Many individuals living with HIV experience persistent inflammation despite antiretroviral treatment, increasing their risk for cardiovascular diseases, cognitive decline, and other noncommunicable diseases. Carotenoids can inhibit this inflammation by reducing lipid peroxidation. Carotenoid intake and plasma concentrations can be approximated using a noninvasive cutaneous spectrophotometer. This study quantified skin carotenoid levels in Tanzanian children ages 5 to 15 years old (N = 185) both with and without HIV. Over 95% had low to moderate skin carotenoid scores (<400 units). In children living with HIV, higher viral loads were linked to lower skin carotenoid scores (rho = -0.57, P <0.001), whereas higher CD4 counts correlated with increased skin carotenoid scores (rho = 0.52, P <0.001). Overall, carotenoid levels were low and associated with immune status, suggesting that elevated carotenoid scores correlate with lower inflammation in children living with HIV. Future studies investigating dietary carotenoid interventions to support immune function are warranted.
The demographics of leishmaniasis in Brazil have shifted in recent decades, coinciding with dietary changes and an increase in overweight/obesity. Cutaneous leishmaniasis becomes more treatment refractory in obese individuals, highlighting the impact of obesity on disease outcome. The impact of the overweight/obese state on infection with Leishmania infantum, which causes visceral leishmaniasis (VL), is unclear. We previously showed that an obesity-prone diet restricts L. infantum expansion in the livers of mice, but the immunological basis remained unexplored. Herein, we investigated whether this reflected improved granuloma formation and parasite control or a response to diet-induced hepatic steatosis and inflammation. To evaluate hepatic responses to VL during obesity, mice were maintained on a high-fat, high-cholesterol (HFHC) diet or a control diet before and throughout L. infantum infection. High-fat, high-cholesterol feeding significantly reduced hepatic parasite burdens but increased splenic parasite burdens. Control animals developed well-organized hepatic granulomas before local resolution, whereas HFHC-fed mouse livers developed diffuse inflammation and early fibrosis consistent with steatohepatitis. They completely failed to form mature granulomas. Quantitative analysis confirmed organized granulomas in 100% of infected control mice, whereas HFHC-fed infected mice showed no or else loosely aggregated, immature infiltrates in their livers. Transcriptional profiling revealed a pronounced inflammatory response in naïve HFHC-fed livers that was minimally exacerbated by infection. These data suggest that diet-induced obesity does not prevent an inflammatory response to the parasite. Rather, the obesity diet impairs formation of the tissue-specific granulomatous response that might normally contain L. infantum locally in the liver.
Guinea worm disease (GWD) is on track to be the first parasitic infectious disease to be eradicated. Substantial progress has been made, from 3.5 million human cases reported annually in the 1980s to only 10 in 2025. However, 684 animal infections were reported in 2025, the majority of which were in dogs. While animal infections continue, the human population remains at risk; elimination requires interrupting infections in both humans and animals. In the present study, agent-based simulation modeling was used to evaluate the time to elimination of GWD among domestic dogs in Chad. Infections were projected over 20 years in a variety of scenarios that accounted for current interventions, namely reactive and proactive tethering, Abate® water treatments, and novel domestic dog diagnostics. Simulation results indicated that high levels of interventions were needed to achieve the elimination of GWD in dogs in Chad; they suggested that elimination could be achieved in 7 years (95% empirical interval: 3-10 years) with "high" levels of proactive tethering and 90% Abate impact, whereas lower levels of these interventions extended the time to elimination beyond 20 years. Importantly, tools such as novel dog diagnostics (under development) could accelerate progress when paired with frequent testing and sustained tethering of dogs that have tested positive. Although challenges remain, intensified application of proven strategies combined with innovative tools offers a path to eliminating GWD in dogs and ultimately achieving global eradication.
After the introduction of West Nile virus (WNV) in 1999, the virus became endemic in the United States, causing approximately 1,300 severe neurological disease cases and 130 deaths annually. WNV is also responsible for a substantial disease burden in Canada, Europe, and countries around the Mediterranean Sea. WNV prevention currently relies on personal protective behaviors (PPBs) and mosquito control, but these measures have been inadequate to substantially reduce WNV disease cases or deaths. Additional measures are also necessary to diagnose, treat, prevent, and control WNV disease. Human WNV vaccine, anti-WNV monoclonal antibody used as preexposure prophylaxis in patients at higher risk for severe WNV disease, and more rapidly detecting WNV infection, among other measures, will be critical to help combat WNV disease morbidity and mortality. Partners in government, academia, and private industry should collaborate to ensure optimal use and availability of current and additional lifesaving measures.
To characterize the burden of and identify risk factors for post-coronavirus disease (COVID) condition among high-risk, nonhospitalized patients in Honduras, patients with acute coronavirus disease 2019 (COVID-19) who were discharged from five urban triage facilities were prospectively recruited. These patients were recruited between May and September 2022. Inclusion criteria included a positive COVID-19 antigen test result and either age greater than 60 years or age greater than 45 years with elevated risk for severe COVID-19. Follow-up was conducted at 3 and 4.5 months by telephone. Multivariable logistic regression was used to identify predictors of post-COVID condition. At enrollment, 98% of participants had received two or more doses of the COVID vaccine. Three months after enrollment, 464/1,133 participants (41%) reported ongoing symptoms. Female sex (adjusted odd ratio [aOR]: 1.68, 95% CI: 1.29-2.19), three or more comorbidities (aOR: 1.62, 95% CI: 1.03-2.55), and the number of symptoms at enrollment (aOR: 2.41, 95% CI: 1.59-3.71 for 7-9 symptoms; aOR 3.61, 95% CI: 2.25-5.86 for 10 or more symptoms) were predictive of ongoing symptoms. A total of 4.5 months after enrollment, 258/852 patients (30%) reported ongoing symptoms. Female sex (aOR: 1.82, 95% CI: 1.31-2.54), the number of comorbidities (aOR: 1.87, 95% CI: 1.07-3.36 for two comorbidities; aOR: 2.38, 95% CI: 1.33-4.39 for three or more comorbidities), the number of enrollment symptoms (aOR: 1.73, 95% CI: 1.05-2.95 for 7-9 symptoms; aOR: 2.59, 95% CI: 1.45-4.71 for 10 or more symptoms), and three versus four vaccine doses (aOR: 1.54, 95% CI: 1.06-2.22) were predictive of ongoing symptoms. These findings raise concern for an under-recognized burden of post-COVID condition in Honduras. Further research is needed to determine if findings from this high-risk cohort are indicative of post-COVID condition burden among other populations in the region.
Leptospirosis is a globally distributed disease associated with recreational aquatic activities; environmental exposure; and a range of occupational exposures, including animal handling, sanitation work, military operations, and sewer maintenance. We report a case of severe leptospirosis in a New York City sanitation worker after exposure to contaminated water. Because of the nonspecific presentation of his infection and the nuances of diagnostic testing, the patient presented to multiple care settings before leptospirosis was diagnosed. This case illustrates the importance of clinician awareness of urban leptospirosis and its broadening epidemiology in the United States, the time-dependent performance of diagnostic testing, and opportunities to improve personal protective equipment recommendations for sanitation employees.
In low- and middle-income settings, microbiologic evaluation of chemotherapy-associated febrile illness is limited by cost. Cost-effective diagnostic algorithms could streamline evaluation for chemotherapy-associated febrile illness where comprehensive testing is not possible, particularly in HIV- and tuberculosis (TB)-endemic settings. In this study, we created a decision analytic model to evaluate costs, diagnostic yield, and cost-effectiveness of diagnostic algorithms for adult inpatients with solid tumors who developed chemotherapy-associated febrile illness in Uganda. Given the high prevalence of HIV, TB, and malaria, diagnostics included serum cryptococcal antigen (CrAg) lateral flow assay, Alere TB urinary lipoarabinomannan (LAM), malaria rapid testing, and aerobic blood cultures. We considered the following testing algorithms: 1) a comprehensive approach where all tests were performed on all participants and 2) stepwise algorithms where tests were performed in series and stopped with the first positive result. Prevalence data and test performance were taken from the published literature. A comprehensive testing strategy yielded 32.2% correct diagnoses at a cost of $97.85 per correct diagnosis. Of the stepwise strategies, testing CrAg first yielded the cheapest strategy at a cost of $85.49 per correct diagnosis and the highest number of appropriate diagnoses (29.9%). The incremental cost-effectiveness ratio was $234 per additional correct diagnosis for the comprehensive strategy when compared with the sequential strategy. Although comprehensive diagnostic testing is optimal for patients who experience chemotherapy-associated febrile illness, if this strategy is unavailable, stepwise testing with CrAg first and then, TB LAM is optimal to maximize correct diagnosis and minimize costs.
Pediculosis capitis remains a persistent public health issue, especially in developing countries where resistance to standard neurotoxic pediculicides like permethrin is increasingly prevalent. This study aimed to compare the effectiveness of alternative treatment options against the standard care in a resource-limited setting. We conducted a single-blind randomized controlled trial involving three primary schools in Chachoengsao Province, Thailand (ClinicalTrials.gov: NCT06332872). Eighty-five female participants ages 6-13 years with active infestations were enrolled. Schools were randomly assigned to three treatment arms: 1) oral ivermectin (200 µg/kg) on Days 0 and 7; 2) 1% permethrin shampoo on Days 0 and 7, or 3) 4% dimethicone liquid gel as a single dose on Day 0. The primary outcome was the cure rate, defined as the absence of live lice and viable nits upon clinical assessment on Day 9. Of the 66 participants included in the final per-protocol analysis, oral ivermectin achieved a cure rate of 95.5% (21/22), which was significantly higher than that of the 1% permethrin standard of care (37.0%; 10/27) and the 4% dimethicone physical suffocant (29.4%; 5/17) (P <0.001). Although dimethicone achieved high initial parasitic clearance on Day 0 (88.2%), a rapid reinfestation rate of 58.8% was observed by Day 9, indicating that a single-dose protocol may be clinically insufficient. Adverse events were mild and temporary across all groups. Oral ivermectin appears significantly more effective than both 1% permethrin and single-dose 4% dimethicone in this population. These findings suggest that permethrin resistance is clinically prevalent and relevant in this area.
Scrub typhus, caused by Orientia tsutsugamushi, is a mite-borne febrile illness endemic to the Asia-Pacific region. Although most patients respond promptly to appropriate antibiotic therapy, a subset exhibits delayed defervescence, the clinical significance and predictors of which remain insufficiently understood. In the present study, the authors aimed to identify clinical, laboratory, and radiological factors associated with delayed defervescence in patients with scrub typhus. In this retrospective cohort study, scrub typhus patients who were hospitalized at Chosun University Hospital, Gwangju, South Korea, between November 2005 and November 2008 were assessed. Demographic characteristics, clinical manifestations, laboratory values, and radiological findings were compared. Multivariate logistic regression was used to identify independent predictors. During the study period, 413 patients were recorded initially. Among 160 confirmed scrub typhus patients, 22 (13.8%) experienced delayed defervescence. Compared with patients with early defervescence, those with delayed defervescence had significantly lower hemoglobin levels (P = 0.045), higher rates of anemia (P = 0.006) and leukocytosis (P = 0.017), and elevated C-reactive protein levels (P = 0.034). Pneumonia was also more common in the delayed group. In multivariate logistic regression analysis, anemia (odds ratio [OR]: 2.79; 95% CI: 1.00-7.79) and pneumonia (OR: 2.86; 95% CI: 1.07-7.59) were the strongest independent predictors of delayed defervescence. Delayed defervescence may reflect ongoing systemic inflammation and greater disease severity. Pneumonia and anemia could help identify patients at risk of a more severe clinical course or complications despite appropriate treatment, underscoring the importance of close monitoring.
Artemisinin partial resistance (ART-R) threatens the control of falciparum malaria, but its impact on the treatment of severe malaria has been unclear. Two recent studies in Uganda have considered associations between PfK13 mutations linked to ART-R and treatment outcomes in children hospitalized with complicated or severe malaria and treated with intravenous artesunate. Children infected with ART-R parasites experienced delayed parasite clearance compared to those infected with drug-sensitive parasites. However, clinical outcomes, including mortality, length of hospital stay, incidence of subsequent febrile illness, and incidence of readmission did not differ between children infected with ART-R or drug-sensitive parasites. Therefore, at present treatment with intravenous artesunate should remain the standard-of-care to treat severe malaria in sub-Saharan Africa, even in the setting of ART-R, although continued study of treatment efficacy is warranted.
Chagas disease, caused by Trypanosoma cruzi, poses an emerging and under recognized threat to U.S. military personnel deployed in endemic regions. Despite significant morbidity and mortality risks, the US Department of Defense (DoD) lacks comprehensive policies for Chagas disease prevention, screening, or treatment, unlike other similar infectious diseases. We conducted a comparative policy analysis of existing DoD policies on tuberculosis, HIV, and hepatitis C to inform the development of Chagas disease policy. Using an adapted Political, Administrative, Social, Technological, Economic, Legal factors (PASTEL) framework, we evaluated five policy alternatives through expert consensus scoring. Military health policies and literature were systematically reviewed to identify screening protocols, risk assessment tools, and prevention strategies. Analysis of current military screening policies revealed significant gaps in Chagas disease coverage in comparison with analogous infectious diseases. The decision matrix analysis identified an integrated Periodic Health Assessment (PHA) approach as the optimal policy alternative (weighted score 4.20/5.0), followed by targeted risk-based screening (3.85/5.0). Universal screening scored lowest (2.20/5.0) due to poor cost-effectiveness and implementation challenges. The recommended approach leverages existing annual health assessment infrastructure while incorporating Chagas disease-specific risk evaluation tools. A tiered policy strategy integrating Chagas disease risk assessment into routine military health evaluations offers the most feasible approach for protecting service members. Implementation should prioritize risk-based screening, vector-control measures (e.g., insecticide-treated uniforms), and enhanced surveillance in endemic deployment areas. This framework provides an evidence-based foundation for developing comprehensive DoD Chagas disease policies.
Una virus (UNAV) is an understudied alphavirus with the capacity to infect humans. Although it was discovered decades ago in South America, little is still known about this virus because accurate diagnostic tests are still needed. The first UNAV-specific real-time reverse transcription polymerase chain reaction (rRT-PCR) test is described in the present study. This assay targets the nonstructural protein 1 coding region and was designed from an alignment using all available UNAV sequences. The linear range of the UNAV rRT-PCR extended from 6.2 to 0.2 log10 copies/µL, with a lower limit of 95% detection of 2.0 copies/µL. The assay offered sensitive UNAV detection in contrived whole-blood samples. In addition, no amplification was observed in the assay when tested with genomic RNA from multiple closely related arboviruses. The UNAV rRT-PCR exhibits high sensitivity and specificity, which is critical for research into this virus in regions where multiple related alphaviruses co-circulate.
Invasive aspergillosis typically occurs in immunocompromised hosts but has been increasingly recognized following viral illnesses, including dengue and coronavirus disease 2019. Herein, a fatal case of disseminated aspergillosis following severe dengue is described, and the association is systematically reviewed. A previously healthy 25-year-old woman presented with fever and multiorgan dysfunction. Dengue IgM results were positive, and other tropical infections were excluded. Despite intensive care, the patient developed progressive respiratory failure, refractory shock, and acute kidney injury and died. An autopsy revealed diffuse alveolar damage and extensive invasive aspergillosis involving the bronchi, pulmonary vasculature, and myocardium. In the present systematic review, 21 additional cases of invasive aspergillosis following dengue (total n = 22; median age 36 years, 59% male) were identified, predominantly in Asia. Fifteen cases (68%) had pulmonary involvement. Most patients had severe dengue with multiorgan dysfunction. The overall mortality was 63.6%; 23% of cases were diagnosed postmortem. Invasive aspergillosis complicating severe dengue broadens the spectrum of viral-associated aspergillosis.
Schistosomiasis remains a significant but frequently underrecognized parasitic infection among migrants from endemic regions living in Europe. A retrospective cross-sectional study of sub-Saharan African migrants diagnosed with schistosomiasis was conducted at a referral center in northern Spain between 2012 and 2023. Cases were primarily defined by positive serological results, with parasitological confirmation available only in a minority of patients. The aim was to describe demographic, clinical, and diagnostic characteristics, with particular attention to sex-based differences. Among 538 screened individuals (52.8% men), 121 (22.5%) were diagnosed with schistosomiasis, including 59 women (48.7%). The mean age was 33 ± 14 years. Women had a longer duration of residence in Spain before diagnosis compared with men (39 ± 59 versus 30 ± 37 months; P = 0.037). Most patients were asymptomatic (62.7% of women and 58% of men). Hematuria was observed exclusively in men (P = 0.001), with bladder abnormalities confirmed in two cases. Among 33 women with available gynecological history, 60.6% reported reproductive tract morbidity, including recurrent miscarriage and infertility. These findings highlight the substantial burden of imported schistosomiasis among migrants from sub-Saharan Africa and reveal clinically relevant sex-related differences in presentation and associated conditions. The study results support the need for targeted screening strategies in nonendemic settings and emphasize the importance of incorporating reproductive health assessment into the evaluation of women with suspected schistosomiasis.
Melioidosis is a potentially fatal tropical infection caused by Burkholderia pseudomallei. Although well described in Southeast Asia and northern Australia, its burden in South America remains poorly characterized and likely underestimated. A case of severe disseminated melioidosis in a 35-year-old man with poorly controlled diabetes mellitus residing in the Peruvian Amazon is reported here. The patient presented multifocal pneumonia, bacteremia, and septic shock requiring mechanical ventilation and vasopressor support. During hospitalization, he developed cutaneous microabscesses and septic arthritis of the left knee. Burkholderia pseudomallei was isolated from both blood cultures and synovial fluid, confirming hematogenous dissemination. This case highlights the presence of severe melioidosis in the Peruvian Amazon and underscores the need to consider this pathogen in patients presenting with severe sepsis in tropical regions with high environmental exposure and metabolic risk factors. Strengthening microbiological diagnostic capacity is essential to improve detection of this emerging infection in South America.
Leprosy or Hansen's disease remains a public health concern in Ecuador, where diagnosis still relies on clinical evaluation and bacilloscopy. This pilot study evaluated the performance of three polymerase chain reaction (PCR) protocols for detection of Mycobacterium leprae in 31 clinical specimens from patients clinically suspected of leprosy. Two real-time PCR assays (quantitative polymerase chain reaction [qPCR]) and one conventional PCR were compared with bacilloscopy. The two qPCR assays showed identical positivity rates of 32.3% (n = 10/31), whereas the conventional PCR detected only 3.2% (n = 1/31) positives. Overall, PCR positivity was 38.7% (n = 12/31) compared with 25.8% (n = 8/31) for bacilloscopy. The combined reference standard (considering a sample true positive when either bacilloscopy or PCR was positive) diagnosed 45.2% (n = 14/31) of samples as positive. A significant lower sensitivity was observed for conventional PCR compared with qPCR. These findings support the use of qPCR together with bacilloscopy to improve leprosy diagnosis in Ecuador.
Enterobius vermicularis is the most common nematode infection in the United States. Despite this prevalence, few studies have evaluated current clinical practices with regard to diagnosis and management. Price increases in anthelmintics in the United States add a component of cost-conscious care to treatment selection. We conducted a retrospective analysis of 200 patients in the Military Health System with an International Classification of Diseases code diagnosis of enterobiasis from 2011 to 2018. A clinical diagnosis was made in 70.0% of symptomatic patients. A pinworm paddle or cellophane adhesive was ordered in 12.7% of symptomatic cases, with a positivity rate of 41.2%. Diagnostic studies ineffective for the diagnosis of enterobiasis were ordered in 12.0% of symptomatic cases, with the most common being ova and parasite examinations of the stool (10.0%). The most common initial treatment of enterobiasis was albendazole (73.6%) followed by mebendazole (15.0%), pyrantel (10.9%), and ivermectin (0.5%). Empiric retreatment of patients after initial treatment and empiric treatment of household members were prescribed or recommended in 86.0% and 49.7% of cases, respectively. Counseling on decontamination measures to prevent reinfection was documented in 35.2% of cases. This study suggests that there are knowledge gaps in the optimal diagnostic approach to enterobiasis as well as the role of adjunctive measures to prevent a cycle of continuous reinfection, such as empiric retreatment, empiric treatment of household members, and counseling on decontamination measures. Additionally, the prominence of albendazole use relative to pyrantel pamoate represents an opportunity for cost-conscious care.
