To evaluate the durability of long-acting cabotegravir (CAB) plus rilpivirine (RPV), available in Italy since June 2022, for maintaining HIV-1 virological suppression. This multicentric observational study included 191 virologically suppressed adults (HIV-RNA < 50 copies/mL) from 11 centers in Tuscany, followed from first CAB + RPV injection until discontinuation, death, or last visit. Discontinuation was defined as regimen switch or two consecutive missed doses, virological failure (VF) as two consecutive HIV-RNA > 50 copies/mL or a single > 1000 copies/mL. Kaplan-Meier survival analysis assessed discontinuation rates. Follow-up was 209.5 person-years with a median of 1 year (IQR 0.5-1.5). Median age was 51 years (IQR 43-58); 81.7% were male; median ART duration was 13.8 years (IQR 8.7-20.2). Eighteen participants (9.2%) discontinued due to adverse events (3.7%), VF (2.6%), personal choice (2.1%), medical decision (0.5%), or loss to follow-up (0.5%). Overall discontinuation was 8.5/100 person-years (95% CI: 5.4-13.6). VF incidence was 2.3/100 person-years (95% CI 0.9-5.7). All VFs, occurred within 28 weeks, except one at Week 72 with resistance mutations. Discontinuation rates were slightly higher than clinical trials but consistent with real-world data. The VF incidence was slightly higher than reported in prior reports, highlighting the need for real-life clinical monitoring.

BACKGROUND:Although the acute phase of the COVID-19 pandemic has subsided, long COVID remains a significant and ongoing public health concern. Persistent symptoms continue to affect a substantial proportion of COVID-19 survivors, increasing healthcare burden. OBJECTIVE:This study aims to identify the determinants of long-term symptom trajectories following COVID-19 infection. METHODS:We conducted a prospective cohort study of 1666 adults discharged after hospitalisation for COVID-19 in Tuscany, Italy. The presence of mental confusion, exertional dyspnoea, fatigue, and insomnia was assessed at 1, 3, 6, 9, and 12 months post-discharge. The mean hospital stay was 13.6 (±12) days and 131 patients required intensive care unit admissions. Latent growth curve models were used to examine the baseline prevalence and longitudinal trajectories of each symptom, and to identify demographic and clinical factors associated with symptom persistence. RESULTS:Fatigue was the most common persistent symptom at baseline, followed by exertional dyspnoea, insomnia, and mental confusion. Female sex was consistently associated with both baseline presence and persistence of all symptoms. Older age was linked to baseline mental confusion and to persistent dyspnoea and fatigue. Markers of greater acute severity (ICU admission, longer hospital stay, higher WHO score) were associated with symptom improvement over time. Pre-existing coronary heart disease and cancer independently predicted persistent dyspnoea and fatigue, whereas hypertension appeared protective. CONCLUSIONS:Persistent symptoms are common after COVID-19 and vary by sex, age, comorbidities, and acute disease features. Symptoms may persist up to 12 months post-hospitalisation, underscoring the need for long-term follow-up and targeted interventions.

Neurocysticercosis (NCC) is a major public health concern in low-middle-income countries. Subarachnoid NCC (SANCC), a less frequent form of NCC, is characterized by severe clinical evolution, high mortality and impactful neurological sequelae in survivors. However, due to a long pre-clinical period, early diagnosis and treatment of SANCC would likely improve the clinical course and reduce the occurrence of complications. To date, data on the prevalence of SANCC in endemic settings are scant, and there are no commercially available tests for SANCC screening in at-risk populations. Between October 2023 and May 2024, we conducted a population-based cross-sectional study aimed at implementing a non-invasive screening for SANCC in a low-resource area of the Plurinational State of Bolivia, using a home-made Ag-ELISA urine assay based on the monoclonal antibody set TsW5-TsW8. Questionnaires were also administered to the study population to assess the presence of behaviors and risk factors for active transmission of Taenia solium in the area. The study involved 1,232 subjects aged ≥10 years, 1,130 of whom delivered a urine sample. Among them, a median age of 27.4 years was observed, with 38.1% of subjects being males. Overall, 7 subjects with positive urine antigen test, confirmed on two different samples, were identified and underwent magnetic resonance imaging. The diagnosis of SANCC was radiologically confirmed in 4/7 subjects, for a prevalence of SANCC in the enrolled population of 3.54/1,000. The antigen assay showed a positive predictive value for SANCC of 57.1%. Risk factors for active transmission of T. solium, such as lack of access to adequate sanitation and the widespread practice of domestic pig breeding and sacrifice, were frequent. While further studies are needed to better define the diagnostic performance of the employed urine assay, this study confirms the presence of SANCC in the study area, consistent with evidence from similar endemic settings.

Abstract Introduction Valacyclovir is the only treatment option during pregnancy which has been demonstrated to be effective within a randomized clinical trial for prevention of transplacental cytomegalovirus (CMV) transmission. However, the use of high dose intravenous hyperimmunoglobulin (HIG) could reduce the rate of vertical transmission according to some observational studies. Cases presentation We report three peculiar cases in which high dose HIG was administered in substitution to or in addition to valacyclovir to reduce the risk of transplacental transmission of CMV. Two were immunocompromised pregnant women—one with recurrent CMV reactivations due to solid organ transplant-related immunosuppression and one with primary CMV infection and lack of IgG production due to anti-CD20 treatment for multiple sclerosis—in which HIG was co-administered with valacyclovir. The third case involved an immunocompetent pregnant woman to whom HIG was administered in substitution to valacyclovir due to severe gastrointestinal side effects related to the latter medication. In all cases, the treatment was well tolerated and the newborns tested negative for CMV at birth. Conclusion Together, these cases give an interesting perspective on the possible role of HIG in selected immunocompromised pregnant women with primary and non-primary CMV infection in addition to valacyclovir, and in immunocompetent pregnant women unable to tolerate valacyclovir or in whom the drug is contraindicated.

Due to migration phenomena, Chagas disease (CD) is emerging in Europe, where CD-related gastrointestinal complications are rarely reported. We describe a case of CD-related megaoesophagus in a patient from El Salvador, in Italy since 14 years, highlighting the importance of considering complicated CD in patients at risk with suggestive symptoms.

INTRODUCTION:Adherence to tuberculosis (TB) treatment is essential to achieve favourable outcomes, yet difficult to evaluate. Our study evaluates adherence using pharmacy refill data, and assesses COVID-19 pandemic's impact on TB care cascade. MATERIALS AND METHODS:We retrospectively analysed patients diagnosed with TB at our unit in Florence (Italy) between January 2020 and December 2023. Adherence was measured using the Proportion of Days Covered (PDC) and compared with self-reported adherence and attendance at follow-up visits. PDC was calculated for the intensive (PDC1) and continuation phase (PDC2), and overall treatment (PDC). Data were compared between the pandemic (2020-2021) and post-pandemic (2022-2023) periods. RESULTS:Among 135 subjects, 73.3% had a favourable outcome. Lost-to-follow-up patients (14.8%) more frequently included transgender, foreign-born and HIV-coinfected individuals. Mean PDC was 0.67; 74.5% of patients exhibited PDC<1. Adherence was lower during the continuation phase (PDC2 = 0.84) compared to the intensive phase (PDC1 = 0.94). PDC and PDC1 were significantly lower during the pandemic. Non-adherent patients reported more missed doses and skipped appointments. CONCLUSIONS:PDC is a simple, cost-effective tool to monitor adherence, that correlates well with self-reported adherence and follow-up visits attendance. TB treatment adherence remains suboptimal and the COVID-19 pandemic further exacerbated barriers to care, particularly among vulnerable populations such as migrants.

Babesiosis, a tick-borne disease caused by protozoa of the genus Babesia, is endemic in North America, but rarely reported in Europe. We report a case involving a splenectomised 72-year-old man from New Hampshire, USA, who was admitted at Careggi University Hospital (Florence, Italy), complaining of a febrile syndrome appeared during a trip to central Italy. After the laboratory flagged the presence of intra-erythrocytic ring-shaped elements, malaria was initially suspected but subsequently excluded by molecular testing. Based on epidemiological and clinical history, Babesia microti infection was suspected and confirmed by molecular test on peripheral blood. Oral atovaquone and intravenous azithromycin were administered for 7 days, switched to oral therapy following clinical improvement and parasitemia clearance. In non-endemic regions, the typical clinical features of this case might not raise suspicion. Nevertheless, rapid diagnosis and treatment are key to ensure favorable clinical outcomes, since babesiosis can cause rapidly aggravating illness, particularly in splenectomised patients.

Objectives Oxazolidinones are antibiotics of remarkable clinical importance, and resistance to these drugs is a matter of concern. This study investigated the presence of optrA, poxtA and cfr transferable oxazolidinone resistance determinants among enterococci and other non-obligate anaerobic fecal Gram-positives from healthy children living in a rural area of Bolivia. Methods Fecal samples were collected in transport medium and screened for isolates growing on Colistin-Nalidixic Acid blood agar containing florfenicol 16 mg/L. Isolates were identified by MALDI-ToF mass spectrometry and subjected to Real-time PCR to detect the presence of optrA, poxtA and cfr genes. Antimicrobial susceptibility to florfenicol, vancomycin and linezolid was tested by reference broth microdilution. Results Overall, 184/420 (43.8%) faecal samples yielded growth on the selective medium and 241 isolates of 13 different species of Lactobacillales (mostly Enterococcus spp. but also lactococci and Vagococcus teuberi) were obtained for further investigation. Most of them carried either optrA (182/241) or poxtA (43/241) or a combination thereof (7/241). cfr was detected in 5/241 isolates, always in combination with the other genes. Conclusions Present findings report the highest prevalence of faecal carriage of optrA- and poxtA-positive commensals so far observed in healthy subjects, raising concerns about the potential clinical and epidemiological implications.

Background:Community-acquired pneumonia (CAP) remains a leading cause of infectious mortality worldwide. The increasing prevalence of multidrug-resistant (MDR) pathogens challenges the established empirical antibiotic therapy schemes. This study aimed to derive and validate a clinical score (RESPIRE) to identify CAP-MDR patients. Methods:We conducted an observational study in a setting of medium-high multidrug-resistant (MDR) endemicity. The primary outcome was the derivation of a clinical score predicting MDR-CAP. A retrospective derivation cohort (January 2022-December 2023) including adult patients hospitalized with microbiologically confirmed CAP by culture on respiratory samples was used for score derivation. A prospective cohort (January 2024-December 2025) including adult patients with the same clinical features was used for score validation. Results:The derivation cohort included 275 patients (mean age 68.3 years), with an MDR prevalence of 30.1% (n = 83). The RESPIRE score assigns 1.5 points for recent hospitalization and prior antibiotic use, and 1 point each for enteral feeding, poor functional status, and residence in long-term care facilities (maximum 6 points). A cutoff ≥ 2 showed optimal performance in predicting CAP-MDR (AUROC 0.85; 95% CI 0.80-0.91), outperforming other scores except DRIP. Validation in 141 patients (39% MDR) confirmed an AUROC of 0.88 (95% CI 0.74-0.89) showing better performance compared to other diagnostic models. Conclusions:The RESPIRE score outperformed HCAP criteria and other clinical scores in predicting CAP-MDR. Its implementation in protocols could support antimicrobial stewardship for empiric treatment of cases of CAP presenting at the Emergency Department. A multicenter validation is warranted to confirm the performance of the RESPIRE score. Trial registration number:NCT07425561.

BACKGROUND:Neglected Tropical Diseases (NTDs) affect nearly two billion people worldwide, yet preparedness to diagnose and manage them remains limited in high-income countries (HICs), where shifting epidemiology driven by climate changes, migration, mobility, international food and animal trade and global interconnection requires broader clinical competencies. Evidence on NTD-related knowledge among medical trainees in Europe is scarce. This study aimed to develop, validate, and field-test a comprehensive instrument assessing knowledge, attitudes, and practices (KAP) regarding NTDs among Italian medical students, recent graduates, and residents. METHODS:A structured questionnaire was developed using a multi-step approach informed by World Health Organization (WHO) Neglected Tropical Diseases priorities and a targeted literature review. Content validity was assessed through a two-round Delphi process with a multidisciplinary national expert panel (Round 1: n = 36; Round 2: n = 34), followed by external expert evaluation (n = 17). Quantitative content validation included Item- and Scale-Level Content Validity Indices (I-CVI, S-CVI/Ave) and interquartile ranges (IQR) to assess expert consensus. Reliability and psychometric properties were evaluated in a national sample of Italian medical trainees (n = 96), including internal consistency (Cronbach's α; KR-20), test-retest reliability (ICC; Cohen's κ), and item performance analyses. RESULTS:Across Delphi rounds, 91-98% of items reached consensus (IQR ≤ 1), and overall content validity was excellent (S-CVI/Ave 0.96-0.98). Reliability metrics confirmed strong internal consistency (α = 0.863; KR-20 = 0.82) and good temporal stability (ICC = 0.89; κ = 0.72-0.84). Known-groups validity was demonstrated by significantly higher knowledge scores among residents compared with medical students (p = 0.014). CONCLUSIONS:This study provides the first Delphi-validated national instrument assessing NTD-related knowledge among Italian medical trainees. The tool can offer a foundation for evaluating curricula and informing educational reform, supporting the integration of NTD-related competencies in European medical education in response to evolving global health challenges.

OBJECTIVES:To report on clinical outcomes associated with vancomycin-resistant Enterococcus faecium (VRE) Bloodstream infections (BSIs) observed during a 6-year period at a hospital from an area of high VRE endemicity. MATERIAL AND METHODS:Retrospective study of patients with VRE and/or vancomycin-susceptible E. faecium (VSE) BSI in an Italian tertiary care hospital from January 2018 to December 2023. RESULTS:The cohort included 116 VRE and 225 VSE BSIs. The baseline characteristics were comparable in both populations. Almost half VRE population (53/116, 46%) received no or ineffective empiric therapy against VRE. A targeted effective therapy was initiated with a mean delay of 2.2,  ± 0.4 days in the VRE patients and of 1.2 ± 0.1 days (P < 0.01) in the VSE patients. The univariate analysis showed higher rates of septic shock in the VRE group (60% versus 40%, P < 0.01), and the 30-day mortality rate was 29% and 46% in VSE and VRE BSIs, respectively (P < 0.01). By multivariate analysis, Sequential Organ Failure Assessment score (HR 1.25; 95% CI 1.19-1.31, P < 0.001), Charlson Comorbidity Index (HR 1.14; 95% CI 1.06-1.22, P = 0.001) and vancomycin resistance (HR 1.93; 95% CI 1.33-2.82, P = 0.001) resulted as independent predictors of mortality. The statistical association was confirmed in a sensitive analysis after removing polymicrobial BSI. CONCLUSIONS:E. faecium BSIs confirmed to be associated with high mortality rate, especially in fragile patients. Moreover, vancomycin resistance is an independent mortality factor. Further studies are needed to identify patients at higher risk for E. faecium BSI.

OBJECTIVES:To evaluate the seroprevalence of Toxocara spp. infection among internationally adopted children and to assess the diagnostic performance og IgG-TES-ELISA test compared with IgG-TES-WB test. Furthermore, to determine wether a dual-step diagnostic strategy approve diagnostic accurancy and reduces unnecesary second-level investigations and albendazole therapy. METHODS:We performed a retrospective study of all internationally adopted children consecutively evaluated at the Infectious Diseases Unit of Meyer Children's University Hospital between 2009 and 2025 as part of the standardized "Adopted child screening." Two diagnostic approaches were used: a one-step protocol based solely on IgG-TES ELISA (2009-2017) and a two-step protocol integrating ELISA with confirmatory IgG-TES Western blot (2018-2025). Clinical characteristics, eosinophil counts, co-infections, second-line diagnostic procedures, and treatment decisions were systematically reviewed. RESULTS:Among 2657 children screened for toxocariasis, 2085 underwent the ELISA-only approach, 370 resulted positives. From 2018 onward, 572 children were tested, with 92 ELISA-positive results; 68 were confirmed by Western blot. Overall, second-line investigations and treatment were required more frequently in the ELISA-only group than in the combined protocol group (P = 0.002). Using Western blot as reference, ELISA exhibited high sensitivity (95.8%) but modest specificity (67.1%). Most seropositive children were asymptomatic or displayed covert toxocariasis, with only one visceral case identified. More than one-third of children with eosinophilia were seropositive for Toxocara spp. CONCLUSIONS:Approximately one in six internationally adopted children shows Toxocara spp. seropositivity. While IgG-TES ELISA is a sensitive screening tool, confirmatory Western blot substantially improves specificity and diagnostic stewardship, reducing unnecessary second-level investigations. A substantial proportion of seropositive children likely represent clinically inactive seropositivity, for which it is not possible to differentiate recent infection from past exposure to the parasite. Integrating serology with eosinophil counts, IgE levels, and clinical assessment is crucial to distinguish active from resolved infection and to identify children who require clinical and instrumental follow-up and albendazole therapy, thereby avoiding unnecessary interventions.

Despite advancements in antiretroviral therapy (ART) in Tanzania, adherence remains a challenge, especially among young people living with HIV (YPLHIV) aged 10–24 years. This study, conducted in the Shinyanga region of Tanzania, explored the factors affecting access and adherence to ART among YPLHIV. Access to ART refers to the ability to reach, enroll, and receive HIV care and education; adherence refers to proper use of medications as prescribed. The research employed focus group discussions and in-depth interviews with YPLHIV and their caregivers. Data were transcribed and thematically analyzed using Atlas.ti software. The qualitative data analysis revealed clear categories of barriers and facilitators. Barriers to ART access and adherence included forgetfulness, lack of privacy, family instability, poverty, reflected in lack of food or water. Perceived stigma and discrimination from family, school or community members played a significant role, alongside low participation in adherence support activities. Factors facilitating ART access and adherence included disclosure of HIV status and access to social or emotional support from the family members, peers, teachers, health workers, and community members. These factors may increase knowledge about the risks of treatment failure and drug resistance, help reduce their perceived stigma and discrimination and support treatment continuity. Interventions by health workers, family members, peers, teachers—at individual and social levels—as well as by government and local health authorities—at the policy level—are needed to address the above barriers and facilitators to ART access and adherence among YPLHIV enrolled in HIV care. A pesar de los avances en la terapia antirretroviral (TAR) en Tanzania, la adherencia sigue siendo un desafío, especialmente entre los jóvenes que viven con VIH (JVVHIV) de entre 10 y 24 años. Este estudio, realizado en la región de Shinyanga en Tanzania, exploró los factores que afectan el acceso y la adherencia a la TAR entre los JVVHIV. El acceso a la TAR se refiere a la capacidad de llegar, inscribirse y recibir atención y educación sobre el VIH; la adherencia se refiere al uso adecuado de los medicamentos según lo prescrito. La investigación empleó discusiones en grupos focales y entrevistas en profundidad con los JVVHIV y sus cuidadores. Los datos fueron transcritos y analizados temáticamente utilizando el software Atlas.ti. El análisis cualitativo reveló categorías claras de barreras y facilitadores. Las barreras al acceso y la adherencia a la TAR incluyeron el olvido, la falta de privacidad, la inestabilidad familiar y la pobreza, reflejada en la falta de alimentos o agua. La percepción de estigma y discriminación por parte de familiares, compañeros de escuela o miembros de la comunidad desempeñó un papel significativo, junto con una baja participación en actividades de apoyo a la adherencia. Los factores que facilitan el acceso y la adherencia a la TAR incluyeron la divulgación del estado serológico y el acceso a apoyo social o emocional por parte de familiares, compañeros, maestros, trabajadores de la salud y miembros de la comunidad. Estos factores pueden aumentar el conocimiento sobre los riesgos de fracaso del tratamiento y resistencia a los medicamentos, ayudar a reducir la percepción de estigma y discriminación y apoyar la continuidad del tratamiento. Se necesitan intervenciones por parte de los trabajadores de la salud, familiares, compañeros, maestros—a nivel individual y social—así como por parte del gobierno y las autoridades sanitarias locales—a nivel de políticas—para abordar las barreras y facilitadores mencionados en el acceso y adherencia a la TAR entre los JVVHIV inscritos en cuidados por VIH.

INTRODUCTION:Leishmaniases are a group of vector-borne diseases caused by parasites of the genus Leishmania, which are renowned for increasing global spread due to factors like climate change, globalisation, urbanisation and migration. Leishmaniasis is classified as a neglected tropical disease but is endemic in several areas of the Mediterranean Basin, including Italy, where Leishmania infantum is most involved as the parasite, phlebotomine sand fly as the vector and dog as the principal reservoir. Effective surveillance of communicable infectious diseases is a goal worldwide for organisations such as the WHO and for local and national governments but is an unfulfilled objective. Even in Italy and particularly in the region of Tuscany, despite mandatory reporting, significant gaps each year are identified between reported cases and hospital admissions. By estimating the underreporting of confirmed human leishmaniasis cases, this protocol aims to suggest actions to strengthen the current epidemiological surveillance system to enable timely and effective public health intervention in human and veterinary populations. METHODS AND ANALYSIS:This retrospective multicentre study, conducted in the Central Tuscany Health District, the most populous area of the Tuscany region with approximately 1.6 million inhabitants, is based on the analysis of data collected from 2014 to 2024 using diagnostic laboratory, hospital and regional information system sources. The primary objective is to estimate the degree of underreporting of leishmaniasis in this area through the application of capture-recapture models. The secondary objective is to analyse the clinical and demographic characteristics of individuals diagnosed as confirmed leishmaniasis cases between January 2014 and December 2024, as well as to perform a geolocation analysis of the cases. The study includes the entire population, both adult and paediatric, of the Central Tuscany Health District who underwent laboratory testing for leishmaniasis (serological tests identifying the presence of antibodies; parasitological examination with evidence of amastigotes in aspirates, smears or biopsy sections; culture examination of aspirates, biopsies and/or peripheral blood positive for the presence of promastigotes; identification of Leishmania nucleic acid in aspirates, biopsies and/or peripheral blood samples via molecular diagnosis). ETHICS AND DISSEMINATION:The study is being conducted in accordance with the protocol approved by the Ethics Committee of the Tuscany Region - Pediatrics Section, in November 2024. Ethics Committee opinion register number: 219/2024. Because the study uses only pseudonymised, routinely collected administrative and laboratory data with no direct patient contact or intervention, individual informed consent was not required, as confirmed by the Ethics Committee. Findings will be submitted to a peer-reviewed journal, presented at international conferences and presented at stakeholder workshops.

BACKGROUND:Severe Plasmodium falciparum (P.f.) malaria remains a major health threat for travellers. World Health Organization (WHO) defines criteria for severe malaria, including hyperparasitaemia ≥10% infected red blood cells (iRBCs), as major risk factors for adverse outcome. Additionally, WHO recognizes 'uncomplicated hyperparasitaemia' with 4-10% iRBC, a parasite density usually defining severe malaria outside endemic areas. Overall, the role of hyperparasitaemia as an independent risk factor in imported severe malaria is unclear, with most data predating the artemisinin era. METHODS:We retrospectively analysed adult in-patients with hyperparasitaemia (≥4% iRBC) and/or severe P.f. malaria according to WHO criteria who received artemisinin-based treatment at two German university hospitals 2013-2023, to assess the risk for critical disease with need for organ replacement therapy or vasopressors. Based on multivariable nominal logistic regression, we developed a scoring system to identify patients with critical disease and validated it on an independent cohort. RESULTS:Of 168 patients, 33 (20%) developed critical disease, all of whom presented with at least one WHO criterion other than hyperparasitaemia. Of 72 patients with isolated hyperparasitaemia, none developed critical disease. Hyperparasitaemia was no independent risk factor for critical disease in logistic regression (adjusted odds ratio (aOR) 0.85 95%CI 0.23-3.12), in contrast to creatinine >3 mg/dl (aOR 6.74 95%CI 1.06-42.75), oligo-/anuria (aOR 5.94 95%CI 1.27-27.82), lactate ≥5 mmol/l (aOR 8.16 95%CI 8.16-35.03), confusion (aOR 4.07 95%CI 1.39-11.94) and circulatory shock and respiratory failure, which are inherently critical conditions. The risk score identified all 33 patients with and 131/135 (97.0%) without critical disease (AUC = 0.99; sensitivity: 100%; specificity: 97.0%). In the validation cohort, all eight patients with critical disease and 39/44 (89%) without were correctly identified. CONCLUSION:Isolated hyperparasitaemia was no independent risk factor for critical disease in this patient cohort treated with artemisinins, suggesting that such patients can be managed outside intensive care units.

Despite being relatively common in endemic settings, amoebic liver abscesses are rarely diagnosed in high-resource countries, where they are usually imported by migrants or travelers to endemic areas. Between 2010 and 2024, we observed two cases of amoebic liver abscess that were successfully managed in a tertiary-care center in Italy. In both cases, the infection was contracted in Colombia. Given the high morbidity and mortality associated with nontreated amoebic liver abscesses, this report aims at underlying the importance of travel history and of considering amoebic liver abscess among the differential diagnoses for people coming from endemic countries with compatible clinical presentations. Prompt diagnosis and treatment are of paramount importance for favorable clinical outcomes.

Introduction: Cutaneous leishmaniasis (CL) poses a number of challenges when it comes to diagnosis and treatment, due to the variety of clinical presentations that mimic other conditions and hinder the choice of the most appropriate therapeutic approach, especially in the context of immunodepression. Case presentation: We present the case of a 63-year-old woman on anti-tumor necrosis factor (TNF) therapy, who underwent surgical excision for the diagnostic purposes of a chronic non-healing lesion located on her right arm. The histopathological examination revealed the presence of Leishmania amastigotes. CL relapsed in the following months, with new lesions appearing both close to the excision scar and at a different body site. At this point, in order to avoid another surgical intervention, cutaneous swabs for Leishmania Polymerase Chain Reaction (PCR) were performed on both lesions. Both samples yielded positive results, and the patient was treated with a 4-week course of miltefosine. Conclusions: These results support the use of cutaneous swabs as a highly sensitive and less invasive tool for the diagnostic workup of CL. In addition, our case prompts a reflection on the management of immunosuppressed patients with CL, with particular emphasis on the risk of reactivation or simultaneous involvement of multiple anatomical sites, thus suggesting the need for specific considerations and personalized management for this group of subjects.