HIV continues to disproportionately affect Sub-Saharan African (SSA) migrants in Italy, who often experience late diagnosis and complex clinical and social challenges. This multicenter cross-sectional study evaluated determinants of poor immunological and virological outcomes and sex-based differences among 762 SSA migrants living with HIV in the Veneto, Friuli Venezia Giulia and Trentino Alto Adige regions (northeast Italy). Data on demographic, clinical, and social factors were collected from ten Infectious Diseases Centers between January and August 2023. Sex-based differences in clinical and socio-demographic characteristics were assessed using bivariate analyses. Univariate and multivariable logistic regression analyses were performed to evaluate determinants of immunological and virological outcomes, adjusting for relevant covariates. Late HIV diagnosis affected over two-thirds of participants. Despite high antiretroviral therapy coverage, only 38.3% achieved full virological suppression, while 60.6% had HIV-RNA < 200 copies/mL. Temporary residence permits were significantly associated with detectable viremia, underscoring the role of social and structural vulnerability on treatment outcomes. Females, who represented the majority of the cohort, had higher unemployment and longer HIV infection duration but better immunological profiles and fewer coinfections than males. Comorbidities, including psychiatric conditions, were similarly prevalent among both sexes, yet females accessed psychological support more frequently. These findings highlight the need for integrated, gender-sensitive healthcare and social interventions to improve early diagnosis, treatment continuity, and HIV outcomes in SSA migrant populations in Italy.
Clostridioides difficile is a leading cause of healthcare-associated gastrointestinal infection, with outcomes that range widely in severity. The pathogenesis of C. difficile is driven by virulence factors that induce colonic inflammation and epithelial damage. This illness is categorized as an urgent threat, and in recent years, its prevalence has increased, with recurrent episodes occurring in approximately 15-35% of cases. The life cycle of C. difficile infection (CDI) is multifactorial and strongly influenced by antibiotic exposure, host immune responses, the gut microbiota, and microbial metabolites. Disruption of intestinal homeostasis gradually alters the ecological niches of C. difficile and the immunological landscape of the disease. In addition to these risk factors, recurrent C. difficile infection (rCDI) can be exacerbated by certain 'hypervirulent' strains that are more difficult to eradicate. As in many infectious diseases, host immunological responses, particularly in rCDI, appear to play a crucial role in determining recovery versus recurrence. Recent strategies to address this problem include fecal microbiota transplantation (FMT) and novel therapeutic approaches such as polyclonal and monoclonal antibodies. Nevertheless, the immunological mechanisms underlying rCDI remain incompletely understood. A deeper insight into how the immune response develops and functions during rCDI may facilitate the identification of new therapeutic targets. In this review, we summarize current knowledge on C. difficile recurrence and highlight the host immune response in the context of rCDI.
SARS-CoV-2 XFG (nicknamed Stratus), a recombinant lineage arising from LP.8.1.2 and LF.7, is currently the most prevalent circulating lineage. Although most recombinant lineages do not pose a significant public health concern, some have shown the capacity to emerge and spread, highlighting the importance of their investigation. In this context, we performed a genome-based analysis to assess the genetic variability of XFG and to identify its recombination breakpoint. The breakpoint was mapped to approximately position 1507 within the spike (S) gene, in the distal region of the receptor-binding domain. This configuration suggests that LP.8.1.2 contributed the genomic backbone as the acceptor, whereas LF.7 acted as the donor. Phylodynamic survey suggests that XFG originated in early 2024, approximately 10 months before its first genomic detection. Bayesian Skyline Plot revealed a transient expansion phase beginning in August 2024, followed by a plateau, indicating limited and non-sustained growth. The estimated evolutionary rate of XFG (2.90 × 10-4 subs/site/year) was comparable to those of its parental lineages, supporting a relatively low level of genetic variability. Overall, these findings suggest that the widespread prevalence of XFG is more likely driven by lineage turnover rather than increased transmissibility, highlighting the importance of continuous genomic surveillance for monitoring emerging SARS-CoV-2 lineages.
Leptospirosis, a zoonotic disease caused by Leptospira spp. poses significant public health and economic challenges. Its transmission is favored in interface environments where wild and synanthropic rodents acting as maintenance hosts contaminate surroundings with urine. Additionally, water sources can harbor leptospires, serving as an infection risk for humans and animals. This study aimed to investigate the presence of Leptospira spp. in surface and underground water resources, detect leptospiras in wild and synanthropic rodents, and identify/genotype isolation in rural environments from Tandil county, Argentina. Thirty-five water samples and kidney samples from 30 rodents were collected. Leptospira spp. Isolation was attempted via culture in a selective EMJH-STAFF medium with observations made through fluorescence microscopy. Growth of leptospires was observed in one rodent kidney tissue sample. The presence of a pathogenic Leptospira strain was confirmed by 16S rRNA PCR and subsequently genotyped by MLST. Notably, this represents the first isolation of Leptospira interrogans serogroup Canicola allelic profile ST3 from Akodon Azarae in Argentina, making a significant epidemiological finding for the region. While Leptospira spp. was not detected in the analyzed water samples, the isolation of L. interrogans highlights the role of wild rodents as persistent reservoirs in the rural-urban interface. This finding suggests that the transmission dynamics may involve a more complex network of wild reservoirs, highlighting the potential public health risk to local inhabitants and domestic animals.
The persistence of human rabies transmitted by dogs in informal urban settings poses a significant challenge to global health. Although almost always fatal but completely preventable, the disease disproportionately affects marginalized populations. This suggests that the limitations in rabies elimination are not only biological but also reflect spatial, infrastructural, and governance determinants specific to informal settlements. To develop a conceptual framework integrating urban planning, the One Health approach, and rabies epidemiology to understand why existing biomedical strategies are less effective in informal settings and to identify spatial factors useful for more sustainable elimination strategies. An interdisciplinary conceptual research approach was adopted, synthesizing evidence from rabies epidemiology, One Health governance, and urban planning. The analysis focused on how spatial and infrastructural determinants influence the effectiveness of rabies control interventions at the neighborhood level. Rabies is treated as an urban-structural phenomenon, linking urban spatial configurations to dog ecology, human exposure, and access to prevention. The RABIES-SAFE SETTLEMENT framework integrates these dimensions through a micro-territorial One Health perspective, highlighting the role of urban planning as an upstream factor that can influence the performance of established biomedical interventions. Progress toward rabies elimination is influenced not only by the availability of effective biomedical tools, but also by the material and spatial characteristics of urban settlements. Integrating urban planning considerations into One Health approaches can promote more equitable and sustainable reductions in human rabies transmitted by dogs, especially in informal communities.
Given the current high efficacy of antiretroviral therapy and the availability of prophylactic medications, the spectrum of illnesses requiring hospitalization in people with HIV (PWH) has evolved over time. All hospitalizations with a diagnosis of HIV and/or AIDS at the National Registry of Hospital Discharges were retrospectively examined in Spain from 1997 to 2022. There were 610,912 admissions in PWH. Male represented 73%. Mean age at admission was 43.2 years-old and increased from 33.5 years in 1997 to 53.2 in 2022 (p < 0.0001). Overall, hospitalizations declined by 36.3%. AIDS was present in 71.1% of admissions, with 31.4% diagnosed during the same admission. Across three periods (1997-2007, 2008-2015, 2016-2022), the proportion of admissions with AIDS decreased (76.1%, 68.6%, and 64%), as did new AIDS diagnoses (36.2%, 28.3%, and 23.3%) (p < 0.001). Among those newly diagnosed with AIDS, 78.8% had opportunistic infections (OIs), and 19.5% AIDS-associated cancers. OIs declined (84.7%, 73.1%, and 54.8%), while neoplasms increased (14.1%, 24.4%, and 31.5%) (p < 0.001). In-hospital mortality was 5.4% and decreased (6%, 5.2% and 4.5%) (p < 0.001). Hospitalizations and mortality among PWH in Spain have decreased over 25 years. While OIs dropped 23.3%, AIDS-related cancers rose by 20%. Mean age at admission reached 53.2 years in 2022.
Anopheles stephensi is an important malaria vector in India which has been repeatedly incriminated for transmitting urban malaria in different parts of the country. The fight for its control in the metropolitan cities of India dates back to as early as 1911. Using an integrated approach of bio-environmental control along with community education and strict enforcement of legislatures, India has shown exemplary success in the control of malaria in different urban cities. From this perspective, we discuss the different success stories and the way forward for An. stephensi control in a global manner.
Here, we report the emergence of a new mpox lineage, named B.1.6.1. This lineage is native to Peru and has been reported mainly in young and adult men with immunocompromised systems. It is characterized by 5 mutations: OPG019 (Q81stop), OPG025 (A21T, E34K), OPG121 (S65L), OPG064 (M424I) and OPG210 (S1590F).
Crimean - Congo hemorrhagic fever (CCHF) is a severe tick-borne infection with high mortality, where macrophage activation and systemic inflammation drive pathogenesis. Prognostic biomarkers are crucial for early risk stratification. In this prospective study (April - July 2025), 60 confirmed CCHF patients (30 severe, 30 mild - moderate) and 50 healthy controls were enrolled. Soluble CD163 (sCD163) and interleukin-6 (IL-6) were measured by ELISA, while platelet-to-lymphocyte ratio (PLR) and systemic immune - inflammation index (SII) were derived from blood counts. Severe cases showed lower platelet counts, PLR, and SII, but higher AST, ALT, LDH, GGT, CK, direct bilirubin, fibrinogen, sCD163, and IL-6 than mild - moderate patients (all p < 0.05). Compared with controls, CCHF patients had elevated sCD163 and IL-6 (p < 0.001). sCD163 correlated negatively with platelet count (r=-0.453, p = 0.001) and positively with AST, ALT, and IL-6 (r = 0.953, p < 0.001), linking macrophage activation to systemic inflammation. ROC analysis showed sCD163 (AUC = 0.853) and IL-6 (AUC = 0.852) as accurate predictors of severe CCHF, with an sCD163 cutoff of 2.7 ng/mL yielding 96% sensitivity and 77% specificity. PLR and SII also distinguished severity but with lower accuracy. These findings highlight sCD163 and IL-6 as strong early prognostic biomarkers that may improve clinical assessment and guide timely therapeutic interventions in CCHF.
Schistosomiasis is a parasitic disease primarily controlled by Praziquantel-based Mass Drug Administration (MDA) targeting school-aged children. This study aimed to generate a high-resolution schistosomiasis prevalence map in a region with regular MDA in Madagascar, identify at-risk groups, assess population knowledge, and explore risk factors to support alignment with WHO guidelines. Conducted between July and October 2022 in the District of Vatomandry, Madagascar, this cross-sectional study included participants aged five and older. Point-of-Care Circulating Cathodic Antigen testing determined infection prevalence. A choropleth map was generated to show the geographical distribution of schistosome infection across local communities. Individual risk factors were assessed using hierarchical Poisson regression. The study included 1,215 households (5,200 participants) from 42 communities revealing a high overall prevalence of 59%. Adjusted prevalence ratios (PR) indicated higher infection risks for farmers (PR = 1.17, 95% CI: 1.09-1.25) and older age groups (≥38 years: PR = 1.34, 95% CI: 1.16-1.55; against ≤15 years), while participants with higher education or knowledge about schistosome transmission showed a reduced risk (PR = 0.88, 95% CI: 0.78-0.99). The results show high schistosome prevalence in adults, emphasizing the need to adapt strategies in endemic countries to meet the WHO's 2030 goal of eliminating schistosomiasis as public health problem.
Dengue fever is a growing global health concern, especially in regions like the United Arab Emirates (UAE), where environmental factors and high levels of international travel increase the risk of outbreaks. Despite this, public awareness and adoption of preventive measures remain understudied. This cross-sectional study aimed to assess the public's knowledge, attitudes, and practices (KAP) regarding dengue fever and its prevention. A validated online questionnaire was distributed to 1106 individuals using convenience sampling. The results revealed significant knowledge gaps, with only 24.6% correctly identifying dengue as a viral infection and 24.5% recognizing mosquito transmission. Median knowledge scores were higher among participants with elementary education (median = 13, IQR: 13-18), postgraduate degrees (median = 12, IQR: 8-15) than among those with other education levels, and higher among those with health insurance (median = 11, IQR: 10-13) than among those without insurance. Attitudes varied significantly based on education and residency, while regression analysis showed that male gender, older age, and smoking were associated with higher practice scores. These findings emphasize the need for targeted educational campaigns and public health interventions to improve awareness and engagement with dengue prevention, particularly in vulnerable demographic groups.
Crimean-Congo hemorrhagic fever (CCHF) is a potentially fatal zoonotic disease caused by a tick-borne virus from the genus Orthonairovirus. This study investigates the feasibility of using high-density lipoprotein (HDL) and eosinophils as novel parameters in determining the prognosis of the disease. Sixty patients with CCHF admitted to our hospital's infectious diseases ward between March and September 2022 were included in the study. The patients'CCHF reverse transcriptase (RT)-PCR tests performed on blood samples were positive. Their recorded clinical findings and routine laboratory, biochemistry, complete blood count, and coagulation tests were investigated retrospectively. The patients'demographic, clinical, and laboratory data were recorded, and the disease severity was scored. The patients were then assigned into one of three groups depending on that severity. HDL, low-density lipoprotein (LDL), cholesterol, and triglyceride values were compared between the groups. Negative correlations were observed between HDL, LDL, and cholesterol values and increasing disease severity, while no difference was determined between the groups' triglyceride values. Eosinophil values were also negatively correlated with disease severity between the three groups. The most marked correlations with disease severity were observed in HDL and eosinophils. New scoring systems for determining the prognosis of CCHF have been investigated in recent years. HDL and eosinophil levels may represent the most important prognostic parameters in these novel scoring systems.
Our unpreparedness in responding to the prompt emergence of COVID-19 in its early stage of outbreak, especially the lack of rapid and early diagnostic techniques for mass screening which should have been prioritized, contributed to the virus' spread alongside other factors. This article provides an overview of the common diagnostic techniques with special focus on the reported and/or authorized point-of-care methods for early COVID-19 diagnosis, including lateral flow assays and localized surface plasmon resonance-based approaches. The inherent limitations of these techniques are critically examined. We then propose a potentially more competent alternative, i.e. direct detection of viral particles with aptamer-conjugated gold nanoparticles in liquid solution in combination with noninvasive breath sampling or saliva sampling, for further improvement in early diagnostic capability for infectious respiratory diseases like COVID-19. In addition, an integration of air sampling with in-situ direct colorimetric detection of viral particles could represent a potential option for airborne virus detection, thus minimizing the transmission of infectious diseases and their impact on the economy and life in the future.
Cases of travel-associated Legionnaires' disease (TALD) are frequently reported in Italy. From 1987 to 2021, 61 cases of TALD were linked to 22 hotels in a municipality in northern Italy. Legionella pneumophila serogroup 1 (Lp1) strains isolated from both patients and hotel water systems were identified as sequence type (ST) 901, a genotype rarely associated with travel-related infections in Italy or elsewhere. Whole-genome sequencing was used to analyze 41 isolates, and phylogenetic relationships were inferred by core genome multilocus sequence typing (cgMLST), single nucleotide polymorphisms (SNP) and pangenome analyses. The Lp ST901 isolates were found to form a clade characterized by some accessory genomic islands (AGI) already described in other epidemic strains, such as Alcoy, Corby, Paris and Philadelphia; other islands, containing either transposase/recombinase or transcriptional regulator factors or Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-cas systems, were specific to Lp ST901. Lp ST901 also appears to have undergone possible recombination with other strains, such as Lp ST47 (Lorraine strain). Additionally, CRISPR-Cas systems may have contributed to the protection of Lp ST901 from external dangers, while the colonized hotel water systems may have provided an ideal environmental protective niche. Our findings highlight that Lp ST901 has public health significance and deserves attention in Legionnaires' disease surveillance and risk assessment.
Sustained by urbanization, globalization and climate change, infectious diseases transmitted by arthropod vectors, such as mosquitoes, ticks and sandflies, are emerging or resurging in Europe, including Italy. There are limited therapeutic treatments and vaccines for most arthropod-borne pathogens, thus monitoring and control of vectors remains the most-effective prevention strategy. Supported by a country-wide initiative that aims at providing strategic guidance for preventing vector-borne diseases in Italy, including suirveillance and control initiatives that results in the acquistion of a large number of field samples, we conceived a digital repository of samples from arthropod vectors and their metadata to promote their sharing among the scientific community. We built a relational database called RAV-IT, accessible at https://mosqit.unipv.it/. Currently, RAV-IT aggregates seventeen Italian institutions and hosts nearly two thousand vector samples and their metadata, which can be viewed and requested for research purposes. RAV-IT is interactive and can accept further samples from any users. RAV-IT is a non-profit repository that is expected to enhance resource sharing for research on arthropod vectors.
BACKGROUND:With increased Chinese enterprises involvement in Sierra Leone under the Belt and Road Initiative, understanding the prevalence of infectious diseases among local populations, particularly employees of Chinese firms, is crucial for enterprise management and public health interventions. This cross-sectional study aimed to assess the seroprevalence of HIV, HBV, HCV, syphilis, malaria, and tuberculosis among the local population, including co-infection prevalence and associated risk factors. METHODS:A serological survey was conducted among 342 local employees from six Chinese enterprises and 165 community residents (controls). Blood samples were tested using rapid immunological kits. Demographic data, occupational details, body temperature, and blood pressure were collected. Seroprevalence rates and risk factors were analyzed, with a focus on co-infections. RESULTS:The seroprevalence rates, in descending order, were as follows: malaria parasites (14.6%, 95% CI: 11.64%-17.97%), HBV (10.1%, 95% CI: 7.58%-13.01%), HIV (6.1%, 95% CI: 4.20%-8.57%), tuberculosis (4.3%, 95% CI: 2.74%-6.50%), syphilis (3.7%, 95% CI: 2.27%-5.79%), and HCV (0.0%, NA) for both the company employees and community residents. For mono-infection, there is a significantly lower seroprevalence in HIV and syphilis among company employees than in community controls (4.4% vs 9.7%, p = 0.019; 2.3% vs 6.7%, p = 0.016). Both the co-infection rate (3.5% vs 8.5%, p = 0.017) and the overall infection rate (29.8% vs 39.4%, p = 0.032) are also significantly lower among company employees compared to community controls. CONCLUSION:This study provides insights into the prevalence of infectious diseases and co-infection levels among local employees of Chinese enterprises and community residents in Sierra Leone. It highlights the importance of pre-employment screenings and post-employment health evaluations. The findings underscore the need for broader epidemiological investigations and surveillance to combat infectious diseases in sub-Saharan Africa effectively.
We analyzed the geographic risk of Lyme borreliosis taking into account the biogeography of tick vectors and wild carrier hosts, together with environmental and anthropogenic factors. Four pathogeographical scenarios were set in order to represent the contribution of vectors and hosts in the spatial zoonotic risk. For that propose, we built distribution models based on the occurrence of Lyme borreliosis cases in humans and ixodid vectors. Besides Ixodes species, we considered other ixodid ticks with potential to be vectors. These models were combined through fuzzy logic operators, according to the criteria established in each scenario. Finally, the transmission risk model for Lyme borreliosis which best fitted its global distribution was selected. The risk model selected considered ixodid vectors and mammal carriers as explanatory variables together with environment and anthropogenic factors. Ixodes species contributed to explain the geographical risk of Lyme borreliosis to a larger extent than other ixodid ticks. The risk model described regions with Lyme borreliosis transmission risk where its presence is still uncertain, such as northern Africa and inland areas of western U.S.A. Likewise, our model indicated favorable conditions for the presence of human cases in northern latitudes beyond its endemic distribution. Applying this multi-scenario methodology approach have led us to a risk model, in which the diversity of ixodid vectors and carrier hosts might modify the spatial risk without a geographical limitation.
Tuberculosis (TB) is a highly infectious disease caused by Mycobacterium tuberculosis. The World Health Organization (WHO) has reported more than 8 million new or relapse TB cases and 1.25 million deaths in 2023. Even though the global End TB strategy implemented by WHO has reduced the TB incidence rate between the years 2015 and 2023 up to 8.3%, TB remains one of the leading infectious causes of death worldwide. Active tuberculosis can affect any part of the body, and the clinical symptoms include fever, weight loss, and night sweats, whereas latent TB does not show any clinical symptoms. One of the significant concerns regarding the control of TB is the reservoir nature of latent tuberculosis. The Bacillus Calmette-Guerin (BCG) vaccine helps control TB and is still used globally to combat it. Currently, two methods are primarily used to identify tuberculosis infection: the Tuberculin Skin Test (TST) and the Interferon-Gamma Release Assay (IGRA). A significant disadvantage of these two methods is the inability to differentiate between latent and active tuberculosis. Accurate and timely diagnosis of TB is essential for effective management, mainly due to the emergence of multidrug-resistant strains. Specific biomarkers are required to evaluate tuberculosis infection, and novel biomarkers are needed to develop new diagnostic methods for tuberculosis. This article presents a brief review of recent developments in TB diagnostics, covering immunological, molecular, and monoclonal antibody-based platforms. The review also discusses the emerging role of artificial intelligence and deep machine learning platforms as complementary diagnostic tools.
Neglected tropical vector-borne diseases (NTVBDs) pose a significant global health challenge, disproportionately affecting low- and middle-income countries. This review begins by defining NTVBDs and their classification criteria, providing a comprehensive overview of their geographical distribution, vectors, and causative agents. Climate change, socioeconomic factors, and land-use changes are changing NTVBD transmission dynamics, with temperature increases expanding vector ranges and creating new transmission hotspots in previously unsuitable regions. The review examines both established vector control approaches and emerging technologies, including CRISPR-based gene editing, artificial intelligence, and microbiome manipulation for NTVBD control. Housing improvements have shown particular promise, with studies demonstrating significant reductions in vector presence through structural interventions. Sustainable control programs emphasize community-based and culturally appropriate interventions, with gender-responsive approaches enhancing both intervention coverage and women's economic empowerment. The review explores the integration of NTVBD control with existing health systems through formal coordination mechanisms and sustainable financing frameworks beyond traditional donor-dependent models. Recent field initiatives addressing the psychological dimensions of NTVBDs highlight the importance of comprehensive approaches that extend beyond physical symptoms. To address the complex challenges of NTVBDs in a rapidly changing world, the review concludes that a multidisciplinary approach integrating technological innovation with social and ecological considerations is essential. Future research should examine the long-term effects of climate change on NTVBD dynamics, develop broadly protective vaccines, optimize integrated control strategies, and investigate innovative funding mechanisms for resource-limited settings.
Infections caused by the Hepatitis A virus (HAV) occur worldwide. Molecular epidemiology is crucial to understanding the transmission dynamics; however, the current genotype assignment fails to provide useful epidemiologic information. We classified HAV sequences available in GenBank based on 460 bp of the VP1/2A region in clades. Additionally, we associated the site of isolation of the strains with the country's HAV endemicity. We analyzed 1369 sequences available in GenBank up to December 2023 which fulfilled inclusion criteria for our study. The collection date ranged from 1957 to 2023, and genotypes IA (n = 986) and IB (n = 290) comprised the majority of sequences. Sequences were assigned to 70 different clades; sequences from most clades (n = 36) were detected in one country or a few countries within a single continent, while sequences of only 9 clades were detected in more than two continents. Countries with lower HAV endemicity showed higher diversity of clades compared with countries with higher HAV endemicity. In addition, multinational HAV outbreaks were associated with specific clades. In conclusion, characterization of HAV strains below the genotype level should be helpful to analyze transmission patterns within and between countries.
