Infectious Diseases of Poverty最新文献

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.

Background: Clonorchiasis is caused by the ingestion of raw freshwater fish containing infective metacercariae of Clonorchis sinensis. This study aimed to fully evaluate disease burden in terms of disability-adjusted life years (DALYs) for clonorchiasis in China.

Methods: Following our previous study which established the fine-scale prevalence distribution of C. sinensis infection in China, we further adopted Bayesian geostatistical models to estimate the infection intensity in terms of eggs per gram of feces (EPG) in infected individuals based on the national surveillance data of clonorchiasis between 2016 and 2021. Disability weight was then captured through its quantitative association with EPG, and used to estimate years of life living with a disability (YLDs). Incidence of cholangiocarcinoma attributed to C. sinensis infection was employed to calculate years of life lost (YLLs). DALYs was then estimated at 5 × 5 km² resolution, and aggregated by areas and populations.

Results: In 2020, 431,009 [95% Bayesian credible interval (BCI): 370,427 to 500,553] DALYs were exerted due to clonorchiasis in China, of which 372,918 (95% BCI: 318,775-435,727) was due to YLDs and 57,998 (95% BCI: 50,816-66,069) due to YLLs. The DALYs, YLDs and YLLs per 1000 were 0.31 (95% BCI: 0.26-0.35), 0.26 (95% BCI: 0.23-0.31), and 0.04 (95% BCI: 0.04-0.05), respectively. The DALYs predominantly distributed in southern areas including Guangxi (201,029, 95% BCI: 157,589-248,287) and Guangdong (161,958, 95% BCI: 128,326-211,358). The DALYs was over doubled in male (302,678, 95% BCI: 262,028-348,300) than in female (127,970, 95% BCI: 106,834-151,699), and high in middle aged population.

Conclusions: Clonorchiasis causes significant disease burden in China especially in southern areas including Guangxi and Guangdong. Urgent control is needed for clonorchiasis in the endemic areas with high burden, and adult males need to be prioritized.

Background: Despite advancements in tuberculosis (TB) control policies in Brazil, the disease remains a significant public health concern. This study aimed to analyze long-term trends and projections of pulmonary tuberculosis (PTB) incidence rates in metropolitan and non-metropolitan areas of Brazil from 2001 to 2035, as well as to quantify the contributions of demographic and epidemiological changes to these patterns.

Methods: This ecological study used national PTB case notification data reported to Brazil's Notifiable Diseases Information System from 2001 to 2020. Joinpoint regression was applied to identify changes in temporal trends. Age-period-cohort models were employed to examine the effects of age, period, and birth cohort on disease risk. A decomposition analysis was then conducted to assess the contributions of population aging, demographic growth, and epidemiological changes. Finally, Bayesian age-period-cohort models were used to project the TB burden through 2035, stratified by sex and area.

Results: Between 2001 and 2020, PTB incidence declined by an average of - 2.67% (95% CI - 3.43, - 2.08) per year in metropolitan areas and - 2.54% (95% CI - 2.92, - 2.16) in non-metropolitan areas of Brazil. However, decomposition analysis showed that the absolute number of PTB cases in metropolitan areas increased, primarily driven by population growth (+ 21,610 cases in men; + 10,545 in women), with a smaller contribution from population aging (+ 2649 and + 521 cases, respectively). In non-metropolitan areas, reductions were mainly explained by epidemiological improvements (- 8314 cases in men; - 6663 in women) and population decline (- 4972 and - 2380 cases, respectively), outweighing the effects of aging. Looking ahead, projections indicate that PTB incidence will rise in metropolitan areas, from 52.6 in 2015 to 62.4 [95% credible interval (CrI): 37.1-87.8] per 100,000 by 2035, while stabilizing at relatively high levels in non-metropolitan areas, increasing from 28.4 to 33.8 per 100,000 (95% CrI: 19.3-48.3) among men.

Conclusion: Metropolitan areas are projected to experience substantial increases in PTB incidence, while non-metropolitan regions are expected to stabilize at persistently high levels, particularly among men. The findings indicate that current TB control efforts in Brazil need to be strengthened for the country to meet the 2035 targets, especially in metropolitan areas.

Background: Tuberculosis (TB) remains a major global health challenge, and China bearing the world's third-highest burden. TB healthcare workers (TB-HCWs) in primary healthcare (PHC) settings are pivotal for implementing the national TB Control Program (TCP). This study aimed to develop a TB knowledge assessment questionnaire and systematically evaluate TB-HCWs' knowledge, practices, and perceived concerns regarding TCP implementation in western China.

Methods: A 30-item TB knowledge questionnaire was developed through item generation, expert consultation, and pilot testing. A multicenter cross-sectional study was conducted among TB-HCWs in Chongqing Municipality, Guizhou Province, and Xizang Zizhiqu from February 2022 to July 2023, using multistage stratified random sampling. A structured survey assessed demographics, TB knowledge, TCP practices, and perceived concerns. Multilevel logistic regression identified factors associated with TCP implementation.

Results: Among 2807 TB-HCWs, overall TB knowledge was low (38.4%), particularly for TB Treatment (25.1%). Rural TB-HCWs performed better in case management (41.3% vs. 40.1%; P < 0.05) and health education (50.0% vs. 47.1%; P < 0.001), while urban TB-HCWs scored higher in case detection and TB treatment (42.3% vs. 40.9%; P < 0.05). TCP practice implementation generally fell short of national standards, though urban HCWs achieved required levels in first-home visiting (≥ 90%) and health education (≥ 85%). Workforce-intensive services, particularly directly observed therapy, were suboptimally delivered in both settings, especially rural (< 70%). Positive working attitudes and working satisfaction predicted higher implementation across all dimensions [odds ratio (OR) > 1], while rural settings and infrequent training (≤ 1/half-year) were negative predictors (OR < 1). Key concerns included inadequate training, poor public/patient cooperation, insufficient workforce, weak coordination with TB-designated hospitals, and lack of incentives.

Conclusions: TB-HCWs in western China face substantial gaps in knowledge and practice that hinder effective PHC-based TCP delivery. Targeted and frequent training, context-specific and patient-centered adherence strategies, improved institutional support, and strengthened community engagement are needed. Future longitudinal studies should evaluate the effectiveness and long-term impact of these interventions to accelerate progress toward national and global End TB targets.

Background: Diarrhea remains a major health concern in children under five years, with enteric pathogens being key contributors. However, the interactions among these pathogens and their combined effects on disease severity are not well understood. The study investigates the interactions among co-infecting enteric pathogens on diarrhea pathogenesis within an epidemiological framework.

Methods: This large-scale, multicenter case-control study was conducted from January 1, 2024 to December 31, 2024, across four tertiary hospitals in Guangzhou, Guangdong Province, China. Stool samples were collected from children under five years with diarrhea (cases) and those without (non-diarrheal children). 21 enteric pathogens in each specimen were identified. Potential interactions between co-infecting pathogens were assessed using both additive and multiplicative models.

Results: Enteric pathogens were more frequently detected in children with diarrhea than in non-diarrheal children (53.6% vs. 27.8%, P < 0.001), with significantly higher detection of both viral (23.3% vs. 13.3%) and bacterial pathogens (34.2% vs. 12.5%). Pathogens independently associated with diarrhea included diarrheagenic Escherichia coli (DEC), Vibrio parahaemolyticus, Clostridioides difficile (CD), group A rotavirus (RVA), and Norovirus GII (NoVs GII). The proportion of children with any form of co-infection was also significantly higher in the diarrhea group compared with non-diarrheal children (16.1% vs. 4.5%, χ² = 32.594, P < 0.001). Several specific dual-pathogen combinations-namely RVA + DEC (χ² = 4.956, P = 0.026), RVA + CD (χ² = 10.313, P < 0.001), RVA + NoVs GII (χ² = 15.503, P < 0.001), and DEC + Blastocystis hominis (Bh)-were significantly more common among diarrhea cases (χ² = 4.207, P = 0.041). Multiplicative interaction analysis further identified significant synergistic effects for RVA + DEC [odds ratio (OR) = 2.304, 95% confidence interval (CI): 1.194-5.089], RVA + CD (OR = 6.199, 95% CI: 1.701-10.601), RVA + NoVs GII (OR = 6.296, 95% CI: 2.061-10.723), and DEC + Bh (OR = 4.602, 95% CI: 2.213-9.878).

Conclusion: This study demonstrates the frequent occurrence of co-infections in diarrheal children, and enteric pathogens may interact synergistically or antagonistically. It highlights the central role of RVA in exacerbating the severity of these co-infections. The findings emphasize the critical role of RVA vaccination in alleviating the burden and severity of diarrhea. Trial Registration The study was registered in the Chinese Clinical Trial Registry (ChiCTR-ROC-17013620).

Schistosomiasis was first reported in the People's Republic of China (P.R. China) 120 years ago. The national programme of schistosomiasis control started in mid-1950s. The transmission interruption was achieved by 2023. Here we summarize the experience as the five core parts of a running chariot. While the specific historical context of P.R. China's way of schistosomiasis control may be difficult to replicate, the experiences gained underscore several critical principles that might be applicable elsewhere.

Malaria incidence in the Lao People's Democratic Republic has declined over the past 10 years. There is a continued risk of outbreaks, particularly in the Southern region, due to high-risk behaviors, primarily in remote ethnic communities among forest goers (individuals who regularly work or sleep in the forest), farmers on forest fringes, and vulnerable populations in these highly receptive areas. Conventional malaria control interventions alone in these areas are insufficient to push elimination beyond "the last mile". In 2022, an innovative approach to accelerate malaria elimination, termed locally as "Accelerator Strategies" was implemented. Activities included targeted drug administration and intermittent preventive treatment for forest goers and mobile populations, specifically farmers on forest fringes, as chemoprevention among individuals at increased risk of malaria irrespective of infectious status. Community engagement approaches were essential to ensure participation and acceptance as the intervention requires individuals without symptoms to take medicine. Three key enablers for community participation were identified as: (1) Service delivery and community engagement by the community members themselves; (2) Strong advocacy and political commitment from senior local political leaders, and village authorities and influencers and (3) Delivering people-centered services beyond the village with granular local data on risk behaviors, population movement and geographic information system mapping. Early and sustained community engagement resulted in high coverage of the interventions and greater acceptance by the community that resulted in a decreased malaria burden.