Laura Shirima Eliaichi A. Mlay Alice Andongolile Ray Kayaga Semvua Kilonzo Blandina T. Mmbaga Jaffu Chilongola

Background: Crimean–Congo hemorrhagic fever virus (CCHFV) is an important tick-borne zoonosis and an emerging public health threat across Africa. Although evidence of viral circulation is mounting, information remains fragmented, limiting a comprehensive understanding of transmission ecology, regional hotspot heterogeneity, and preparedness needs across the continent. Methods: This narrative review critically synthesized published literature on CCHFV in Africa, identified through PubMed, Scopus, and Google Scholar and supplemented by citation tracking and authoritative public health reports. Evidence from epidemiological, ecological, molecular, surveillance, and One Health studies was integrated to examine transmission dynamics, geographic hotspot distribution, viral diversity, risk factors, diagnostic and surveillance challenges, and preparedness strategies. Results: Available evidence shows marked geographic heterogeneity in CCHFV transmission across Africa, with hotspot regions shaped by ecological suitability, Hyalomma tick distribution, livestock–human interactions, and health system capacity. Livestock consistently show higher exposure than humans, underscoring their role as key indicators of viral circulation. Diagnostic limitations, passive surveillance, ecological variability, and serological cross-reactivity contribute to substantial under recognition of disease burden, while molecular studies reveal considerable viral diversity and ongoing evolution across African regions. Conclusions: CCHFV remains underdiagnosed and underreported in many African settings because of limited surveillance and diagnostic capacity. Strengthening integrated One Health surveillance, expanding laboratory and genomic capacity, utilizing livestock as sentinel populations, and improving cross-sectoral collaboration are critical for enhancing early detection, outbreak preparedness, and effective public health response across the continent.

Tropical Medicine and Infectious Disease doi: 10.3390/tropicalmed11060160

Authors: Tukisho Mphahlele Thendo Gertie Makhado Lufuno Makhado

Background/Objectives: Rifampicin-resistant tuberculosis (RR-TB) and HIV co-infection remain major contributors to morbidity and mortality, particularly in high-burden settings. HIV-related clinical factors, including viral suppression, CD4-defined immune status, HIV drug resistance, virological failure, and ART failure, may influence RR-TB treatment response; however, existing evidence remains fragmented. This systematic review and meta-analysis protocol aims to synthesize evidence on the impact of HIV viral suppression, immune status, and HIV drug resistance/ART resistance status on RR-TB treatment outcomes. Methods: This protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. Published peer-reviewed studies and relevant grey literature from January 2005 to December 2025 will be searched in PubMed/MEDLINE, Cochrane Library, Embase, Web of Science, ScienceDirect, EBSCOhost, PsycINFO, Google Scholar, and other relevant sources. No language restriction will be applied at the search stage. Where feasible, non-English records will be translated for title/abstract and full-text screening. Two reviewers will independently screen studies, extract data, and assess study quality, with disagreements resolved by a third reviewer. Study-level risk of bias will be assessed using design-appropriate tools, and the certainty of evidence for each outcome will be evaluated using GRADE. Results: Evidence will be synthesized narratively and, where studies are sufficiently homogeneous, quantitatively through meta-analysis. Outcomes of interest will include treatment success, treatment failure, mortality, treatment completion, microbiological cure, and adverse events. Subgroup analyses will be considered by viral suppression status, CD4-defined immune status, HIV drug resistance/ART resistance status, geographic region, and treatment regimen where data permit. Conclusions: This review will provide evidence on how HIV viral suppression, immune status, and HIV drug resistance/ART resistance influence RR-TB treatment outcomes. The findings may inform integrated TB/HIV care, clinical monitoring, and treatment strategies for individuals co-infected with HIV and RR-TB.