Trop. Med. Infect. Dis., Volume 10, Issue 8 (August 2025) – 35 articles

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

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

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

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

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

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

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

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

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

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

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

A review was conducted on snakebites in Central America. Information was extracted using the databases of PubMed, SciELO, and LILACS. Information included retrospective studies, case reports, and case series; in this way, valuable information was retrieved from limited sources. The identified studies comprised those discussing envenoming snakebites. Several species were identified, but three of them had major epidemiological features impacting envenoming by snakebites: Bothrops asper, Crotalus simus, and Micrurus sp. Adolescents and young adult males living in rural areas and engaged in agricultural activities were identified as the main victims of snakebites by clinical records. Symptoms of local damage in the bite sites included edema and skin and muscle necrosis. In addition, the cardiovascular system was affected, with symptoms like hypotension, bleeding, and coagulation disorders. Neurotoxicity causing sensitivity and motricity problems was also reported. For El Salvador, accidents caused by Crotalus simus and Micrurus spp. were given more attention due to their greater relevance. The role of Bothrops species was more relevant in the envenoming reported by other countries. Treatment was found to be provided based on antivenoms produced in Costa Rica, and the recovery of the patients depended on the time elapsed between the accident and the initial treatment in the healthcare system. Full article

Research is required to determine whether the coinfections by Fasciola spp. and other parasite species result from poor rural hygiene or reflect underlying epidemiological patterns and causes. Therefore, the role of fascioliasis is analyzed concerning coinfection complexity, risk of multiparasitism, parasite associations, pathogenic implications and their multifactorial causes. Helminth and protozoan coinfections are studied in 2575 previously untreated individuals from four rural hyperendemic areas (Northern Bolivian Altiplano, Peruvian Altiplano and Cajamarca valley, and the Egyptian Nile Delta). This cross-sectional study was conducted from January 2011 to December 2023. Coinfections were coprologically assessed by the merthiolate–iodine–formalin and formol–ether concentration techniques. Infection intensity was measured as eggs/gram of feces (epg) with the Kato–Katz technique. Parasite and coinfection prevalences were stratified by age, sex and geographical location. High mixed infections, fascioliasis prevalences and very low non-coinfected Fasciola-infected subjects were associated with the following regions: Bolivian Altiplano, 96.5%, 16.8% and 3.5%; Peruvian Altiplano, 100%, 24.6% and 0%; Cajamarca valley, 98.7%, 21.4% and 1.8%; Nile Delta, 84.1%, 13.0% and 15.9%. Transmission routes and human infection sources underlie fascioliasis associations with protozoan and other helminth infections. Prevalence pattern of protozoan–helminth coinfections differed between Fasciola-infected individuals and individuals not infected with Fasciola, presenting higher prevalences in individuals with fascioliasis. Multiparasitism diagnosed in Fasciola-infected subjects included coinfections by up to nine parasite species, eight protozoan species, and five helminth species. The most prevalent pathogenic protozoan was Giardia intestinalis. The most prevalent helminth species differ according to environmental conditions. Several parasites indicate fecal environmental contamination. When the fascioliasis burden increases, the total number of parasite species also increases. The fascioliasis risk increases when the total helminth species number/host increases. Fasciola-infected subjects may present a modification in the clinical phenotypes of coinfecting parasitic diseases. Fascioliasis coinfection factors include transmission ways and immunological, environmental and social aspects. Coinfections must be considered when assessing the health impact of fascioliasis, including the analysis of the fascioliasis effects on malnutrition and physical/intellectual child development. Fascioliasis-control schemes should, therefore, integrate control measures mainly against other helminthiases. Full article

Respiratory syncytial virus (RSV) is a major cause of morbidity and mortality from lower respiratory infections (LRIs) worldwide. This study analyzes trends in age-standardized death rates (ASDRs) and disability-adjusted life years (DALYs) due to RSV-induced LRIs from 1990 to 2019, using data from the Global Burden of Disease Study 2021 (GBD 2021). The findings show a gradual decline in deaths, ASDR, and DALYs throughout this period. However, these indicators were higher in men than in women, as well as more pronounced in sub-Saharan West Africa. Developed countries exhibited higher ASDR and DALY values than developing countries, with the highest burden observed among children and the elderly in low Socio-demographic Index (SDI) regions. Globally, RSV-induced LRIs have shown a significant reduction in burden, but interventions are still urgently needed—particularly in low SDI areas—to reduce the impact on vulnerable populations. Public health policies focusing on these high-risk groups are essential for addressing the remaining disparities in RSV-related morbidity and mortality. Full article

Rabies remains a significant global public health concern, causing an estimated 59,000–69,000 human fatalities annually. Despite being entirely preventable through vaccination, rabies continues to impose substantial economic burdens worldwide. This study presents a scoping review of the economic research on rabies to determine overlaps and gaps in knowledge and inform future research strategies. We selected 150 studies (1973–2024) to analyze. The review categorizes the literature based on geographic distribution, species focus, and type of study. Findings indicate that economic studies are disproportionately concentrated in developed countries, such as the United States and parts of Europe, where rabies risk is low, while high-risk regions, particularly in Africa and Asia, remain underrepresented. Most studies focus on dog-mediated rabies, reflecting its dominant role in human transmission, while fewer studies assess the economic impacts of wildlife and livestock-mediated rabies. Case studies and modeling approaches dominate the literature, whereas cost–benefit and cost–effectiveness analyses—critical for informing resource allocation—are limited. The review highlights the need for more economic evaluations in rabies-endemic regions, expanded research on non-dog reservoirs, and broader use of economic methods. Addressing these gaps will be crucial for optimizing rabies control and supporting global initiatives to eliminate dog-mediated rabies by 2030. Full article

Triclabendazole (TCBZ) is the gold standard treatment for fascioliasis. However, reports on resistance are increasing, emphasizing the need for alternative therapy. Combining TCBZ with ivermectin (IVM) was found to be effective for treating animal fascioliasis. Building on this, we aimed to evaluate the efficacy of the TCBZ/IVM combination therapy for human fascioliasis. This study enrolled 136 patients with Fasciola from Upper Egypt, and they were divided into the first group (n = 65), who received TCBZ monotherapy, and the second group (n = 71), who received the TCBZ/IVM combination. Assessments were to evaluate treatment response based on clinical, eosinophilic, and radiological parameters. Chronic fasciolosis was diagnosed in 17 patients (12.5%). No differences were observed in age and sex. Significant improvements were noted in all parameters in both groups, with more pronounced effects observed in the second group. A significantly higher complete response, including clinical, eosinophilic, and radiological improvements, was reported in the combined therapy group, with 53.3% compared to 26.2% in the monotherapy group (p < 0.001). A high baseline eosinophilic count was significantly associated with response. The efficacy of the TCBZ/IVM combination for treating human fascioliasis suggested a possible boosting effect, which can benefit regions of TCBZ failure. Further large-scale randomized studies are warranted to confirm these findings. 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

Insecticide resistance monitoring is essential for effective mosquito control. This study compared CDC Bottle Bioassays (BBAs) using technical and formulated insecticides (deltamethrin/Deltagard and malathion/Fyfanon EW) against the Culex pipiens complex (Fogg Rd) and Culex tarsalis Coquillett (Vic Fazio). BBAs indicated resistance to deltamethrin and emerging resistance to malathion in Fogg Rd, as well as resistance to both in Vic Fazio. Field trials, however, showed high efficacy: Deltagard caused 97.7% mortality in Fogg Rd and 99.4% in Vic Fazio. Fyfanon EW produced 100% mortality in Fogg Rd but only 47% in Vic Fazio. Extended BBA endpoints at 120 and 180 min aligned better with field outcomes. Deltagard achieved 100% mortality at 120 min in both populations; technical deltamethrin reached 85.7% (Fogg Rd) and 83.5% (Vic Fazio) at 180 min. Fyfanon EW and malathion showed similar performance: 100% mortality was achieved in Fogg Rd by 120 min but was lower in Vic Fazio; malathion reached 55%; and Fyfanon EW reached 58.6% by 180 min. Statistical analysis confirmed that BBAs using formulated products better reflected field performance, particularly when proprietary ingredients were involved. These findings support the use of formulated products and extended observation times in BBAs to improve operational relevance and resistance interpretation in addition to detecting levels of insecticide resistance. Full article

Background: Polyparasitic infections remain widespread in endemic regions, yet its contributing factors and health impact are not well understood. This study aims to estimate the prevalence and associated factors and examines the effect of polyparasitic infection on haemoglobin levels among children. Methods: A cross-sectional study was conducted in Lambaréné, Gabon, among children aged 2–17 years from November 2019 to December 2020. Haemoglobin levels, environmental conditions, and sociodemographic data were collected. Stool, urine, and blood samples were analysed using light microscopy for parasite detection. Factors associated with polyparasitism were explored. Results: Out of 656 participants, 65.4% had at least one infection, with intestinal protozoa species (21.3%), Trichuris trichiura (33%), Ascaris lumbricoides (22%), Schistosoma haematobium (20%), and Plasmodium falciparum (10%) being the most common. Polyparasitic infection was identified in 26% of children, mostly as bi-infections (69.2%), and was negatively associated with haemoglobin levels (β = −0.06). Conclusions: These findings emphasise the burden of polyparasitic infections and adverse health effects in Lambaréné, Gabon. Full article

Background: Dyslipidemia and schistosomiasis are major public health challenges, particularly in endemic regions where their coexistence may influence host metabolism and immune responses. This study aimed to evaluate visceral adipose tissue (AT) remodeling in a murine model of acute Schistosoma mansoni infection combined with diet-induced dyslipidemia. Methodology: Female Swiss Webster mice were fed either a standard or high-fat diet (HFD) for 29 weeks and infected with S. mansoni at week 20. Nine weeks after infection, biochemical, morphometric, histopathological, and immunological analyses were performed. Results: The HFD promoted weight gain and dyslipidemia, while S. mansoni infection alone did not alter lipid profiles but partially mitigated the metabolic effects of the HFD. Morphometric analysis revealed adipocyte hypertrophy and reduced cell number in HFD-fed animals. In HFD-fed infected mice, infection partially reversed hypertrophy, suggesting a modulatory effect on AT remodeling. Histopathological examinations showed that while a HFD induced mild inflammation, infection led to intense leukocyte infiltration, hyperemia, and plasma cell degeneration. Peritoneal lavage confirmed a proinflammatory immune profile. Conclusions: These findings indicate that the interaction between a HFD and S. mansoni infection exacerbates adipose tissue inflammation and metabolic alterations, highlighting the complex interplay between parasitic infection, diet, and immune-metabolic regulation. Full article

Objective: To characterize the profiles of resistance mutations to HIV reverse transcriptase inhibitors in Gabon. Design: Cross-sectional study conducted over 37 months, from October 2019 to October 2022, at the IST/HIV/AIDS Reference Laboratory, a reference center for the biological monitoring of people living with the human immunodeficiency virus (PWHIV) in Gabon. Methods: Plasma from 666 PWHIV receiving antiretroviral treatment was collected, followed by RNA extraction, amplification, and reverse transcriptase gene sequencing. Statistical analyses were performed using Stata^® 14.0 software (USA). Results: Six hundred and sixty-six (666) PWHIV plasma collected from 252 male and 414 female patients were analyzed and 1654 mutations were detected in 388 patients, including 849 (51.3%) associated with nucleoside reverse transcriptase inhibitors (NRTIs) and 805 (48.7%) with non-nucleoside reverse transcriptase inhibitors (NNRTIs). Three of the most prescribed treatment regimens were associated to the appearance of both NRTIs and NNRTIs resistance mutations: TDF + 3TC + EFV (24.02%; 160/666); TDF + FTC + EFV) (17.2%; 114/666) and AZT + 3TC + EFV (14.6%; 97/666). Additionally, stage 3 of CD4 T-lymphocyte deficiency, the higher viral load, and treatment duration are risk factors influencing the appearance of virus mutations. Also, treatment containing TDF-3TC + DTG is more protective against mutations. Conclusions: Drug resistance mutations are common in Gabon and compromise the efficacy of ART. Further study must search for other causes of therapeutic failure in Gabon in PWHIV. Full article

Background: Since the current increase in antimicrobial resistance globally, parasitic infectious diseases have become a greater public health crisis than ever before and an absolute priority. The Egyptian community pharmacist, as a health care provider and advisor, has a potential role to play in deworming. Objective: To evaluate the outcomes of community pharmacist-led deworming-related counseling services. Methods: A prospective randomized controlled study was conducted in Damanhur, Behera, Egypt. The intervention group received community pharmacy counseling, and the control group received the usual care. Both groups were monitored for 12 months for recurrence evaluation. Results: A total of 173 patients were included, of whom 96 (55.5%) received patient counseling. The types of infection included Oxyuris (44.5%), Entamoeba histolytica (28.9%), Ascaris (8.7%), Entamoeba Cyst (8.7%), Giardiasis (4.6%), Schistosomiasis (2.9%), and pinworm (1.7%). A total of 119 participants (68.8%) reported a need for dose repetition. Personal hygiene practices were reported by 71 participants (41%). Recurrence of infection was observed in 101 cases (58.4%). Patient counseling was significantly associated with lower recurrence rates and higher rates of personal hygiene application (p < 0.001). Multivariate logistic regression analysis revealed that patient counseling and personal hygiene measures were the only significant predictors of infection recurrence rate. Conclusions: Community pharmacists’ deworming-related counseling had positive behavioral and clinical outcomes. Full article

Introduction: Despite the key role of healthcare workers (HCWs) in tuberculosis (TB) prevention and control, there is a lack of regional data on their knowledge, attitudes, and practices (KAPs) regarding the disease in Atlantic Canada. Objectives: To assess the KAPs of HCWs and identify targets for educational interventions to enhance TB care and control. Methods: A cross-sectional study was conducted among HCWs in Atlantic Canada aged $\ge$19 years from October 2023 to February 2024. Participants were recruited via multiple channels such as social media, collegiate email lists, and snowball sampling. Survey data were collected using an online platform and analyzed using IBM SPSS Statistics v29. KAPs were assessed using Likert-type scales and internal consistency was evaluated using Cronbach’s alpha. Results: A total of 157 HCWs participated in this study (age range: 19 to 69 years); most were women (n = 145, 92%), born in Canada (n = 134, 85.4%), with nearly three-quarters (n = 115, 73.2%) who had never lived outside of Canada. Study participants demonstrated moderately high knowledge (M = 29.32, SD = 3.25) and positive attitudes (M = 3.87, SD = 0.37) towards TB and strong practices (M = 4.24, SD = 0.69) in TB care; however, gaps were identified in HCW abilities to recognize less common TB symptoms (e.g., rash and nausea), as well as inconsistent practices in ventilation and pre-treatment initiation. Internal consistency analysis indicated suboptimal reliability across all three KAP domains, with Cronbach’s alpha values falling below 0.7, thwarting further planned analyses. Conclusions: This study found overall moderate-to-strong TB-related KAPs among HCWs in Atlantic Canada; however, critical gaps in knowledge and practice were noted. This new information can now guide future educational initiatives and targeted training to enhance TB preparedness and ensure equitable care for patients in the region. Full article

Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus, whose 2020 outbreak was characterized as a pandemic by the World Health Organization. Restriction measures changed healthcare delivery, with telehealth providing a viable alternative throughout the pandemic. This study analyzed a telemedicine platform database with the goal of developing a diagnostic prediction model for COVID-19 patients. This is a longitudinal study of patients seen on the Conexa Saúde telemedicine platform in 2022. A multiple binary logistic regression model of controls (negative confirmation for COVID-19 or confirmation of other influenza-like illness) versus COVID-19 was developed to obtain an odds ratio (OR) and a 95% confidence interval (CI). In the final binary logistic regression model, six factors were considered significant: presence of rhinorrhea, ocular symptoms, abdominal pain, rhinosinusopathy, and wheezing/asthma and bronchospasm were more frequent in controls, thus indicating a greater chance of flu-like illnesses than COVID-19. The presence of tiredness and fatigue was three times more prevalent in COVID-19 cases (OR = 3.631; CI = 1.138–11.581; p-value = 0.029). Our findings suggest potential predictors associated with influenza-like illness and COVID-19 that may distinguish between these infections. Full article

Background: Arthropod-borne diseases primarily affect tropical and subtropical regions, exhibiting seasonal patterns that peak during hot and rainy months when conditions favor mosquito vector proliferation. Factors such as high temperatures, elevated humidity, rainfall, urbanization, and the abundance of natural and artificial breeding sites influence Aedes vector dynamics. In this context, arboviruses pose significant public health challenges, likely worsened by global warming. In Brazil, Aedes (Stegomyia) aegypti (Linnaeus, 1762) is the primary vector for yellow fever, dengue, chikungunya, and Zika. Aedes (Stegomyia) albopictus (Skuse, 1894) is an important global arbovirus vector and is considered a potential vector in Brazil. Entomological surveillance of these species often uses oviposition traps targeting immature stages. Evaluating studies that use ovitraps to collect Ae. aegypti and Ae. albopictus egg is essential for improving mosquito surveillance strategies. This study systematically reviewed peer-reviewed articles on ovitrap-based surveillance of Aedes mosquitoes in Brazil, published in Portuguese and English from 2012 to 2022. The findings suggest that ovitraps are an effective method for detecting the presence or absence of Ae. aegypti and Ae. albopictus, serving as a reliable proxy for estimating mosquito abundance in Brazilian contexts. Full article

Neisseria gonorrhoeae, the causative agent of gonorrhea, represents a major public health concern due to its increasing antimicrobial resistance. While often asymptomatic—particularly in extragenital infections—untreated cases can lead to severe complications and further transmission. Despite global efforts to monitor antimicrobial resistance, data on the molecular determinants underlying decreased susceptibility in N. gonorrhoeae remain scarce in Peru. This study aimed to detect mutations in the penA and 23S rRNA genes, which confer decreased susceptibility to cephalosporins and azithromycin resistance. We extracted DNA from 124 N. gonorrhoeae-positive clinical rectal specimens collected in Aptima Combo 2 transport tubes from MSM patients. These DNA samples were then screened using the Mismatch Amplification Mutation Assay-based real-time PCR (MAMA-qPCR) to identify mutations in the 23S rRNA and penA genes. Each sample underwent separate reactions to detect A2059G and C2611T mutations in the 23S rRNA gene, and 86 of these samples were further tested in individual qPCR assays for the penA D345 deletion (D345del) or G545S mutations. Sanger sequencing was performed on all DNA samples positive for 23S rRNA mutations by MAMA-qPCR assay, and on 27 DNA samples that yielded sufficient penA amplicons for additional sequencing. Using the MAMA-qPCR assay for the 23S rRNA gene, 64 of 124 samples amplified in the A2059G reaction: 2 (3.1%) carried the mutation, and 62 were classified as wild type. In the C2611T reaction, 42 of 124 samples amplified, and none of them carried the mutation. Using the MAMA-qPCR assay for the penA gene, we only analyzed 86 samples, as the remaining 38 samples had insufficient DNA yield. A total of 44 of the 86 samples amplified in the D345del reaction: 5 (11.4%) carried the D345del, and 39 were classified as wild type. In the G545S reaction, 4 (6.4%) carried the mutation, and 58 were classified as wild type. Finally, sequencing of the penA gene in the 27 samples revealed mutations related to decreased susceptibility to cephalosporins. This study identified genetic mutations conferring resistance to azithromycin and decreased susceptibility to cephalosporins, providing an overview of the circulating mutations conferring resistance in N. gonorrhoeae strains in Peru. Full article

Weeksella virosa (W. virosa) is a rare, non-saccharolytic Gram-negative bacterium initially described in the 1970s, later proposed as a distinct genus in 1986. The genus Weeksella currently contains two species, namely W. virosa and W. massiliensis. Although primarily considered non-pathogenic, recent evidence has linked W. virosa to a limited number of clinical infections, mostly in immunocompromised patients. This review aims to consolidate the current body of knowledge on W. virosa, encompassing its microbiological and biochemical characteristics, involvement in human and animal infections, antimicrobial susceptibility profiles, and a critical evaluation of existing diagnostic methodologies. This review includes 13 case reports detailing 16 human cases retrieved from multiple databases, highlighting diagnostic inconsistencies and a lack of standardized antimicrobial susceptibility testing. Although W. virosa is generally susceptible to most antibiotics with the exception of aminoglycosides, recent reports seem to suggest a possible emerging resistance trend. The presence of this organism in hospital environments raises concerns about its potential transmission within healthcare settings. While biochemical testing appears to offer reasonably accurate identification of W. virosa, molecular confirmation may be warranted in some cases mainly due to the organism’s rarity. The reliability of MALDI-TOF MS for the identification of W. virosa remains currently uncertain. Further studies, including electron microscopy and genome-wide analysis, are urgently needed to clarify the pathogenic potential of this bacterium and guide clinical management. This review underscores the necessity for awareness among clinicians and microbiologists regarding this underrecognized pathogen. Full article

Introduction: Leptospirosis is an under-recognized zoonosis that affects both tropical and temperate regions. While it is often associated with exposure to contaminated water or infected animals, its presentation and epidemiology in Mediterranean countries remain incompletely understood. This retrospective cohort study investigates the clinical and epidemiological profile of leptospirosis in Crete, Greece, a region where data are scarce. Methods: All adult patients with laboratory-confirmed leptospirosis admitted to three major public hospitals in Crete, Greece, between January 2019 and December 2023 were included in the analysis. Diagnosis was made through serologic testing along with compatible clinical symptoms. Results: A total of 17 patients were included. Their median age was 48 years, with a predominance of males (70.6%). Notably, more than half of the patients had no documented exposure to classic risk factors such as rodents or standing water. Clinical presentations were varied but commonly included fever, fatigue, acute kidney injury, and jaundice. Of the patients who underwent imaging, most showed hepatomegaly. The median delay from symptom onset to diagnosis was 11 days, underscoring the diagnostic challenge in non-endemic areas. Ceftriaxone was the most frequently administered antibiotic (76.5%), often in combination with tetracyclines or quinolones. Despite treatment, three patients (17.6%) died, all presenting with severe manifestations such as ARDS, liver failure, or shock. A concerning increase in cases was noted in 2023. Conclusions: Leptospirosis can present with severe and potentially fatal outcomes even in previously healthy individuals and in regions not traditionally considered endemic. The relatively high mortality and disease frequency noted emphasize the importance of maintaining a high index of suspicion. Timely diagnosis and appropriate antimicrobial therapy are essential to improving patient outcomes. Additionally, the need for enhanced public health awareness, diagnostic capacity, and possibly environmental surveillance to control this neglected but impactful disease better, should be emphasized. Full article

Background: Scrub typhus (ST) is caused by Orientia tsutsugamushi (OT) infection, which is transmitted to humans through the bites of infected chiggers. The clinical presentations range from mild to life-threatening multi-organ dysfunction. This report describes a cluster of ST cases involving five oil palm estate workers in Pekan district, Pahang, Malaysia. Methods: The clinical history, laboratory, and entomological investigation were conducted on the patients, including the index case and four suspected cases in the cluster. Polymerase chain reaction (PCR) tests for OT and genotyping were performed on the patients’ blood and urine samples. Serological testing by indirect immunoperoxidase (IIP) test against Rickettsial diseases was also conducted. Principal Findings: Patients presented with fever, myalgia, headache, rash, cough, and eschar. The index case developed severe ST complicated by acute kidney injury (AKI) and respiratory distress, requiring intubation and ventilation at the intensive care unit of a tertiary hospital. ST was confirmed through PCR analysis of a urine sample, showcasing a novel diagnostic approach. The other four cases were confirmed by a four-fold rise in immunoglobulin G (IgG) antibody titers. Conclusions: Oil palm estate workers are at high risk for chigger exposure in Malaysia. Awareness among clinicians and the public of ST is crucial for effective prevention, accurate diagnosis, and optimal management. Full article

Background: While efforts have been made to control meningococcal disease or carriage during mass gatherings (MGs), it is still a significant problem. This meta-analysis aims to assess the prevalence and predictors of meningitis carriage during MGs and travel. Methodology: PubMed, Scopus, Embase, and Cochrane were searched from their conception to January 2025. Cohort and cross-sectional studies assessing the prevalence of meningitis carriage and its serotype related to MGs and/or travel, and risk factors associated with its spread, were considered. The Newcastle–Ottawa scale was used for the quality assessment of studies. Results: Out of 1301 studies, 25 were considered for this meta-analysis. The largest geographic area involved was Saudi Arabia. A meta-analysis of 24 studies identified a pooled prevalence rate of meningococcal disease or carriage of 15.9% (95%CI: 4.45–27.4%) and the most frequent infecting organisms to be Serotype C (13.9%; 95%CI: −14.7 to 42.5; 4 studies) and A (11.5%; 95%CI: −2.13 to 25.2; 9 studies) among those at MGs or traveling. Age, gender, smoking history, and the vaccination status did not affect the infection risk. Conclusions: There is an increased prevalence of meningococcal disease and carriage, especially Serogroups A and C, associated with MGs and travel. New interventions and methodologies should be undertaken to control and prevent meningococcal disease or carriage transmission during such events. Full article