Leprosy elimination programmes in low-endemic countries face a paradox: declining disease burden can weaken the surveillance, technical expertise, political commitment, and community awareness needed to sustain interruption of transmission. Eswatini, a low-endemic country in Southern Africa, transitioned over four decades from a centralized institutional model of leprosy care to integrated service delivery within primary healthcare. From 2000 to 2024, only sporadic adult cases were detected, with no child cases reported for over two decades. This paper describes lessons from sustaining elimination during this transition. Key interventions included integrating leprosy diagnosis and treatment into primary healthcare, maintaining referral-level clinical expertise, routine zero-reporting via DHIS2, case-based surveillance with household contact tracing, and embedding leprosy indicators within national neglected tropical disease policies. The programme also implemented the WHO-recommended Leprosy Elimination Monitoring Tool (LEMT) and Leprosy Programme and Transmission Assessment (LPTA) to support verification. The Eswatini experience shows that sustaining interruption in low-burden settings requires continuous surveillance, minimal technical expertise, social inclusion, sustained political commitment, and cross-border collaboration to prevent re-establishment among mobile populations. WHO-verification processes drove programme strengthening by identifying gaps and reinforcing accountability. These lessons may inform other low-endemic countries progressing toward verification and the WHO target of zero leprosy by 2030.
BACKGROUND:To evaluate the predictive value of admission platelet-related indices for in-hospital mortality in Crimean-Congo haemorrhagic fever (CCHF). METHODS:This retrospective single-centre study included adults with laboratory-confirmed CCHF between May 2022 and May 2023. The primary outcome was in-hospital mortality. Admission laboratory parameters and platelet-related indices were analysed using receiver operating characteristics analysis, DeLong comparisons, 2000-replicate bootstrap internal validation and reduced Firth logistic regression adjusted for age. RESULTS:A total of 167 patients (median age 47 y [interquartile range 34-62], 61.7% male) were included; 14 (8.4%) died. Non-survivors were older. Platelet count, platelet count multiplied by lymphocyte count (PLT×LYM) and plateletcrit were lower, whereas mean platelet volume:lymphocyte ratio, platelet distribution width:lymphocyte ratio and mean platelet volume:platelet count ratio were higher in non-survivors. Median PLT×LYM was lower in non-survivors than survivors (15.35 vs 49.56; p<0.001). PLT×LYM had the highest discriminatory performance (area under the curve 0.882, cut-off 39.33, sensitivity 100%, specificity 66.7%, positive predictive value 21.5%, negative predictive value 100.0%). In the logistic regression model, each 10-unit increase in PLT×LYM was associated with an adjusted odds ratio of 0.50 (95% confidence interval 0.30 to 0.73). CONCLUSION:Admission PLT×LYM may serve as practical early marker for mortality risk stratification in CCHF; external validation is required.
OBJECTIVES:Madariaga virus (MADV) is an emerging arboviral pathogen in Central and South America, but systematic entomological surveillance data remain limited in Colombia. We investigated MADV circulation in mosquitoes from the Alto Cotocá wetlands, Córdoba department, Colombia. METHODS:Adult mosquitoes were collected during November-December 2017 and February-March 2018 using CDC light traps, Shannon traps, and manual aspiration. A total of 2984 mosquitoes were processed in 136 pools of 1-20 specimens and screened using generic Alphavirus RT-PCR with MADV-specific confirmation, bidirectional sequencing, and Bayesian phylogenetic analysis. RESULTS:MADV was detected in 8 of 136 pools (5.9%) across five mosquito taxa: Culex erraticus, Culex quinquefasciatus, Culex spp., Mansonia titillans, and Psorophora ferox. The overall minimum infection rate was 2.68 per 1000 specimens (95% CI: 1.16-5.28). All sequences (GenBank MK131010-MK131017) clustered within Lineage III with 96.59%-96.62% identity to Colombian equine reference strains. Two haplotypes were identified among positive pools. CONCLUSION:This baseline assessment provides molecular evidence of MADV Lineage III in Colombian mosquito populations, establishes methodology for expanded surveillance, and supports the inclusion of MADV in differential diagnostic and surveillance considerations for arboviral encephalitis in Colombia.
Congenital Chagas disease is a public health priority in Latin America, yet its status in Mexico remains poorly characterized. This systematic review aims to analyse the available evidence on Trypanosoma cruzi maternal infection, vertical transmission rates and diagnostic challenges in Mexico. A systematic search was conducted in PubMed, Scopus and Web of Science following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Original observational studies and case reports on maternal-foetal T. cruzi infection in Mexico were included. Seventeen studies met the inclusion criteria, covering 63 373 analysed samples between 1998 and 2021. While 82.4% of studies reported maternal seroprevalence (estimated at 2.21% nationally), only 41.2% documented confirmed congenital transmission. A critical gap in clinical follow-up was identified: only 29.4% of studies reported neonatal monitoring and only 5.9% explicitly documented antiparasitic treatment. Geographic evidence is highly concentrated in Yucatan (41.2%), Chiapas and Veracruz. High diagnostic heterogeneity persists, with 88.2% of studies using enzyme-linked immunosorbent assay, while molecular methods (polymerase chain reaction) were used in 52.9%. Evidence on congenital Chagas in Mexico is fragmented and geographically biased. The disconnect between maternal detection and neonatal treatment highlights a fractured care chain. Implementing universal prenatal screening and standardized molecular diagnostics at birth is urgently needed to close the gap in maternal-infant care and fulfil the regional commitments established under the Pan American Health Organization Elimination Initiative.
CASE REPORT:A 34-year-old man with advanced HIV infection presented with localized cutaneous leishmaniasis, after unsuccessful trestment with pentavalent antimonials, progressive dissemination ocurred . On re-evaluation, he exhibited numerous widespread ulcerated papules and nodules , accompanied by systemic symptoms and significant weight loss. Skin smears and histopathology demonstrated intracellular amastigotes. A diagnosis of intermediate cutaneous leishmaniasis with HIV coinfection was established. Treatment with liposomal amphotericin B followed by oral miltefosine led only to transitory clinical resolution. DISCUSSION:This case highlights the diagnostic and therapeutic challenges of leishmaniasis in immunocompromised patients and underscores the dynamic nature of the clinical classification of cutaneous leishmaniasis.
OBJECTIVES:Concurrent pulmonary tuberculosis (PTB) and antifungal-resistant candidiasis pose significant clinical and public challenges in resource-limited settings. This study determined the prevalence of PTB and antifungal-resistant Candida albicans co-infection among people living with HIV/AIDS (PLWHA) in Gombe State, Nigeria. METHODS:Sputum samples from 348 PLWHA were processed and tested for Mycobacterium tuberculosis using GeneXpert equipment. Moreover, C. albicans was isolated and identified using CHROMagar, germ tube test, and 18S rRNA-ITS-PCR sequencing, and its antifungal susceptibility patterns were determined by the disc diffusion method. RESULTS:The prevalence values for C. albicans, PTB, and C. albicans-PTB co-infections were 9.2%, 9.2%, and 6.3%, respectively. All Mycobacterium tuberculosis strains were rifampicin-susceptible but were significantly associated with age (P = .0033) and biological sex (P = .03). About 40.6%, 31.3%, and 28.1% of the C. albicans strains were resistant to fluconazole, voriconazole, and amphotericin-B, respectively. PLWHA aged >60 years had significantly higher odds of C. albicans infection (OR = 54.6, P = .0156). History of antibiotic use, pet ownership, and presence of PTB were significantly associated with C. albicans (P < .05). About 87.5% of PLWHA with C. albicans had CD4⁺ T-cell counts of <200 cells/mm³. CONCLUSION:The levels of PTB and C. albicans mono- or co-infections among PLWHA were moderate, with a high frequency of fluconazole-resistant C. albicans. This study provided updated local surveillance data on pulmonary infections among PLWHA.
OBJECTIVES:Malaria and stunting are highly prevalent in Papua, Indonesia, yet their association remains poorly understood. We examined dose-response relationships between postnatal malaria and stunting, trimester-specific prenatal effects, effect modification by insecticide-treated net (ITN) use, and risk by Plasmodium species. METHODS:Unmatched case-control study of 1301 children 12-60 months (435 cases; 866 controls) from 25 primary health centres. Exposure was ascertained from health centre registers and maternal cohort records. Multivariable logistic regression with cluster-robust standard errors was used; ITN effect modification was assessed using an interaction term. RESULTS:One postnatal malaria episode was associated with increased stunting odds [adjusted OR (aOR) 1.52; 95% CI 1.02-2.29], with a significant dose-response trend compared with no malaria exposure. Prenatal malaria was not significant after adjustment. Low birth weight was the strongest predictor (aOR 2.22; 95% CI 1.29-3.82). ITN use modified the malaria-stunting association (interaction aOR 0.37; 95% CI 0.18-0.73). Plasmodium falciparum was associated with increased stunting odds vs no prenatal malaria (OR 1.84; 95% CI 1.18-2.89). CONCLUSION:Recurrent postnatal malaria is associated with stunting in a dose-response pattern, modified by ITN use. Findings support malaria control and nutrition programme integration in endemic settings.
OBJECTIVES:Intestinal parasites have higher prevalences in poor tropical countries. In Costa Rica, the problem in vulnerable zones has not been epidemiologically characterized over the last two decades. This study aimed to characterize the intestinal parasitic infections among schoolchildren in vulnerable zones of Costa Rica and to explore their multidimensional determinants. METHODS:Data from faecal tests results from schoolchildren living in vulnerable zones of Costa Rica (2008-2019) was compiled with social, climatic and other environmental variables to perform descriptive epidemiological and comparative analyses. Prevalence calculations and maps of protozoan and helminth infections were generated. RESULTS:Intestinal protozoan and soil-transmitted helminth infections affected 46.7% and 26.2% of children, respectively. Prevalence was highest in the Caribbean region: Limoncito and Chirripó led for both soil transmitted helminths (38.1% and 36.6%) and intestinal protozoans (62.8% and 59.5%), with Telire reaching 62.8% for intestinal protozoans. The 7-9-year age group had the highest burden for both infection types. Logistic regression identified geographic inaccessibility, composite socioeconomic-educational-housing scores, and climatic conditions as significant predictors for parasite infections risk. CONCLUSION:Data demonstrate the persistence of high rates of intestinal parasitic infections in vulnerable communities of Costa Rica, highlighting potential associations that reflect the multidimensional nature of the problem.
BACKGROUND:Cutaneous leishmaniasis (CL) is a major public health concern in Pakistan. This systematic review aimed to assess geographical distribution, prevalence trends and epidemiological risk factors associated with CL from 2014 to 2024. METHODS:A systematic literature search was conducted using PubMed, ScienceDirect and Google Scholar for studies published from January 2014 to December 2024. Keywords included 'cutaneous leishmaniasis', 'epidemiology', 'Pakistan' and 'geographical distribution'. Of 1000 retrieved publications, 600 were screened and 25 met predefined inclusion and quality criteria. The extracted data included study area, research design, diagnostic methods, gender distribution and Leishmania species. RESULTS:A total of 27 380 confirmed CL cases were reported. The highest burden was in Khyber Pakhtunkhwa (60%), followed by Balochistan (16%), Sindh (8%), Punjab (8%) and Azad Jammu and Kashmir and Chitral (4%). A male predominance (approximately 60-65%) was reported. The dominant species were Leishmania tropica and Leishmania major. Diagnosis relied mainly on microscopy (80%), with an annual incidence rate of 8-10% over the previous decade. CONCLUSIONS:CL shows a widespread and increasing distribution pattern in Pakistan. The main factors involve poverty, vectors, climate change and migration. These findings focus on the need to improve the surveillance network, molecular diagnostic methods and public awareness to decrease the growing impact of the disease.
Snakebite during pregnancy is an uncommon but potentially catastrophic event, with maternal and foetal outcomes closely related to the severity of envenomation. While snakebite in pregnant women has been sporadically reported and is known to be associated with significant obstetrical complications, envenomation in animals, particularly in pregnant horses, is exceedingly rare. Only a few isolated cases of snakebite in horses have been documented, and to the best of our knowledge, snakebite in a pregnant mare has not been previously reported in the medical or veterinary literature. Russell's viper (Daboia russelii) envenomation is a major cause of morbidity and mortality in South Asia. We describe the first documented case of severe Russell's viper envenomation in a 5.5-year-old Marwari mare at 9 months of gestation following confirmed double bites to the muzzle. The mare developed rapidly progressive craniofacial oedema, respiratory compromise and severe venom-induced consumption coagulopathy with recurrent rebound coagulopathy. Management required intensive monitoring and administration of an unusually high cumulative dose of equine polyvalent antivenom totalling 60 vials. Despite the high venom burden, pregnancy-associated bleeding risk and delayed venom redistribution from facial tissues, the mare achieved complete clinical recovery with preservation of foetal viability. This case highlights the unique challenges of snakebite management in pregnant large animals, including venom depot effects, recurrent coagulopathy and foetal risk. Aggressive antivenom therapy guided by coagulation monitoring can result in favourable maternal and foetal outcomes. This report represents the first documented case of Russell's viper envenomation in a pregnant horse.
OBJECTIVES:Hematophagous terrestrial leeches are common in rainforest habitats and widely regarded as pests. Despite limited research, circumstantial evidence raises the possibility that, beyond being an annoyance, terrestrial leeches could potentially transmit diseases. METHODS:We explored this possibility using multiple approaches. First, we reviewed published literature to synthesize knowledge related to disease transmission by leeches. Second, we collected terrestrial leeches (genus Haemadipsa) from human-occupied rainforests in Peninsular Malaysia and applied metagenomic methods for virus discovery to their anterior segments. Finally, we conducted interviews to probe local knowledge and behavior related to leeches, testing whether cultures may encode information that recognizes and helps to prevent vector-borne disease transmission. RESULTS:Results indicate that terrestrial leeches are potential disease vectors, particularly via mechanical vector-borne transmission stimulated by human removal techniques. Supporting this, we identified four novel viruses within leeches, three of which are distantly related to medically important animal and human viruses which could potentially be transmitted among animal species, including humans. However, ethno-etiological evidence suggests that local Indigenous cultures do not recognize land leeches as disease vectors or promote behaviors likely to reduce transmission, suggesting knowledge may not encompass difficult-to-observe vectors. CONCLUSION:We conclude that disease transmission by terrestrial leeches is plausible and merits experimental study. Accession numbers: PX094876, PX118495, PX118496, PX118497, PX118498, PX118499.
Abstract Objectives Urban heat islands (UHIs) produce 2°C–8°C in urban cores excesses, accelerating Aedes aegypti development and shortening chikungunya virus (CHIKV) extrinsic incubation, yet UHI intensity's (UHII) independent contribution to CHIKV transmission remanins unquantified. Methods We conducted an ecological time-series analysis of five Brazilian cities (2015–24; n = 563 city-months) . Monthly UHII was derived from MODIS land surface temperature (urban-core minus peri-urban) via Google Earth Engine; CHIKV incidence came from InfoDengue. Lag-specific (0-3 months) Poisson generalized linear models were adjusted for temperature, humidity, and seasonality. Given severe overdispersion, quasi-Poisson and negative-binomial models were the preferred sensitivity analyses. Results Across 261 353 cases, each 1°C UHII increase was associated with higher lag-1 incidence in subtropical Rio de Janeiro (RR = 2.857, 95% CI 2.799–2.915) and Salvador (RR = 1.168, 1.156–1.179; both P < .001). Brasília showed inverse associations (lags 0–3), Fortaleza (highest burden, 133 371 cases) a mixed lag pattern, and São Paulo minimal effects despite the highest UHII. Incidence peaked in April–May. Conclusions UHII–CHIKV associations were heterogeneous; city-specific thermal context should inform integrating satellite-derived heat metrics into arboviral surveillance, as several associations attenuated or lost statistical significance under overdispersion-robust models and were sensitive to individual epidemic years.
BACKGROUND:Cryptosporidium is an important enteric parasite causing diarrhoea in humans and animals worldwide. Data on the molecular epidemiology of Cryptosporidium infection in adults in Zambia are limited. METHODS:A total of 566 stool samples from adults (18-50 years) were examined for Cryptosporidium oocysts by light microscopy following modified Ziehl-Neelsen staining. Molecular analysis of positive samples targeted the 60-kDa glycoprotein and heat shock protein 70-kDa genes. Demographic and potential risk factor information was obtained by semi-structured closed questionnaires. RESULTS:The prevalence of Cryptosporidium infection was 3.0% (17/566), affecting a higher proportion of people living with human immunodeficiency virus (HIV) compared with HIV-negative participants, with a significantly higher prevalence among people living with HIV not using antiretroviral therapy (ART) (p=0.001). Additional associated factors included the use of municipal water (p=0.016), moderate monthly income (p=0.01), watery stool and frequent diarrhoea (p=0.001) and haemoglobin levels <10 g/dl (p=0.001). Both Cryptosporidium parvum and Cryptosporidium hominis were identified and all C. parvum subtypes were associated with anthroponotic transmission (IIiA9 [n=4], IIiA6 [n=2], IIeA11G1 [n=1] and IIcA5G3 [n=2]). For C. hominis subtypes, IeA11G3T3 (n=2), IaA26R3 (n=1) and IdA13 (n=1) were identified. CONCLUSION:Cryptosporidium infection continues to be a significant issue among individuals living with HIV. Health education focusing on reducing anthroponotic transmission routes should be a priority.
OBJECTIVES:About one-half of the world's population is endangered by malaria, particularly those in underdeveloped countries. Because of poor prevention measures, in 2023, the WHO Africa region accounted for 95% of cases and 96% of deaths. Malaria is a prevalent tropical disease with high morbidity, mortality, and economic and social impact. The WHO recommends integrated vector management for malaria control, which has shown promise in reducing the diseas e burden. METHODS:We conducted a cross-sectional qualitative study in Unyama and Koro subcounties in Gulu District. We collected data from eight focus group discussions and 10 in-depth interviews with community members, leaders, and health workers. We analysed data using thematic content analysis and Atlas ti software. RESULTS:The facilitators for community-integrated malaria control were government mosquito net distribution, village health teams, and combined preventive methods. The barriers were inconsistent preventive practices, financial and resource constraints, misuse of mosquito nets, cultural misconceptions, and limited support for volunteers. CONCLUSION:Although integrated malaria-prevention approaches have demonstrated effectiveness, their full implementation in Uganda remains constrained. Persistent socioeconomic barriers undermine both uptake and long-term sustainability at the community level. Addressing these structural and contextual challenges is essential to translate proven interventions into sustained malaria-control gains.
BACKGROUND:Kyasanur Forest disease (KFD) is a tick-borne viral haemorrhagic fever in which thrombocytopaenia and transaminitis are well recognized, but the basis of coagulation abnormalities remains incompletely understood. Isolated prolongation of the activated partial thromboplastin time (APTT) with a normal prothrombin time (PT) has been frequently observed, although the mechanism remains unclear. CASE SERIES:We describe nine patients with confirmed KFD who had isolated prolonged APTT with normal PT during the acute phase of illness. The patients ranged in age from 29 to 78 years, and seven were female. The duration of fever before admission ranged from 3 to 8 days. One patient had epistaxis, while the remaining patients had no clinically evident bleeding manifestations. APTT ranged from 37.0 to 74.8 s. In all patients, mixing studies showed correction with aged serum but not with adsorbed plasma, suggesting isolated factor IX deficiency. Factor assays confirmed reduced factor IX activity, ranging from 24.0% to 48.4%, with preserved or elevated factor VIII levels. Factor IX inhibitor screening was negative in the two patients tested. On follow-up, APTT normalized in all patients. Repeat factor IX activity was available in eight patients and had returned to within the reference range in seven. CONCLUSIONS:This case series suggests that transient acquired factor IX deficiency is an important explanation for isolated APTT prolongation in acute KFD. Recognition of this pattern may help distinguish selective intrinsic pathway dysfunction from disseminated intravascular coagulation and may guide appropriate coagulation support in severe disease.
Various forms of voluntary migration have been and remain among the leading causes of the worldwide dispersal of parasites. Although helminthic infections are common in Africa, they are rare in Israel, making diagnosis challenging for many clinicians. We present 22 years of experience diagnosing under-recognized, long-lasting helminthic infections in migrants from African countries: Strongyloides stercoralis (up to 24 years), Schistosoma mansoni (up to 15 years), and hookworm (up to 12 years).
Leishmaniasis remains a major public health challenge in many tropical and subtropical regions despite long-standing emphasis on controlling adult sandflies. This commentary highlights an important ecological gap that has received limited attention: the immature stages of sandflies. Unlike mosquitoes, sandflies develop in cryptic terrestrial microhabitats that are rarely detected through routine surveillance. Consequently, most vector control programmes concentrate on suppressing adult populations, while the biological processes that generate new adult vectors remain poorly understood. Recent ecological studies indicate that breeding activity may be spatially structured and biologically detectable. Surveillance approaches that consider oviposition behaviour and breeding ecology may therefore help make vector population dynamics more measurable and support more sustainable, biology-based control strategies.
BACKGROUND:Schistosomiasis control has transitioned from focusing on morbidity control to elimination of the disease. Nevertheless, preschool-age children (PSAC) are left out of control programs and consequently serve as a source of continued transmission. This study determined the prevalence and predictors of Schistosoma mansoni infection among PSAC. METHODS:An analytical cross-sectional study was conducted among 417 PSAC. The infection prevalence and intensity was determined using the Kato-Katz technique and a structured questionnaire was used to collect demographic and risk profile. A logistic regression model was used to determine factors associated with S. mansoni infection. RESULTS:The prevalence of S. mansoni infection was 14.4% (95% confidence interval [CI] 11.2 to 18.1) and the geometric mean eggs per gram of faeces was 77.2 (95% CI 61.7 to 96.6) with 33.3% and 5.0% having moderate and heavy infections, respectively. Passive water contact (adjusted odds ratio [AOR] 7.19 [95% CI 2.34 to 21.81]) and living within 500 m of a water body (AOR 16.25 [95% CI 4.97 to 53.21]) were significantly associated with S. mansoni infection (p<0.001). CONCLUSION:PSAC are at risk for S. mansoni infection and accumulating moderate to heavy infections. Proximity to a water body and engaging in passive water contact activities were significant predictors of infection. These findings call for the inclusion of PSAC in the ongoing praziquantel mass drug administration programs. There is an urgent need for improved water supply, sanitation and public health education to reduce population exposure to infested freshwater bodies.
