Infectious Diseases of Poverty最新文献

Background: Biomphalaria straminea, an intermediate host of Schistosoma mansoni, is originally native to Brazil but has invaded southern China since 1974. Nowadays, increasing human mobility raises the risk of S. mansoni dissemination. Therefore, this study aims to elucidate the genetic variation and structure of B. straminea in China and develop molecular tools for tracing its geographic origins, which could aid in schistosomiasis prevention and control.

Methods: We collected 290 B. straminea individuals from Shenzhen City (GDSZ, n = 171), Dongguan City (GDDG, n = 65), and Hong Kong (HK, n = 54). Double digest restriction associated DNA (ddRAD) sequencing was applied to genotype the samples. A subset of single nucleotide polymorphisms (SNPs) was validated by the Sequenom MassARRAY iPLEX assay. The MaxEnt model was employed to predict suitable habitats for B. straminea in China under current and future climate conditions.

Results: Analysis of ddRAD sequencing data led to the identification of 80 high-confidence SNPs. B. straminea from GDSZ exhibited higher genetic diversity than those from other locations. The total observed heterozygosity (Ho = 0.35) was higher than the total expected heterozygosity (He = 0.26), resulting in a negative inbreeding coefficient (Fis = - 0.35), indicating that outbreeding has dominated the recent genetic history of B. straminea. Pairwise genetic distance (Fst < 0.05) and number of effective migrants (Nm > 4) indicated low genetic differentiation. The populations in GDSZ, GDDG and HK were genetically similar, with the first two being more closely related. Three high-quality SNPs displayed distinct geographical population specificity and could serve as geographically specific SNP markers. The MaxEnt model predicted an expansion of suitable habitats for B. straminea in China under future climate conditions. High invasion risk in Hainan Province, Guangxi Zhuang Autonomous Region, and Taiwan Province warrants attention.

Conclusions: This study provides the first genome-wide insights into the population structure and genetic diversity of B. straminea in China. The populations are genetically similar, suggesting a common invasion source. Applying the geographically specific SNPs could enable rapid prediction of the geographic origin of B. straminea in future invasion events. Future climate conditions are likely to facilitate the spread of B. straminea, increasing the risk of schistosomiasis transmission in China.

Background: Extrapulmonary tuberculosis (TB) remains a diagnostic challenge due to its nonspecific clinical manifestations, low bacterial burden, and the need for invasive procedures to obtain diagnostic samples. Breast TB, a particularly rare form, can closely mimic other conditions such as inflammatory breast carcinoma.

Case presentation: A 30-year-old Peruvian woman with no relevant medical history was admitted with painful erythema of the right breast and two fistulous tracts secreting purulent discharge. Initial microbiological tests, including interferon-gamma release assay (IGRA) and cultures, were negative. Imaging revealed multiple pulmonary micronodules, and breast biopsy demonstrated granulomatous inflammation with Langhans giant cells. Despite negative PCR and culture results for mycobacteria, empirical antitubercular therapy was initiated based on clinical, radiological, and histopathological evidence. The patient was initiated on standard antitubercular therapy, which was simplified two months later. Progressive clinical improvement was observed, with complete ulcer healing by month 4 and resolution of pulmonary nodules by month 7. By month 12, she remained in good clinical condition with no signs of recurrence.

Conclusions: This case highlights the diagnostic complexity of breast TB and underscores the importance of a multidisciplinary approach in the absence of microbiological confirmation. Clinical context, imaging, and histology may guide successful empirical treatment and improve patient outcomes.

Background: Schistosomiasis is a parasitic worm infection that affects an estimated 250 million people. In Côte d'Ivoire, schistosomiasis remains a public health problem despite control efforts that have been mounted since the new millennium. The aim of this study was to assess the pooled prevalence of human schistosomiasis, to determine trends over the past 50 years and to identify risk factors for schistosomiasis.

Methods: We systematically searched Google Scholar, PubMed, Scopus and Web of Science Core Collection without language restriction for papers published from January 1, 1974 to December 31, 2023. We adhered to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. We performed random effect models for meta-analysis and generated forest plots. Pooled schistosomiasis prevalences and corresponding 95% confidence intervals (CIs) were determined. Heterogeneity among studies were evaluated using Cochran's Q test and I² statistic test. Publication bias was assessed with funnel plot and Egger's test.

Results: Overall, 326 articles involving 279,340 participants were included, comprising 254,954 school-aged children and 520 preschool-aged children. The pooled prevalence of schistosomiasis was 26.1%. The prevalence decreased from 66.5% in 1994-2003 to 15.0% in 2014-2023. The highest pooled prevalence of schistosomiasis was observed in Tonkpi regional health directorate. The main risk factors for schistosomiasis were sex [male: odds ratio (OR) = 1.24, 95% CI: 1.13-1.35], age group (> 15 years: OR = 2.45, 95% CI: 1.82-3.08, compared to children aged 6-10 years), and altitude (< 400 m, OR = 4.76, 95% CI: 4.00-5.88).

Conclusion: Our findings revealed that the prevalence of schistosomiasis in Côte d'Ivoire has considerably declined over the past decades. However, the disease remains a public health problem, and hence, surveillance should be tightened up and control efforts targeted to high-risk communities.

Background: Schistosomiasis, a snail-borne parasitic disease of public health and veterinary importance in tropical areas, is highly prevalent in sub-Saharan Africa, particularly in West Africa. The World Health Organization (WHO) has established ambitious goals of eliminating schistosomiasis as public health problem or interrupting its transmission by 2030. The zoonotic transmission of schistosomiasis involving nonhuman mammals (NHMs) complicates disease endemicity and hinders the attainment of these objectives. This study synthesized recent trends and the prevalence of human-infective schistosomes (HISs), including Schistosoma mansoni, S. haematobium, S. haematobium × S. bovis hybrids, S. guineensis, and S. intercalatum-across 16 West African countries.

Methods: We conducted a systematic literature search from March 25 to April 30, 2025, across PubMed, Scopus, Embase, and Web of Science, to identify studies on HISs (S. mansoni, S. haematobium, S. haematobium × S. bovis, S. guineensis, and S. intercalatum) in NHMs in western Africa. In addition, we manually searched African Journal Online (AJOL) and screened the references of the included articles. The data were organized in Microsoft Excel 2021 and analyzed via GraphPad Prism to identify publication trends, NHM infection incidence, and species-specific positivity rates (with 95% CIs). The spatial distribution of HIS-infected NHMs was visualized with QGIS to pinpoint high-risk areas.

Results: Four countries (Benin, Ghana, Nigeria, and Senegal) reported cases of HIS infection in NHMs with an overall prevalence of 8% (95% CI: 7-9%). Benin had the highest proportion of infected hosts (50%, 95% CI: 40-60%) and Senegal had the lowest proportion (5%, 95% CI: 4-6%). Bos taurus (60% prevalence) was the most affected species and served as a reservoir for S. haematobium × S. bovis hybrids, whereas S. mansoni exhibited an extensive distribution among rodent and primate hosts.

Conclusion: For effective elimination, integrated control strategies-spanning NHM surveillance, snail intermediate host monitoring, and human mass drug administration-must be prioritized. Policy reforms should address zoonotic transmission risks, particularly in high-prevalence zones, to align interventions with the complex ecology of schistosomiasis in West Africa.

Background: Arboviral infections impose significant public health challenges globally, yet routine surveillance typically captures only symptomatic infections, underestimating the true extent of exposure. Insights into how regional and demographic factors influence population immunity are essential for targeted surveillance and prevention, but such multidimensional insights remain limited. This study aimed to quantify population-level arboviral sero exposure and delineate the effects of regional and demographic factors on immunity to inform targeted surveillance and prevention.

Methods: We utilized a programmable phage display platform, ArboScan, which evaluates antibody binding to overlapping peptides that represent the proteomes of 691 human and zoonotic arboviruses. We profiled baseline antibody reactivity in serum samples from 400 healthy individuals, collected before the dengue outbreaks reported in Hainan in 2019. Antibody reactivity was quantified as normalized fold-change (FC) values relative to negative controls, and analyzed by region, sex, and age. Normality was assessed using the Shapiro-Wilk test. Two-group comparisons were conducted using independent two-sample t tests for normally distributed data or Mann-Whitney U tests otherwise; comparisons among > 2 groups were performed using One-way Analysis of Variance for normally distributed data.

Results: Regional ranking by mean product fold change (MPFC) showed northern enrichment for bluetongue virus (MPFC = 3.56), whereas southern cohorts were enriched for mosquito-borne arboviruses-dengue virus (MPFC = 3.54), Alagoas vesiculovirus (MPFC = 3.50), and Venezuelan equine encephalitis virus (MPFC = 3.39). Females exhibited higher FC than males for selected arboviral families (P < 0.001). By family-level analysis, Flaviviridae, Togaviridae, and Phenuiviridae showed no age-stratified differences (P > 0.05). High fold-change values were detected for non-arboviral viruses such as human cytomegaloviruses and human adenoviruses across all regions.

Conclusions: Our findings reveal distinct regional and demographic patterns of arboviral antibody reactivity in China, reflecting differing histories of exposure and potentially informing region-specific surveillance strategies. The stable antibody levels across age groups, together with higher fold-change values in females, underscore the influence of biological and social factors on arboviral immunity. The ArboScan platform, and programmable peptide display platforms in general, offer a scalable approach to characterize population-level immunity and could enhance early detection and public health preparedness in arbovirus-endemic areas.

Purpose: Schistosomiasis (SCH) japonica remains a persistent public health concern in the Philippines despite continuing control efforts. This study aims to examine the transmission dynamics of SCH japonica and evaluate different intervention strategies using a One Health modeling approach, with the goal of supporting feasible control and elimination targets.

Methods: We developed a compartmental mathematical model calibrated using field survey data collected in 2022 from eight endemic barangays in Agusan del Sur and Surigao del Norte. The dataset included SCH prevalence, egg excretion levels in humans and animals quantified through Kato-Katz, modified McMaster, and sedimentation techniques, and household distance to potential transmission sites. Multiple intervention strategies were examined, including human and animal chemotherapy, WaSH (water access, sanitation, and hygiene) adoption, pasture prohibition, vegetation clearing, and snail control. Sensitivity analysis using Partial Rank Correlation Coefficients (PRCC) was performed to identify influential transmission drivers.

Results: The model estimates baseline prevalence at approximately 20% in humans across the study areas. Under medium WaSH adoption, human prevalence is projected to decline to approximately 1.01% by 2030, whereas high WaSH coverage further reduces prevalence to 0.64%. Combining WaSH and pasture prohibition alongside chemotherapy is projected to reduce human prevalence to 0.09% and animal prevalence to 0.10% by 2030. Sensitivity analysis identified snail-to-human transmission rate (PRCC = 0.612) and snail shedding rate (PRCC = 0.607) as the most influential parameters.

Conclusion: Integrated strategies focusing on WaSH, reduced animal exposure, and targeted chemotherapy offer the most effective pathway toward achieving World Health Organization's (WHO's) 2030 SCH targets. Implementation should be strengthened through health education, behavioral interventions, mechanization support, and active Local Government Unit (LGU) participation.

Background: China, once a malaria-endemic country, has developed a comprehensive set of extensive strategies and accumulated practical experience over 70 years of malaria elimination efforts. On June 30, 2021, China was officially certified by the World Health Organization as malaria-free. Substantial research has already summarized China's malaria control experience from a technical standpoint. This study aims to examine China's malaria elimination practices from a new perspective of the health system and social development.

Methods: Semi-structured interviews were conducted with key informants, including national malaria program managers, renowned scholars, and technical personnels from China, international organizations, and high-burden countries in Africa. Interviews were conducted from July 2023 to July 2025, and data were analyzed using the thematic framework method.

Results: A total of 42 participants responded to the interview, and 7 key components from social development was proposed. The thematic analysis identified key factors influencing the achievement of malaria elimination in China. Specifically, 57.14% of experts mentioned agricultural crop types, 66.67% highlighted health education, 64.29% noted the working environment, 52.38% referred to employment opportunities, 59.52% addressed water and sanitation, 71.43% emphasized the living environment, and all experts underscored the critical role of the health system.

Conclusions: Social development is closely intertwined with malaria elimination, as advancements in healthcare, infrastructure, and community engagement are essential for ensuring the long-term success of malaria control efforts. Future studies could further explore the impact of specific factors on malaria elimination, thereby contributing valuable insights to global malaria elimination efforts.

Background: Cutaneous leishmaniasis (CL) is a neglected tropical disease with substantial physical, psychological, and social consequences, particularly in endemic, resource-limited settings. This study assessed the impact of CL on health-related quality of life (HRQoL) and patient satisfaction with care in an endemic region of Syria.

Methods: A cross-sectional study was conducted from May 1 to July 1, 2024 in Damascus University Hospital for Dermatology, Aleppo University Hospital, and two Ministry of Health CL treatment centers in Aleppo, Syria. HRQoL was measured using the dermatology life quality index (DLQI), and patient satisfaction using patient satisfaction questionnaire short form (PSQ-18). Sociodemographic and clinical characteristics were collected. Data were analyzed using SPSS (version 29). Medians and interquartile ranges (IQR) were used to describe non-normally distributed variables. Statistical tests included the Mann-Whitney U, Kruskal-Wallis, and Spearman's rank correlation. A P-value < 0.05 was considered significant.

Results: A total of 353 patients (55.9% female; median age 33 years) participated. The median DLQI score showed modest impairment, with the Symptoms and Feelings domain most affected (median 2, IQR 1-3; 87.5% scoring > 0). Female sex was significantly associated with higher Symptoms and Feelings (P = 0.018) and Personal Relationships (P = 0.020) scores. Head/neck lesions were significantly associated with worse Personal Relationships scores (P = 0.014). Satisfaction was generally high, with the highest median scores in Technical Quality (median 16, IQR 14-17) and Accessibility and Convenience (median 14, IQR 12-16). Urban residence was associated with higher General Satisfaction (P < 0.001), while number of treatment visits negatively correlated with Accessibility and Convenience (ρ = - 0.112, P = 0.035).

Conclusions: CL in Syria imposes measurable psychosocial and functional burdens, particularly among women and those with visible lesions. Despite overall high satisfaction with care, disparities related to geography and treatment logistics persist. Addressing psychosocial needs and inequities in care accessibility may improve patient outcomes endemic settings.

Background: Cryptococcosis is a major opportunistic fungal infection with heterogeneous clinical outcomes; however, data on clinical features and prognostic factors in non-HIV populations remain limited. This study aimed to provide real-world evidence on the clinical characteristics, immune stratification, diagnostic performance, treatment patterns, and outcomes of cryptococcosis.

Methods: We performed a multi-center ambispective cohort study of patients with cryptococcosis diagnosed between 2013 and 2025 across 48 hospitals in southeastern China, including Jiangsu and Fujian provinces. Patients were stratified according to immune status, disease type, and prognosis. Categorical variables were compared using the chi-square test or Fisher's exact test, and continuous variables were analyzed using the Mann-Whitney U test or Kruskal-Wallis test, as appropriate.

Results: A total of 396 patients were included, with a median age of 52 years; 61.9% were male. Most patients were immunocompetent (57.1%), while 33.1% had mild and 9.9% severe immunodeficiency. Pulmonary disease predominated (89.7%), whereas 10.1% had meningitis/dissemination. Severe immunodeficiency (SID) was associated with fever, neurological symptoms, lymphopenia, and elevated C-reactive protein (CRP) (all P < 0.01). Patients with meningitis/dissemination had more neurological manifestations and a markedly worse prognosis than those with pulmonary disease (mortality 35.1% vs. 2.1%). Among 319 patients with available follow-up data, follow-up duration varied from several days to several years, with prospective patients followed for up to 12 months. Overall, 89.0% recovered or improved, while 6.0% deteriorated or died. Poor outcomes were associated with older age, SID, central nervous system (CNS) involvement, lymphopenia, and elevated CRP. Serum cryptococcal antigen (CrAg) assays showed 94.6% concordance (122/129) between qualitative and quantitative methods. Quantitative ELISA identified four additional positive cases but missed three qualitative positive cases. In pulmonary cryptococcosis, amphotericin B-containing regimens were rarely used, while azole monotherapy was administered to over 95% of patients across severity groups and achieved favorable outcomes.

Conclusions: Host immune status, CNS involvement, and systemic inflammation are key predictors of outcome in cryptococcosis. Quantitative and qualitative CrAg assays demonstrate high diagnostic performance and azole monotherapy remained effective for pulmonary disease. These findings support risk-stratified diagnostic and therapeutic strategies in routine clinical practice, particularly in resource-limited settings.

Background: Sustaining the elimination of malaria requires robust surveillance to prevent reintroduction, but standardized frameworks for assessing the surveillance capacity of a country post-elimination are lacking. This study aims to develop a standardized framework for assessing malaria surveillance and response capacity in countries that have eliminated malaria.

Methods: We developed a malaria surveillance and response assessment framework through a three-stage process. First, two systematic reviews were conducted to identify indicators used in post-elimination settings worldwide and specifically in China. The candidate indicators were refined through expert panel discussions, which yielded 45 indicators across six domains. Next, a modified two-round Delphi process was conducted, involving 30 experts in epidemiology, disease control, and public health from diverse institutions and administrative levels. The experts rated the importance and feasibility of the indicators using structured questionnaires and then engaged in group discussions to contextualize the findings. Indicator weights were determined using a combined analytic hierarchy process (AHP) and entropy methods.

Results: The systematic reviews and expert consultations identified 45 candidate indicators. After two rounds of expert consultation, a framework comprising 34 indicators across six domains for assessing malaria surveillance and response capacity in post-elimination settings was developed. The weights of the six domains are as follows: surveillance system coverage and performance (0.240); the quality and use of the surveillance data (0.3710); the functioning of the information management system (0.0973); the availability and adequacy of resources (0.0375); early diagnosis and treatment (0.1571); and quality control supervision and training (0.0973). The expert authority coefficient (Cr) values of the first and second rounds were 0.777 and 0.895 respectively. Of the 34 indicators, the proportion of confirmed cases with completed epidemiological investigations and submitted reports (0.1153) and the interval between the first medical visit and diagnosis (0.1131) had the highest weights.

Conclusion: This consensus-based framework provides a standardized tool for evaluating malaria surveillance and response capacity in post-elimination settings. Adoption of the framework could help countries monitor and improve their systems to sustain elimination of the disease, mitigate reintroduction risks, and support global malaria eradication efforts.