OBJECTIVES:Low-grade appendiceal mucinous neoplasm (LAMN) is a rare tumor with limited malignant potential but a risk of pseudomyxoma peritonei (PMP) if perforation occurs. We aimed to characterize clinicopathological features, assess recurrence risk, and evaluate postoperative surveillance. METHODS:We retrospectively reviewed 44 patients with pathologically confirmed LAMN who underwent surgery at our institution between 2010 and 2025. Clinicopathological factors, recurrence, and surveillance strategies, including tumor markers and computed tomography (CT), were analyzed. Recurrence-free survival (RFS), overall survival (OS), and disease-specific survival were calculated. RESULTS:Median age was 64 years. Preoperative tumor marker elevation was uncommon. Risk factors included pT4 in 14 patients (33%), extra-appendiceal mucin in 1 (2.3%), positive margin in 1 (2.3%), and perforation in 15 (34.1%). Over a median 36-month follow-up, no recurrences or PMP occurred; one death from an unrelated cause was observed, resulting in 5-year RFS and OS of 97.7%. No disease-specific deaths occurred. Median annual CT frequency was 1.7 (42 mSv). The estimated annual copayment for follow-up examinations was approximately ¥7,200 per patient. CONCLUSIONS:Surgically resected LAMN showed favorable mid-term outcomes. However, given the limited follow-up and absence of events, the findings should be interpreted cautiously as preliminary insights into postoperative surveillance.
BACKGROUND:The impact of the coronavirus disease 2019 (COVID-19) pandemic on acute coronary syndrome (ACS) care has varied widely across regions. Data from stable regional healthcare systems remain limited, particularly regarding potential delayed effects after the acute pandemic phase. METHODS:We conducted a retrospective, population-based observational study of percutaneous coronary intervention (PCI)-treated ACS in Kurume City, Japan, across three periods: pre-pandemic (2019), pandemic (2020-2021), and post-restriction (2022). PCI data were collected from all four PCI-capable hospitals in the region. The primary endpoint was in-hospital mortality among ACS patients. Secondary endpoints included ACS subtype distribution and use of mechanical circulatory support (MCS). RESULTS:A total of 4,694 PCI procedures were performed between 2019 and 2022, including 1,692 for ACS. Annual PCI volume and the proportion performed for ACS (34.1%-38.6%) remained stable. The proportion of ST-segment elevation myocardial infarction was higher in 2020 and remained elevated in 2022 compared with 2019 (p=0.015). In-hospital mortality among ACS patients was comparable during the pandemic years but increased significantly in 2022 (7.4% vs 2.3%-4.0%; p=0.0006), even after excluding post-cardiac arrest syndrome. Rates of MCS use did not differ significantly across years. Emergency medical transport times increased modestly. CONCLUSION:In this regional healthcare system, the COVID-19 pandemic did not substantially disrupt emergent coronary revascularization or worsen short-term outcomes of PCI-treated ACS during the acute phase. However, in-hospital mortality increased in the post-restriction period, suggesting delayed cardiovascular consequences of the pandemic.
Anger may arise following harmful experiences such as violence, and managing anger may be crucial for the mental health of those working in environments prone to physical or verbal abuse, such as psychiatric wards. Although anger is a basic emotion, research concerning anger is limited. To examine the association between anger and mental health status in the context of workplace violence, we distributed a questionnaire to 569 psychiatric nurses in Japan. Compared to studies conducted outside Japan, these nurses' mean scores on the Dimensions of Anger Reaction-5 (DAR-5) scale were lower. A multivariate analysis revealed that the following significantly predicted higher levels of anger: working in a chronic care ward, psychological distress, secondary traumatic stress, and the experience of workplace violence. These findings highlight the importance of conducting further research on anger related to workplace trauma.
Virtual Reality (VR) is increasingly used in surgical education. This study examines the impact of VR-integrated training on learning, memory, and psychological responses. A prototype VR system with immersive OR views was tested on 67 clinical clerkship students. OR experiences followed the simulation. Thirty-two questionnaires covered surgical procedures and systems. Mood and personality were assessed using POMS-2, focusing on Total Mood Disturbance (TMD), fatigue-inertia (FI), vigor-activity (VA), and friendliness (F). VR modestly increased interest in surgery (~3.4/5) but training confidence stayed low (2.2/5). Understanding of abdominal surgery improved (2.6/5), with 96% correctly identifying the sterile field. Robotic roles were partially grasped; DCS understanding remained low (2.3/5). VR users better located OR equipment but 22% experienced nausea and 46% disliked the design. Compared to non-VR peers, they had lower procedural knowledge (p<0.01), but reported less stress and improved teamwork awareness (p<0.01). Mood analysis showed increased TMD and FI, decreased VA and F (all p<0.01), and reduced anxiety (TA). Personality traits (low neuroticism, high extraversion) were linked to stronger emotional reactions. VR sickness (51%) correlated with cognitive confusion and higher TMD (p<0.01). This VR approach enhances surgical understanding and team role awareness, offering experiential value in preclinical training.
Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft-tissue infection requiring prompt diagnosis and aggressive surgical intervention. Although approximately 20% of NF cases arise from postoperative infections, its occurrence after cesarean delivery is extremely rare, with an estimated incidence of 0.18%. We report a case of a 35-year-old primigravida with no significant medical history who underwent emergency cesarean section for non-reassuring fetal status. On postoperative day (POD) 6, she developed fever, elevated inflammatory markers, and uterine tenderness consistent with intrauterine infection. Subsequently, erythema and induration developed at the surgical site, and despite antibiotic therapy, her condition progressed to blistering and skin necrosis. Imaging revealed gas formation and fluid collection at the incision site. Emergency surgical debridement confirmed NF involving tissues from the epidermis to the rectus fascia. Methicillin-resistant Staphylococcus aureus was isolated from wound cultures, and intravenous meropenem and vancomycin were administered. Hyperbaric oxygen therapy and negative-pressure wound therapy were applied sequentially, followed by delayed wound closure. The patient recovered well and was discharged on POD51. Although rare in obstetric practice, NF should be considered when cesarean wound infections fail to respond to standard therapy.
INTRODUCTION:Lower gastrointestinal tract stenoses are commonly treated with surgery or endoscopic balloon dilation. We conducted a clinical trial to investigate a novel endoscopic treatment called radial incision and cutting (RIC). Although RIC has demonstrated a high technical success rate and has been shown to improve subjective symptoms, the relatively high rate of delayed bleeding in cases of ileocolonic anastomotic strictures due to Crohn's disease (CD) can be problematic. Herein, we report the design of a prospective, single-center, single-arm, exploratory pilot study to evaluate safety and feasibility of self-expandable metallic stent (SEMS) placement as an alternative dilation strategy for ileocolonic anastomotic strictures in CD, particularly in patients in whom delayed bleeding after RIC has been a clinical concern. METHODS:The major inclusion criteria include age 18-80 years, ileocolonic anastomotic strictures after surgery for CD, and a history of endoscopic balloon dilation or RIC for such strictures. We will employ a SEMS designed for malignant biliary stenosis and conduct SEMS placement in five participants. The primary outcome is the safety of SEMS placement, assessed by determining the frequency of adverse events of special interest, including delayed bleeding and perforation. The secondary outcomes include the technical success rate of SEMS placement, procedure duration, improvement in subjective symptoms, SEMS migration rate, success rate of SEMS removal 1 week after placement, and duration of hospitalization. Subjective symptom improvement is evaluated using the visual analog scale, and long-term results are analyzed using descriptive statistics, Student's t-test, and Kaplan-Meier curves. CONCLUSION:This exploratory study provides useful information regarding the safety of SEMS placement for ileocolonic anastomotic strictures due to CD, which may contribute to further investigation.
Background:The emergence of mobile colistin resistance determinants in clinically relevant Acinetobacter species poses a growing challenge to antimicrobial stewardship and One Health surveillance. Although mcr-4.3 has been reported in Acinetobacter, its occurrence in imported food animals and its broader phylogenomic context remain poorly defined. Methods:We investigated fecal samples collected from 150 beef cattle imported from Australia to China. Acinetobacter isolates recovered by selective culture were subjected to whole-genome sequencing, and the mcr-4.3-positive isolate was further resolved by hybrid assembly using short- and long-read sequencing. Comparative plasmid analysis and global phylogenomic analysis were performed using publicly available A. nosocomialis genomes. Results:Among 54 Acinetobacter isolates recovered from imported cattle, one A. nosocomialis isolate, NB148, carried mcr-4.3. Complete genome sequencing showed that mcr-4.3 was located on a 28,233-bp plasmid, designated pNB148_mcr-4.3, which harbored plasmid maintenance-associated toxin-antitoxin systems and shared substantial backbone similarity with previously reported mcr-4.3-bearing plasmids from Acinetobacter species. The mcr-4.3 region was positioned downstream of a putative recombinase and a Tn3-family transposase, suggesting a conserved genetic framework for this resistance determinant. Global phylogenomic analysis incorporating 574 publicly available A. nosocomialis genomes placed NB148 within a diverse international population characterized by mixing across animal, environmental, and human sources. Among the global collection, 11 genomes carried mcr-4.3, of which 10 belonged to ST279, indicating that this lineage may represent an important genomic background for the persistence and international distribution of mcr-4.3-positive A. nosocomialis. Conclusions:This study documents plasmid-borne mcr-4.3 in A. nosocomialis recovered from imported beef cattle and places this finding within a broader international One Health context. Our data expand the known ecological range of mcr-4.3-positive A. nosocomialis and support strengthened genomic surveillance at animal-human-environment interfaces, particularly in importation and border inspection settings.
Objectives:To evaluate the zoonotic risk of Simplexvirus macacine alpha 1 (B virus), a macaque-associated alphaherpesvirus that can cause severe and frequently fatal encephalitis in humans, and to assess the potential for cross-border risk through international macaque trade. Methods:A comprehensive literature review was conducted to identify documented human B virus infections between 1932 and 2024. International trade records for Macaca species from the CITES Trade Database (2019-2022) were analyzed for trade volume, source, and purpose. Quarantine regulations across countries were compared, using South Korea as a case study. Results:Among 33 documented infections, most were occupational exposures in laboratory settings. Recent cases highlight non-occupational risks, including viral reactivation decades after exposure. From 2019 to 2022, exporter-reported CITES data documented over 170,000 live macaques in international trade, with an increasing proportional share of wild-caught animals. Regulatory frameworks varied by country, with South Korea relying on recommendation-based biosafety oversight, whereas the U.S. applies legally binding import-control measures. Conclusions:Although rare, B virus poses a severe and underappreciated zoonotic threat. The increasing wild-caught macaque trade and gaps in quarantine protocols necessitate stronger international coordination and the implementation of standardized biosafety regulations within a One Health framework.
Background:Wild birds are major reservoirs contributing to the spread of highly pathogenic avian influenza (HPAI). Accordingly, fecal-based surveillance of wild birds has been implemented as an early warning system for poultry in South Korea. However, the efficiency of the current system remains limited due to the absence of a quantitative basis. This study aimed to develop a risk-based strategy for optimizing fecal sampling sites, thereby strengthening early warning capacity and preventing the introduction of HPAI into poultry farms. Methods:The study area comprised 110 designated surveillance areas divided into 1-km edge hexagonal grids. The study period covered October to February from 2021 to 2024. For each grid, we integrated wild bird fecal sampling data with various categories of factors. The dependent variable was the detection of avian influenza virus (AIV) in wild bird feces, while all other variables served as predictors. The risk of AIV detection was estimated using machine learning algorithms, including logistic regression, gradient boosting machine, extreme gradient boosting, and an ensemble model. Model performance was evaluated using the area under the curve (AUC), sensitivity, specificity, and accuracy. Results:The ensemble model achieved the best predictive performance. Climatic factors, sample size, population, and elevation were identified as the most influential predictors. Spatial inconsistency was observed between the current sampling sites and the proposed risk-based sampling sites. Conclusions:The proposed risk-based framework enables prioritization of sampling sites, thereby optimizing fecal-based surveillance for HPAI. This approach is expected to enhance the efficiency of EWS and contribute to the prevention of HPAI spread to poultry.
West Nile virus (WNV) is a growing risk to public and veterinary health in Europe, with intensifying outbreaks over recent decades coinciding with a rapidly warming climate. Thermal biology models parameterized through laboratory experiments on the mosquito vectors and the pathogen play a central role in our causal understanding of the effects of temperature on WNV transmission. We evaluated the ability of a thermal biology model of WNV's relative basic reproduction number (R0) to explain patterns of real-world transmission risk using monthly records of human West Nile virus neuroinvasive disease (WNND) in Europe between 2010 and 2023. We assessed spatial and temporal alignments of R0 estimates and WNND observations and calculated R0 estimates from temperature data of varying resolution, assessing the value of these estimates for WNND risk ranking compared to temperature alone. Moreover, we used generalized additive models to investigate if the effect of temperature on the WNND incidence across Europe mirrors the R0 temperature response, including the optimal temperature for transmission. We found that R0 accurately captured the seasonality of WNND, the temperatures associated with peak risk, and marginally improved WNND risk ranking compared to temperature alone. However, R0 poorly explained the irregular interannual incidence pattern and more limited geographical range of reported WNND cases. Additionally, nonlinear averaging of R0 calculations from high temporal resolution temperature data slightly improved risk ranking at elevated temperatures, whereas estimates based on average temperatures were better when lower temperatures were also included. Sensitivity analyses suggested that the validation of the optimal transmission temperature was largely informed by observations from Greece, as other countries contributed little information at such high temperatures. These findings demonstrate that thermal biology models capture important aspects of WNND risk in Europe. However, incorporation of additional ecological and epidemiological drivers is needed to develop more accurate risk predictions.
Antimicrobial resistance (AMR), particularly among extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE), represents a major challenge at the human-animal-environment interface. We conducted a nationwide study assessing faecal carriage of ESBL-PE in free-ranging hedgehogs, a synanthropic species well adapted to urban environments. Between December 2022 and September 2023, 246 hedgehogs rescued across Israel and admitted to the country's sole wildlife hospital were screened on admission, with all isolates undergoing antimicrobial susceptibility testing. Overall, 71% of hedgehogs carried at least one ESBL-PE isolate, and 2% harboured carbapenem-resistant Enterobacterales. Escherichia coli was the predominant species, followed by Citrobacter, Klebsiella, and Enterobacter spp. High resistance rates were observed to quinolones (83%) and trimethoprim-sulfamethoxazole (46%). Carriage prevalence varied over time, with higher rates observed during months associated with holiday periods and increased outdoor recreational activity. These findings suggest that free-ranging hedgehogs may serve as a complementary sentinel species for monitoring AMR patterns in One Health contexts.
Background:Surveillance of dog-mediated rabies in India remains constrained, especially in livestock and other animals by limited diagnostic access, biosafety concerns, fragmented reporting systems, and weak integration between field veterinary services and laboratories. Public-private partnerships (PPPs) and One Health oriented capacity building are increasingly promoted as strategies to address these gaps, yet evidence on such approaches remains limited. A two-day workshop titled "Skill Enhancement of Field Veterinarians to Improve Surveillance of Dog-Mediated Rabies in Livestock and Wildlife in Assam" was organised on 25-26 July 2024 in Guwahati, Assam to strengthen field-level rabies surveillance by building sampling and transport capacity, introducing rapid LFA-based diagnostics, enhancing data reporting practices, and promoting a One Health perspective. This article aims to provide implementation of insights into rabies surveillance through One Health collaboration using a PPP approach. Methodology:This study presents an implementation-focused qualitative analysis through a PPP-led capacity-building workshop for field veterinarians in Assam, India. Structured group discussions held prior to hands-on training explored perceived barriers, operational challenges, and feasible strategies for improving animal rabies surveillance in resource-limited settings. Discussion outputs were thematically analysed to identify recurring system-level constraints and opportunities. Results:Thirty-two field veterinarians from 18 districts and one NGO participated in the workshop. Thematic analysis of group discussions highlighted five interlinked themes influencing rabies surveillance: (i) biosafety and sampling constraints at field level, (ii) limited diagnostic reach and transport logistics, (iii) uncertainty around rapid test interpretation and confirmatory pathways, (iv) fragmented reporting and feedback mechanisms, and (v) the need for institutional coordination across veterinary, public health, and wildlife sectors. Conclusions:This implementation report demonstrates how PPP-based One Health capacity building can generate practice-based insights from frontline veterinarians and inform feasible approaches to decentralise and strengthen animal rabies surveillance in resource constrained settings.
Cystic echinococcosis (CE), caused by Echinococcus granulosus sensu lato, is a parasitic zoonosis of major public health and economic significance. Ethiopia is among the most affected countries, yet baseline data on community knowledge, attitudes and practices (KAP) relating to CE remain limited. A cross-sectional questionnaire survey was administered to 310 individuals across four regions and four city administrations in central, western, southern and southwestern Ethiopia between May and August 2025. Data were analysed descriptively using chi-square tests, and multiple correspondence analysis (MCA) was applied to document latent KAP profiles in relation to education level. Respondents were predominantly male, rural and engaged in farming, although veterinarians and other occupational groups were represented. Dog ownership was common, livestock were largely grazed on open pasture, and high-risk behaviours were widespread, including free-roaming dogs, backyard slaughter, feeding infected offal to dogs, and consumption of raw vegetables and unboiled water. More than half of respondents demonstrated limited knowledge, negative attitudes and risky practices, whereas only small proportions exhibited sound knowledge, positive attitudes or safe practices. Veterinarians scored highest overall, while farmers and rural residents scored lowest, and education was strongly associated with improved knowledge and safer practices. MCA revealed heterogeneous behavioural profiles and an incomplete translation of knowledge into practice. These findings highlight persistent awareness-behaviour gaps and underscore the need for coordinated, context-specific interventions, including culturally tailored education, regular dog deworming, improved abattoir services, and guidance on safe slaughter and household hygiene, aligned with the WHO 2030 roadmap for neglected tropical diseases and the Sustainable Development Goals.
Background:Community-Led Total Sanitation (CLTS) does not formally include animal feces management, despite its goal to prevent fecal matter from entering the environment. By integrating animal feces management into an existing community-level program to safely manage human feces, greater reductions in exposure to feces may be achieved, supporting improvements to both human and animal health. Methods:We adapted the CLTS intervention to be animal-inclusive and piloted the resulting intervention in twenty-five villages; ten villages received an integrated human and animal feces CLTS program (A-CLTS), ten villages received standard CLTS followed by animal feces intervention components (CLTS+A), and five villages received only the standard CLTS program. Open-defecation free (ODF) status was assessed at the community level, using both human feces and animal feces indicators. Results:Our animal-inclusive CLTS intervention included development and promotion of animal confinement structures (with separate locations for sick animals); training on improved composting, manure application, hygienic milking, and hygienic birthing; and education on zoonotic diseases, animal disease management (vaccination and deworming), and the risks posed to children by close contact with animals and animal feces. Of the five villages that received standard CLTS only, only one met all ODF criteria when it was evaluated 1.5 years after CLTS triggering. The other villages were evaluated using animal-inclusive indicators for ODF and evaluated 5-6 months after triggering; four of ten CLTS+A villages and six of ten A-CLTS villages met all of the animal-inclusive ODF criteria. Conclusion:An animal-inclusive version of CLTS that included triggering activities focused on increasing awareness of the risk of both uncontained animal and human feces in the environment, proposed interventions to improve human and animal health, established village sanitation committees, and included supportive follow-up visits the potential to support participating communities achieve ODF status for both human and animal feces.
Autoimmune hepatitis (AIH) is a liver disease of unknown etiology, characterized by the presence of autoantibodies, increased immunoglobulin G levels in blood, chronic/persistent liver disorder, and favorable response to immunosuppressive therapy. Although the diagnosis of typical AIH cases has become easier, the absence of disease-specific markers poses challenges when diagnosing atypical cases, such as acute-onset AIH or AIH overlapping with drug-induced liver injury, metabolic liver disease, or other autoimmune disorders. Corticosteroids remain the first-line treatment for AIH; however, azathioprine is now covered by health insurance in Japan and can be used to treat AIH. Expanding treatment options is desirable, particularly for elderly patients and refractory cases. This review aims to provide an overview of the diagnosis, treatment, and prognosis of AIH while introducing historical perspectives and current emerging topics. The prevalence of AIH is increasing in Japan and other countries. Although the prognosis is generally favorable, given the possibility of long-term survival, periodic cancer screenings are advisable owing to the risk of carcinogenesis.
This study aimed to investigate anatomical features by comparing and verifying the shape of the talus and calcaneofibular ligament (CFL) depending on the number of anterior talofibular ligament (ATFL) bundles. We also aimed to reveal the relationship between the ATFL and talofibular and CFL. We examined 118 feet from 59 cadaveric specimens and measured the ATFL and CFL, as well as the length, width and thickness of the talus and foot, by using digital calipers. We counted the number of ATFL bundles, calcaneofibular ligament, talus and foot. The ATFL was divided into two groups: one group with one bundle and one group with two bundles. We further examined the relationship between the shapes of the ATFL, CFL, talus and foot. The results were tested for differences in sex and showed that women had significantly wider (p<0.05) and longer (p<0.05) talus in the two-bundle group than in the one bundle group. The CFL was also significantly longer in the two-bundle group (p<0.05). A moderately significant correlation was found between the shapes of the ATFL and the talofibular and CFL. This study provided new anatomical findings that the ATFL attached to the high talus has two bundles. In addition, the ankle joint evaluation and rehabilitation was basic research that considered sex differences.
OBJECTIVES:We aim to establish support for bereaved families during the anticipated recurrence of an infectious pandemic by clarifying the relationship between the experiences of bereaved families during the COVID-19 pandemic with their depression symptoms and post-traumatic growth (PTG). METHODS:We surveyed bereaved family members who lost their loved ones during the COVID-19 pandemic. Participants were asked to answer questions regarding "experiences of bereaved families during the COVID-19 pandemic," "depressive symptoms," and "PTG." Multivariate analysis was then performed to examine their correlations. RESULTS:Individuals were anxious about contracting an infection and those who had lost a spouse or partner were more likely to experience depression. In addition, a lack of satisfactory interactions with the deceased prior to death can lead to depression. Those who had satisfying interactions with medical professionals and who received support from medical professionals and neighbors tended to have higher PTG scores. CONCLUSION:During pandemics, meaningful interactions with the deceased prior to death and adequate social support for bereaved individuals, especially those who have lost their spouses or partners, is important.
Elizabethkingia miricola is an emerging opportunistic pathogen with increasing human clinical isolation. Infections pose major therapeutic challenges. This study sequenced the genomes of five clinical E. miricola isolates and employed comparative genomics with globally sourced strains to investigate resistance mechanisms, pathogenicity, phylogenetic relationships, and transmission patterns. Phylogenetic analysis revealed that E. miricola evolution exhibits no strict correlation with sample source, geographical origin, or region. Isolates from amphibians clustered within clinical lineages, implicating environmental reservoirs—potentially sink water—as infection sources. Geographically, pathogenic E. miricola demonstrates worldwide dissemination, with high prevalence in China and Europe. Putative transmission networks indicate intra-hospital spread and transnational circulation, suggesting nosocomial outbreak risks. Shared resistance genes (including BlaB and GOB β-lactamases) and virulence profiles between human and anuran strains highlight intrinsic resistance and pathogenic potential. Minocycline and doxycycline exhibited potent antimicrobial activity, indicating promising therapeutic alternatives. These findings highlight the zoonotic threat of E. miricola via nosocomial and potentially international horizontal transmission. Preventing outbreaks necessitates enhanced genomic surveillance of this pathogen.
Coronaviruses are RNA viruses with high genomic plasticity and with the ability to infect a wide range of animal hosts, including humans. Among them, the highly pathogenic SARS-CoV-2, a betacoronavirus, is the causative agent of severe respiratory infection, and has also been associated with extrapulmonary manifestations, including cardiac involvement. BCoV, another betacoronavirus, is a major pathogen of cattle, primarily affecting the respiratory and enteric systems. Herein, a case of death in a calf with clinical signs consistent with BCoV infection is described. Potential cardiac involvement was further investigated, motivated by evidence of SARS-CoV-2 associated cardiac pathology in humans. Pulmonary and cardiac tissues were subjected to molecular and histological analyses. BCoV RNA was detected in both heart and lungs while immunohistochemical and immunofluorescence analyses confirmed BCoV antigen presence in both tissues. Cardiac detection was mainly observed in the conduction system and the endothelial cells. This study provides the first evidence of cardiac detection of BCoV and lays the foundation for future research on the closely related human coronavirus OC43, contributing to the One Health approach.
Zoonotic tuberculosis (zTB) remains a blind spot in TB control, sustained less by biological rarity than by diagnostic and surveillance design. Brazil illustrates this gap: despite endemic bovine TB and sustained zoonotic transmission risks, zTB is rarely identified because it is not actively targeted. We show that only two human zTB cases were notified between 2013 and 2024 following introduction of reporting, and six cases are described in the literature. Further detection of mono-pyrazinamide resistance may represent undiagnosed zTB, but diagnostic gaps prevent estimation. By outlining current diagnostic paths, we argue that the human-centric diagnostics obscures occupational, foodborne, and animal-linked infection. Emerging subnational One Health initiatives demonstrate that integrated animal-human surveillance is feasible. Therefore, we propose a risk-based, One Health diagnostic protocol for zTB within the Brazilian public health system, and argue that without structural and policy adaptation, human-TB elimination strategies will continue to exclude zTB by design, not only in Brazil.
