Lymphatic filariasis is a vector-borne infectious disease, most commonly caused by Wuchereria bancrofti, that affects 120 million people. It invades the lymphatic system of humans, who are the definitive hosts. We compared the administration of doxycycline with intensified hygiene measures alone in patients diagnosed with bancroftian filariasis. We searched PubMed, Scopus, and Embase and included 12 randomized controlled trials. A random-effects model was used to calculate the mean difference (MD)/risk ratio (RR) and I2 for heterogeneity. The risk of bias and GRADE evaluated the certainty of evidence. Pooled analysis showed a significant reduction in the number of Wolbachia per microfilaria (MD = -3.09; 95% CI: -3.94 to -2.25; P <0.00001, I2 = 42%). Although initial analysis suggested a reduction in microfilarial count, this finding was highly heterogeneous (I2 = 99%) and became nonsignificant upon sensitivity analysis, indicating unstable results. Regarding adverse events, vomiting was significantly more common in the doxycycline group (RR = 6.25; 95% CI: 2.14-18.24; P = 0.0008, I2 = 0%). In conclusion, doxycycline combined with intensified hygiene protocols reduces the Wolbachia burden but shows a limited role in clinically significant lymphedema reduction, and the evidence for microfilarial reduction is not robust. Large-scale trials are required to better combat this neglected tropical disease in endemic populations worldwide.

The immunopathology of cutaneous leishmaniasis (CL) caused by Leishmania aethopica is not well understood. This study aimed to characterize the host's localized immune response in formalin-fixed paraffin-embedded (FFPE) skin biopsies taken from skin lesions of patients who had developed localized CL due to infection with L. aethiopica. A retrospective cross-sectional study was conducted on 40 FFPE skin biopsy samples collected from 2018 to 2022 in the ALERT hospital, Addis Ababa, Ethiopia. Immunohistochemical techniques were used to examine localized immune T helper 1 (Th1) and T helper 2 (Th2) cytokines. GraphPad Prism v. 10 was used for statistical analysis and visualization. The Mann-Whitney U test and Kruskal-Wallis tests were used to compare the median values of different groups of cytokines and cell markers. In comparison with healthy controls (n = 11), localized CL patients (n = 40) had higher expression levels of anti-inflammatory Th2 cytokines (IL-10 and TGF-β) (P <0.0001) than proinflammatory cytokines (IFNγ and TNF-α). Further, when comparing localized CL patients with healthy controls, the median value of CD8 marker expression was slightly higher than that of CD4 marker expression, although not statistically significant. Our immunohistochemical analysis indicates that in the skin lesions of patients with localized CL, L. aethiopica infection is associated with greater local availability of Th2-associated anti-inflammatory cytokines in comparison with Th1-associated proinflammatory cytokines. The current study offers a paradigm for researching local cytokine production in parasitic infection and supports findings linking unique cytokine expression profiles to the immunopathogenesis of human CL.

Pediculosis capitis remains a persistent public health issue, especially in developing countries where resistance to standard neurotoxic pediculicides like permethrin is increasingly prevalent. This study aimed to compare the effectiveness of alternative treatment options against the standard care in a resource-limited setting. We conducted a single-blind randomized controlled trial involving three primary schools in Chachoengsao Province, Thailand (ClinicalTrials.gov: NCT06332872). Eighty-five female participants ages 6-13 years with active infestations were enrolled. Schools were randomly assigned to three treatment arms: 1) oral ivermectin (200 µg/kg) on Days 0 and 7; 2) 1% permethrin shampoo on Days 0 and 7, or 3) 4% dimethicone liquid gel as a single dose on Day 0. The primary outcome was the cure rate, defined as the absence of live lice and viable nits upon clinical assessment on Day 9. Of the 66 participants included in the final per-protocol analysis, oral ivermectin achieved a cure rate of 95.5% (21/22), which was significantly higher than that of the 1% permethrin standard of care (37.0%; 10/27) and the 4% dimethicone physical suffocant (29.4%; 5/17) (P <0.001). Although dimethicone achieved high initial parasitic clearance on Day 0 (88.2%), a rapid reinfestation rate of 58.8% was observed by Day 9, indicating that a single-dose protocol may be clinically insufficient. Adverse events were mild and temporary across all groups. Oral ivermectin appears significantly more effective than both 1% permethrin and single-dose 4% dimethicone in this population. These findings suggest that permethrin resistance is clinically prevalent and relevant in this area.

Wolbachia introgression into Aedes aegypti (Ae. aegypti) mosquito populations is an effective strategy for preventing dengue and is currently under evaluation for WHO prequalification. The standard protocol for trials and deployments currently being conducted in Brazil by the World Mosquito Program (WMP) for long-term monitoring of Wolbachia introgression involves the use of BG-Sentinel traps (BG-traps; Biogents AG [Regensburg, Germany]), which are labor-intensive and costly. More affordable alternatives, such as oviposition traps (ovitraps), have been used in other settings; however, a comparison of the WMP protocol for Wolbachia surveillance has not been performed. As part of the EVITA dengue trial, Ae. aegypti eggs and adults were collected from 124 ovitraps and 237 BG-traps across 12 clusters in Belo Horizonte, Brazil, between March and May 2023. Eggs collected from ovitraps were reared to L3 and L4 larvae, and wMel Wolbachia was detected using quantitative polymerase chain reaction testing in larvae and adult mosquitoes from BG-traps. Mixed-effects models were used to compare cluster-level estimates of wMel introgression derived from ovitrap and BG-trap data over time. Among 3,675 larvae reared from ovitraps, wMel prevalence was 0.50 (95% CI: 0.48-0.51), whereas 1,244 adults from BG-traps had a prevalence of 0.45 (95% CI: 0.42-0.48). Cluster-level introgression estimates from larvae and adults were strongly correlated (Spearman's r = 0.70; P <0.001). Multivariate models incorporating current- and previous-month ovitrap data and mosquito abundance revealed strong agreement between ovitrap-based predictions and BG-trap estimates (rs ≥0.98). These findings reveal that ovitrap-based surveillance provides a low-resource, efficient, and precise alternative for monitoring Wolbachia introgression as interventions are scaled in high-burden dengue settings.

Management of malaria-negative febrile patients is hampered by a lack of rapid diagnostic tests (RDTs) that guide treatment decisions, increasing the risks of antibiotic overuse and antimicrobial resistance. The simultaneous detection of malaria and C-reactive protein (CRP), a potentially useful host biomarker for distinguishing between bacterial and nonbacterial infections, using RDTs could help address this challenge. A prospective study was conducted at seven sites in India from April to December 2019 to evaluate the performance of the SD BIOSENSOR STANDARD™ Q Malaria/CRP Duo Test (SD BIOSENSOR, Gyeonggi-do, South Korea) against expert microscopy for malaria and against a commercial biochemistry kit for CRP, with a total of 1,799 patients with suspected malaria included in the analysis. The prevalence of malaria parasitemia according to microscopy was 13.3% (3.3% Plasmodium falciparum [P. falciparum], 10.1% Plasmodium vivax [P. vivax]). The Duo test was used to diagnose malaria, P. falciparum, and P. vivax infections, with sensitivities of 97.9% (95% CI: 95.2%-99.1%), 91.4% (95% CI: 81.4%-96.3%), and 95.0% (95% CI: 90.7%-97.3%), respectively. The Duo test performed better for detecting pan malaria and P. vivax infections compared with the routine RDT (SD BIOLINE Malaria P.f/pan antigen test; sensitivity 86.1% [95% CI: 81.1%-89.9%] and 79.9% [95% CI: 73.4%-85.1%] for malaria and P. vivax, respectively). The Duo test's sensitivity and specificity for detecting CRP at levels of 20 mg/L or higher were estimated at 87.4% (95% CI: 84.7%-89.7%) and 94.0% (95% CI: 92.4%-95.3%), respectively. The satisfactory agreement between test results and standard reference methods suggests that the test can be used in malaria-endemic settings; however, additional studies are needed to assess its impact on malaria testing and antibiotic prescription practices.

Echinococcosis in pregnancy represents a complex clinical condition in terms of diagnosis and treatment with potential risk to both maternal and fetal health. There are limited clinical data on the nature and consequences of echinococcosis during pregnancy. This systematic review summarizes the current evidence on the clinical presentation, management, complications, and outcomes of echinococcosis during pregnancy. PubMed, Scopus, Web of Science, and Embase databases from 1990 to 2025 were queried. Sixty-seven articles met the inclusion criteria, and a total of 120 pregnant patients with echinococcosis were studied, of whom 118 were diagnosed with cystic echinococcosis (CE) and 2 were diagnoses with alveolar echinococcosis. Among patients with CE, the mean maternal age was 28 years old, and the liver was the most commonly affected organ (69%). Successful delivery of healthy infants was reported in 73% of the CE patients. Embryonic/fetal death was reported in 18% of cases, whereas preterm delivery was reported in 28% of pregnancies with available delivery data. The most common management strategy during pregnancy was the watch-and-wait approach (50%) followed by surgery (18%), percutaneous interventions (12%), albendazole therapy (9%), combined surgery and benzimidazole therapy (8%), and percutaneous interventions combined with albendazole (2%). Given the potential for serious maternal and fetal complications in pregnancy and the paucity of high-quality evidence in this area, there is a clear need for further well-designed clinical studies to improve our understanding of diagnostic approaches, clinical management, therapeutic strategies, and maternal and fetal long-term outcomes.

The impact of environmental contamination with Echinococcus granulosus eggs on the transmission to humans remains unknown. The control of free-roaming and stray dogs is a public health problem in urban and periurban areas of the Cusco region, such as the city of Sicuani in the Canchis province. Nearly one in four human cystic echinococcosis cases referred to tertiary hospitals in the Cusco region of Peru is referred from the Sicuani district. This study sought to determine the frequency and spatial distribution of E. granulosus DNA in dog stool collected within urban public spaces of Sicuani. We conducted a cross-sectional study using a systematic 100 × 100-meters2 grid-based sampling design. Dog stools located at the closest point to georeferenced square vertices were selected for collection. Epidemiologically relevant locations, such as abattoirs and food markets, were also georeferenced. Nineteen (5.5%) of 347 collected samples tested positive for E. granulosus DNA. Polymerase chain reaction (PCR)-positive stools were located at a shorter median distance than negative stools to abattoirs (564 versus 1,292 meters, respectively, P <0.01). Northern Sicuani, an area where informal slaughtering is performed, was identified as a hot spot for PCR-positive stools. The sequence analysis of the PCR products of positive samples closely aligned with sequences of E. granulosus sensu stricto (G1) with close phylogenetic relationship. Our field study revealed that E. granulosus PCR-positive dog stools were associated with spatial proximity to abattoirs. Interventions to decrease E. granulosus infections among dogs, particularly around abattoirs, may decrease the potential environmental contamination with infective stages.

Paragonimiasis is a parasitic disease that involves the lungs but can manifest in extrapulmonary sites, including the peritoneum or subcutaneous tissue. Diagnosis is limited by nonspecific clinical manifestations and overlapping features with other diseases, such as tuberculosis (TB). A 55-year-old Korean male presented with acute abdominal pain and a recurrent subcutaneous mass in the left thigh. Although TB peritonitis was initially suspected, further diagnostic tests were performed. To confirm the diagnosis, multiplex real-time polymerase chain reaction (PCR) targeting the 28S rRNA gene and conventional PCR targeting the ITS2 region were performed on the ascitic fluid. Sequence analysis and phylogenetic clustering confirmed Paragonimus westermani. The patient was treated with praziquantel and showed clinical improvement. This case highlights the importance of considering paragonimiasis in patients with unexplained eosinophilia and peritoneal symptoms, even in the absence of pulmonary involvement. Molecular diagnostic tools can help confirm extrapulmonary infections and prevent misdiagnosis, particularly in endemic regions.

Organophosphate poisoning is a common method of attempting suicide in developing countries, particularly in rural areas. The current WHO protocols emphasize intubation and transfer to a facility with intensive care. Both recommendations are beyond the resources of many rural hospitals in developing countries and their poor patients. Because organophosphate poisoning is a commonly seen condition in Kenya and because intubation is beyond the equipment and training of many rural hospitals, a protocol involving atropine without intubation was developed and used. The protocol includes placement of a nasogastric tube, activated charcoal, intravenous fluids, and atropine along with other supportive measures; the protocol was developed based on a literature search of international medical journals and has been in use for years at Kapsowar Mission Hospital (KMH). Organophosphate poisoning outcome data at KMH were reviewed for 2021-2023. One patient died within minutes of presentation to the Casualty Ward, but the rest survived to discharge using the above protocol. The cost of the atropine protocol is over U.S. $200 in Kenya. The recommendations of the WHO are usually helpful to practitioners in underresourced facilities. In the case of organophosphate poisoning, the recommendations are more appropriate to higher-income countries and highest-level hospitals in low- and middle-income countries, facilities that have intubation capability and large quantities of atropine. A protocol using less atropine could be offered as an alternative.

Sporotrichosis caused by Sporothrix brasiliensis is endemic in Brazil and may present with atypical clinical features. We report a case of verrucous sporotrichosis of the eyelid mimicking cutaneous leishmaniasis in a 28-year-old woman without cat exposure or trauma. Initial diagnostic studies were inconclusive, and prolonged treatment with oral itraconazole failed. Subsequent fungal culture and polymerase chain reaction established the diagnosis. Medication review revealed concomitant pantoprazole use, likely impairing itraconazole absorption through pH-dependent bioavailability. Lesion resolution occurred after a 3-month course of oral terbinafine. This case highlights two critical considerations: sporotrichosis should remain in the differential diagnosis of chronic verrucous lesions in endemic regions, and careful evaluation of drug-drug interactions is essential to prevent antifungal treatment failure.

West Nile Virus (WNV) is endemic throughout the world and is a leading cause of mosquito-borne severe and/or fatal encephalitic disease. Although several promising WNV vaccines have been developed, none have been approved for human use. Studies were conducted to evaluate the immunogenicity, protective efficacy, and safety of a recombinant subunit WNV candidate vaccine (WN-80E) formulated with aluminum hydroxide (Alhydrogel™) adjuvant and/or in combination with a semi-synthetic saponin (GPI-0100) adjuvant in mice and hamsters, and for toxicology, immunogenicity and safety in rabbits. Adult mice and hamsters were immunized twice via the intramuscular (IM) route 3 to 4 weeks apart with escalating doses of WN-80E adsorbed to Alhydrogel™. Mice were also immunized with WN-80E in combination with the GPI-0100 adjuvant. All animals were subsequently challenged with a lethal dose of virulent WNV. The rabbits received four IM immunizations 3 weeks apart with WN-80E/Alhydrogel™ that was compared to WN-80E/Alhydrogel™ plus various amounts of GPI-0100. The results of immunogenicity and challenge experiments demonstrated that all WN-80E vaccine formulations with Alhydrogel™ with or without GPI-0100 were immunogenic and afforded complete protection to mice and hamsters against morbidity and mortality following challenge with WNV. Also, the WN-80E/Alhydrogel formulations with or without GPI-0100 were well tolerated and elicited high neutralizing antibody (nAb) titers in rabbits. Cumulatively, because these findings demonstrated that the WN-80E formulated with Alhydrogel™ alone elicited robust antibody responses and protection against viral challenge, this formulation was selected for further evaluation in clinical trials for the prevention of WNV disease in humans.

When a country has reached a low trachoma prevalence, it can be difficult to reliably train survey graders to accurately grade trachoma signs. Conjunctival photography provides an opportunity to capture images for grading. Recently, a training manual targeting survey data recorders was published. In July 2023, this manual was used during a photography training, after which certified trainees served as data recorders and photographers during the Enhancing the 'A' in SAFE (ETAS) study in South Sudan. Five of 10 trainees passed the training and became certified. These individuals took 7,064 smartphone photographs (two photographs per eye) of 1,766 children during the ETAS study. Certified photograph graders at the Gondar Grading Center in Ethiopia determined that nearly all eyes (>99%) had at least one gradable photograph. The new manual successfully facilitated the training of data recorders to take gradable conjunctival photos and will be an important tool for trachoma programs.

Guillain-Barré syndrome (GBS) is a rare and potentially fatal immune-mediated disorder. During a large community outbreak in Pune City, India, investigations of GBS cases were conducted to identify the causes of antecedent or concurrent infections using serological and molecular methods. Water and poultry samples were also tested to determine the source of infection. From January to March 2025, 230 GBS cases, including 12 deaths (case fatality ratio 5.2%), were investigated. The cases were concentrated in Southwest Pune. All age groups were affected, with a male-to-female ratio of 2.2:1. Antecedent illness was reported in 147 (63.9%) cases, primarily diarrhea (37%). Among 193 cases, 108 (56%) were linked to infectious agents. Campylobacter jejuni (C. jejuni) infection was confirmed in 72 (48.7%) of 148 cases. Norovirus was confirmed in 40 (22.2%) of 180 cases, either as a coinfection (n = 19) or alone (n = 21). Water contamination was detected, with positive results for Campylobacter (n = 1/208) and norovirus (n = 8/208). Among 66 fecal samples from poultry, Campylobacter and norovirus were detected in 24 and five samples, respectively. No evidence of toxins was found in the nine water samples tested representatively. A significant GBS outbreak occurred in Pune City in early 2025, preceded by an acute diarrhea outbreak. A mixed etiology of the GBS outbreak was confirmed, with C. jejuni the leading cause in nearly half of the cases. Norovirus infection was also identified in more than one-fifth of the cases. Water contamination by both agents was detected, along with a possible link to poultry as a source of infection.

The growing threat of artemisinin partial resistance prompted the WHO to recommend routine monitoring of drug efficacy and resistance. Advances in sequencing technologies and expanded laboratory capacity across Africa have made malaria molecular surveillance (MMS) a viable option for many countries. Despite improved access to next-generation sequencing platforms, the uptake of MMS for programmatic decision-making and the availability of antimalarial resistance marker data in southern Africa have lagged behind those in other regions. The Genomics of Malaria in the Elimination Eight (GenE8) initiative implemented a regional MMS model comprising 1) regional consensus-building and governance, 2) capacity strengthening, and 3) evidence generation. Through this initiative, standardized parasite genomic data across five southern African countries (Angola, Eswatini, Namibia, South Africa, and Zambia) were generated using a targeted amplicon deep-sequencing workflow. Regional laboratory and analytical skills were strengthened, and national malaria programs (NMPs) were capacitated to use genomic data for decision-making through a regional MMS fellowship and training workshops. Although the initiative achieved important successes, persistent challenges limited its overall impact despite the implementation of integrated mitigation strategies. Challenges included constraints in regional bioinformatics capacity, delays in sample shipment and cross-border data sharing, and a lack of sustained funding. In the present case study, the GenE8 model, operational experiences, and cross-cutting lessons learned are described. The GenE8 experience reveals that regional MMS is feasible in southern Africa and that near-real-time resistance data can inform policy and intervention decisions, but that it requires sustained investment in governance mechanisms, bioinformatics expertise, and institutionalized NMP capacity to be sustainable.