The 2026 Ebola outbreak caused by Bundibugyo ebolavirus in the Democratic Republic of the Congo and Uganda exposes a persistent structural flaw in global health security: preparedness remains overwhelmingly reactive and pathogen-specific. Despite the $518 million Africa CDC-WHO joint continental plan, no licensed BDBV vaccine or therapeutic is available; a 21-day (three-week) detection delay and cross-border transmission expose inadequate inter-epidemic investment in non-Zaire ebolavirus countermeasures. We argue for sustained, ring-fenced financing, institutionalised cross-border coordination, species-inclusive diagnostics, and real-time genomic data sharing to move African Ebola preparedness from reactive to pre-emptive.
Background Syphilis poses substantial diagnostic complexity due to its diverse dermatologic and systemic manifestations, underscoring the importance of early identification to prevent progression and complications. Case presentation Herein, we present a clinical case of a 24-year-old female patient experiencing a three-week history of fever, arthralgia, and a generalized maculopapular rash. While the diagnosis of syphilis was confirmed by serological and molecular tests, histopathology revealed unusual granulomatous dermatitis. Conclusion This report of atypical granulomatous secondary syphilis emphasizes the need to include secondary syphilis in the differential diagnosis of atypical cutaneous eruptions of return travelers and supports the incorporation of molecular techniques into diagnostic evaluation.
INTRODUCTION:Cerebral cryptococcoma is a rare focal form of central nervous system (CNS) cryptococcosis, typically described in immunocompromised hosts. In immunocompetent individuals, it may present as a solitary mass lesion, closely mimicking a high-grade glioma and posing a significant diagnostic challenge, especially in returning travelers from endemic regions. CASE PRESENTATION:A 36-year-old previously healthy man from a rural region of South America presented with progressive left hemiparesis, headache, behavioral changes, and a generalized tonic-clonic seizure. Neuroimaging revealed a large, enhancing right parietal lobe lesion with extensive perilesional edema, mass effect, and midline shift-features highly suggestive of glioblastoma. The patient underwent emergency craniotomy with macroscopic complete resection. Histopathological examination, however, demonstrated a cryptococcoma with characteristic mucopolysaccharide capsules and budding yeasts, confirmed by special stains. Serum and cerebrospinal fluid cryptococcal antigen were positive. HIV serology was negative, and CD4 count was normal. He was treated with liposomal amphotericin B and flucytosine, followed by fluconazole, with good neurological recovery. SYSTEMATIC LITERATURE REVIEW:A systematic PubMed search identified 13 previously reported cases of cerebral cryptococcoma in immunocompetent patients. The mean age was 56.1 years (range 40-64 years), with a male predominance (69.2%, 9/13). The most common locations were cerebral parenchyma (38.5%, 5/13) and intraventricular (23.1%, 3/13). Surgical intervention was performed in 84.6% (11/13) of cases. Outcomes were favorable in 84.6% (11/13), with one fatal outcome (7.7%) and one patient surviving with persistent sequelae (7.7%). CONCLUSION:Cerebral cryptococcoma should be considered in the differential diagnosis of ring-enhancing CNS mass lesions, even in immunocompetent travelers or migrants from endemic areas. Preoperative serum cryptococcal antigen testing may aid diagnosis and help avoid unnecessary surgical resection. Histopathology remains the diagnostic gold standard.
Malaria is a major global health problem that causes substantial socioeconomic losses in developing countries and is associated with high morbidity and mortality, particularly in endemic areas. For these reasons, access to effective pharmacological therapies and adequate healthcare services is essential for the prevention, treatment, and control of malaria. In the present study, an advanced oral drug delivery system based on mesoporous silica-doped nutriosomes co-loaded with apigenin and artemisinin was developed to improve malaria therapy. Vesicles were prepared with phosphatidylcholine and increasing amounts of Nutriose® FM06. To stably load apigenin, a carbonate-bicarbonate buffer solution at pH 9 was used as hydrating medium. Unfortunately, this pH condition promoted the degradation of artemisinin, leading to the formation of non-peroxidic analogues, which are known to be less effective in malaria treatment. Nevertheless, the resulting nutriosomes exhibited in vitro antiplasmodial activity, with IC50 and IC90 values against Plasmodium falciparum comparable to those of artemisinin solution. Moreover, when orally administered at the IC90 dose to infected mice, the formulation resulted in survival rates similar to those observed for artemisinin solution. These findings provide an encouraging proof of concept for the proposed formulation. They demonstrate the potential of this delivery strategy to improve oral antimalarial therapy and establish a solid basis for further pharmacological and in vivo investigations aimed at optimizing and fully evaluating the system.
BACKGROUND:Enhancing oxygen-carrying capacity has been suggested as a potential therapeutic strategy for alleviating sleep quality and cognitive performance at high-altitude. METHODS:60 healthy young male participants who had resided at 4300 m for at least six months, were enrolled and randomly assigned at a 1:1 ratio to either a mild hyperbaric oxygen (mHBOT) group or a control group for a 5-day intervention. The primary outcomes included insomnia severity, assessed using the Pittsburgh Sleep Quality Index (PSQI), and brain function, evaluated via functional near-infrared spectroscopy (fNIRS) during 2-back and working memory (WM) task. RESULTS:Following the intervention, the mHBOT group showed a significantly greater reduction in PSQI scores compared to the control group (3.17 ± 2.69 vs. 4.43 ± 3.39; adjusted mean difference [aMD] = -1.08, 95% CI: -1.76 to -0.46, p = 0.003). In terms of cognitive performance, the mHBOT group achieved a significantly higher accuracy rate on the WM task than the control group. Furthermore, fNIRS data indicated a significant decrease in oxygenated hemoglobin levels in the superior temporal gyrus (STG; channels 18-22) during WM performance after mHBOT compared to baseline (FDR-corrected p < 0.05), suggesting altered activation patterns and reduced metabolic demand in this region. Analysis of cerebral functional connectivity also revealed enhanced network integration and modified activation profiles following mHBOT treatment, may indicate improved neurocognitive efficiency. CONCLUSION:Findings indicate that mHBOT may be a promising intervention for enhancing both sleep quality and cognitive performance in healthy young adults at high altitude.
In this study, we identified a case of Bertiella studeri infection in a child using etiological and molecular biological methods, which provided clear guidance for subsequent diagnostic work. Cytochrome c oxidase subunit 1 gene (COX1) was amplified and the sequence is closely related to Bertiella studeri (OP474069.1) The patient had been treated with Praziquantel 1 pill for one time and took it continuously for 6 days as a course of treatment. After six months, the patient did not find any more proglottids in the feces and returned to normal. The patient was a 2 years and 7 months boy, who lived in Fuxi county, Huangshan City, Anhui Province, China. The patient had a history of contact with livestock, and taking cauliflower snake meat and white worm on trees at 2021. The main symptoms of the patient were abdominal pains, perianal itching. Streaky worms were found in stool for two months. The patient came to National Children's Medical Center Children's Hospital of Fudan University for doctors' advice. The results of blood count showed that the Leukocyte count was 13.44 × 109/L and Eosinophil count was 370/μl, which were both significantly higher than normal value. There were no differences between values of the red blood cell count and hemoglobin content which means the patient had no obvious symptoms of anemia.
Severe dengue is typically linked to secondary infection. We report dengue with warning signs due to primary DENV-3 infection in a healthy Italian adolescent returning from the Philippines. Severe thrombocytopenia and mucosal bleeding, with clinical and laboratory features suggestive of possible plasma leakage, were managed without shock, highlighting the need for multidisciplinary monitoring and care even in primary dengue.
BACKGROUND:Mefloquine (MQ) was evaluated as intermittent preventive treatment in pregnancy (IPTp) in a randomized clinical trial, as part of the ongoing search for alternatives to sulfadoxine-pyrimethamine (SP). Although MQ was not recommended for IPTp due to poor tolerability, no psychiatric differences were found between trial arms. Nevertheless, widespread concerns about MQ's neuropsychiatric effects persist and remain clinically relevant - particularly for pregnant travelers to malaria-endemic areas for whom MQ prophylaxis is still indicated. Long-term data on MQ's effects on maternal mental health and infant neurodevelopment are lacking. METHODS:Data come from the Benin subsample of the MiPPAD randomized, three-arm clinical trial (N = 1183), conducted across antenatal care clinics in three study sites (Allada, Sékou, and Attogon) between 2009 and 2013. Women received either SP, MQ full dose (15 mg/kg), or MQ split dose (same total dose over two days). At one year postpartum, 752 mother-child pairs provided information on depression and anxiety (Edinburgh Postnatal Depression Scale (EPDS)), maternal-child interactions (Home Observation for Measurement of the Environment (HOME)), and 745 infants had information on neuropsychological outcomes (Mullen Scales of Early Learning (MSEL)). Logistic and linear regressions estimated odds ratios (OR) and beta coefficients (β) with 95% Confidence Intervals (CI). FINDINGS:Mothers were approximately 26 years of age at inclusion. No significant associations were found between IPTp regimen and maternal depressive symptoms (score ≥9: MQ full dose OR 0.85 [95% CI 0.60, 1.20]; MQ split dose OR 0.94 [95% CI 0.66, 1.34]), severe depression (score ≥12: MQ full dose OR 0.98 [95% CI 0.63, 1.54]; MQ split dose OR 1.26 [95% CI 0.82, 1.95]), or anxiety (MQ full dose OR 0.91 [95% CI 0.59, 1.40]; MQ split dose OR 1.03 [95% CI 0.67, 1.59]), all compared with SP. No associations were observed for infant MSEL composite scores (MQ full dose β -1.21 [95% CI -3.61, 1.18]; MQ split dose β -1.17 [95% CI -3.59, 1.25]) or total HOME scores (MQ full dose β 0.29 [95% CI -0.10, 0.69]; MQ split dose β 0.34 [95% CI -0.06, 0.74]). Subscale analyses suggested positive associations between MQ full dose and maternal involvement (β 0.12 [95% CI 0.02, 0.22]) and learning materials (β 0.21 [95% CI 0.02, 0.39]). INTERPRETATION:We found no evidence that MQ compared with SP affected maternal depression, anxiety, or infant development at one year. The associations with maternal involvement and learning materials warrant further investigation into possible indirect or behavioral effects of MQ. TRIAL REGISTRATION:ClinicalTrials.gov NCT00811421; Pan African Clinical Trials Registry PACTR 2010020001429343.
BACKGROUND:Recent global epidemics and pandemics have highlighted the need for adequate diagnostic capacities to respond to emerging threats. Strengthening operational capacities can lead to improved preparation; investing in emergency response infrastructure may diminish progression of outbreaks and prevent escalation. METHODS:An email-linked survey was sent January-March-2025 to two global infectious disease surveillance networks' (GeoSentinel and TropNet) participating clinics assessing capacity for Oropouche virus (OROV) diagnostic testing. Data on testing capacity for other arboviruses was also requested. RESULTS:Responses were obtained for 58 GeoSentinel/TropNet sites (58/104, 55.8%): 50% responding sites (29/58) had OROV diagnostic testing available at a public reference laboratory; 23 sites (40%) had capacity for OROV RNA detection; 10 sites (17%) had OROV serological testing onsite. Estimated median turn-around times from phlebotomy-molecular OROV results were 4 days onsite and 6 days at the reference laboratory. Viral culture was available onsite at 9% of sites (at the reference laboratory for 26%). Molecular diagnostics availability for other arboviruses onsite showed >50% could test for at least one other arbovirus: dengue virus (31/58, 53%), chikungunya virus (29/58, 50%), West Nile virus (22/58, 38%) and yellow fever virus (12/58, 21%). Onsite serologic testing for non-OROV arboviruses was available at 39/58 sites (67%). CONCLUSIONS:The survey identified potential weaknesses in novel pathogen preparedness with respect to diagnostic capacity for OROV testing at specialized travel medicine clinics participating in two international networks. These findings provide an opportunity to implement measures to improve communication and planning and to strengthen diagnostic infrastructure prior to future outbreaks.
We report a rare case of purulent pericarditis with cardiac tamponade due to Neisseria meningitidis serogroup W135 in a 15-year-old pilgrim returning from the Hajj. Initial suspicion of Middle East respiratory syndrome coronavirus (MERS-CoV) was prompted by pneumonia and camel milk exposure, misdirecting the diagnosis. The patient developed cardiac tamponade requiring urgent pericardiocentesis; 16S rRNA PCR confirmed N. meningitidis W135 despite negative cultures. He recovered fully with ceftriaxone and colchicine. This case highlights diagnostic anchoring bias in travel medicine and the need for appropriate meningococcal vaccination.
In Italy Malaria is still mainly seen as a travel-related infection, with around 700 cases reported each year. We describe a severe, non-imported (cryptic) Plasmodium falciparum malaria case diagnosed in August 2024 in the Grosseto area (Tuscany) in an Italian patient with no travel to malaria-endemic countries and no alternative risk factors. Since June 2024, he had been staying in a nearby village on the Maremma coast. This is a well-known former malarious area (Italy was declared malaria-free in 1970) that remains receptive, with residual anophelism and the presence of Anopheles labranchiae, one of the most efficient malaria vectors in the Mediterranean basin. Marked thrombocytopenia was the initial clue and prompted blood smear microscopy, which showed 10% parasitaemia. The result was rapidly confirmed by LAMP and species identification. The patient was admitted and, once severe malaria was recognised, was treated immediately with intravenous artesunate, with subsequent clinical improvement. The case was promptly notified and investigated, but no index case, secondary cases, or transmission chain were identified. This episode is a reminder that receptive areas still need clinical suspicion, diagnostic readiness, and a surveillance response that can move quickly even when travel history is negative.
BACKGROUND:Lyme borreliosis is the most common tick-borne disease in the Northern Hemisphere, with an expanding geographic distribution driven by climate change, environmental modifications, and increased human mobility. Despite its rising incidence, diagnosis remains challenging, particularly in non-endemic areas where clinical suspicion is low and presentations are often atypical. CASE PRESENTATION:We describe three cases of Lyme borreliosis presenting with cutaneous manifestations after travel to endemic regions. In all patients, diagnosis was delayed due to non-specific symptoms or misinterpretation of early findings. Serological testing confirmed infection, and treatment with doxycycline resulted in complete clinical resolution. CONCLUSIONS:These cases underscore the importance of a careful travel history assessment, recognition of atypical clinical presentations, and maintaining a high index of suspicion for Lyme disease, even in regions traditionally considered non-endemic.
PURPOSE:To describe the prevalence of imported infections in pediatric patients prior to immunosuppressive therapy after implementing a structured screening protocol, and to assess adherence and diagnostic yield. METHODS:Retrospective study of patients <18 years from non-Western countries screened between 2020 and 2024 at a tertiary hospital in Madrid, Spain. Screening followed a standardized protocol including serology, tuberculosis testing, stool analysis, and vaccination assessment. RESULTS:Sixty-three children were included (median age 9.5 years; 55.6% male), mainly from Latin America (65.1%), with hematologic malignancies (52.4%) or awaiting solid organ transplant (33.3%). Only 19% completed full screening. At least one infection was detected in 28.6%, mainly toxoplasmosis (7/57, 12.3%), strongyloidiasis (5/56, 8.9%), malaria (3/22, 13.6%), and schistosomiasis (3/25, 12%). Immunity to hepatitis B (65.5%), measles and varicella (<50%) was suboptimal. CONCLUSION:Imported infections were frequent, supporting systematic screening before immunosuppression.
INTRODUCTION:Rabies is a fatal zoonotic disease; however, no comprehensive studies have been conducted on rabies prevention among Japanese travelers with animal exposure providing detailed information on pre-travel consultation, pre-exposure prophylaxis (PrEP), rabies immunoglobulin administration, and post-exposure prophylaxis (PEP). Therefore, this study aimed to assess the risk factors of delayed PEP among Japanese travelers exposed to animal bites. MATERIALS AND METHODS:This multicenter retrospective study evaluated patients who underwent PEP in Japan between January 2018 and December 2024. RESULTS:Among 508 patients, 303 (60%) received PEP within 24 h. Delayed PEP was associated with female sex, age 20-59 years, destination in Europe, Category II exposure, prior PrEP, and pre-travel consultation. Subsequent analyses revealed that female sex, category II exposure, and prior PrEP use were independent predictors of delayed PEP. Sensitivity analyses using delayed PEP thresholds of >24 h, >48 h, and >72 h showed highly stable patterns across demographic, travel, and exposure factors. Female sex, category II exposure, and PrEP consistently predicted delays, while backpacking was associated with delays >48 h. Other variables showed minimal fluctuations. CONCLUSIONS:A considerable proportion of patients received delayed PEP. Additionally, female sex, category II exposure, and prior PrEP were identified as the key determinants of delayed PEP. These findings underscore the need for targeted strategies to enhance compliance with rabies prophylaxis among Japanese travelers.
