Tropical Medicine and Infectious Disease最新文献

With population aging, the burden of tuberculosis (TB) among the elderly is rising. Older adults are at high risk of TB but susceptible to poor TB care. In this study, we enrolled TB patients aged over 60 years registered in Shanghai during 2019-2021. A seven-step care cascade from estimated TB burden in the community to treatment outcomes was constructed to quantify retention and attrition at each step of TB health service. Patient pathway analysis was carried out in two districts of Shanghai to describe patients' care-seeking behaviors, service coverage, and diagnosis delays. Across the care cascade, the largest gaps occurred from symptom onset to care seeking (11.3%) and from treatment initiation to completion (10.7%). Male sex, older age, and mycobacterium tuberculosis positivity were associated with treatment discontinuation and unfavorable outcomes. The patient pathway analysis revealed that first contact at lower-level or non-TB-designated hospitals was associated with more complex pathways and may contribute to diagnostic delays. These findings highlight the need to promote proactive care seeking upon symptoms, strengthen targeted adherence support for older people, and improve diagnostic capacity and referral efficiency at lower-level health facilities.

Background: In tropical regions, dengue and leptospirosis coexist and share a nonspecific clinical onset that hinders timely diagnosis. Coinfection may worsen the clinical course and increase mortality.

Objective: To estimate the prevalence of dengue, leptospirosis, and coinfection among patients with febrile syndrome in Madre de Dios (Peru) and to identify associated clinical factors.

Methods: Observational, analytical, cross-sectional, retrospective study conducted at a primary-level health facility. Clinical and laboratory records of patients with febrile syndrome seen in 2024 were analyzed. Categorical variables were summarized as frequencies (%) and numeric variables as mean ± SD or median [IQR]. Comparisons used chi-square or Fisher's exact test, Student's t test, or the Mann-Whitney U test, as appropriate. Associations were estimated using Poisson regression models with robust variance, adjusted for sex, reporting prevalence ratios (PRs) and 95% CIs. Analyses were performed in R 4.0.2.

Results: A total of 226 patients were included. Positivity was 19.0% for dengue (43/226), 66.8% for leptospirosis (151/226), and 5.8% for coinfection (13/226). In the bivariate analysis, dengue was associated with higher temperature (p < 0.001), lower mean arterial pressure (p = 0.007), mucosal bleeding/ecchymosis (p = 0.049), and lower fluid intake (p = 0.021); temperature was also higher in coinfection (p = 0.021). In Poisson models, dengue was associated with tachycardia (PR = 5.69; 95% CI: 1.95-13.07; p < 0.001), temperature (PR = 1.61 per °C; 1.23-2.12; p = 0.001), bilateral polyarthralgia (PR = 2.55; 1.14-5.04; p = 0.012), and mucosal bleeding/ecchymosis (PR = 3.31; 0.94-8.37; p = 0.027). Leptospirosis was associated with male sex (PR = 0.78 vs. female; 0.65-0.94; p = 0.010) and fever (PR = 2.38; 1.17-6.03; p = 0.035). Leptospira-dengue coinfection was related to higher temperature (PR = 1.75 per °C; 1.05-3.01; p = 0.036).

Conclusions: Simple clinical signs such as fever/elevated temperature, tachycardia, bilateral polyarthralgia, and mucosal bleeding can help prioritize suspicion of dengue, leptospirosis, or coinfection; guide requests for dual testing (dengue-Leptospira), early hydration in dengue, and timely initiation of antibiotic therapy in leptospirosis. These findings support the development of integrated triage algorithms and strengthening access to molecular diagnostics in high-burden febrile syndrome settings.

Emerging evidence suggests that certain cestodes, including Taenia solium, may actively modulate the host's hormonal and immune environment to facilitate their survival. This study aimed to determine whether patients diagnosed with neurocysticercosis (NCC) exhibit immunoendocrine alterations associated with infection. A clinical study was conducted in Honduras, enrolling 11 adult NCC patients (9 female, 2 male) and 11 age- and sex-matched healthy controls. Serum concentrations of seven hormones and two cytokines were evaluated. Compared to controls, NCC patients showed significantly elevated levels of 17β-Estradiol (E2), Progesterone (P4), Androstenedione (A4), Luteinizing Hormone (LH), Follicle-Stimulating Hormone (FSH), Interleukin-6 (IL-6), and Interleukin-10 (IL-10). Conversely, Free testosterone (FT) and Dihydrotestosterone (DHT) levels were significantly reduced. These findings support the hypothesis that T. solium may manipulate host immunoendocrine pathways to promote its establishment and persistence within the central nervous system.

Background: Cryptococcal meningitis (CM) remains a leading cause of mortality among people with advanced HIV disease (AHD) in sub-Saharan Africa. Current guidelines recommend induction therapy with amphotericin B and flucytosine, typically administered in an inpatient setting due to concerns over severe clinical presentation and drug-related toxicities. This requirement poses a significant burden on resource-limited health systems. We evaluated the real-world outcomes of a fully outpatient model for CM therapy in Maputo, Mozambique.

Methods: A longitudinal retrospective cohort study was conducted at the Centro de Referência de Alto-Maé (CRAM), a specialized AHD outpatient clinic. We included 83 PLWH with laboratory-confirmed CM treated between October 2020 and December 2024. The primary outcome was hospitalization-free survival (HFS) within the first 10 weeks of treatment. Secondary outcomes included the frequency and severity of adverse drug reactions (ADRs), analysed by tracking haemoglobin (Hgb), potassium (K+), and creatinine (Creat) levels on days 1, 3, and 7 of induction therapy, and retention in care (RIC) at 6, 12, and 24 months. Statistical analyses included Kaplan-Meier survival estimates and paired t-tests.

Results: The median age was 37 years (IQR: 27-42), 63.9% were male, and the median CD4 count was 62 cells/µL (IQR: 27-105). Most patients (95.2%) were symptomatic at presentation, and 56.6% had concurrent tuberculosis. For the 52 patients who completed the full induction protocol at CRAM, the HFS rate at 10 weeks was 84.6% (44/52), with an overall survival of 90.4% (47/52). ADR analysis (n = 52) showed a predictable pattern of mild, manageable toxicity: a significant decline in Hgb (11.2 ± 1.8 to 10.6 ± 2.0 g/dL, p < 0.001) and K+ (4.27 ± 0.66 to 3.86 ± 0.78 mmol/L, p = 0.008), and a transient increase in Creat (0.83 ± 0.42 to 1.13 ± 0.64 mg/dL, p = 0.001) from day 1 to day 3, with stabilization or a trend toward recovery by day 7. No significant differences in ADRs were found between single-dose (47%) and multiple-dose (53%) L-AmB regimens. RIC for the entire cohort (n = 83) was high at 81.9% at 6 months, declining to 74.0% at 12 months and 70.4% at 24 months.

Conclusions: An ambulatory model for CM therapy is feasible and effective in a resource-limited setting, demonstrating high hospitalization-free survival, manageable and reversible adverse drug reactions, and excellent medium-term retention in care. These findings suggest potential benefits and provide support for re-evaluating the standard of inpatient care. They indicate that integrating outpatient CM management into advanced HIV disease (AHD) care packages could help alleviate health system burdens and may contribute to improved patient outcomes.

COVID-19, caused by SARS-CoV-2, is a highly contagious disease with variable clinical presentation. Severe forms are more common in patients with pre-existing chronic conditions. The objective of this study is to evaluate the prognostic value of the Charlson Comorbidity Index (CCI) in relation to disease severity and outcome in hospitalized COVID-19 patients with comorbidities. A retrospective analysis was conducted on 558 patients, hospitalized at the Infectious Diseases Clinic of "St. Marina" University Hospital, Varna, Bulgaria, between March 2020 and March 2021. CCI score was calculated to estimate 10-year survival probabilities. Prevalent comorbidities were arterial hypertension (78.55%), type 2 diabetes (16.09%), and ischemic heart disease (5.82%). A higher number of comorbidities was associated with increased rates of bilateral pulmonary consolidation (χ² = 6.63, p = 0.010), oxygen therapy needs (χ² = 5.41, p = 0.020), and mortality (χ² = 7.88, p = 0.005). Patients with higher CCI scores had worse outcomes. A CCI score above 5 was common among non-survivors and those with pulmonary consolidation and respiratory failure. The findings confirm that advanced age and multiple comorbidities are strong predictors of poor COVID-19 prognosis. Early CCI calculation at hospital admission would help identify high-risk patients and support timely, targeted medical interventions.

Tungiasis, caused by the sand flea Tunga penetrans, results in itching and pain. Effective treatments, such as dimeticones, are often unaffordable. A 3% phenothrin lotion has shown safety and efficacy in Kenyan trials. This study compared the cure rate and safety of 3% phenothrin lotion (as the intervention) and 0.05% potassium permanganate (KMnO₄; as the standard-care comparator) over 14 days. This parallel-group, three-arm, non-blinded, randomised comparative trial was conducted in Vihiga County, Kenya. Participants aged ≥2 years with ≥1 viable flea on each foot were allocated (2:1:1) to KMnO₄, single-dose 3% phenothrin, or two-dose 3% phenothrin groups. Overall, 415 fleas from 79 participants were followed up to day 14 (KMnO₄, 213; single-dose, 129; two-dose, 73). On days 4 and 7, the single-dose phenothrin showed significantly higher cure rates (11.6% and 21.7%) than KMnO₄ (0.9% and 11.7%) (p < 0.001 and p = 0.013). The differences diminished by days 10 and 14 because of spontaneous flea death. The cure rate of the two-dose group on day-7 (8.2%) was lower than that of the single-dose group. Single-dose 3% phenothrin improved early cure rates compared to KMnO₄, but not by days 10-14; two-dose phenothrin showed no benefit compared with single dose from day 7 onwards.

Loiasis exists in regions where malaria is highly endemic, yet few studies have investigated their association as concomitant infectious diseases. Secondary data analysis from a cross-sectional survey conducted in Gabon (2015-2016) was performed to assess the association between malaria and loiasis. A total of 947 participants of all ages were enrolled in the original study. In crude analyses, malaria showed a seemingly protective association with loiasis, manifesting in an odds ratio (OR) of 0.67 (95% CI: 0.45 to 1.01; p = 0.0521). This borderline association disappeared completely after adjustment for confounders (adjusted OR: 1.31; 95% CI: 0.81 to 2.11; p = 0.276), particularly age. The apparent crude protective association is therefore likely explained by the different epidemiological distribution of both diseases according to age rather than a true biological interaction. Malaria predominantly occurred in children and loiasis mainly in older individuals. Findings of this study do not support an association between malaria and loiasis in this setting.

The Incompatible Insect Technique (IIT) is a species-specific, eco-friendly mosquito control method that relies on releasing Wolbachia-infected males, which induce cytoplasmic incompatibility (CI), rendering eggs inviable when mating with wild females. Aiming at optimizing IIT protocols in terms of cost-effectiveness, data on incompatible male dispersal and survival and the distance- and time-related impact of induced sterility are fundamental. This study plans to fill this gap and reports findings from a two-year field trial (2022-2023) at the ENEA-Casaccia Research Center, based on single-spot releases of incompatible Aedes albopictus males (ARwP strain). Male releases were carried out in late September 2022 (~15,000 released males) and the early Ae. albopictus season (at the end of June 2023; ~24,000 released males). Fifty-eight ovitraps were located at a 20-900 m distance from the ARwP release spot and were monitored weekly from May to November to assess egg hatching rates and measure CI effects in relation to both distance and time. Following the 2023 release, samples of adults were collected at increasing distances from the release site and at multiple post-release time points to assess, individually, wild female fertility and ARwP male dispersal and survival using Wolbachia as a genetic marker. Statistical analyses revealed that: (a) the highest reduction in the egg hatching was found within 100 m from the release spot (46.5% and 19.9%, respectively, in 2022 and 2023) but remained significant even at greater distances (29.9% and 7.7% at 300 m, respectively, in 2022 and 2023); (b) accordingly, the highest reduction in the wild female fertility occurred within 100 m from the release spot (47.3%), but similar effects were recognizable up to 600 m; (c) the overflooding ratio of the ARwP males did not significantly differ between 3 and 11 days after the release, with ARwP males remaining active up to 18 days and dispersing as far as 400 m. These results demonstrate the potential of localized, non-inundative IIT trials to furnish clues for the setup of spatially optimized release strategies, especially in scaled-up applications. The study also emphasizes the need for standardized assessment tools and further research regarding environmental and behavioral factors influencing long-term suppression outcomes.

Chikungunya virus (CHIKV) poses an increasing global public health threat, as evidenced by the significant 2025 Foshan outbreak in China. Rapid, whole-genome sequencing (WGS) is critical for outbreak response but is challenged by primer mismatches across diverse lineages and a lack of direct sequencing platform comparisons. To address this, we developed a novel lineage-inclusive primer set and performed parallel WGS on 24 clinical samples from the outbreak using both Illumina (NGS) and Oxford Nanopore Technologies (TGS) platforms. Our lineage-inclusive primer set successfully amplified full-length CHIKV genomes across all samples. Comparisons revealed that Illumina NGS provided higher raw read accuracy, while Nanopore TGS achieved more complete coverage of terminal UTRs with a faster turnaround time. Crucially, after polishing, variant calls between the two platforms were 100% concordant. Phylogenetic analysis was consistent with a single introduction event, with all outbreak isolates forming a monophyletic clade within the ECSA lineage most closely related to contemporaneous strains from Réunion Island. This study validates a lineage-inclusive amplicon-based sequencing strategy and demonstrates that NGS and TGS offer complementary advantages. When integrated, they provide a robust framework for real-time genomic surveillance, enhancing preparedness and guiding public health interventions against CHIKV.

Background: Tuberculosis remains a major global public health challenge, particularly among children. This study aims to provide a comprehensive assessment of the global, regional, and national burden of tuberculosis among children (0-14 years) using data from the Global Burden of Disease (GBD) 2021 study. Methods: Data on the incidence of tuberculosis (drug-susceptible, MDR-TB, and XDR-TB), as well as disability-adjusted life years (DALYs), among children aged 0-14 years in 204 countries and territories from 1990 to 2021 were obtained from the GBD 2021 study. Estimated annual percentage changes (EAPCs) in age-standardised incidence rates (ASIRs) and DALY rate were calculated overall and stratified by age, sex, and sociodemographic index (SDI) to quantify temporal trends. Spearman correlation analyses were performed to assess associations between tuberculosis burden and SDI. Results: In 2021, there were an estimated 759,300 new tuberculosis cases (ASIR: 37.7 per 100,000 population) among children globally, including 32,515 cases of MDR-TB (ASIR: 1.6) and 1193 cases of XDR-TB (ASIR: 0.1). Both global ASIR and DALY rate exhibited a declining trend from 1990 to 2021, with EAPC of -2.61% (95%CI: -2.74 to -2.47) and -4.38% (-4.61 to -4.14), respectively. From 1990 to 2021, High-income North America was the only GBD region with an increasing ASIR for tuberculosis (EAPC = 1.12, 95% CI: 0.61 to 1.64). From 1990 to 2021, there was no significant change in ASIR of MDR-TB (EAPC = 1.18, 95% CI: -0.16 to 2.54). However, eight of the 21 GBD regions exhibited increasing trends in the ASIR of MDR-TB, with the largest increase observed in Oceania (11.99, 10.49 to 13.52), followed by Central Asia (9.76, 6.48 to 13.13) and South Asia (5.71, 3.10 to 8.38). A strong negative correlation was observed between tuberculosis burden and SDI, with the highest disease burden concentrated in low-SDI regions. Conclusions: Achieving elimination targets will require stronger diagnostics and treatment for childhood tuberculosis, alongside reduced transmission, improved infection detection, and preventive therapy for exposed children, especially those under 5 years.