Tropical Medicine and Infectious Disease最新文献

Adolescents living with HIV face unique challenges when transitioning from pediatric to adult care-including stigma, disclosure concerns, and loss of support-that undermine continuity. We systematically searched PubMed, Embase, and Web of Science through August 2025 in accordance with PRISMA 2020. Two reviewers independently screened records and appraised risk of bias using Joanna Briggs Institute (JBI) tools by study design; appraisals informed interpretation but did not determine inclusion. Thirty-two studies met criteria; given heterogeneity, findings were narratively synthesized. Post-transition outcomes were suboptimal: retention often declined to ~70% by two years and viral suppression to roughly two-thirds, below global targets. Older transfer age and minimal gaps between pediatric discharge and adult enrollment were associated with better retention. Structured programs combining early preparation, coordinated handoffs, psychosocial/peer support, and youth-friendly adult services consistently improved engagement (often >90% 12-month retention), though improvements in viral suppression were less uniform. JBI appraisal indicated mostly moderate methodological quality with common risks from confounding and incomplete follow-up, tempering certainty. Purposeful, well-supported transition models are essential to sustain treatment success into adulthood; future work should evaluate scalable delivery and long-term outcomes across diverse settings.

Background: Migration phenomena from low- to high-income countries have been constantly increasing in the past years, and migrants living with HIV (MLHIVs) currently represent a non-negligible proportion of the population living with HIV in the European setting. When taken into care, MLHIVs should be screened for tropical diseases capable of asymptomatically persisting for years and leading to severe and/or chronic complications, especially in immunocompromised populations.

Methods: We conducted a retrospective study aimed at analyzing the screening ratios and seroprevalences of strongyloidiasis, schistosomiasis, and Chagas disease among MLHIVs who attended a tertiary care hospital outpatient clinic in Florence, Italy.

Results: Between 2014 and 2023, 251 MLHIVs were enrolled, of which 85 (33.9%), 137 (54.6%), and 219 (87.3%) were at risk for schistosomiasis, Chagas disease, and strongyloidiasis, respectively. Among individuals at risk for each of these parasitic diseases, 43.4% were screened for strongyloidiasis, 25.9% for schistosomiasis, and 65.0% for Chagas disease, with a seroprevalence of 5.3%, 13.6%, and 0%, respectively.

Conclusions: While confirming the relevant burden of neglected parasitic diseases in the MLHIV population, our results suggest the need to improve awareness of these diseases even in the specialist context in order to reduce underdiagnoses and the risk of severe complications, especially in particularly vulnerable groups of the population.

As Honduras approaches malaria elimination, imported infections pose a growing challenge to disease surveillance and control. In this study, we analyzed 14 molecular markers-six from Plasmodium falciparum and eight from P. vivax-in samples from local and migrant subjects to assess their utility in differentiating local versus imported infections. All P. falciparum isolates carried the wild-type pfcrt haplotype associated with chloroquine susceptibility. However, polymorphisms in pfmdr1, pfama1, pfglurp, and pfs47 revealed distinct genotypes in migrant versus local samples, suggesting external origins. For P. vivax, three novel pvcsp VK210 haplotypes and the first detection of a VK247 variant in Honduras were identified in migrants. Additional novel haplotypes were found in pvmsp1, pvmsp3α, pvmsp3β, pvs47, and pvs48/45. Several of these markers-particularly pfmdr1, pfs47, pvs47, and pvs48/45-proved informative for inferring geographic origin. This study demonstrates the value of molecular surveillance in low-transmission settings, supporting public health efforts by identifying potentially imported cases.

Antimicrobial resistance (AMR) surveillance plays a critical role in tracking emerging trends and informing evidence-based policies. This study assessed bacterial contamination and resistance profiles of Escherichia coli and Pseudomonas aeruginosa in 1886 drinking water samples from 12 regions of Ghana between April 2024 and April 2025. Findings were compared to a baseline study from the Greater Accra region (2022). Water samples analysed included sachet, bottled, tap, borehole, well, and surface water. Isolates were tested for antibiotic susceptibility using the Kirby-Bauer disk diffusion method. The majority of treated and packaged water samples were free from bacterial contamination. E. coli was frequently detected in untreated surface water (68%) and well water (63%). E. coli isolates from untreated water samples exhibited high resistance to cefuroxime (74%) and amoxicillin-clavulanate (50%); resistance to gentamicin increased from 3% in 2022 to 35% in 2025, while ertapenem resistance rose from 6% to 18%. Multidrug-resistant (MDR) E. coli isolates were found in samples from eight regions, and MDR P. aeruginosa in three, mostly from borehole water. These findings highlight the urgency to integrate AMR surveillance into national water quality initiatives, along with coordinated public health interventions, to educate communities on household water treatment practices and the health risks posed by AMR.

Leptospirosis is a zoonotic disease caused by pathogenic Leptospira, prevalent in tropical/sub-tropical regions. This study aimed to clarify the prevailing leptospiral species, clinical features, and risk factors of leptospirosis in north-central Bangladesh in 2024. Venous blood and urine samples were collected from 117 patients with clinically suspected leptospirosis. Among these cases, 75 (64%) tested positive for Leptospira infection by IgM ELISA test and/or PCR. By phylogenetic analysis of the 16S rRNA gene, all the samples tested were classified into L. wolffii (pathogenic group P2), showing high sequence identity to those of the type strain Khorat-H2 (97-99%) and L. wolffii reported in Bangladesh previously. Confirmed leptospirosis patients were mostly male (93%), aged 15-60 years (93%), living in rural areas in low socioeconomic conditions. Variable symptoms were presented by patients, with jaundice (84%), nausea/vomiting (84%), and myalgia (67%) being common. Some patients showed severe symptoms involving the nervous system (disorientation and neck stiffness) and the respiratory tract (cough, shortness of breath, and hemoptysis). Major risk factors for leptospirosis were exposures to mud/wet soil, sanding water, heavy rain, working in a paddy field, and cattle. In conclusion, L. wolffii was revealed to be circulating endemically in north-central Bangladesh, since its first detection in 2018, associated with variable and severe clinical symptoms in humans.

Background: Tularemia is a zoonotic infection caused by Francisella tularensis, transmitted to humans through direct contact with infected animals, arthropod bites, or by ingesting contaminated water. It commonly presents with fever, lymphadenopathy, and oropharyngeal symptoms. In Turkey, where waterborne outbreaks are frequent, tularemia remains a significant public health concern. This study aimed to compare the clinical, epidemiological, and laboratory characteristics of patients diagnosed with tularemia and those with similar clinical features but seronegative results, with the goal of identifying parameters that may assist in differential diagnosis.

Methods: This retrospective study included adults (≥18 years) who presented to the Infectious Diseases Outpatient Clinic between 2016 and 2024 with suspected tularemia and were tested using a microagglutination test (MAT). Patients with a positive MAT (≥1:160) or a fourfold titre increase were classified as tularemia cases, while seronegative patients were defined as tularemia-like cases. Demographic data, clinical symptoms, epidemiological risk factors, and laboratory findings were compared between the two groups.

Results: A total of 105 patients were included, 54 (51.4%) of whom were diagnosed with tularemia. The duration from symptom onset to healthcare presentation was significantly longer in tularemia cases (20.3 ± 5.7 vs. 15.7 ± 6.2 days; p < 0.001). Sore throat (66.7% vs. 43.1%; p = 0.026) and tonsillitis/pharyngitis (55.6% vs. 21.6%; p = 0.001) were significantly more prevalent in the tularemia group. Epidemiological risk factors, including rural residence (92.6%), animal husbandry (74.1%), agricultural activity (72.2%), and contact with lake or stream water, were significantly more prevalent among tularemia cases (all p < 0.001). Alanine aminotransaminase (p = 0.019) and C-reactive protein levels (p = 0.027) were significantly lower in the tularemia group.

Conclusions: Tularemia cases are associated with particular epidemiological risk factors and oropharyngeal symptoms. A thorough epidemiological evaluation is crucial for diagnosis, and enhancing awareness among healthcare providers and the public may facilitate earlier recognition and management.

We evaluated the effectiveness of three locally available disinfectants in reducing Escherichia coli (E. coli) contamination of wastewater-irrigated lettuce while preserving structural integrity. We conducted a quasi-experimental study using lettuce from two farms (Accra and Tamale) in Ghana. Disinfectants tested included (i) salt combined with vinegar, (ii) sequential salt and potassium permanganate, and (iii) sequential vinegar and potassium permanganate. Structural integrity (stem crispness and leaf mushiness) was assessed at 5, 10, and 15 min. E. coli counts and antibiotic resistance were determined pre- and post-disinfection. All three disinfectants preserved structural integrity of lettuce at 5 and 10 min. At 15 min, sequential disinfectants preserved 100% structural integrity, while the salt-vinegar mix caused mushiness in 16%. Pre-disinfection E. coli counts were 9720 cfu/g for Accra (Inter Quartile range, IQR: 3915-14,175) and 72 cfu/g (IQR: 36-189) for Tamale. All disinfectants eliminated E. coli after 15 min. Multi-drug-resistant isolates were common (45% in Accra and 30% in Tamale), particularly against "Watch, restricted use" antibiotics. A 15 min exposure of lettuce to locally available disinfectants, particularly when used sequentially, can eliminate E. coli contamination while preserving structural quality. This practical, low-cost intervention can empower households, vendors, and farmers to limit lettuce-borne diarrheal diseases and antimicrobial resistance transmission.

Background: Crimean-Congo hemorrhagic fever (CCHF) is a severe zoonotic viral infection with high mortality rates. This study aimed to examine the prognostic value of new-generation inflammatory markers-CRP/albumin ratio (CAR), D-dimer/albumin ratio (DAR), D-dimer/fibrinogen ratio (DFR), and triglyceride-glucose index (TGI)-in predicting mortality among patients diagnosed with CCHF.

Methods: This prospective study involved 76 patients with a positive polymerase chain reaction test for CCHF and 38 age- and sex-matched healthy controls between 15 April 2023 and 15 October 2024. Participants' demographic, clinical, and laboratory data at presentation were recorded.

Results: CAR, DAR, DFR, and TGI levels were significantly higher in the patient group compared to the control group (all p < 0.001). Furthermore, when mortal cases were compared with survivors, all of these markers were found to be significantly higher in the mortal group (p = 0.005, p = 0.004, p = 0.001, and p = 0.003, respectively). In Kaplan-Meier analysis, survival time was significantly shorter in patients with higher levels of these parameters (p < 0.001 for all). In the Receiver Operating Characteristic analysis conducted to differentiate mortal cases from survivors, DFR and TGI were identified as the markers with the highest predictive power (area under the curve: 0.938 and 0.899, respectively).

Conclusions: Inflammatory markers CAR, DAR, DFR and TGI may serve as significant prognostic tools to predict mortality in CCHF.

Background: An epidemiological survey of Onchocerca volvulus infection and onchocerciasis in Igbo-Eze North Local Government Area, Enugu State, Nigeria, was undertaken to assess its distribution and risks among individuals in the area. Methods: A total of 201 residents who have lived in the study area for at least one year were recruited. At recruitment, they were examined using a rapid assessment method. Their demographic information and risk factors were obtained using a structured questionnaire. Results: The overall prevalence for onchocerciasis was 3.5% (7/201). The prevalence of onchocerciasis was observed to be non-significantly (p = 0.689) different among the studied communities. The sex and age-related prevalence differences were non-significant (p > 0.05); however, onchocerciasis was more prevalent among males and those between 30 and 39 years of age. The prevalence of onchocerciasis was higher (p = 0.001) among farmers/fishermen. The significant risk associated with onchocerciasis is the proximity of the water body to houses (p = 0.034). Conclusions: The onchocerciasis prevalence was low and not dependent on sex or age but rather occupation. Risks to onchocerciasis are environmental and occupational, with chances of scaled up prevalence and burden overtime if unchecked. There is a need for awareness campaigning to enable proper education of the people about onchocerciasis in the area and neighboring communities.

Controlling Rhipicephalus microplus is currently one of the main challenges in livestock farming due to the significant economic losses it causes. Traditionally, managing this parasite has been based on the use of synthetic ixodicides, among which fipronil has proven to be highly effective. However, its low water solubility and the limitations of commercially available formulations can affect the bioavailability of this compound, favoring the emergence of resistance in tick populations. In this context, fipronil-loaded nanoparticles were developed using the Eudragit^® E PO polymer (NP_F) (Helm, Naucalpan, Mexico, Mexico), which were physicochemically characterized and evaluated against fipronil-susceptible R. microplus larvae. NP_F had an average size of 143.43 ± 1.88 nm, a polydispersity index (PDI) of 0.162 ± 0.01, a ζ (P ζ) of 21.16 ± 0.54, an encapsulation percentage (%E) of 7.36 ± 0.30, and an encapsulation efficiency percentage (%EE) of 66.28 ± 3.5%. Free fipronil showed an LC₅₀ of 0.582 µg/mL and an LC₉₀ of 2.503 µg/mL against R. microplus. The NP_F formulation showed an LC₅₀ of 0.427 µg/mL and an LC₉₀ of 2.092 µg/mL. These results suggest that incorporating fipronil into nanoparticles improves its ixodicide efficacy, positioning it as an innovative and promising alternative for the development of effective tick control formulations.