Infectious Diseases of Poverty最新文献

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.

Background: COVID-19 occurred in successive waves driven by different SARS-CoV-2 variants and shaped by vaccine availability and public health measures. This study analyzes differences in clinical characteristics and outcomes of hospitalized patients across three waves in Brazil.

Methods: This retrospective cohort study included adult COVID-19 patients admitted to 41 hospitals across six Brazilian states from March 2020 to August 2022. Data on demographics, clinical characteristics, and outcomes were collected from medical records and compared across three pandemic waves. Categorical variables were analyzed using Chi-square or Fisher's exact tests, with post hoc Z tests and Bonferroni correction. Continuous variables were analyzed using Analysis of Variance (ANOVA) with Tukey's test or Kruskal-Wallis with Dunn's test and Bonferroni correction.

Results: Among 18,632 patients, 37% were hospitalized during the first wave, 55% in the second, and 8% in the third. The median age decreased during the second wave but increased in the third (60 vs 58 vs 66 years; P < 0.001). A higher proportion of patients with three or more comorbidities were admitted during the third wave (15.9% vs 11.9% vs 20.6%; P < 0.001). Anosmia, ageusia, and fever were less frequently reported in the third wave (P < 0.001). Intensive care unit admissions (38.7% vs 37.1% vs 25.5%; P < 0.001) and in-hospital mortality (21.3% vs 23.7% vs 18.2%; P < 0.001) declined throughout the pandemic.

Conclusion: Clinical manifestations and outcomes evolved across the pandemic waves. The third wave demonstrated fewer chemosensory symptoms, lower severity at admission, and reduced mortality, despite an older and more comorbid patient population.

Background: In February 2025, a fatal outbreak of a hemorrhagic fever-like illness emerged in the Basankusu Health Zone of the Democratic Republic of Congo (DRC), a region where the burdens of poverty and infectious disease intersect. Initial field diagnostics for common filoviruses like Ebola and Marburg returned negative, creating a critical diagnostic void and confronting local health systems with a potential "Disease X." This opinion piece analyzes the outbreak's unique clinical and ecological context to advance a specific, actionable hypothesis.

Main body: We argue that the presenting clinical syndrome, particularly the unusual combination of hemorrhagic signs with intractable hiccups and dysphagia, is highly consistent with a fulminant zoonotic orthopoxvirus infection. We hypothesize that this spillover event is directly linked to the socio-ecological pressures of poverty, including reliance on bushmeat for protein and accelerated deforestation for subsistence agriculture and charcoal production, which increase human-wildlife contact. Framing the outbreak through this lens shifts the public health paradigm from confronting a complete unknown to managing a new variant of a known threat. This perspective underscores that the poverty-driven exploitation of ecosystems is a primary engine of novel epidemics.

Conclusions: The definitive etiology of the Basankusu outbreak remains unresolved, but the clinical and ecological evidence points toward a potential zoonotic origin consistent with known patterns of pathogen emergence in the Congo Basin. In a setting constrained by limited diagnostic capacity, such evidence-informed approach provides a pragmatic framework for immediate public health action-guiding the deployment of targeted diagnostics (pan-poxvirus PCR), therapeutics (tecovirimat), and vaccines (MVA-BN). Ultimately, preventing future outbreaks of diseases of poverty requires a global commitment to investing in local diagnostic capacity, sustainable development, and equitable health security within high-risk endemic regions like the Congo Basin.

Background: Childhood infectious diseases and related symptoms, such as fever, cough, and diarrhea among children constitute the leading cause of death in low and middle-income countries (LMICs). We examined the environmental predictors of double and triple burden (D/TB) of infection symptoms among under-five children using multilevel machine learning (ML) methods.

Methods: We used Demographic and Health Surveys (DHS) data from 58 LMICs between 2000 and 2023. These data were merged with cluster-level particulate matter and nitrogen dioxide from the National Aeronautics and Space Administration and country-level data on political, social, and economic globalization from the World Bank report. We applied multilevel models to screen out the most important predictors of D/TB symptoms and applied machine learning algorithms to predict these symptoms among children across LMICs. We trained and validated ML algorithms on (80, 70, and 60%) of the data and tested on the remaining (20, 30, and 40%) with 2, 5 and 10 cross-validations.

Results: Of 1,546,243 children, 19.2%, 20.5% and 12.6% had fever, cough, and diarrhea, respectively; while the overall D/TB prevalence was 11.9% and 3.7%, respectively. The result revealed D/TB were associated with the location of a child, survey years, wealth index, family size, air pollutants, and environmental covariates. The estimated prevalence of both D/TB symptoms substantially varies across districts [intraclass correlation (intraclass correlation, ICC = 13.3%)] and countries (ICC = 8.8%). We found that the Random Forest gave the maximum Area Under the Curve of 94% and 99% for D/TBs for the K10 protocol and 80:20 training and testing dataset splits.

Conclusions: The study found substantial variation in the prevalences of D/TB of illness among children under five and identified several environmental and sociodemographic predictors of these health outcomes. The Random Forest algorithm performed best in predicting these burdens. The study emphasized how integrating environmental and sociodemographic data with machine learning can enhance targeted interventions to reduce childhood infectious disease burdens in low- and middle-income countries.

Background: The One Health approach recognizes the interconnectedness of human, animal, and environmental health to address global health threats. While the global One Health Index (GOHI) has been applied nationally, its adaptation to sub-national contexts remains unexplored. This study aimed to adapt GOHI to construct localized indicators for Fukuoka, Japan, and assess One Health implementation across municipalities.

Methods: The research followed a three-phase approach: (1) Indicator Selection, where 34 indicators were selected from GOHI and Fukuoka One Health Promotion Action Plan through expert consultation; (2) Data Collection and Score Standardization using robust scaling methods; and (3) Weight Determination using Fuzzy Analytic Hierarchy Process. Fukuoka One Health Index (FOHI) scores were computed and analyzed using descriptive statistics and Latent Class Analysis (LCA).

Results: The mean FOHI score was 52.27 (range: 41.01-63.71), with the lowest average score in Core Drivers Index (47.11) compared to Internal Drivers Index (59.17) and External Drivers (50.43). Municipalities performed strongest in zoonotic disease management (72.33) but weakest in One Health governance (6.36). Miyama City achieved the highest overall score, demonstrating strong governance and integrated implementations. LCA identified two municipal classes differentiated by External Drivers Index scores with clear geographic clustering.

Conclusions: This study demonstrated the feasibility of adapting GOHI to municipal settings and revealed significant variation in One Health implementation across Fukuoka's municipalities. Performance gaps were identified, particularly in One Health governance despite strong health infrastructure. The methodology offers a blueprint for similar adaptations globally, potentially accelerating the operationalization of One Health principles in local governance contexts.

Background: Patient journeys highlight evolving processes of care seeking from patient perspectives over the course of time and disease progression. Patient journeys for neglected tropical diseases (NTDs) in rural sub-Saharan Africa (SSA) are poorly understood. This review aims to identify studies including patient journeys for NTDs in rural SSA.

Methods: Systematic search of six scientific databases from inception to 18 November 2024. All studies were required to include patient journeys for NTDs, defined as the continuous arc of the patient care seeking experience at multiple time points while navigating increasingly debilitating disease. All patient journeys were depicted explicitly using flow diagrams, lists of ordered journey components, or patient narratives. Variables extracted included the use and rationale of referrals, types of healthcare delivery providers engaged in the patient journey, and barriers and facilitators of care continuity. Journeys were analysed using framework synthesis.

Results: Searches returned 2605 studies where after de-duplication and eligibility screening, 22 studies were identified for inclusion Included studies represented eight NTDs, which were categorised into four groups: severe and stigmatising skin NTDs (SSSDs) (13/22) including Buruli ulcer, lymphatic filariasis, onchocerciasis, and yaws; human African trypanosomiasis (HAT) (3/22); snakebite and rabies (4/22); and schistosomiasis (intestinal and female genital) (2/22). NTD patient journeys revealed health system constraints relating to limited medical resources and ineffective referral pathways, social dimensions of gender and stigma hindering access to care, and logistical concerns related to distance to health facilities, and lack of transport. Patient journeys for different NTDs highlighted specific dimensions of this local context, including challenges with mental health distress for individuals living with SSSDs, difficulties obtaining diagnoses for HAT as an NTD with non-specific symptoms, and inaccessibility of treatment for schistosomiasis in the context of missed mass drug administration.

Conclusions: NTD patient journeys show varied care seeking experiences within the broader context of neglect and health inequity that characterises settings where NTDs are endemic. For NTDs resulting in long-term or chronic conditions, these journeys highlight inaccessible care and a lack of integrated approaches for prevention, treatment, and management within health systems. By understanding patient journeys, NTD researchers and practitioners can determine how best to support NTD patients in navigating access to care.

Background: Cutaneous tuberculosis (CTB) is an unusual manifestation of extrapulmonary tuberculosis, accounting for only 1.0%-1.5% of cases. It presents with a wide range of clinical morphologies, often mimicking other dermatoses such as fungal infections, leprosy, or sarcoidosis. Among its different variants, the ulcerative form is particularly rare and clinically deceptive. Reporting rare presentation is important to raise awareness among physicians, as early recognition and prompt treatment are essential to prevent complications such as scarring, contractures, or malignant transformation.

Case presentation: We report the case of a 24-year-old Malian male admitted to the National Institute for Infectious Diseases Lazzaro Spallanzani. The patient presented with a 4-month history of ulcerative skin lesions on the chest, neck, and left leg, accompanied by systemic symptoms including asthenia, cachexia, and generalized lymphadenopathy. Imaging revealed extensive bilateral psoas abscesses, vertebral involvement consistent with spondylodiscitis, and signs of empyema necessitans. Polymerase chain reaction (PCR) testing of drained abscess fluid confirmed Mycobacterium tuberculosis complex. Skin biopsy histology and PCR further supported the diagnosis of CTB. The patient was treated with standard anti-tuberculosis therapy (isoniazid, rifampicin, ethambutol, pyrazinamide) alongside broad-spectrum antibiotics. After 30 days, partial improvement of skin lesions was observed, although complete resolution was not achieved after 8 months of follow-up.

Conclusions: This case highlights the diagnostic challenge and chronicity of CTB, particularly in the ulcerative presentation. The patient developed disseminated tuberculosis with cutaneous involvement without any recent travel or known tuberculosis exposure, and the probable etiology is latent reactivation. There should be a high index of suspicion for CTB in patients presenting with indolent, atypical skin lesions, particularly those from an endemic region. Early diagnosis and prolonged therapy are crucial to avoid long-term sequelae.

Background: Cervical cancer driven by human papillomavirus (HPV) infection remains a critical global health challenge. Co-infection with Trichomonas vaginalis, a prevalent sexually transmitted protozoan, is strongly associated with increased susceptibility to HPV, yet the molecular basis for this synergy is unclear. Here, we investigated the role of T. vaginalis adhesion protein 65 (TvAP65) in HPV entry, focusing on its interaction with host factors in epithelium.

Methods: Using in vitro (human adult low calcium high temperature keratinocytes, HaCaT cells) and in vivo (BALB/c athymic nude mice, BALB/cA-nu mice) models, we assessed HPV infection rates and the expression of HPV entry receptors (cluster of differentiation 151, CD151 and heparan sulfate proteoglycan 2, HSPG2) under T. vaginalis exposure. TvAP65 was either knocked down or overexpressed to evaluate its functional impact. A siRNA screen targeting 12 host molecules that interact with TvAP65 identified signal peptidase complex subunit 1 (SPCS1) as a key mediator. Dual knockdown of TvAP65 and SPCS1 or HPV receptors (CD151/HSPG2) was performed to dissect mechanistic hierarchies. Statistical analyses were performed using Student's t-test for two-group comparisons and analysis of variance (ANOVA) for comparisons involving three or more groups (P < 0.05).

Results: T. vaginalis markedly enhanced HPV entry in epithelial cells by upregulating CD151 and HSPG2 (P < 0.001). TvAP65 knockdown reversed this effect, reducing HPV infection by 21.76 ± 0.12% (P < 0.001) and protein-level expression of the receptors (P < 0.001), while overexpression amplified both. Strikingly, SPCS1 knockdown alone attenuated HPV infection by 33.61 ± 0.40% and abolished T. vaginalis-driven CD151/HSPG2 upregulation. Dual knockdown of TvAP65 and SPCS1 synergistically suppressed HPV entry (54.64 ± 0.39% reduction, P < 0.001), confirming the central role of SPCS1 in TvAP65-mediated receptor activation.

Conclusions: Our study unveils a previously uncharacterized mechanism by which T. vaginalis exacerbates HPV infection: TvAP65 hijacks SPCS1 to transcriptionally upregulate CD151 and HSPG2, thereby facilitating HPV entry into host cells. This TvAP65-SPCS1-CD151/HSPG2 axis highlights potential therapeutic targets to disrupt the synergy between HPV and T. vaginalis, offering new strategies for cervical cancer prevention.

Background: India accounts for over a quarter of the global tuberculosis (TB) burden. Among the most affected are India's Scheduled Tribes (STs) communities, experiencing a disproportionately higher TB prevalence compared to non-STs. Encouragingly, two successive rounds of National Family Health Survey (NFHS) showed the declined trend in overall TB prevalence in India, the rate of decline was markedly slower among STs, signalling that national gains have not translated into equitable progress. This study examines the point prevalence of TB and its determinants among STs and non-STs populations in constitutionally protected Scheduled and Non-Scheduled areas of India.

Methods: We analysed data from 2,077,924 individuals aged 15 and above from NFHS-5 (2019-2021) in India. Districts were stratified into: (1) Scheduled Area districts (with protections under Schedules V/VI), (2) non-Scheduled districts with > 60% STs, and (3) non-Scheduled districts with < 60% STs. We estimated TB point prevalence per 100,000 among STs and non-STs across these categories and examined associated socio-demographic, environmental, and behavioural factors. Multivariable logistic regression models assessed the adjusted odds of TB.

Results: STs experienced significantly higher TB prevalence (416/100,000) than non-STs (277/100,000). This disparity persisted across all district categories. STs in Scheduled area districts had the lowest TB prevalence (330 per 100,000), while non-Scheduled districts with > 60% STs populations had the highest prevalence (608 per 100,000). Tribal identity remained an independent risk factor for TB [adjusted odd ratio (aOR) = 1.47; 95% confidence internal (CI) 1.38 -1.56], even after adjusting for covariates. Additional risk factors included older age, male sex, low household wealth, adverse household environments, tobacco and alcohol consumption, and hypertension and diabetes.

Conclusions: Tribal communities continue to shoulder a disproportionate TB burden, reflecting deep-rooted social and structural inequities. While constitutional protections in Scheduled Areas appear to offer some safeguards, disparities between STs and non-STs remain stark. Our findings serve as evidence and a call to action to ensure that tribal communities are at the forefront of TB control initiatives, so that the burden of TB is no longer borne disproportionately by those already burdened by socio-economic disadvantage.