PLOS Neglected Tropical Diseases: New Articles

Editorial Note: Multispacer Sequence Typing Relapsing Fever Borreliae in Africa

2026-06-10T14:00:00Z

by The PLOS Neglected Tropical Diseases Editors

Editorial note: multiplex real-time PCR diagnostic of relapsing fevers in Africa

2026-06-10T14:00:00Z

by The PLOS Neglected Tropical Diseases Editors

Prevalence of hookworm infection and its proportion among pregnant women with intestinal helminth infection in Ethiopia: A systematic review and meta-analysis

2026-06-10T14:00:00Z

by Mengistie Kassahun Tariku, Gezahegn Eshetu Mekuriya, Habtamu Wagnew Abuhay, Lidetu Demoze, Gedefaw Abeje, Mekuriaw Nibret Aweke, Habtamu Abebe Getahun, Samuel Teferi Chanie, Gelila Yitageasu, Gebrie Getu Alemu, Asebe Hagos

Background

Hookworms are the most common soil-transmitted helminths in tropical and subtropical regions. Although infection with hookworms is a principal cause of maternal anemia, there is limited consolidated evidence on pooled prevalence and its proportion among intestinal helminths infections in pregnant women in Ethiopia. This study aimed to estimate the pooled prevalence of infection with hookworms and its proportion among intestinal helminths in pregnant women in Ethiopia.

Methods

A systematic review and meta-analysis were conducted following the PRISMA guidelines. Articles published between 2010 and 2024 were retrieved from databases including PubMed, Google Scholar, ScienceDirect, and African Journals Online using relevant search terms related to Ethiopia. Data extraction was performed using a standardized Excel spreadsheet after assessing the quality of the studies with the Newcastle-Ottawa Scale. Data were analyzed using STATA version 17. A random-effects model using the DerSimonian–Laird method was employed to account for heterogeneity, which was assessed using the I² statistic and the p-value of Cochrane’s Q test. Publication bias was evaluated using funnel plots, Begg’s, and Egger’s tests. Results were presented using forest plots with 95% confidence intervals (CIs).

Results

A total of 33 studies, including 13367 pregnant women were analysed. Among these 4161 women infected with intestinal Helminthiases, including 1853 cases of infection with hookworms. The pooled prevalence of infection with hookworms among pregnant women in Ethiopia was 12.21% (95% CI: 9.46%–14.95%), while the pooled proportion of hookworms among intestinal helminths was 44.0% (95% CI: 33.24%–55.75%). Regionally, prevalence was highest in Amhara (13.11%, 95% CI: 9.17%–17.05%) and the lowest in Gambella (4.44%, 95% CI: 2.32%–6.57%). The proportion was highest in Amhara (67.86%, 95% CI: 57.87%–77.84%) and lowest in Harerge (16.67%, 95% CI: 9.21%–24.12%). By diagnostic method, the concentration technique yielded the highest prevalence (16.11%, 95% CI: 9.31%–22.90%), while combined methods showed the lowest (9.48%, 95% CI: 6.14%–12.83%).

Conclusion

Infection with hookworms remains a public health concern among pregnant women in Ethiopia (pooled prevalence: 12.21%), accounting for 44.0% of intestinal helminths. Marked regional variation exists, highest in Amhara and lowest in Gambella. Prevalence estimates varied by diagnostic method, with higher values from concentration techniques. Targeted interventions, improved sanitation, deworming, and standardized diagnostics are needed.

Identification of a persistent Ascaris-derived Kalirin epitope associated with chronic T cell activation in the lung

2026-06-09T14:00:00Z

by Yifan Wu, Leroy Versteeg, Meng-Chih Wu, Jill E. Weatherhead

Ascariasis remains a dominant global health burden due to its vast prevalence and associated morbidity. The obligatory migration of Ascaris larvae through pulmonary tissue triggers intense type-2 inflammation which typically presents as acute allergic airway disease. Even after the parasite is eliminated, a single episode of larval migration can result in chronic lung damage and dysfunction, which may be driven by the long-term retention of helminth antigens in macrophages. However, the molecular identity of these retained antigens, and the mechanisms by which they sustain chronic T cell responses, remain unknown. In this study, we utilized immunopeptidomics to identify a retained peptide specific from Ascaris that is sequestered and presented by pulmonary macrophages via MHC-II. We further demonstrated that this retained peptide serves as an epitope which is associated with the development of specific T helper cell populations that persist long after the infection has cleared. These findings define a potential molecular mechanism for persistent helminth-induced immune cell activiation in the lungs and identify a retained epitope as a potential contributor to the development of chronic pulmonary inflammation following parasite elimination from the lungs.

Correction: Identification of Leishmania spp. and Trypanosoma cruzi in bats captured in El Paso County, Texas

2026-06-09T14:00:00Z

by Juan C. Silva-Espinoza, Priscila S. G. Farani, Edith Sandoval, Maria Fernanda Lopez, Felipe Rodriguez, Kenneth A. Waldrup, Delfina C. Domínguez, Rosa A. Maldonado

Predictive modeling of localized mobile app to improve Snakebite Management in Ghana

2026-06-08T14:00:00Z

by Eric Nyarko, Aashna Uppal, Nicholas Amani Hamman, Louis Agyekum, Pascal Antwi, Nuhu Mohammed, Obu-Amoah Ampomah, Iddrisu Abugbil Atubiga, Trudie Lang

Background

Snakebite envenoming (SBE) is a significant yet often overlooked public health crisis that primarily affects impoverished communities. Mobile applications (apps) can be effective tools for managing snakebites. To meet the World Health Organization’s (WHO) goal of reducing SBE by 50% by 2030, app developers must consider regional users’ preferences to ensure their apps provide relevant and accurate information. This study predicted the importance of various functionalities of a mobile app for managing snakebites based on user preferences. Our objective was to provide quantitative evidence on which functions should be prioritized to inform the development of a customized local app to enhance snakebite care in Ghana.

Methods

A cross-sectional survey using a quantitative statistical experiment design method was conducted to identify healthcare workers’ preferences for vital mobile app functions for managing snakebites. Participants were selected from two deprived and predominantly rural districts in the Eastern region of Ghana through a multi-stage sampling technique. The attributes used in the questionnaire were developed based on literature reviews and focus group discussions, and a statistical block design was employed to create the choice tasks. To rigorously evaluate the performance of the machine learning (ML) models and reduce the risk of overfitting, we employed 5-fold cross-validation and multiple evaluation metrics. The data were analyzed using seven ML models.

Results

The four most vital mobile app functions identified by the participants were “step-by-step assistance for victims and first responders” (utility estimates (β) =0.3924; 95% confidence interval (CI): 0.3183 to 0.4665), “providing educational and training materials” (β = 0.2243; 95% CI: 0.1500 to 0.2987), “identifying venomous snakes through clinical evidence or symptoms” (β = 0.1718; 95% CI: 0.0982 to 0.2454) and “identifying venomous snake biodiversity in your area/region” (β = 0.0898; 95% CI: 0.0176 to 0.1620). Conversely, the app functions that were less favored included “platform for sharing snakebite treatment experiences” (β = -0.2503; 95% CI: -0.3268 to -0.1738) and “designing educational games about snakes” (β = -0.3995; 95% CI: -0.4737 to -0.3252). These findings align with subgroup analyses by gender, suggesting a consistent understanding of needs across different demographic groups.

Conclusions

This study provides quantitative evidence on which mobile app functions should be prioritized to inform the development of a customized local app to improve management and care for snakebite victims in Ghana and other sub-Saharan African countries.

Multivariate predictive model for predicting in-hospital mortality in HIV-associated talaromycosis: a multicenter retrospective study

2026-06-08T14:00:00Z

by Zhikai Wan, Mengyan Wang, Weiwei Zhang, Yu Zhou, Biao Zhu

Background

Talaromycosis is an invasive fungal infection that predominantly affects immunocompromised individuals, with a particularly high incidence and mortality rate among HIV-infected patients. The purpose of this study was to develop and validate a novel nomogram model to predict mortality risk in HIV-associated talaromycosis (HTM) patients.

Method

The authors retrospectively analyzed HTM patients from January 2013 and December 2023 at three research centers. The research participants were randomly divided into the training and validation set at a ratio of 7:3. To determine the crucial variables for establishment of the predictive model, the study sequentially applied univariate logistic regression, lasso regression, stepwise logistic regression. validation set was used to assess the performance of the established prediction model, with its efficacy evaluated through receiver operating characteristics curve, clinical decision curves, and calibration curves.

Result

A total of 431 subjects were enrolled in the study with 55/431 (12.76%) patients died during hospitalization. Statistical analysis shows that there was no difference between training set and validation set in the baseline demographic and clinical characteristics. Five factors including breathlessness, elevated TB, APRI, CRP and decreased Hb were identified as predictive factors for HTM mortality. A nomogram model was built and the area under the curve (AUC) for the nomogram in predicting death was 0.83 (95% CI: 0.76-0.90) in the training set and 0.81 (95% CI: 0.70-0.93) in the validation set. The H-L test and calibration curves showed a strong alignment between predicted and actual results in both sets. Additionally, the decision curve analysis (DCA) indicated that the model provided significant net benefits for patients experiencing poor outcomes.

Conclusion

The nomogram model developed in this study integrating easily accessible clinical indicators and symptoms is effective in predicting in-hospital mortality in patients with HTM, which will greatly assist clinicians in the individual management of HTM patients.

Government health care worker training needs for intestinal schistosomiasis morbidity management

2026-06-08T14:00:00Z

by Phyllis Munyiva Isaiah, Betty Nabatte, Lauren Wilburn, John Bosco Oryema, Noah Ukumu, Morris Okumu, Juma Nabhonge, Hilda Kyarisiima, Prudence Beinamaryo, Victor Anguajibi, Christopher K. Opio, Narcis B. Kabatereine, Goylette F. Chami

Background

Schistosomiasis causes substantial chronic morbidity in sub-Saharan Africa, yet case definitions, clinical management guidance, and health worker training for schistosomiasis-related morbidity remain limited.

Methods

We conducted a qualitative needs assessment for schistosomiasis morbidity management. Workshops were held over one day in each of Pakwach, Buliisa, and Mayuge Districts in Uganda in October 2024. 105 government health workers participated including clinicians, nurses, laboratory technicians, sonographers, and district health managers from health facilities at different levels of care. The workshops comprised six structured sessions: presentations on schistosomiasis burden in Uganda and the SchistoTrack cohort, a clinical case report by an expert clinician, an interactive session on patient case studies from the SchistoTrack cohort, mapping of patient pathways, anonymous participation and feedback, and demonstrations of schistosomiasis diagnosis. Workshop discussions were documented through notes taken in English and analysed using qualitative thematic analysis as per Braun and Clarke.

Results

Health workers demonstrated substantial gaps in understanding schistosomiasis case definitions, particularly in distinguishing current infection from chronic morbidity and in grading disease severity. Patient pathways for schistosomiasis morbidity management were fragmented and inconsistent, with weak triage, unclear referral and feedback mechanisms, and limited follow-up across facility levels. Health facilities lacked essential capacity and resources, including routine access to praziquantel outside mass drug administration, diagnostic reagents, functional ultrasound equipment, trained sonographers, and standardized training and reference tools. Collectively, these gaps contributed to inconsistent clinical decision-making and under-recognition of severe schistosomiasis-related morbidity.

Conclusions

Integrating case management into routine health services through standardized case definitions, clearer patient pathways, and targeted practical training for health workers is essential to complement preventive chemotherapy and reduce preventable morbidity. The engagement framework and patient case studies used here can support needs-based assessments in other endemic settings to inform the development of context-appropriate clinical guidance and training programmes.

Ecological signature on the epidemiological dynamics of severe fever with thrombocytopenia syndrome

2026-06-08T14:00:00Z

by Zhe Lou, Jing Lu, Shuyi Liang, Wei Zhao, Ling Huang, Haowei Wang, Xiang Li, Jianli Hu, Ruiyun Li

Background

Severe fever with thrombocytopenia syndrome (SFTS) is prioritized as an emerging tick-borne disease, posing a continuing threat to human populations. Existing evidence has shown that tick-to-human transmission is the primary route of human infection. However, this insight has not been consistently incorporated into studies examining the ecological dependence of vectored disease dynamics.

Methods

We employ an eco-epidemiological model to assess tick abundance in response to the natural environment and its contribution to SFTS transmission. Our statistical model, which integrates demographic, ecological, and behavioural factors, investigates how vector abundance impacts case fatality risk.

Results

Our findings identified a shift in peak incidence from July to May among endemic counties since 2021. Additionally, we show that local climate conditions influence SFTS dynamics by modulating local vector populations, revealing clear spatial heterogeneity in transmission potential across endemic counties. Further investigations suggest that the odds of death are higher for patients living in the areas with higher tick abundance.

Conclusions

These insights emphasize the profound influence of ecological factors on disease dynamics and severity. Therefore, understanding the interrelation between climate and vector population dynamics is crucial for both research and policymaking related to climate-sensitive vectored diseases.

Stranger swings: Temperature-dependent upsides and downsides of a densovirus in Aedes albopictus

2026-06-08T14:00:00Z

by Christophe Boëte, Marco Perriat-Sanguinet, Anne-Sophie Gosselin-Grenet, Patrick Makoundou, Mylène Ogliastro, Mathieu Sicard, Sandra Unal, Mylène Weill, Célestine Atyame

Vector-borne diseases remain a significant global health concern, with the invasive mosquito Aedes albopictus playing a key role in the transmission of arboviruses including dengue, chikungunya, and Zika viruses. As this species expands in novel territories, effective vector control strategies are increasingly critical. Densoviruses (DVs) have emerged as potential biological control agents, either through direct pathogenic effects on mosquito populations or via paratransgenesis. However, the influence of combined environmental factors, such as temperature and densovirus infection on mosquito life-history traits remains largely unexplored. In this study, we investigated the effects of different temperatures (28°C, 31°C, and 34°C) and exposure to the densovirus AalDV2 on the survival of Ae. albopictus and on several mosquito life-history traits including its development time, size and symmetry at adult stage. Larvae were individually reared under controlled conditions and exposed to AalDV2 or a control treatment. Temperature had a strong threshold-like effect on survival, with dramatic mortality increases at 34°C. Unexpectedly, AalDV2-infected larvae showed significantly higher survival than controls at this extreme temperature, suggesting a protective effect under thermal stress. Across all temperatures, viral infection delayed pupation in a sex-dependent manner, with females experiencing greater delays and reduced adult wing size. Quantitative PCR revealed high infection rates (>96%) across all conditions with a viral load increasing with higher temperature in a sex-dependent manner. Our findings reveal a paradoxical outcome: while AalDV2 imposes fitness costs through delayed development and reduced body size, it confers an unexpected survival advantage at the extreme temperature. This represents the first documentation of temperature-dependent protective effects by an entomopathogenic virus in mosquitoes, challenging conventional assumptions about pathogen impacts. These results have critical implications for vector biocontrol strategies in a warming climate, as densovirus deployment could inadvertently enhance mosquito resilience in heat-stressed regions. Further research is needed to elucidate the underlying mechanisms and assess the impact on mosquito population dynamics.

Preclinical animal models for onchocerciasis and loiasis: A systematic review of applications in drug screening

2026-06-08T14:00:00Z

by Rene Bilingwe Ayiseh, Blendin Serri Gemuh, Glory Enjong Mbah, Stephen Mbigha Ghogomu, Fidelis Cho-Ngwa

Background

Onchocerciasis and loiasis are co-endemic filarial neglected tropical diseases in Central and West Africa. While ivermectin-based mass drug administration has reduced onchocerciasis burden, it can trigger severe neurological adverse events in individuals with high Loa loa microfilaraemia. This limitation highlights the urgent need for safe macrofilaricidal therapies and appropriate preclinical models.

Methodology/Principal findings

We conducted a systematic review following PRISMA guidelines to evaluate animal models used for preclinical drug screening in onchocerciasis and loiasis. Studies published between 1990 and 2025 were retrieved from PubMed and Google Scholar, and one-hundred and one eligible study were included in the qualitative synthesis. Models were assessed based on parasite stage permissiveness, survival duration, physiological relevance, host immune status, and suitability for drug evaluation. The bovine Onchocerca ochengi natural infection system emerged as the most physiologically relevant model, supporting the full parasite life cycle. Immunocompromised mouse models, including SCID and humanised NSG mice, allow controlled evaluation of parasite development and direct drug effects but incompletely reproduce human infection. Intraperitoneal adult male O. ochengi implant models in SCID mice and gerbils provide robust platforms for macrofilaricide screening. Semi-permissive rodent models offer practical systems for early-stage screening but are limited by non-physiological parasite localisation. For loiasis, non-human primate models, particularly Papio anubis, remain the most representative system.

Conclusions/Significance

No single model fully recapitulates human co-endemic infection. While the bovine model remains the gold standard, rodent implant models enable scalable screening. The absence of a physiologically relevant co-infection model remains a major barrier to developing safe macrofilaricides.

Beneficiary feedback mechanisms: Exploring ways to systematically integrate community feedback in mass drug administration delivery for NTDs

2026-06-08T14:00:00Z

by Jake D. Mathewson, Charlie Aardewijn, Sake J. de Vlas, Dunstan J. Matungwa, Mirjam I. Bakker

Background

Neglected tropical diseases (NTDs) affect over one billion people globally and disproportionately impact marginalized populations in low- and middle-income countries. Mass drug administration (MDA) is the WHO recommended strategy for controlling five major NTDs. However, persistent operational challenges, like treatment fatigue, mistrust, and systematically missed populations, undermine MDA effectiveness. Beneficiary Feedback Mechanisms (BFM) are emerging tools in global health that enable structured collection of community input to improve program delivery, but their application in NTD programs remains limited and understudied. This study examines how BFM are operationalized within routine MDA programs, providing operational insight into their perceived value, practical applications, and implementation challenges across diverse stakeholder roles.

Methods

This study used semi-structured key informant interviews (KII) to examine how BFM can be operationalized to enhance MDA delivery. Interviews were conducted with 14 informants involved in MDA implementation, funding, monitoring and evaluation, and research, primarily across countries in sub-Saharan Africa that were supported by the Accelerating the Sustainable Control and Elimination of Neglected tropical Diseases (ASCEND) program. Participants were selected purposively based on their professional experience with BFM and MDA. Transcripts were analyzed using a thematic analysis approach in NVivo software, applying both inductive and deductive coding strategies to identify patterns and develop meaningful themes.

Results

Informants identified that BFM yielded timely and actionable feedback, particularly through daily community drug distributor meetings and post-MDA surveys, as the most impactful. Integrating BFM into existing systems was favored over new platforms, particularly in resource-constrained settings. Key barriers included limited integration into digital monitoring systems and lack of dedicated personnel to review and respond to feedback. BFM also highlighted issues that may have hindered optimal drug coverage in some communities, including gender barriers and misinformation. Informants emphasized that closing the loop, communicating back to communities how their feedback was used, was essential to maintaining trust and engagement in future MDA activities.

Conclusions

BFM were perceived by informants as a promising pathway to enhance the equity, responsiveness, and effectiveness of MDA programs. Their success depends on timely use, integration into routine systems, and capacity to address community concerns. Multilateral organizations such as WHO can support scale-up by issuing guidance and standardizing tools. Further research is needed to evaluate impact and best practices for implementation.

Discovery of a novel coltivirus in a newly identified Bat Bug Species (Heteroptera: Cimicidae) in Cambodia

2026-06-08T14:00:00Z

by Jurre Y. Siegers, Heidi Auerswald, Pierre-Olivier Maquart, Tamara Szentiványi, Julia Guillebaud, Thavry Hoem, Xiang Li, Kimhuor Suor, Leakhena Pum, Limmey Khun, Sithun Nuon, Kimlay Chea, Vireak Heang, Kathrina Mae Bienes, Yvonne C.F. Su, Veasna Duong, Janin Nouhin, Sébastien Boyer, Erik A. Karlsson

Bats and their ectoparasites are significant reservoirs and potential vectors of emerging zoonotic pathogens, yet the viral diversity within bat-associated arthropods remains poorly characterized. This study reports the identification of a novel coltivirus (order Reovirales), provisionally designated Stricticimex coltivirus (SCCV), in a newly described bat bug species, Stricticimex phnomsampovensis, collected from cave-dwelling wrinkle-lipped free-tailed bats (Mops plicatus) in Cambodia. Metagenomic sequencing and phylogenetic analysis revealed that SCCV clusters within the Coltivirus genus, showing closest similarity to Tai Forest Reovirus (TFRV) previously isolated from African bats. SCCV was detected in 18.4% of examined bat bugs and successfully isolated in VeroE6 cells, with replication confirmed in multiple mammalian cell lines. The discovery of SCCV extends the known diversity and geographic range of coltiviruses and highlights bat ectoparasites as overlooked hosts of potentially zoonotic viruses. These findings underscore the importance of integrated One Health surveillance targeting both bats and their ectoparasites to better assess the risk of pathogen spillover in biodiverse regions with high human-animal contact.

Plasma proteomics improves risk prediction in heart failure and reveals unique biology in chronic chagas cardiomyopathy

2026-06-08T14:00:00Z

by José S. L. Patané, Fernando R. Giugni, Rogério S. Rosa, Fabiana G. Marcondes-Braga, Alfredo J. Mansur, Alexandre C. Pereira, Jose E. Krieger

Background

Chronic Chagas cardiomyopathy (CCC) remains a major cause of heart failure (HF)–related mortality in Latin America and is increasingly recognized as a global health concern. Prognostic models developed in non-Chagas populations often perform poorly in CCC, highlighting the need for etiology-specific risk stratification.

Methodology/principal findings

We applied high-throughput plasma proteomics to evaluate 2-year mortality risk in CCC compared with other HF etiologies. Baseline plasma from 1,212 adults with heart failure with reduced ejection fraction (HFrEF; LVEF <50%) was analyzed to quantify 734 circulating proteins. CCC was confirmed in 191 participants (16%) by dual Trypanosoma cruzi serology. Two-year mortality was higher in CCC than in the overall HF cohort (26% vs. 16%, p < 0.01). Feature-selection methods identified a nine-protein panel (P9: C1QA, CCL4, REN, EGLN1, COL9A1, GP1BA, ITM2A, CNPY2, NT-proBNP) that improved risk classification compared with NT-proBNP alone, increasing F1-macro by 20% (0.674 vs. 0.560) and integrated time-dependent discrimination for 2-year mortality (iAUC) by 6%. Performance gains varied by HF etiology. Improvements were greatest in hypertensive (+40%) and ischemic (+21%) HF, whereas in CCC the P9 panel underperformed NT-proBNP alone (−16%), suggesting distinct underlying disease biology. External validation in the UK Biobank confirmed generalizability: compared with NT-proBNP, P9 improved F1-macro by 18% and iAUC by 7.4%, reaching an F1-macro of 0.612 in the highest-risk tertile. Pathway enrichment identified 14 CCC-specific pathways, mainly related to fibrosis, integrin signaling, immune dysregulation, and impaired protein trafficking. Exploratory analyses also highlighted potential pathway-linked therapeutic targets consistent with distinct CCC mechanisms.

Conclusions/significance

The P9 proteomic panel improved mortality risk prediction beyond NT-proBNP and the MAGGIC clinical score across most HF etiologies and showed consistent performance in an independent population-based cohort. In contrast, in CCC P9 underperformed NT-proBNP alone, highlighting the distinct biological features of this disease. These findings underscore the limitations of universal biomarker models in CCC and support the need for etiology-specific risk stratification strategies.

Emergence of Marburg virus disease in Ethiopia: Implications for public health preparedness and its impact on Ethiopia’s health system

2026-06-05T14:00:00Z

by Sibhatu Biadgilign, Mesfin Fransua, Anteneh Eshetu, Abdu Bedru

Background

Marburg virus disease (MVD) is a rare but highly lethal viral hemorrhagic fever (VHF) caused by Marburg virus (MARV) and Ravn virus (RAVV). While MVD has historically been limited to specific areas of sub-Saharan Africa, recent outbreaks in previously unaffected countries indicate an expanding ecological and epidemiological risk. In November 2025, Ethiopia confirmed its first-ever MVD outbreak, constituting a significant national and regional public health emergency.

Methods

This narrative review synthesizes publicly available epidemiological data, government situation reports, and official communications from the Ethiopian Ministry of Health (MoH), Ethiopian Public Health Institute (EPHI), Africa Centres for Disease Control and Prevention (Africa CDC), and the World Health Organization (WHO).

Results

The outbreak was initially detected in Jinka town, South Ethiopia Region, an area bordering Kenya and South Sudan. As of 25 January 2026, more than 3,800 diagnostic tests were conducted, leading to a total of 19 cases comprising 14 confirmed (including nine deaths) and five probable (all deaths) and five recoveries from MVD in the country’s South Ethiopia and Sidama regions, which were reported. A total of 857 contacts listed for monitoring all had completed their 21-day follow-up as of 25 January 2026. Ethiopia’s response included rapid notification, laboratory confirmation, activation of incident management systems, deployment of mobile high-biosafety laboratories, establishment of isolation and treatment centers, and issuance of national clinical management guidelines. International partners provided technical, financial, and logistical support. However, the outbreak exposed ongoing challenges, including health system fragility, workforce shortages, misinformation, funding limitations, and heightened cross-border transmission risk.

Conclusion

The emergence of MVD in Ethiopia represents a pivotal moment for national and regional health security. Sustained containment will require strengthened surveillance, community engagement, cross-border collaboration, and integrated One Health approaches. Long-term investment in resilient health systems and coordinated regional preparedness is essential to prevent future spillover events and protect vulnerable populations.

Plant-based therapeutics for leishmaniasis: A systematic review emphasizing human studies and clinical trial evidence

2026-06-05T14:00:00Z

by Alberta Serwah Anning, Vanesa Osmani, Stefanie J. Klug, Dorcas Obiri-Yeboah

Background

Leishmaniasis is a parasitic disease caused by Leishmania species and transmitted through sand fly bites, affecting some of the most vulnerable populations globally. Current treatments are limited by high toxicity, poor tolerability, and resistance. Plant-based therapies offer a promising alternative, but human evidence has not been comprehensively reviewed. This review summarizes current evidence on the efficacy and safety of plant-based treatments for leishmaniasis in humans.

Methodology/findings

We conducted a systematic review including studies that evaluated the efficacy and safety of plant-based treatments for leishmaniasis in humans. This review was registered with PROSPERO (ID: CRD42024567764). We searched PubMed, Scopus, and Web of Science from inception to May 28, 2024. Risk of bias was assessed using the Cochrane RoB 2 tool. We summarized the main study results qualitatively and quantitatively (where possible) by estimating risk ratios with 95% confidence intervals for treatment outcomes using the meta package in R. Ten studies met the inclusion criteria, nine from Iran and one from Sudan, all focused on cutaneous leishmaniasis (CL). Most used topical creams derived from medicinal plants, either alone or with conventional treatments. In studies combining herbal and standard treatments, four of six studies showed better outcomes in the intervention group. In studies using only the plant-based treatments compared to a standard treatment group, two of four showed better outcomes in the intervention group. Quantitative analysis of eight studies indicated significant healing improvements in the intervention group in three studies, specifically those using Juniperus excelsa, Nigella sativa, and poly-herbal formulations consisting of the pure extract mixture of Althaea (A.) rosa, A. officinalis, and members of the families Leguminosae, Faliaceae, Malvaceae, and Lythraceae (named Z-HE). Mild side effects such as itching and burning were reported with some herbal treatments, while conventional therapies caused more severe reactions in some cases. The risk of bias was mostly high in the studies.

Conclusions

This review highlights the potential of certain plant-based compounds as adjunct or alternative therapies for CL. Despite promising results with Plantago ovata, Juniperus excelsa, and Z-HE poly-herbal extracts, current evidence is limited by methodological weaknesses. Larger, rigorously designed trials with broader representation are needed to confirm efficacy and safety and support policy integration in endemic regions.

A systematic mapping review of therapeutic clinical trials in dengue

2026-06-05T14:00:00Z

by Tran Bang Huyen, Angela McBride, Tun-Linn Thein, Khoi Minh Le, Tran Luu, Nguyen Quang Huy, Eli Harriss, Matthew J.W. Kain, Jonathan Cattrall, Caitlin Naylor, Ho Quang Chanh, Nguyen Lam Vuong, Daniel Munblit, Po-Ying Chia, Phung Khanh Lam, James A. Watson, Sophie Yacoub

Background

Dengue is a growing public health threat with increasing case numbers globally. Despite the substantial burden, there are no licensed therapeutics for patients with dengue. To inform the design of large-scale practice-changing clinical trials and to assess the feasibility of an individual patient data platform for meta-analysis, we conducted a systematic mapping review of clinical trials evaluating dengue therapeutics. Our aims were to characterise published and registered dengue therapeutic trials, describe their endpoints, and assess study design quality and internal validity to inform feasibility of meta-analysis and future research.

Methods

We systematically searched Ovid MEDLINE, Ovid EMBASE, WHO ICTRP and ClinicalTrials.gov for prospective clinical trials evaluating therapeutics in patients with symptomatic dengue. Two independent reviewers screened records using Covidence. Data were extracted into a REDCap database, and risk of bias was assessed using the ROB-2 and ROBINS-I tools to describe trial design rigour. Descriptive analyses summarised the interventions, trial characteristics, study populations, and primary endpoints. This systematic review was pre-registered with PROSPERO (CRD42023469022).

Results & discussion

A total of 121 clinical studies were identified, comprising 72 published trials and 49 registered but unpublished studies. Interventions were categorised according to the authors’ proposed mechanism of action: antiviral (n = 10), host-directed (HDT, n = 34), supportive (n = 31), or undefined (n = 46). Aside from the studies of supportive therapies (n = 31) and unpublished studies (n = 37) which were only reviewed for their primary outcomes, 53 publications remained for review of therapeutic efficacy. Methodological concerns were common – 24 of 53 published trials (45%) were classified as having high or critical risk of bias. Corticosteroids were the most frequently evaluated intervention, involving a total of 944 randomised patients. The primary endpoints used in both antiviral and HDT trials were highly heterogeneous, limiting comparability. The combination of methodological concerns and non-standardised endpoints precluded meta-analysis for any intervention. No single treatment had sufficient or consistent evidence to support recommendations for use in clinical practice.

Conclusions

Our findings highlight a remarkably sparse evidence base for dengue therapeutics and a lack of standardised, clinically meaningful endpoints. These factors have hindered progress in evaluating candidate treatments and limited the potential for individual patient data meta-analyses. Large, high-quality trials - powered for harmonised and clinically relevant endpoints - are urgently needed to advance the development of effective therapies for dengue.

Accelerating vaccine research and development for skin neglected tropical diseases: A case for leishmaniasis, leprosy, and Buruli ulcer

2026-06-05T14:00:00Z

by Hua Wang, Fernanda Oliveira Novais, Maria Adelaida Gómez, Stephen Muhi, Camila I. de Oliveira, Thao-Thy Pham, Samantha Vermaak, VALIDATE Network Skin NTDs Working Group , Rajko Reljic

Neglected tropical diseases (NTDs), particularly those with prominent cutaneous manifestations such as leishmaniasis, leprosy, and Buruli ulcer, represent a substantial global health burden, affecting hundreds of millions of people and perpetuating cycles of poverty and disability. Despite the current availability of treatment strategies, vaccines remain the most sustainable and cost-effective intervention that can reduce reliance on chemotherapeutics. However, vaccine research and development (R&D) for these diseases face considerable challenges that cannot be overcome without a strategic shift in response by national and international health programmes and organisations, research funders, and the pharmaceutical industry. This paper draws on collective insights from the VALIDATE Network workshop on “Vaccines for Skin Neglected Tropical Diseases—Progress and Challenges” (Bogotá, Colombia, 5–8 May 2025). We advocate for a multisectoral shift across three critical pillars: i) an increase in funding for NTD vaccine R&D, ii) integration of NTD vaccine R&D into the preparedness and response policies by international agencies and local governments, and iii) fostering patient and public engagement and advocacy for NTD vaccine R&D and implementation. Coordinated efforts across these three pillars will unlock the transformative potential of vaccines and substantially reduce the health, societal, and economic burdens from these diseases.

Development of a deep learning based framework for classification of Indian venomous snakes integrated with explainable artificial intelligence for primary and emergency care providers

2026-06-05T14:00:00Z

by Ikhlaas Ifthikar Abusayeed Manna, Usha Wagle, Badhrinarayanan Balaji, Vrinda Lath, Niranjana Sampathila, P. Sudhakara Upadya, Freston Marc Sirur

Background

Snakebite envenoming is a significant global health crisis that has been long neglected as a global health priority. It is a huge problem for rural communities of low and middle-income countries, India accounts for the largest proportion of snakebite deaths globally. Timely identification of venomous snakebite and its syndromic pattern is essential for effective administration of antivenom and supportive treatment. Expert identification of snake species and syndromes is not always available in peripheral healthcare settings. This leads to delays, unnecessary referrals, or improper treatment choices. Additionally, diverse snake species distribution and venom variations across regions pose challenges. AI-powered image classification methods can help overcome these barriers. We propose a clinically oriented deep learning pipeline for binary classification of venomous and non-venomous snake species of India using real-world imagery data. This pipeline would serve as a baseline step towards aiding snakebite management at peripheral healthcare setups with scarce resources.

Methods

The selected dataset consisted of 20 medically important Indian species. MobileViT-S, ConvNeXt-Tiny, EfficientNet-V2-S and ResNeXt-50 (32 × 4d) were trained under same conditions for comparison of results. Model interpretability was evaluated using Grad-CAM ++ to ensure that classification was not performed based on background but on features like head shape and stripes present on body. For reliable implementation we connected it to a web interface with human in loop expert verification. Experts can confirm or override predictions in real time.

Results

Among the evaluated architectures, ResNeXt-50 (32 × 4d) showed the most reliable and consistent performance in classifying venomous and non-venomous snakes. It achieved the highest test accuracy, sensitivity, specificity, and F1-score. The model also had strong discriminative ability, with a ROC-AUC of 0.9950 and PR-AUC of 0.9959. These results indicate dependable performance in safety-critical screening situations. Grad-CAM++ visualizations confirmed that predictions were based on anatomically relevant features, especially in the head and body contour areas. This supports model interpretability and reduces background bias.

Conclusions

Although the dataset size and single-institution source limit how widely the results can be applied, the proposed framework shows that it's possible to create a clinically oriented, ready-to-use deep learning system for snakebite triage support. This system is intended as a scalable tool to help rural healthcare workers, emergency responders, and telemedicine platforms in areas where snakebites are common.

An intuitive sampling framework for setting-specific decision-making in soil-transmitted helminthiasis control programs

2026-06-05T14:00:00Z

by Adama Kazienga, Bruno Levecke, Sake J. de Vlas, Luc E. Coffeng

Background

We recently developed a general egg count framework to support cost-efficient survey design choices to inform soil-transmitted helminthiasis (STH) control programs. Yet, the interpretation and the application was not always intuitive for program managers.

Methods

We first adapted the existing framework to make the interpretation of risks of incorrect decision making more intuitive and to allow for prior information. Then, we assessed the impact of the allowable risk of incorrect decision-making and prior information on the required sample size. Finally, we determined the most cost-efficient survey design to inform the decisions (i) to switch to an event-based deworming program, and (ii) to declare STH eliminated as a public health problem (EPHP).

Principal findings

The required sample sizes increased when the allowable risk of incorrect decision reduced and when the mean prior approached the program prevalence threshold. For the decisions to switch to event-based deworming and to declare EPHP, we found that duplicate Kato-Katz thick smears on a single stool sample was the most cost-efficient survey design, particularly when accounting for the added benefits of the free internal quality control. The required sample size for these survey designs varied between program targets and STH species. When aiming to have one sample size that fits all STHs, we recommend sampling 6 schools and 56 children per school for decisions on switching to event-based control programs and 11 schools (74 children per school) for the decision to declare EPHP.

Conclusions/significance

We developed an intuitive sampling framework for setting-specific decision-making in STH control programs. We identified the most cost-efficient survey designs for critical program decisions, but these are based on subjective but reasonable choices regarding the risk of incorrect decision making. Reaching consensus within the STH community on acceptable levels of risk is crucial to further support evidence-based decision-making.

Severe visceral leishmaniasis in Ethiopia: Outcomes, co-infections and mortality in a prospective real-world cohort

2026-06-05T14:00:00Z

by Eleni Ayele, Saskia van Henten, Desalew Getahun Ayalew, Saba Atnafu, Asnakew Engidaw Mereed, Hana Yohannes, Tigist Mekonnen, Tadfe Bogale, Aman Mossa, Gebrehiwot Lema Legese, Jemal Yasin, Nicole Berens-Riha, Thao-Thy Pham, Carl Boodman, Annelies Mondelaers, Wim J. Adriaensen, Saïd Abdellati, Ermias Diro, Rezika Mohammed, Fabiana Alves, Mezgebu Silamsaw Asres, Myrthe Pareyn, Mekibib Kassa, Johan van Griensven

Background

Visceral leishmaniasis (VL) remains a major public health challenge in East Africa, particularly in Ethiopia. Clinical trials on VL often exclude patients with severe comorbidities or laboratory abnormalities, limiting the generalizability of evidence used to guide real-world management. We comprehensively characterised the clinical profile, treatment outcomes, and mortality of VL patients treated in a referral centre.

Methodology and principal findings

This prospective cohort study enrolled patients at the Leishmaniasis Research and Treatment Center (LRTC), University of Gondar (02/2023-06/2024). All VL cases fulfilling eligibility criteria underwent detailed clinical, laboratory, and radiological assessments. VL treatment followed WHO guidelines. Outcomes, adverse events, and supportive care measures were recorded during treatment and over a 12-month follow-up period. Patients meeting at least one exclusion criterion (e.g., comorbidities, clinical signs of severe VL) of standard phase III VL treatment trials were defined as trial-ineligible patients and compared with trial-eligible patients. A total of 314 VL patients, mostly young adult males (median age 22 years), were enrolled. Of these, 21 (6.7%) had HIV co-infection; 204 (65%) met ≥ 1 key exclusion criterion typically used in VL clinical trials. Trial-ineligible patients had high parasitemia, more concurrent infections, more pronounced clinical and laboratory abnormalities and a higher need of supportive care measures including systemic antibiotics and blood transfusion. Overall cure rate was 90.1%. Mortality after the first VL treatment course was 6.4%, ranging from 1.8% in trial-eligible patients to 8.8% in trial-ineligible patients. Leading causes of death included severe bacterial infections, acute liver failure and haemorrhagic complications.

Conclusions

These findings underscore the severity and complexity of VL in routine care in our study population, and highlight the limitations of current trial populations to inform broader clinical practice. Strengthening supportive care and expanding research inclusivity designed to respond to the needs of this patient population are critical to achieve VL elimination targets.

Xeno-monitoring the impact of Vector Control on trypanosome transmission in the Forecariah sleeping sickness focus (Guinea)

2026-06-05T14:00:00Z

by Abdoulaye Dansy Camara, Patrice Boedouno, Issiaga Camara, Aissata Soumah, Mohamed Kébé, Jeannette Koivogui, Brice Rotureau, Jean-Mathieu Bart, Bruno Bucheton, Alexandre Delamou, Adrien Marie Gaston Belem, Moise Kagbadouno, Mamadou Camara

Background

Forecariah is one of the most active foci of gambiense human African trypanosomiasis (gHAT) in Guinea. The study aimed to evaluate the impact of a vector control intervention carried out in this focus from 2018 to 2021. To achieve this, thousands of deltamethrin-impregnated blue tiny targets were deployed annually.

Methodology and principal findings

Thirty-one sentinel traps were used to assess the following entomological and parasitological parameters: (i) the apparent density (AD) of tsetse flies, monitored twice per year; (ii) the tsetse fly infection rates, evaluated once per year; and (iii) the trypanosome species, determined by molecular approaches before and after three years of vector control. Prior to the VC campaign, significantly higher densities of Glossina palpalis gambiensis were observed in the mangroves (AD = 17.2 F/T/D) than in mainland areas (AD = 6.2 F/T/D). Just 18 months after the start of the VC campaign, the maximum reduction in AD was reached (mean AD = 1.1 F/T/D; p < 0.001; 92% reduction) and was maintained throughout the campaign. Prior to VC, 18 out of 31 (58%) sentinel traps presented at least one infected fly observed by microscopy, whereas only two out of 31 (6%; p = 0.002) traps were positive after three years of VC. Molecular analysis of the tsetse midgut revealed positivity for T. brucei sl DNA in 45.2% of the traps prior to the VC baseline. T. congolense and T. vivax were observed in 6.5% of traps. Although one T. b. gambiense infection, which is responsible for human disease, was detected three years after the introduction of vector control, a significant decrease in T. brucei sl PCR positivity was observed (45.2% versus 22.6%; p = 0.05), whereas a slight increase was observed for T. vivax (6.5% versus 16.1%), while T. congolense trap positivity (6.5%) remained stable.

Conclusion

In Forecariah, the prevalence of the disease was reduced by 76% during the study period. Hence, these results further emphasize that implementing vector control alongside medical control is an effective way of reducing the transmission of parasites to humans.

Estimating the distributional impact of improving access to snake antivenom in urban and rural Lao People’s Democratic Republic: An extended cost-effectiveness analysis

2026-06-04T14:00:00Z

by Chanthawat Patikorn, Thanapol Khuharatanachai, Jeong-Yeon Cho, Suthira Taychakhoonavudh, Mayfong Mayxay, Khamlub Senbounsou, Joerg Blessmann, Nathorn Chaiyakunapruk

Introduction

Snakebite is a significant public health issue in the Lao People’s Democratic Republic (PDR), with victims often seeking traditional healers due to inadequate antivenom supply and high out-of-pocket (OOP) expenses, contributing to inequities between urban and rural populations.

Methods

An extended cost-effectiveness analysis (ECEA) was conducted to evaluate the distributional impact of improving access to antivenom in urban and rural Lao PDR, where all victims with systemic envenoming clinically indicated for antivenom receive antivenom at conventional hospitals, on disease burdens (deaths and disability-adjusted life years [DALYs]) and economic burden (%household OOP expenditure per monthly income). Sensitivity analyses were performed.

Results

Rural areas had higher mortality (3.14 vs. 0.35, +2.79 per 100,000 population), DALYs lost (78.97 vs. 8.86, +70.11 per 100,000 population), and household OOP expenses (39% vs. 38%, +1% of household monthly income) than urban areas. Full access to antivenom reduced health inequities in mortality (from +2.79 to +1.22 per 100,000 population) and DALYs (from +70.11 to +32.14 per 100,000 population) but increased inequities in household OOP expenses (from +1% to +39% of household monthly income). These differences had considerable uncertainties. Sensitivity analyses showed that free snakebite treatment and transportation costs with one caregiver reduced household OOP expenses in both areas (5% rural, 6% urban).

Conclusions

While improving access to snake antivenom mitigates health inequities in disease burden, it exacerbates financial inequities between urban and rural areas. Policies targeting equitable access to care and financial protection are critical to achieving health equity for snakebites in the Lao PDR.

Epidemiological insights and genetic diversity of the Duffy binding protein of Plasmodium vivax in Duffy-negative Cameroonians

2026-06-04T14:00:00Z

by Cheikh Cambel Dieng, Rene Teh Ning, Canelle Kipayko, Regan Elizabeth Schroeder, Nontokozo Mdluli-Berndt, Bate Ayukenchengamba, Zidedine Nematchoua Weyou, Tabi Doris Sona, Ambendekson Elizabeth Reward, Guofa Zhou, Irene Sumbele Ngole Ule, Helen Kuokuo Kimbi, Eugenia Lo

Background

Malaria remains a major public health concern in sub-Saharan Africa. Plasmodium vivax (P. vivax), historically considered rare due to the predominance of Duffy-negative individuals, is increasingly reported in Central and West Africa. The ability of P. vivax to infect Duffy-negative populations challenges long-standing assumptions regarding parasite invasion biology and highlight surveillance gaps across Africa.

Methodology/Principal findings

This study investigated P. vivax prevalence and genetic diversity across three ecological zones in Cameroon. A total of 1,373 samples were screened by microscopy, rapid diagnostic tests (RDTs), and qPCR; and all participants were genotyped for Duffy antigen status. PvDBP1 region II was successfully sequenced from 75 P. vivax isolates. P. vivax prevalence was 10.8% among hospital patients (86/793) and 5.5% in community participants (32/580), and all confirmed infections occurred in Duffy-negative individuals. Hospital infections exhibited significantly higher parasitemia than asymptomatic cases. PvLDH-based RDTs failed to detect over 85% of qPCR-confirmed infections. Genetic analysis of PvDBP1 identified eight nonsynonymous mutations, with I379L (74.1%) and E225K (61.3%) as the most common variants, suggesting possible adaptive evolution. Phylogenetic analysis clustered Cameroonian P. vivaxisolates with those from Botswana, distinct from East African and Asian lineages, indicating regional adaptation and potential gene flow within Central-Southern Africa.

Conclusion/Significance

This study provides the first integrated epidemiological and PvDBP1 genetic characterization of P. vivax infections in Duffy-negative Central Africans, revealing widespread subclinical infections and poor diagnostic performance of current PvLDH-based RDTs. The observed genetic signatures of adaptation highlight the urgent need to prioritize P. vivax within national malaria programs and investigate alternative invasion pathways beyond PvDBP1 to guide improved diagnostic and vaccine strategies.

Prevalence of multiple human intestinal parasites across diverse environments in Madagascar

2026-06-04T14:00:00Z

by Stephanie M. Wu, Sarina S. Gupta, M. Ando Ravelomanantsoa, Santino Andry, Daniel F. Viana, Jessica Zamborain-Mason, Uwajachukwumma A. Uzomah, Hervet J. Randriamady, Chase Howard, Graham Friedman, Amanda Castonguay, James Hazen, Danny A. Milner Jr., Benjamin L. Rice, Christopher D. Golden

Background

Intestinal parasitic infections affect more than 1·5 billion people globally, leading to severe health consequences such as malnutrition, anemia, diarrhea, and impaired cognitive development.

Methodology/Principal findings

Samples were collected from 3,872 individuals (all ages and both sexes) across 31 rural communities in Madagascar between 2013 and 2017, representing diverse ecological and socioeconomic regions. Intestinal parasite prevalence was assessed by fecal microscopy. Bayesian multilevel logistic regression models were used to estimate overall and regional prevalences while accounting for demographic and spatial variability.Parasite prevalence varied widely across Madagascar, with the highest rates observed for Ascaris lumbricoides (22·0%) and Trichuris trichiura (15·3%), followed by Hymenolepis nana (up to 10·5%), hookworm (up to 8·1%), Strongyloides (0·5%), and Schistosoma mansoni (0·5%). Infection burden was greatest in the northeast and southeast—especially among school-aged children aged 5–19. Sex differences were minor, except for higher hookworm prevalence in males.

Conclusions/Significance

This study provides the most comprehensive assessment to date of intestinal parasite prevalence across Madagascar, revealing that A. lumbricoides and T. trichiura infections were highly endemic in the humid eastern regions, while H. nana was most common in dry regions. The findings highlight substantial geographic heterogeneity and underscore the need for regionally targeted, multi-sectoral interventions, including improved sanitation and deworming.

Genomic and phylogenetic characterization of severe fever with thrombocytopenia syndrome virus in companion animals in Korea, 2023–2024

2026-06-04T14:00:00Z

by Dong-Yeop Lee, Hong-Jae Lee, Hwi-Yeon Choi, Jason S. Park, Dong-Hun Lee

Background

Severe fever with thrombocytopenia syndrome virus (SFTSV) is a tick-borne Phlebovirus with high fatality rates in humans and expanding geographic distribution in East Asia. Companion animals, including dogs and cats, are increasingly recognized as susceptible hosts that may contribute to viral maintenance and spillover. However, genomic information on SFTSV strains circulating in companion animals in Korea remains limited.

Methodology/principal findings

Between April 2023 and June 2024, 63 SFTSV-positive clinical specimens from dogs and cats were collected across the Republic of Korea. Whole-genome sequencing using a multiplex tiling RT-PCR and next-generation sequencing approach yielded 39 complete viral genomes. Phylogenetic analysis revealed that most viruses clustered within genotype B, including 10 viruses classified as the highly virulent B2 subtype. Five reassortant viruses (12.8%) were identified, comprising four intra-genotypic (B1/B2/B2) and one inter-genotypic (B2/C/B2) reassortants. Multiple amino acid substitutions linked to increased human case fatality, such as RdRp-T1433A (94.9%) and Gn-Q341P (97.4%), were prevalent among companion animal viruses. In addition, mutations within neutralizing antibody epitopes (Y83F, K113R, G218S, P222A, F225L, V323I, and S340N) were detected, several of which significantly reduced antibody binding affinity in silico (G218S, P222A, F225L, and S340N).

Conclusions/significance

This study provides nationwide genomic characterization of SFTSV in companion animals in Korea. The detection of highly virulent subtypes, frequent reassortment, and epitope-altering mutations highlights the evolutionary potential of SFTSV in non-human hosts. The close genetic relationship between animal- and human-derived viruses underscores the risk of cross-species transmission. These findings emphasize the need for integrated One Health surveillance systems linking veterinary and human health sectors to enable early detection, risk assessment, and mitigation of emerging SFTSV threats.

CD163⁺ monocytes and soluble CD163 as prognostic indicators in severe fever with thrombocytopenia syndrome: An integrative analysis

2026-06-03T14:00:00Z

by Jie Wang, Haolin Song, Yi Zhang, Ziling Cheng, Lingtong Huang, Bei Jia, Guangqi Zhu, Lifen Hu, Jihua Xue, Jie Li, Wei Wu, Qi Xia

Background

Severe fever with thrombocytopenia syndrome (SFTS) carries high short-term mortality and lacks approved antiviral therapy, highlighting the need for admission risk tools grounded in upstream host immune pathobiology.

Methods

Public single-cell RNA sequencing (scRNA-seq) data (GSE175499) from 15 SFTS patients (4 non-survivors, 11 survivors) and 4 healthy controls were reanalyzed to map cell–cell communication and identify monocyte subsets and pathways. Findings were validated by bulk RNA sequencing and flow cytometry. A multicenter clinical cohort (n = 150, 132 survivors and 18 non-survivors) measured admission sCD163 using enzyme-linked immunosorbent assay (ELISA) and assessed 30-day mortality using area under the curve (AUC), Kaplan–Meier, and Cox models.

Results

Single-cell analysis identified expansion of CD163 ⁺ intermediate monocytes in SFTS, along with antiviral and complement activation programs in non-survivors. Communication analysis prioritized thrombospondin (THBS) signaling with the dominant sender shifting from CD163 ⁺ intermediate (survivors) to CD163 ⁺ classical monocytes (non-survivors). Flow cytometry confirmed increased CD163 ⁺ monocytes in SFTS. At admission, sCD163 independently predicted 30-day mortality (optimal threshold = 1.17 µg/mL, AUC 0.80). A two-marker model combining sCD163 with blood urea nitrogen (BUN) improved discrimination (AUC 0.87), yielded stepwise separation across three risk tiers (Score 0, 1, and 2) and replicated externally (AUC 0.73 and 0.83). Elevated sCD163 was consistently associated with higher mortality across sex and age subgroups. However, further subgroup analyses within the three-tier risk score were limited by small sample sizes and should be considered exploratory.

Conclusions

We identified and orthogonally validated CD163 ⁺ monocyte programs linked to outcomes, establishing admission serum sCD163 as a biomarker. An admission two-marker score (sCD163 and BUN) provides a simple three-tier admission score that rapidly stratifies 30-day mortality risk and guides intensified monitoring and timely supportive care.

A snapshot of selected neglected tropical disease research using the World Health Organization International Clinical Trials Registry Platform database, 1999–2023

2026-06-03T14:00:00Z

by Rhys Peploe, Hannah Jauncey, Yurika Sakai, Ghassan Karam, Anna Laura Ross, Sarah C. Charnaud, Prabin Dahal, Anthony W. Solomon, Philippe J. Guerin, Caitlin Naylor

Background

Knowledge of clinical study methodology and location can inform researchers, clinicians, funders, and policymakers of the gaps which exist in a disease’s evidence landscape, thereby conferring guidance for appropriate resource allocation. This study summarises registered studies for selected neglected tropical diseases (NTDs) and identifies evidence gaps.

Methodology

The International Clinical Trials Registry Platform (ICTRP) was searched in September 2023 to extract 315 clinical study registrations submitted between January 1999 and September 2023 on Chagas disease, schistosomiasis, soil-transmitted helminthiases, and visceral leishmaniasis. Data were standardised before a descriptive analysis was performed on study location, inclusion age range, study design, phase, and population access to studies.

Results

Registered studies were partially aligned to the geographical distribution of disease burden; countries in which the highest number of studies were registered often face great burden, though there were several endemic countries with few or no studies. The number of registered studies increased over time in the period covered by the review, with 51–62% of studies across the 4 diseases conducted in 2014–23 period, as opposed to 42%-49% in the preceding 15 years. Only 12–17% of studies were multi-country studies across the 4 NTDs. 14% of Chagas disease studies included children under the age of 16 years (much lower than other NTDs) and only 2 studies (2%) exclusively studied under 16s.

Conclusions

These findings highlight areas of research for these diseases which have been neglected between 1999–2023, indicating need for further research to fill these gaps and aid progress towards the World Health Organization’s roadmaps to elimination of NTDs by 2030.

Knowledge, attitude, and prevention practices of cutaneous leishmaniasis in highly-endemic rural areas of Kandahar province, Afghanistan: A large cross-sectional community-based study

2026-06-03T14:00:00Z

by Bilal Ahmad Rahimi, Sharafuddin Resha, Mohammadullah Khaksar, Khwaja Mir Islam Saeed, Hashmatullah Osmani, Abdul Baqi Daqiq, Habiburahman Rahmani, Hikmatullah Saleem, Walter R. Taylor

Background

Cutaneous leishmaniasis (CL) is highly endemic in Kandahar province of Afghanistan, but data on the population’s knowledge of CL and measures they adopt to prevent it are unknown. The main objectives of the study were to study the knowledge, attitude, and prevention practices of CL, and their associated factors, in two highly-endemic rural districts, Daman and Arghandab, in Kandahar province.

Methods

This community-based cross-sectional analytical study took place over seven months, from September 2024–March 2025, in adults. Data were analysed by descriptive statistics, the Chi-square test, and multivariate logistic regression.

Results

A total of 2,118 adults were recruited with a mean age of 35.8 years; 60.3% were males, 56.1% farmers, 91.5% illiterate, and 91.4% from poor families. Among the study participants, 24.1%, 41.5%, and 17.9% had good CL knowledge, a positive attitude towards CL, and good preventive practices towards CL. Independent factors associated with: (i) poor CL knowledge were being not single (adjusted odds ratio [AOR] 1.2), being a farmer (AOR 1.1) and coming from a poor family (AOR 1.3), (ii) a negative attitude towards CL were being aged >40 years (AOR 1.3) female (AOR 1.5), a resident in Arghandab district (AOR 1.2), and literate (AOR 1.1), and (iii) poor preventive practices against CL were being resident of Daman district (AOR 1.6), single (AOR 1.5), and illiterate (AOR 2.5).

Conclusions

The majority of Daman and Arghandab residents had poor CL knowledge, a negative attitude, and poor prevention practices. Our results underscore the need for the Afghan Ministry of Public Health and international donor agencies, such as WHO and UNICEF, to plan and implement strategies to create/increase awareness of CL and measures to prevent and control it in Kandahar Province and beyond.

Geographical disparities and programmatic determinants of hydrocele surgery and lymphoedema management coverage for lymphatic filariasis in the Democratic Republic of the Congo, 2018–2024: A national analysis of routine programme data

2026-06-02T14:00:00Z

by Jean Claude Makenga Bof, Daniel Muteba

Background

Lymphatic filariasis (LF) is a significant neglected tropical disease in the Democratic Republic of the Congo (DRC). Although progress has been made toward interrupting transmission through mass drug administration, LF-related morbidities—particularly hydrocele, lymphoedema, and recurrent acute dermatolymphangioadenitis—continue to cause substantial disability, comorbid infections, and reduced quality of life. National evidence on the burden of LF morbidities and factors associated with access to morbidity management remains limited.

Methods

We conducted a national retrospective analysis of routinely collected programmatic data from the National Neglected Tropical Diseases Control Programme in the DRC between 2018 and 2024. Data included estimates and management of LF-related hydrocele and lymphoedema across endemic provinces. Descriptive analyses assessed morbidity burden, geographic distribution, and temporal trends. Care cascade analyses were performed to quantify attrition across key stages of morbidity management. Multivariable linear regression models at provincial level were used to identify programmatic and health-system factors associated with hydrocele surgery coverage and lymphoedema management coverage.

Results

A total of 8,471 hydrocele cases and 5,310 lymphoedema cases were identified nationwide. During the study period, 2,013 hydrocele surgeries (23.8%) were performed, while 877 lymphoedema patients (16.5%) received the essential package of care. Marked geographic disparities were observed, with several high-burden provinces exhibiting particularly low coverage. Care cascade analyses revealed substantial attrition between case identification and receipt of care for both conditions. In multivariable analyses, hydrocele surgery coverage was positively associated with external partner support and availability of trained surgical personnel, while higher caseloads, post–Transmission Assessment Survey (post-TAS) surveillance phase, and geographic inaccessibility were associated with lower coverage. Lymphoedema management coverage was strongly associated with community-based care activities, health worker training, and availability of basic hygiene supplies.

Conclusions

LF-related morbidities remain a substantial and unevenly addressed public health burden in the DRC, including in provinces that have achieved or are approaching interruption of transmission. Strengthening and scaling up morbidity management and disability prevention services—particularly for lymphoedema and hydrocele—are essential to improve patient quality of life and to meet World Health Organization requirements for elimination of lymphatic filariasis as a public health problem.