Campylobacteriosis remains underestimated in Latin America due to limited surveillance and diagnostic capacity. In this context, a comparison was made of clinical Campylobacter strains from two distinct healthcare settings in Santiago, Chile: a public pediatric hospital and a private tertiary clinic. Through genomic analysis, host-source attribution was observed to vary across socioeconomic profiles: poultry-associated lineages (such as ST-353 and ST-443 complexes) were, as expected, frequently identified across all analyzed populations, although comparatively more frequent in the public health settings; in contrast, cattle-associated strains (ST-22 complex) were primarily isolated from patients of higher incomes. These findings provide the first evidence of Campylobacter infection frequency in a lower-income pediatric population in Chile, highlighting this pathogen as an important cause of gastroenteritis across socioeconomic groups in this setting. Furthermore, a link was identified between the Type 6 Secretion System (T6SS) and clinical severity, corresponding to a subgroup of effectors (CJ488_00960c and CJ488_00961) significantly associated with dehydration. High percentages of resistance determinants to tetracycline (tetO) and fluoroquinolones (gyrA T86I) are also reported. These data provide information on the main transmission path for distinct socioeconomic groups within the same city, providing valuable data that could help authorities to take informed decisions in case of potential outbreaks and highlighting the urgent need for integrated genomic surveillance in Chile.

Domestic dogs have been proposed as sentinels for various infectious diseases, including rickettsial infections. In Chile, the only endemic human rickettsiosis is scrub typhus caused by Ca ndidatus Orientia chiloensis, an emerging infectious disease, discovered in recent years in southern Chile. The geographic distribution of scrub typhus and other rickettsial infections across Chile is incompletely understood. This study using domestic dogs as sentinel investigated the potential exposure to members of the three main groups of rickettsiae, scrub typhus orientiae (STGO), spotted fever group rickettsiae (SFGR) and typhus group rickettsiae (TGR), in northern, central, and southern Chile. Serological analyses for STGO, SFGR, and TGR were conducted on 1097 dogs from rural and urban areas, which were sampled during 2010 to 2016 in five Chilean regions using a cross-sectional household-based design. Household and dog-level variables were assessed to investigate retrospectively associated risk factors for rickettsial exposure. Overall seroprevalences were 13.8% for STGO, 1.2% for SFGR, and 1.0% for TGR. Higher seropositivity for STGO was associated with dogs from rural areas, male dogs, older dogs, and dog infestation with ticks. Canine seroreactivity to STGO was found across Chile, including regions not known as endemic for scrub typhus. Absence of external deworming was a significant risk factor for SFGR. The present results suggest that during the study period dogs were exposed to rickettsiae over a broader geographic range than previously recognized. Future epidemiological, ecological, and clinical studies are required to confirm the distribution of Orientia species and potential endemicity of other rickettsiae in Chile.

Objectives Hepatitis E is an emerging but under-recognized viral infection worldwide. In Chile, the epidemiology and ecology of this infection are poorly understood. This study aimed to detect and analyze the hepatitis E seroprevalence among blood donors at a private healthcare center in Santiago, Chile. Methods Left-over sera from 354 volunteer blood donors aged 18–65 years were collected during July 2020. After recording sex, age, and municipality of residence, specimens were anonymized and tested for anti-HEV IgG using a commercial ELISA kit (Wantai BioPharm). Municipalities were classified by socioeconomic status as a proxy for income level. Statistical analyses were conducted using R software. Results Overall seroprevalence was 15.3% (CI95% 11.9–19.4). Prevalence increased significantly with age (50–65 years, 33.9%) and was higher among residents of lower-income municipalities compared with higher-income municipalities (21.9% versus 11.7%). Multivariate analysis confirmed age 50–65 years (OR 20.2) and residence in a lower-income municipality (OR 2.3) as independent predictors of HEV seropositivity. Conclusions The study provides information on HEV exposure of adults in Santiago, Chile. Seroprevalence was highest in older age groups residing in lower-income municipalities. Further hepatitis E studies are needed to clarify transmission cycles, circulating genotypes, and clinical relevance in Chile.

Background Strongyloides stercoralis is a widespread helminth in tropical and subtropical regions, which can persist in humans for life through autoinfection. The clinical picture varies from asymptomatic to life-threatening hyperinfection syndrome. There is concern about increasing prevalence in Europe due to the number of cases imported by migrants and travelers. Methods This is a retrospective chart review of patients evaluated at the Charité Tropical Medicine outpatient clinic in Berlin, Germany. Cases were identified based on either a positive serologic test for Strongyloides (i.e., probable cases) or the detection of Strongyloides larvae in stool samples (i.e., confirmed cases). Results From April 2018 to November 2023, 162 patients with Strongyloides infection were identified. Diagnosis was confirmed in 49 patients (30.2%) and probable in 113 patients (69.8%). About half of the patients (48.8%) were classified as migrants, who were diagnosed through screening in 48.1%. Eosinophilia was present in 27.6% of all patients, with no significant differences between migrants and non-migrants, or between probable or confirmed infections. In patients with a positive stool microscopy, only 8/37 (21.6%) had a positive serology. Conclusion Nearly half of the migrant cases were detected through serology as part of screening. Most patients had no eosinophilia, and the positivity of serological tests was very low in patients with positive stool microscopy. These findings highlight the usefulness of targeted screening strategies in risk populations and suggest implementing sensitive stool tests detecting larvae combined with serology, to improve case detection.

Chagas disease is an emerging problem in migrant health worldwide. Our presented case of severe congenital Chagas disease in a twin pregnancy of a Bolivian migrant mother highlights the importance of screening and treatment of females of childbearing age who are at risk for Chagas disease.

Die Hausarztpraxis ist in der Regel die erste Anlaufstelle, wenn nach einer Reise gastrointestinale Beschwerden auftreten. Häufig fürchten Patienten von Parasiten besiedelt zu sein. Erfahren Sie in diesem Beitrag, wann eine Parasitose tatsächlich in Erwägung zu ziehen ist und welche Erreger berücksichtigt werden sollten.

The recommendations of the Standing Committee on Travel Medicine (StAR) of the German Society for Tropical Medicine, Travel Medicine and Global Health (DTG) provide an evidence-based foundation for travel medicine counseling. These guidelines are based on scientific evidence, clinical expertise, and current epidemiological data. They include detailed, country-specific risk maps developed in collaboration with expert groups from Switzerland, Belgium, the Netherlands, and Austria. Malaria prevention is structured around 3 key pillars: exposure prophylaxis (avoidance of mosquito bites), chemoprophylaxis with antimalarial drugs, and standby emergency treatment (SBET). The selection of appropriate preventive measures requires individualized risk assessment. Avoiding mosquito bites remains essential - even when chemoprophylaxis is used. DEET is considered the gold standard among insect repellents; other options are recommended depending on the traveler's age and individual tolerability. Atovaquone/proguanil, doxycycline (off-label), and mefloquine remain the core pharmacological options for chemoprophylaxis, and their use must be tailored to the destination, type of travel, and the traveler's age and health status. Artemisinin-based combination therapies (e. g., artemether/lumefantrine) are approved for treatment only and not for prophylactic use. Standby emergency treatment may be recommended for travel to areas with moderate malaria risk and limited access to medical care. Country-specific recommendations and maps support differentiated risk assessment. The guidelines also provide specific recommendations for children, pregnant women, immunocompromised patients, and travelers with comorbidities. Particular attention is given to high-risk groups such as migrants from malaria-endemic regions, long-term travelers, expatriates, and participants in international volunteer programs. These recommendations serve as a practical guide for medical professionals involved in travel medicine counseling.

Bedbugs are blood-feeding nocturnal ectoparasites, which are well-adapted to human habitats. In recent decades, bedbug infestation has been an emerging health problem worldwide, affecting all socio-economic population strata. The clinical presentations of bedbug exposure are variable, ranging from simple pruriginous bite lesions to severe cutaneous and systemic manifestations. Diagnosis is challenging and depends on awareness, clinical experience, and a thorough medical history. In our case, cutaneous lesions were accompanied by severe systemic symptoms and hypereosinophilia, leading to prolonged illness and hospitalization. The differential diagnosis of such presentations should include bedbug exposure, to avoid long-lasting disease, unnecessary diagnostic procedures, and the associated psychological burden for the patient.

We report a case of severe conjunctivitis in a traveler infected with a Philophthalmus lacrymosus eye fluke, probably acquired on the Galápagos Islands in Ecuador. This zoonotic parasite is endemic in Brazil and Venezuela, where it has been reported in birds and capybaras.

Background:Cyclospora cayetanensis is a neglected intestinal parasite and emerging cause of gastrointestinal illness in travelers. The global distribution, life cycle, and clinical features of cyclosporiasis remain poorly understood. The present study analyzes the clinico-epidemiological characteristics of cyclosporiasis diagnosed in Santiago, Chile. Methods:We included cyclosporiasis cases diagnosed by molecular methods at Clínica Alemana, Santiago, Chile, from December 2015 to August 2024. Demographic, travel-related, and clinical data were collected from electronic patient records, complemented by a standardized telephone survey. Results:Among 25,061 samples, 61 were positive from C. cayetanensis. The median age of patients was 41 years (range 15-81 years); 59 % were male; all were associated with recent international travel. Medium travel duration was 10 days (4-20); travel reasons were tourism (80.4 %) and business (19.6 %); 92.3 % stayed at all-inclusive resorts or hotels. Infections were predominantly (80.0 %) acquired in Mexico, mostly on the Caribbean coast. Patients presented with diarrhea (100 %), abdominal pain (60.3 %), nausea (37.9 %), weight loss (34.5 %), and vomiting (19.0 %); 35.7 % of patients reported systemic manifestations such as fatigue, myalgia, and fever; 6.1 % of cases were hospitalized. Median time delays from symptom onset to consultation, diagnosis, and treatment were 7 (0-33), 15 (2-36), and 17 (3-42) days, respectively. All patients recovered rapidly after treatment with trimethoprim-sulfamethoxazole. Conclusions:Cyclosporiasis mainly affected tourists visiting all-inclusive resorts and business travelers, most frequently in Mexico. Diagnosis and treatment were often delayed. The presented data may help to raise awareness and optimize pre-travel advice and post-travel management of travelers with prolonged diarrhea.

BACKGROUND:Urinary tract infections are among the most common bacterial illnesses in clinical practice. Urine culture is the diagnostic reference standard for these infections, representing a major proportion of the workload of microbiological laboratories. Conventional urine cultures require 18-24 h of incubation and are negative in about 80.0 %. Uroquattro-HB&L® [Alifax] is an automated urine culture system providing results in 5 h. OBJECTIVES:To evaluate the diagnostic performance of this rapid system compared to conventional culture and test its applicability for rapid identification and susceptibility testing in a real-world setting. METHODS:A total of 1,062 routine urine samples were included and tested in parallel by Uroquattro-HB&L rapid culture and by conventional culture. Uroquattro-HB&L performance was analyzed in comparison to conventional culture and a composite reference standard. Microorganisms from rapid culture were identified by MALDI-TOF technique. In a subset of 58 Uroquattro-HB&L-positive samples, a rapid susceptibility testing protocol was applied using the VITEK 2 XL system. RESULTS:Compared to conventional culture, Uroquattro-HB&L showed a sensitivity of 87.3 %, specificity of 91.1 %, accuracy of 90.5 %, and positive and negative predictive values of 64.9 % and 97.4 %, respectively. Using the composite reference standard, the sensitivity and specificity were 91.3 % and 100 %, respectively. Agreement between the identification results was 92.3 %. Rapid antimicrobial susceptibility testing showed >90.0 % concordance with conventional AST. CONCLUSIONS:Uroquattro-HB&L accurately identified culture-negative urine samples and permitted the identification of positive samples within 4-5 h. The system was also used to obtain rapid susceptibility testing results; however, this application requires further evaluation.

Key words travel medicine - malaria - repellents - chemoprophylaxis - pediatric travelers - pregnant travelers

The expert committees for travel medicine of Belgium, Germany, The Netherlands and Switzerland endorse joint malaria prevention recommendations for travellers. Here, the methodological approach underlying these recommendations, including evidence sources used, risk category definitions and the role of expert opinion, is outlined.

Filamentous fungi are an emergent cause of severe infections in immunocompromised patients. Timely and accurate identification is crucial to initiate appropriate therapy. Traditional identification methods are time-consuming, labor-intensive, and operator-dependent. Matrix-assisted laser desorption/ionization-time-of-flight (MALDI-TOF) mass spectrometry is a rapid and easy-to-perform identification method. The effectiveness of a commercial MALDI-TOF MS platform to identify filamentous fungi in a clinical laboratory was evaluated. The study included 67 fungal isolates from 35 species/species complexes, which were identified and confirmed in mycology reference laboratories; 32 derived from clinical samples, 34 from strain collections and one was an ATCC strain. The study used the VITEK® MS system (v3.2.0 database), after sample extraction by VITEK® MS Mould Kit. Results were classified as “correct species”, “correct species complex”, “correct genus”and “no identification”. VITEK® MS correctly identified 91.0% of isolates (58.2% to species, 29.9% to species complex, and 1.5% to genus level only). In 82%, the result matched the species/species complex identified by reference methods. No misidentifications were observed. The kit was rapid and easy to use. In conclusion, the VITEK® MS system showed a high capability to accurately identify filamentous fungi in a clinical laboratory.

AbstractCandidatus Orientia chiloensis causes scrub typhus over a wide geographical range in southern Chile. The life cycle, including vectors and reservoirs of this novel rickettsial pathogen, is incompletely understood. We analyzed rodent tissue and rodent-associated mite samples collected during a field study in six localities on Chiloé Island, where human scrub typhus cases have occurred. Using molecular methods, we detected Orientia DNA in 24.8% of rodents, belonging to five of seven captured species. Orientia-infection rates showed geographical variations, but were not influenced by rodent species, sex, age, and mite infestation. Phylogenetic analysis showed that Orientia sequences from trombiculid mites (Proschoengastia eloisae) were identical to those from scrub typhus patients from the same region. The results suggest that these rodent-associated mites serve as vectors and play an important role in the ecology of scrub typhus in southern Chile. Further studies are required to determine whether Orientia-infected rodents can also serve as reservoir of Orientia in Chile. Graphical Abstract