Search Results (167)

Leishmaniasis is endemic in 99 countries worldwide, including the USA where it has low endemicity. The disease is emerging but likely underdiagnosed due to its historical absence in the diagnostic differentials of American physicians. Additionally, the public seems to have little knowledge about this disease. Here, a comprehensive literature review was carried out on autochthonous leishmaniases in humans in the USA, including their associated Leishmania spp., capable sand fly vector, transmission route, and risk to the parasitic infection. All 89 cases were cutaneous leishmaniasis reported in Texas, Oklahoma, Arizola, and North Dakota. The collective information should serve to mitigate both autochthonous and imported leishmaniasis by expanding reservoir and vector surveillance and improving physician training in diagnosis in the USA. Full article

The Marburg virus (MARV) is a zoonotic pathogen that causes a high case fatality rate of up to 100% in humans. In response to Marburg virus disease (MVD) outbreaks in the Kagera region, an ecological investigation was initiated to map the population and ecological threat to the reservoir host of MARV: Egyptian fruit bats. The investigation conducted from October 2023 to December 2024 included interviews with local authorities to locate all known autochthonous bat colonies in the region. Bat species confirmation was performed using high-resolution melting analysis (HRMA) and DNA barcoding, targeting two mitochondrial genes: cytochrome oxidase 1 (COI) and 16S rRNA. We found five considerably large cave-dwelling Egyptian fruit bat colonies (with approximately 100,000 individuals) at the geolocations between 1°06′04.2″ and 2°26′35.8″ S latitude and 30°40′49.7″ and 31°51′19.8″ E longitude. The study also provides the first confirmed identification of Egyptian fruit bats (Rousettus aegyptiacus) (accession numbers: PV700530-PV700534) in major bat colonies in the Kagera River Basin ecosystem. Cave-dwelling Egyptian fruit bats in mines face higher risks, and thus, attention is needed to prevent this species from becoming more vulnerable to extinction. The loss of bat roosting sites and subsequent population declines are primarily driven by the destructive practice of burning car tyres and logs, a method used to eliminate colonies through toxic smoke and heat. The collection of guano and partially eaten fruits in mining caves, as well as daily contact with Egyptian fruit bats in mines, homes, and churches, have become major potential risk factors for MARV transmission to humans. Increased threats to bats in the Kagera region warrant the implementation of conservation strategies that ensure the survival of the bat populations and inform policies on MVD risk reduction in Tanzania and the broader East African region. Full article

This study analyses all cases of acute hepatitis E diagnosed in a southern Romanian hospital from 2019 to 2023. Patients with positive anti-HEV IgM antibodies were included in three groups: group A1—96 patients with probable HEV infection and ALT levels over 2.5-fold the upper limit of normal (ULN); group A2—44 patients with probable HEV infection and ALT levels under 2.5-fold ULN; group B—43 patients with probable HEV coinfection with another hepatotropic virus. Between 2019 and 2023, 642 patients were diagnosed with acute viral hepatitis. Positive anti-HEV IgM antibodies were detected in 183 (28.5%) cases, HEV being the second most common cause of acute viral hepatitis. Patients from group A were older than those from group B (47.26 ± 15.13 years vs. 35.95 ± 14.83 years, p < 0.01). Patients from group A were less likely to present clinical features compared to those from group B: digestive symptoms (73.8% vs. 97.2%, p < 0.01), jaundice (38.9% vs. 88.4%, p < 0.01), hepatomegaly (64.1% vs. 88.6%, p = 0.02). Patients from group A, compared to patients from group B, had lower levels of ALT (18.2 ± 29.9 ULN vs. 83.7 ± 56.2 ULN, p < 0.01) and total bilirubin (3.08 ± 5.2 mg/dL vs. 7.82 ± 5.25 mg/dL, p < 0.01) at admission. Patients from group A had higher levels of anti-HEV IgM antibodies (4.3 ± 3.22 vs. 2.55 ± 1.34, p < 0.01) than those from group B. Nearly all patients had no history of travel; therefore, autochthonous origin of HEV is involved in a large majority of cases. Currently, hepatitis E virus is not an uncommon aetiology of acute hepatitis in Romania, more often in adults and elderly patients. The epidemiological and clinical features of HEV infections plead for a zoonotic transmission in most cases. The significant number of cases of hepatitis E diagnosed in a single centre in Bucharest justifies the need to include early testing for HEV in patients with acute hepatitis. Full article

Brazil is the first of the 12 priority countries in Latin America with the highest number of cases of American cutaneous leishmaniasis (ACL). This study estimated the prevalence of ACL in Brazil and classified the states according to the different levels of endemicity in the period from 2014 to 2024. This is a retrospective and cross-sectional study of ACL cases registered in Brazil by the Information System for Notifiable Diseases of the Ministry of Health. The predominant cases were male (73.2%), brown (65.0%), aged between 20 and 39 (41.5%), with a low level of education (44.4%), 0.5% in pregnant women, 80% of cases were confirmed by laboratory criteria, and 90% were classified as cutaneous. A total of 182,072 autochthonous cases were recorded, with a prevalence of 89.6 cases per 100,000 population. Two states were classified as having high intense endemicity; three were classified as having medium intense endemicity; four were classified as having low intense endemicity; five states were classified as having moderate endemicity; and 13 were classified as having low endemicity. The municipality of Presidente Figueiredo, Amazonas, had the highest prevalence of ACL (5503.1%), while Belo Horizonte had the lowest prevalence (72.2%). The month with the highest average number of cases was January with 1731 (with a standard deviation of 364; upper limit of 1933; lower limit of 1572). The heterogeneity of endemicity among States suggests that social and environmental determinants influence the dynamics of ACL transmission. All sociodemographic, clinical, and epidemiological categories, when compared with the different levels of endemicity, showed significant effects (p < 0.05), except for the variable gestational status in high disease endemicity. The inclusion of these variables significantly improved the model’s ability to predict the dependent variable. Full article

Dengue, caused by the dengue virus (DENV), is rapidly expanding its geographical footprint, with increasing incidence not only in over 100 endemic countries in the southern hemisphere but also with more autochthonous transmissions now reported in the northern hemisphere, including regions of Europe and the United States. The clinical presentation of DENV infection ranges from mild febrile illness to severe and potentially fatal conditions, such as dengue hemorrhagic fever (DHF), dengue shock syndrome (DSS), and diverse neurological complications. While vaccine development efforts are underway, significant challenges remain, underscoring the urgent need for a deeper understanding of the virus. This urgency is particularly palpable in Brazil, which has faced an unprecedented surge in dengue cases during the 2024–2025 period. The country has recorded an alarmingly high number of infections and related deaths, stretching its public health infrastructure and highlighting the complex interplay of climate change, urbanization, and viral dynamics in disease propagation. This review provides a global perspective on dengue, systematically exploring its history, morphology, viral cycle, pathogenesis, and epidemiology. By integrating these critical aspects, this article aims to identify pivotal knowledge gaps and guide future research directions essential for developing improved public health interventions against this complex and evolving disease. Full article

Cryptococcosis, caused by the Cryptococcus neoformans and Cryptococcus gattii species complexes (pathogenic Cryptococcus spp.), is an environmentally acquired mycosis of One Health relevance. This study integrates a PRISMA-compliant systematic review (2000–2025) of Portuguese animal, human, and environmental reports with a 13-year retrospective dataset of laboratory-confirmed veterinary cryptococcosis cases (2013–2025). Clinical specimens were cultured and identified by MALDI-TOF mass spectrometry, and associations were assessed using χ² and Fisher’s exact tests. Of 1059 submissions, 48 (4.5%) were culture-positive: 6.8% of canine, 5.3% of feline samples, and 4.0% of avian samples, with no detections in other vertebrate groups (p = 0.705). Cryptococcus neoformans predominated in carnivores (73.7%), while Papiliotrema laurentii (formerly Cryptococcus laurentii) was most frequent in birds (86.2%). Infection was not associated with sex or age. Seasonality was evident, with a July peak and summer predominance (p = 0.010). Most cases were from the Centre region (62.5%), with significant regional variation of Cryptococcus spp. distribution (p < 0.001). The systematic review confirmed autochthonous C. gattii complex disease and widespread C. neoformans contamination in pigeon guano and arboreal niches. These findings demonstrate a compartmentalised eco-epidemiology, reinforcing the need for integrated molecular typing, antifungal susceptibility testing, and coordinated human–animal–environment surveillance to inform targeted prevention and control strategies in Portugal. Full article

Background: Dengue fever is an arboviral infection transmitted by Aedes mosquitoes that has recently become a public health concern also in Europe, causing many outbreaks of autochthonous cases. Methods: We retrospectively retrieved dengue cases in returning travelers from tropical areas diagnosed at the Luigi Sacco Hospital between January 2018 and December 2024. All patients with positive serology for DENV (IgM alone or IgM and IgG or neutralizing antibodies detection) and/or positive real-time polymerase chain reaction (RT-PCR) for DENV RNA on plasma and urine were considered. Analyses were descriptive. Results: This analysis included 159 travelers with confirmed (n = 138; 86.8%) or probable (n = 21; 13.2%) dengue fever. The median age was 38 years (interquartile range [IQR] 30–50); 87 (54.7%) were females. The median time between symptom onset and seeking medical attention was four days (IQR 3–6); 29.6% required hospitalization, with a median stay of four days (IQR 0–5). The most common symptoms included fever (100%), myalgia (52.2%), and headache (49.1%). Laboratory findings revealed thrombocytopenia (53.8%), leukopenia (64.1%), elevated ALT (51.9%), and LDH (60.2%). Among the confirmed cases, 128 (92.8%) were diagnosed with RT-PCR. Serotypes 1 and 2 were the most prevalent (28.9% and 27.3%, respectively). Most cases were classified as dengue without warning signs (150, 94.3%), eight cases (5.0%) as dengue with warning signs, and one as severe dengue. Conclusions: Dengue fever is an important cause of fever among travelers returning to Italy from endemic areas. Although severe dengue is rare among travelers, further prospective studies need to address this issue. Diagnosis should be pursued by using molecular tools because of cross-reactivity with other arboviruses. Full article

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

Background: Hansen’s disease or leprosy is one of the 21 neglected tropical diseases (NTDs). In Ecuador, leprosy is considered eliminated as a public health problem; however, new cases are reported annually. Additionally, Mycobacterium leprae infection was detected in nine-banded armadillos across the country, suggesting a potential zoonotic reservoir. This literature review aims to provide an updated overview of the epidemiological situation of leprosy in Ecuador, identify knowledge gaps, and outline research priorities to support the development of a comprehensive national strategy for achieving zero autochthonous cases. Methods: This article analyses the current situation of leprosy in Ecuador based on international and national publications. A retrospective literature search using five international, regional, and national publications on leprosy published between 1954 and 2024 (70 years) with no restriction on language or publication date, was performed. Findings: Our review identified 28 publications with the earliest article dating back to 1954. Of these, 14 were published in international journals, 15 (53.6%) were in Spanish. Four nationwide studies documented leprosy cases across Ecuador’s three continental regions (Coast, Andes, and Amazon) with a predominance in the tropical coast. No cases have been reported from the Galápagos Islands. From 1983, Ecuador started multi-drug therapy. Data from the Ministry of Public Health (MoH) system identified 1539 incident cases, showing a significant decline in new cases from 2000 to 2024, with no cases in children. New cases detection rate by 100,000 inhabitants was 0.51 in 2019 according to the World Health Organization (WHO). No study has genotyped the Mycobacterium spp. in human cases, other animal species, or environment. According to the MoH, multibacillary leprosy accounts for 78.95% of diagnosed cases, with confirmation based on Ziehl–Neelsen staining and histopathology. No survey has assessed disabilities, knowledge, attitudes, and practices (KAP) or stigma related to leprosy. Research is needed on transmission routes, Mycobacterium genotyping, genetic susceptibility, and antibiotic resistance. BCG vaccination coverage fell to 75.3% in 2021. Cases are currently diagnosed and treated on an outpatient basis in large hospitals. Conclusions: This comprehensive review highlights persistent gaps in leprosy research and critical information, despite seven decades of documented cases in Ecuador. The disease is still endemic across the country, particularly at subnational level in the subtropics and tropics of the Pacific coast and the Amazon. There is a need for nationwide epidemiological research on reservoirs and the environment applying the One Health concept. Increased laboratory facilities and readily available official data are required to improve our understanding of leprosy in Ecuador. Strengthening community-level efforts is essential for Ecuador to meet the targets of the “WHO’s Towards Zero Leprosy: Strategy 2021–2030.” Full article

In recent years, migratory movements have increased. This study aimed to compare tuberculosis cases in migrant and autochthonous patients. We conducted a retrospective analytical cohort study of patients diagnosed with tuberculosis in the Elda Health District (Alicante, Spain) between 2013 and 2023. Of the 98 patients analyzed, 28 (29.6%) were migrants, predominantly male (65%), with a mean age of 35.6 years. Pulmonary tuberculosis was present in 82% of patients in both groups, and nine cases of drug-resistant tuberculosis were identified. No significant differences were observed between groups in treatment cure rates, mortality, or hospitalization. Unfavourable outcomes—a composite endpoint comprising mortality, treatment failure, and loss to follow-up—were more frequent in males and in patients with elevated C-reactive protein (CRP) levels (p = 0.033) or a higher CRP/albumin ratio. Migrants accounted for a substantial proportion of total TB cases and tended to be younger, with fewer comorbidities and lower rates of substance use. They showed a non-significant trend toward higher loss to follow-up and drug resistance. Overall, unfavourable outcomes were associated with elevated CRP levels and the CRP/albumin ratio. Full article

Via a One Health approach, this study concomitantly assessed the susceptibility of humans and dogs to Trypanosoma cruzi infections on three islands and in two mainland seashore areas of southern Brazil. Human serum samples were tested using an enzyme-linked immunosorbent assay (ELISA) to detect anti-T. cruzi antibodies, while dog serum samples were tested using indirect fluorescent antibodies in an immunofluorescence assay (IFA). Seropositive human and dog individuals were also tested using quantitative polymerase chain reaction (qPCR) in corresponding blood samples. Overall, 2/304 (0.6%) human and 1/292 dog samples tested seropositive for T. cruzi by ELISA and IFA, respectively, and these cases were also molecularly positive for T. cruzi by qPCR. Although a relatively low positivity rate was observed herein, these cases were likely autochthonous, and the individuals may have been infected as a consequence of isolated events of disturbance in the natural peridomicile areas nearby. Such a disturbance could come in the form of a fire or deforestation event, which can cause stress and parasitemia in wild reservoirs and, consequently, lead to positive triatomines. In conclusion, T. cruzi monitoring should always be conducted in suspicious areas to ensure a Chagas disease-free status over time. Further studies should also consider entomological and wildlife surveillance to fully capture the transmission and spread of T. cruzi on islands and in seashore mainland areas of Brazil and other endemic countries. Full article

Amebiasis is a rare condition in industrialised countries but is epidemiologically growing. Clinical manifestations may range from asymptomatic to invasive disease. An amebic abscess can be the result of extraintestinal amebiasis, and it is associated with relatively high morbidity and mortality. We present three indigenous cases of amoebic liver abscesses observed within a few weeks (October–November 2023) in patients living in a small area near Lucca in Tuscany, Central Italy. Fever accompanied by abdominal pain and liver abscess was observed in all three patients, and one of them presented necrotising colitis and pleural effusion, too. The parasitological diagnosis was performed by microscopy and confirmed with real-time PCR in liver abscess drainage fluid and stools. Full article

In the Americas, the number of confirmed malaria cases decreased by 65.4% between 2000 and 2023, and malaria elimination is now in sight for many countries. Argentina is currently free of autochthonous malaria transmission. Until 2011, cases of malaria were concentrated in Northwestern Argentina, near the border with Bolivia, a country that continues to have malaria transmission. The Orán department (Salta province, Northwestern Argentina) had particularly high transmission near a main road that is a pathway for migration from Bolivia. The purpose of this study was to identify which factors best explain the extent and timing of changes in the proportion of malaria cases in this area that were locally transmitted versus acquired in another country. Combining information from routinely collected case investigations, epidemiological surveillance data, and satellite imagery, we used a logistic model and a multi-level model of change to identify how demographic and place-level variables influence the proportion of malaria cases that were imported over time. The findings showed that the proportion of cases that were imported varied significantly over time, with a clear trend from predominantly autochthonous cases at the beginning of the study in 1977 (94.52%) to a majority of imported cases in 1992 (53.33%), a pattern that continued and intensified, reaching 76% imported cases by the end of the series in 2009. Nationality and place of work were key demographic factors influencing this shift. In particular, there was a change in transmission patterns after a cross-border intervention was launched in 1996. As Argentina has obtained certification of malaria elimination, these results may inform focal strategies for preventing re-introduction. Full article

This research proposes an update of the use of the concept of “habitus”. In continuity with Wacquant, I suggest using habitus not only as an object of investigation, but also as a methodological tool, reintroducing it for qualitative studies of digital sociology. Additionally, it can be used as an analytical tool to guide the selection of cases of analysis in empirical research. The aim of this study is to provide researchers with a methodological tool in their toolbox that can apply categorizations that can guide the entire research process to interpret social differences and, consequently, the positions that subjects occupy in the social field through critical reconstruction. This study intends to use the concept of habitus, taking the following scheme into account: [(habitus)·(capital) + Field] = practice. However, the scheme is updated through the use of new indicators that are suitable for describing and categorizing subjects and their hybrid interaction in digital platforms, as well as in autochthonous contexts. For this reason, this study has provided an integration of new forms of capital with the classic ones identified by Bourdieu. In this study, habitus will be defined as “popular habitus”, i.e., a rigorous effort that is useful for finding the tools capable of determining which subjects are symbolically categorized in a “popular” representation of the self and in their practical predispositions, as well as which are not. Furthermore, through empirical examples, the capacity of the tool to understand the interaction between digital platforms and social subjects is highlighted, as well as the way in which this interaction contributes to shaping identities and social choices. Full article

Background: Leishmaniasis is a vector-borne zoonotic disease caused by protozoa of the genus Leishmania. While it is endemic in the Mediterranean Basin and the Balkans, Romania remains a non-endemic country. However, climate change, increased international travel, and the documented presence of competent vectors (Phlebotomus spp.) have raised concerns about the potential emergence of autochthonous cases. Case Presentation: We report two cases of imported cutaneous leishmaniasis (CL) diagnosed in central Romania, a region without previously confirmed human or animal cases. The first case involved a 31-year-old male with a recent travel history to Spain, presenting with erythematous papules and plaques that evolved into ulcerated lesions. The diagnosis was confirmed histopathologically and by a PCR. Treatment with miltefosine was effective, with minimal hepatic toxicity and a sustained response at a six-month follow-up. The second case concerned an 11-year-old boy who had traveled to Elba, Italy. He developed ulcerative lesions that progressed rapidly and were complicated by Pseudomonas aeruginosa superinfection. Despite an initially negative smear, PCR testing of the skin lesion confirmed the presence of CL. Antifungal therapy with fluconazole led to clinical improvement; treatment was ongoing at the time of publication. Discussion: These cases highlight the diagnostic and therapeutic challenges associated with CL in non-endemic settings. The varied clinical evolution underscores the importance of considering leishmaniasis in the differential diagnosis of chronic, non-healing cutaneous lesions, particularly in patients with a travel history to endemic regions. Conclusions: Increased awareness among clinicians, supported by accurate diagnostic tools and public health surveillance, is essential to identify and manage imported leishmaniasis. Given the absence of a licensed vaccine and the growing risk of vector expansion in Eastern Europe, these cases support the WHO’s inclusion of leishmaniasis among the priority neglected tropical diseases targeted for intensified global control efforts by 2030. Full article