Whilst multidrug therapy can provide a microbiological cure for leprosy infection, it does not reverse nerve damage that is already established, nor remove the risk of the occurrence of future ocular complications. Ocular conditions associated with leprosy such as lagophthalmos, reduced corneal sensation, exposure keratopathy, uveitis and other sight and eye threatening conditions may be present at diagnosis, develop during treatment, or even progress long after treatment has already been completed. Existing guidance already recommends eye assessment during treatment, but continuity after treatment varies between settings. This viewpoint therefore argues for implementing these recommendations through a minimum pathway which links assessment during treatment to risk-stratified follow-up after treatment completion, clear referral responsibilities, supported self-care and monitoring, and routine assessment of visual outcomes in paper or electronic records. To be successful these measures should be integrated within existing leprosy, primary-care and eye-care services, with links to non-communicable disease programmes where these can support long-term care. Achieving zero disability due to leprosy requires recognising that treatment completion is not the end of ocular risk.
Leprosy, also known as Hansen´s disease (HD), is a chronic infectious disease which mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and the eyes. According to the National Hansen’s Disease Program (NHDP), there were 225 new cases of leprosy reported in the United States of America (USA) in 2023, with Florida ranking as one of the top reporting states. Using publicly available data, we analysed the overall trend of leprosy in Florida from 1996-2025. A total of 359 confirmed cases of leprosy was reported in the state during the study period. The annual incidence rate increased from 0.01 per 100,000 population to 0.15 per 100,000 population, showing a fifteen-fold increase over the 30-year study period. With a total of 113 cases reported for the study duration, Brevard County was observed to be a hotspot for confirmed leprosy cases and locally acquired infections represented the largest category of cases with known acquisition mode.
BackgroundBrucellosis remains endemic in Iran despite more than six decades of vaccination, surveillance, and test-and-slaughter activities. However, the national control program has not been systematically assessed against internationally recognized progressive-control frameworks. We conducted a descriptive and exploratory scoping review combined with an indicator-based policy and implementation gap analysis. The study was not designed to test a conventional epidemiological hypothesis or estimate causal effects.Methodology/principal findingsWe developed 45 measurable indicators by adapting the Food and Agriculture Organization Stepwise Approach for the Progressive Control of Brucellosis across five domains: governance, surveillance, laboratory capacity, prevention and control, and communication. The indicators were informed by nine international normative sources and reviewed by three subject-matter experts. We searched PubMed, Scopus, Web of Science, and Google Scholar for scientific literature published between January 2000 and March 2026 and manually screened relevant publicly accessible official documents, including earlier legal and regulatory sources. Seventy-one eligible documents were included. Two reviewers independently scored all indicators using predefined criteria. Exact agreement was 86.7% (39/45), and weighted Cohen's kappa calculated from the original independent pre-consensus scores was 0.84 (95% CI 0.72-0.93). The six disagreements were resolved by consensus. Overall stage classification was determined separately using a rule-based algorithm based on documented program prerequisites rather than aggregated indicator scores. Under the adapted framework, Iran met the minimum documented prerequisites associated with Stage 3. Major implementation or documentation gaps remained in animal identification and traceability, early warning, laboratory partnerships, wildlife and nomadic-population risk management, joint risk assessment, and public reporting. Six interdependent policy priorities were identified.Conclusions/significanceIran has established important foundations for brucellosis control, but several integrated and elimination-oriented functions remain incomplete or undocumented. The Stage 3 classification is a framework-based interpretation of publicly available documentary evidence, not an official designation or an independently validated measure of national program performance. The framework may support systematic gap identification and program monitoring, but prospective and external validation is required before its broader application.
Background Neglected Tropical Diseases affect over one billion individuals globally, challenging healthcare systems in endemic regions. While promising, Artificial Intelligence (AI) requires rigorous validation for clinical translation. Methodology This systematic review of prediction-model studies evaluated AI applications for leprosy, schistosomiasis, and leishmaniasis (2015–2025). Methodological quality and reporting transparency of the included studies were appraised using the PROBAST+AI and TRIPOD+AI tools, respectively. Findings Among 69 studies identified, 89.9% were published after 2020. The literature predominantly focused on diagnostic support (81.2%), leaving the prognosis of adverse outcomes underexplored (18.8%). Methodological fragility was widely observed: 89.9% of models exhibited a high risk of bias, primarily due to lack of external validation (82.6%) and failure to report or appropriately handle missing data (66.7%). Transparency remains a barrier, with source code unavailable in 76.8% of cases, hindering reproducibility. Conclusion Current evidence indicates that quantitative output outpaces methodological maturity. Bridging the gap between algorithmic potential and public health impact requires prioritizing open science and robust validation.
Helminth infections establish long-term host persistence by inducing regulatory immune responses that limit pathology while promoting parasite survival. Programmed death 1 (PD-1), an inhibitory receptor expressed on activated T cells, plays an essential role in maintaining immune homeostasis during chronic infections. Regulatory T cells (Tregs) expand during helminth infection and are critical for controlling excessive inflammation; however, the metabolic mechanisms linking PD-1 signaling to Treg differentiation during helminth infection remain poorly defined. Here, we investigated the role of PD-1 in regulating Treg differentiation during Trichinella spiralis infection, focusing on metabolic reprogramming in CD4⁺ T cells. Using a murine infection model, we compared wild-type and PD-1–deficient (PD-1 ⁻/⁻ ) mice and evaluated Treg differentiation in vivo and in a bone marrow-derived dendritic cell (BMDC)–CD4⁺ T-cell co-culture system stimulated with muscle larval excretory–secretory products (MES). PD-1 deficiency significantly reduced splenic FoxP3⁺ Treg frequencies following infection and impaired MES-induced Treg differentiation and Treg-associated cytokine production in vitro. Metabolic profiling revealed that CD4⁺ T cells from infected PD-1 ⁻/⁻ mice exhibited markedly reduced fatty acid oxidation (FAO), accompanied by decreased expression of Carnitine Palmitoyltransferase 1A (CPT1A), a key rate-limiting enzyme in FAO. PD-1 deficiency was associated with enhanced PI3K–Akt–mTOR signaling and suppressed AMPK activation. Importantly, pharmacological inhibition of PI3K partially restored FAO activity and rescued Treg differentiation in PD-1 ⁻/⁻ CD4⁺ T cells. These findings suggest that PD-1 supports Treg development during T. spiralis infection, at least in part, through a CPT1A-associated FAO pathway, highlighting a PD-1–associated metabolic pathway that may contribute to helminth-induced immune regulation.
