PLOS Neglected Tropical Diseases

BackgroundTungiasis, a skin infestation caused by the flea Tunga penetrans, affects resource limited tropical communities of Latin America, the Caribbeans and sub-Saharan Africa. Recently considered by the WHO as a Neglected Tropical Diseases, epidemiological data to inform control strategy is lacking in Cameroon. MethodsA cross-sectional study targeting schoolchildren from eight primary schools selected by stratified random sampling method was conducted from November 2024 to July 2025 in Dschang Health District, west Cameroon. Data was collected to assess the prevalence of tungiasis infestation, its associated factors, and related morbidity, while observing all necessary ethical requirements. ResultsSome 407 schoolchildren with a median age of 11 (7-16) years, participated in the study of whom 54.8% were males, 84.0% attended government primary schools, and 81.8% cohabited with domestic animals. Fifty-one of the schoolchildren were infested with tungiasis for an overall prevalence of 12.5% (95% CI: 9.5-15.9). Lesions were located mainly on toes (92.2%) hands (31.4%) and heels (27.%%), and morbidity included pains (72.5%), itching (66.7%), sleep disturbance (72.5%, lack of concentration (49.0%), deformation of toes (15.7%) and difficulties in walking (13.7%). Cohabitation with domestic animals (OR=5.15 (95%CI: 1.09-24.29), p=0.039) especially pigs(OR=2.34 (95%CI:1.13-4.82), p=0.022); being a pupil of class 5 (OR=22.11 (95% CI:4.73-103.36), p<001) or class 6 (OR=7.70 (95% CI: 1.97-30.11), p=0.003) were independently associated with tungiasis infestations. ConclusionThis study reveals a substantial burden of tungiasis among schoolchildren in Dschang and associated with modifiable risk factors involving both the environment and individual behavioral factors. We recommend the implementation of integrated control strategies combining animal reservoir control, hygiene education, and adoption of WHO recommended tungiasis treatment practices. More research is needed to understand the wider spectrum of tungiasis in Cameroon. Author summaryTungiasis, commonly known as jigger, is caused by a parasitic flea and mostly affects people living in poor communities of Latin America, the Caribbeans and sub-Saharan Africa. As jiggers have recently been considered a public health problem by the WHO, there is not enough information on the disease in Cameroon. We therefore carried out a study to assess the burden of the diseases among primary schoolchildren from selected government and private confessional schools in Dschang health district as part of efforts to understand its situation in Cameroon. Among the 407 schoolchildren surveyed, 51(12.5%) of them were infested with jiggers. Toes, hands and heels were the affected parts of the body, and led to pain, itching, sleep disturbance, lack of concentration, deformation of toes and difficulties in walking among the infested schoolchildren. We found out that the schoolchildren took jiggers for granted and practiced self-extraction of lesions followed by application of some ointments and kerosene as means of treatment. We discovered that jigger infestation was closely associated with cohabitation with animals, especially pigs, and being a pupil of class 5 or 6. We conclude that jiggers constitute a major problem among schoolchildren in Dschang and is associated with modifiable risk factors. We therefore recommend the limitation of direct cohabitation with animals, hygiene education and the adoption of the WHO recommendations for the treatment of jiggers. We also recommend more research to understand the wider spectrum of tungiasis in Cameroon.

BackgroundOrally transmitted acute Chagas disease (ACD) mostly affects low-visibility and low-income individuals, mainly in tropical and subtropical zones. However, even more than 100 years after Carlos Chagas discovery, several difficulties in managing ACD are still faced. Ita expansion to other, non-endemic areas through globalization processes has transformed it into a global health problem. Methodology and findingsThis report addresses an outbreak of 39 cases of ACD due to oral transmission. A clinical-epidemiological investigation with an entomological search was performed. Laboratory criteria (positive peripheral blood smear (PBS), seroconversion of IgG and 2x increase in IgG titer) and clinical-epidemiological criteria (clinical findings, epidemiological exposure and at least one positive IgG) were used for diagnoses. In-house conventional polymerase chain reaction (PCR) was performed on 33 samples. All patients were treated with benznidazole. After 4.5 years, IgG was investigated in 26 individuals. Their mean age was 33.6 years, with no difference in gender distribution; the mean incubation period was 13.8 days and mean time between symptom onset and treatment was 16.6 days. The most frequent symptoms were fever and lymphadenopathy (90%). For 66.6%, laboratory criteria yielded the diagnosis and for 23%, clinical-epidemiological criteria, while 10.2% showed negative tests but were treated due to high clinical suspicion. Test positivity rates: PBS 69.7%; serology 91.4%; PCR 100%. There were no deaths. Serological cure was achieved for 34.6% and decreased IgG titers for 15.3%. Conclusions and significanceWe present all the barriers encountered in managing real-life situations: vulnerability of the population; dependence on old diagnostic techniques; lack of standardization of molecular biology techniques; and few therapeutic options. We demonstrated the importance of rapid surveillance action with early treatment, such that this outbreak did not give rise to deaths. We also propose that conventional PCR should become standardized within the diagnostic routine. AUTHOR SUMMARYIn this study we present an outbreak of orally transmitted acute Chagas disease (ACD), a neglected tropical disease. The source of transmission was bacaba juice served at a celebration held in a quilombola community and 39 individuals were affected. The focus of this study was clinical-epidemiological investigation and diagnostic tools. There were no deaths due to this event, probably because of the quick action of the surveillance team and the early start of treatment. We show all the difficulties facing a real-life situation (vulnerability of population affected, weaknesses regarding good food safety practices and obstacles to following what guidelines recommend), discuss the performance and executability of the diagnostic method used and address the global threat that Chagas disease may pose. Furthermore, we propose that the polymerase chain reaction should become standardized in diagnosing acute disease, given that this was the only method with 100% positivity, even among patients whose other tests were all negative.

BackgroundHuman African trypanosomiasis (HAT) is an important disease of sub-Saharan Africa that is approaching elimination in many regions. However, the disease has previously returned from similarly low case numbers in the past, making it important to identify issues that hinder elimination efforts. One important factor is likely to be the recent characterization of individuals with latent HAT infections that are able to tolerate HAT with few symptoms and to control blood parasitaemia to levels that are undetectable by microscopy. Although animal trypanotolerance has been examined in detail, it is unclear how the latent phenotype is maintained in humans. MethodsTo identify immune components involved in latent HAT, we used targeted RNASeq to examine the expression of 495 immune-related transcripts in blood collected from 287 individuals at active disease foci in Guinea. These samples included latent infections, HAT clinical cases, and uninfected controls. The in vivo effects of IL21 functional blockade was investigated using a murine model of trypanosomiasis. ResultsDifferential expression analysis revealed transcripts involved in T cell activation and B cell development that associated with trypanosome infection, including PD1, CD70, and CD80. In particular, IL21 was found to be elevated in infected individuals, although it was significantly higher in clinical cases relative to latent infections. This pattern was replicated at the protein level when patient sera were examined by ELISA. Reducing IL21 pathway activity in mice infected with Trypanosoma brucei led to increased survivorship and reduced parasitaemia in the model animals. ConclusionOur data show that IL21 is a potential biomarker of Human African Trypanosomiasis and is a cause rather than a consequence of symptoms severity. Further investigation of IL21 will contribute to understanding the factors involved in developing latent HAT, improving control efforts to identify and predict such infections. In the future, the factors identified in this study may also serve as intervention targets to control the symptoms of trypanosomiasis.

BackgroundIntegrated approaches to mapping skin Neglected Tropical Diseases (NTDs) may be cost-effective way to guide decisions on resource mobilization. Pilot studies have been carried out, but large-scale data covering multiple countries endemic for skin-NTDs are lacking. Within the LAMP4YAWS project, we collected integrated data on the burden of multiple skin-NTDs. MethodsFrom March 2021 to March 2023, integrated case searches for yaws alongside other skin conditions were performed in endemic health districts of yaws in Cameroon, Cote dIvoire, and Ghana. Initial screening involved a brief clinical examination of participants to determine if any skin conditions were suspected. Cases of skin-NTDs were then referred to a health facility for appropriate management. ResultsOverall 61,080 individuals screened, 11,387 (18.6%) had skin lesions. The majority of individuals (>90%) examined were children aged 15 years old and under. The proportion of serologically confirmed yaws cases was 8.6% (18/210) in Cameroon, 6.8% (84/1232) in Cote dIvoire, and 26.8% (440/1643) in Ghana. Other skin conditions based on clinical examination included: scabies, Buruli ulcer, leprosy, lymphatic filariasis (lymphoedema and hydrocele), tungiasis, and fungal infections. The most common conditions were scabies and superficial fungal infections (scabies versus fungal infections) in Cameroon with 5.1% (214/4204) versus 88.7% (3730/4204), Cote dIvoire with 25.2% (1285/5095) versus 50.4% (2567/5095) and Ghana 20% (419/2090) versus 1.3% (28/2090). Other skin-NTDs were less common across all three countries. ConclusionThis study confirms that integrated screening allows simultaneous detection of multiple skin-NTDs, maximising use of scarce resources. Plain English SummaryMany Neglected Tropical Diseases (NTDs) predominantly affect the skin and are referred to as skin-NTDs. The World Health Organization (WHO) has developed a number of strategies for the control, eradication and elimination of skin-NTDs and recognizes the importance of integrated approaches to mapping skin-NTDs. We conducted a study adopting integrated screening for multiple skin-NTDs and other skin conditions in Cameroon, Cote dIvoire, and Ghana. This ran alongside a study focused on diagnostic tests for one specific skin-NTD - yaws. The results showed that integrated screening is a feasible and cost-effective way to detect multiple skin-NTDs in a single intervention. Of more than 60,000 individuals screened almost one in five had a skin lesion. Cases of yaws confirmed by blood tests were detected more frequently in Ghana compared to Cote dIvoire and Cameroon. The most common skin conditions were scabies and superficial fungal infections. Other skin-NTDs such as Buruli ulcer, leprosy, lymphatic filariasis and tungiasis were less common. Integrated screening allowed detection of skin conditions and co-endemicity of skin-NTDs and the data can guide decisions on resource mobilization to manage skin-NTDs.

BackgroundCutaneous (CL) and mucocutaneous (MCL) leishmaniasis remain as endemic tropical diseases in several Latin American countries. This study aimed to estimate the burden of CL and MCL in Ecuador for the period 2014-2018, in order to inform decision-making and resource allocation to tackle this neglected disease.\n\nMethodsAmbulatory consultations, hospitalizations, and reported cases of Leishmaniasis registered by the Ecuadorian National Institute of Statistics and Census and the Ministry of Public Health were used to estimate the burden of CL and MCL during a five-year period. Case estimations were stratified by prevalence of acute and long-term sequelae, to calculate Years Lived with Disability (YLD) by sex and age group using the DALY package in R. Spatial analysis was conducted to identify statistically significant spatial clusters of leishmaniasis.\n\nResultsBetween years 2014 and 2018, a total 6,937 cases of leishmaniasis were registered, with an average of 1,395 cases reported per year, 97.5% of them were CL and 2.5% MCL. The average cumulative incidence for the study period corrected for underreporting was estimated in 21.98 to 36.10 per 100 thousand inhabitants. Health losses due to leishmaniasis reach 0.32 DALY per 100,000 people per year (95% CI 0.15 - 0.49). The most affected by the disease were men between 15 to 64 years old living below 1,500 m.a.s.l. in sub-tropical and tropical rural communities on both slopes of the Andes mountains. Cantons with the highest cumulative incidence of CL and MCL were Pedro Vicente Maldonado, San Miguel de Los Bancos, and Puerto Quito, in the Pichincha Province; Taisha and Aguarico in the Morona Santiago and Orellana provinces respectively.\n\nConclusionCompared to previous reports, in the past five years CL and MCL persist as a public health problem in Ecuador. There is a need for more comprehensive and robust data sources to track leishmania cases in Ecuador.\n\nAuthor summaryCutaneous (CL) and mucocutaneous (MCL) leishmaniasis remains as an endemic neglected tropical disease in several Latin American countries, including Ecuador. Both CL and MCL can produce disfiguring lesions on exposed parts of the body like face and extremities, and permanent scars, contributing to the burden of the disease due to stigma. In order to inform health authorities in their efforts to improve the control of the transmission of the Leishmaniases in the Ecuadorian population, we estimate the burden of CL and MCL for Ecuador in the period 2014-2018, calculating the years lived with disability due to acute and chronic sequelae. We also look for geographical regions within Ecuador with significant clusters of people with the disease, and we found 17 spatial clusters in sub-tropical and tropical rural communities below 1,500 m.a.s.l. on both slopes of the Andes mountains.

BackgroundLeishmaniasis Is a vector-borne disease caused by obligate intracellular protozoan flagellate parasite, that is transmitted by the bite of infected female phlebotomine sandflies. Cutaneous Leishmaniasis (CL) is endemic in the Middle East, its a major public health concern in Palestine, the current control strategies for Leishmaniasis depend on reservoir and vector control, active case detection and treatment of their disease and the use of insecticides. ObjectivesThis study aims to describe the epidemiology, clinical features, and risk factors of CL in the West Bank, Palestine, from 2020 to 2023. MethodsA retrospective study included all cases of CL that had been reported to the Leishmaniasis Surveillance System in the Department of preventive medicine at the Palestinian Ministry of Health during the period from 2020 to 2023. A total of 322 cases were reported and met the case definition. demographic details, lesion characteristics, and environmental risk factors., Independent t-test and ANOVA were used to obtain the differences between the groups according to lesion duration, number of lesion. FindingsA total of 322 cases of Cutaneous Leishmaniasis were diagnosed in preventive medicine departments in West bank during the period 2020 till 2023, the ages of patients ranges between less than one year to 82 years old, most cases were young, with mean age of 24 years old, the male to female ratio was 3:2, most patients were illiterate. The number of skin lesions was significantly higher in males, farmers and most patients have face lesions mainly nodules. while the duration of the skin lesions was significantly higher in older patients. ConclusionsCL is endemic in the West Bank. Public health strategies should emphasize early detection, community awareness, and targeted vector control measures. FundingNo funding was provided for this research.

Chagas disease (CD) is a neglected tropical disease endemic to Latin America and has emerged as a global health concern due to the migration of infected individuals. With its epidemiological complexity, difficulty in obtaining appropriate diagnoses, and poor treatment, the search for novel therapeutic options remains. In this context, we conducted a systematic review and meta-analysis of preclinical studies employing animal models to verify the progress in CD treatment. We searched the PubMed database for CD treatment studies published between 1990 and 2023, adhering to the PRISMA guidelines. Twelve papers met the inclusion criteria. The findings indicate that the fifteen treatment alternatives examined, mainly between 2010 and 2014, demonstrated efficacy in experimental CD models, evidenced by significant parasitemia reduction. Bis-triazole DO870 and VNI were effective in the acute and chronic phases, respectively. However, of these emerging therapies, only posaconazole and fexinidazole have progressed to clinical trials, yielding unsatisfactory outcomes as CD monotherapies. This meta-analysis highlights the existence of promising new drug candidates for CD treatment, but most remain in the preclinical stages. Those that reached clinical trials did not demonstrate optimal results, underscoring the ongoing challenges in CD therapy. Collaborative efforts among the academic community, pharmaceutical industries, funding agencies, and government agencies are urgently needed to accelerate the development of more effective medications against CD.

BackgroundCutaneous leishmaniasis (CL) is a major public health issue in Ethiopia, often causing lesions on the cheeks, nose, and lips that take months to heal, and leave permanent scars. Data on the lived experiences of people with CL in Ethiopia is needed to support design of interventions that could respond to their needs. MethodsWe interviewed 18 people with active or healed CL to understand their experiences of the disease in Kalu district, South Wollo, Ethiopia. Interviews were audio recorded, transcribed and translated for content analysis which focused on experiences of symptoms, treatment and the consequences of living with CL. ResultsExperiences of CL symptoms and treatments used by people with CL in Kalu were associated with physical discomfort and significant emotional distress. CL began with pain, pruritus, bleeding and ulceration. Most people with CL used painful treatments such as plant-based traditional medicines which irritated the skin or heat to cauterize lesions at home or by traditional healers and expressed dissatisfaction at being left "burnt" but not healed. During treatment, individuals reported abstaining from sexual intercourse as this was believed to worsen CL; people also avoided contact with others whod recently had sex. Individuals with CL experienced psychological distress, reduced self-worth, and self-exclusion from social participation due to anticipated or experienced stigma, fear of spreading the disease and worsening their own disease. ConclusionsCommunity engagement strategies to promote early case detection and treatment at health facilities should acknowledge the specific fears, informational needs and challenges that shape existing care-related behaviours of people with CL. Providing information about the safety of common traditional treatments and correct information about contagiousness are key areas that public health programmes could address to reduce some of the diseases impacts. Existing cultural attitudes that emphasize shared vulnerability to CL and underlie non-stigmatizing behaviors could also inform stigma interventions. Author summaryEthiopia is significantly affected by all forms of leishmaniasis. Cutaneous leishmaniasis (CL) is a significant public health problem with an estimated incidence of 50 000 annually. The skin lesions mostly appear on the face. The visible changes caused by the disease have considerable implications on the psychosocial wellbeing of affected people. This study aimed to understand how people affected by CL make sense of signs and symptoms, locally available treatments and the consequences of living with the disease. People affected by CL in Kalu, Ethiopia experienced physical and emotional discomfort in relation to signs and symptoms and traditional treatments applied. Change in appearance, fear, sadness, anxiety, stigma and abstinence from sexual intercourse were reported as consequences of living with CL. To reduce some of the diseases impacts, our findings imply the need for interventions to target key cultural beliefs that inform needs and behavior of the affected people.

BackgroundPrior studies have demonstrated associations between helminths and mycobacterial infections, suggesting a can alter the susceptibility do mycobacterial infection or disease. Our goal was to assess the association of Mycobacterium leprae infection with parasitic infections in a highly endemic area for Hansens disease in Minas Gerais, Brazil. MethodsAdults and children ages 3 years and older were enrolled from communities in Governador Valadares, Minas Gerais, Brazil, and nearby municipalities. Questionnaires on demographics and infection history were administered. Serological reactivity against M. leprae and parasitic infections was assessed by multiplexed bead assay (MBA). Data were analyzed by multivariable logistic regression with both anti-LID-1 antibody positivity and history of HD as outcomes in separate models. Exposures in the analysis included history of parasites (both antibody results and self-reports) and several pertinent socio-demographics like area of residence (i.e. urban vs. rural). ResultsOf 1,311 enrollees, 72 (5.5%) reported a prior history of HD, 94 (7.2%) tested positive for anti-LID-1, 836 (63.8%) reported having one or more parasitic diseases in the past, 153 (11.7%) tested positive for antibodies to schistosoma egg antigen (SEA), and 69 (5.3%) for antibodies to the Strongyloides stercoralis antigen NIE. There was an association between rural residence and history of HD (aOR, 1.97, CI: 1.14 - 3.38). Rural residence and anti-LID-1 also showed a positive assocation (aOR 1.79, CI: 1.07-3.38). While not statistically significant, there was a positive association between anti-LID-1 and NIE antibodies (aOR 1.57, CI: 0.69-3.57), and a negative association between anti-LID-1 and SEA antibodies (aOR 0.79, CI: 0.38 - 1.61). ConclusionThis study utilized a novel methodology (multiplex bead assay) to simultaneously measure seroreactivity among various pathogens. While we did not find that a history of HD and anti-LID-1 positivity were associated with seropositivity to NIE or SEA, our study found a high burden of several neglected tropical diseases (NTDs). There was also a strong association with rural residence and LID-1 positivity. This warrants further investigation into the prevalence and epidemiology of M. leprae infection, as well as potential spatial and environmental risk factors.

BackgroundCutaneous Leishmaniasis (CL) is a neglected tropical disease with profound physical, psychological, and social consequences, particularly in low-resource settings. In rural Ethiopia, Tigrai, CL remains poorly understood and heavily stigmatized, shaped by deeply rooted sociocultural perceptions that interpret the disease through supernatural, moral, and spiritual frameworks. These beliefs affect how affected individuals are perceived and treated within their communities, often resulting in social exclusion and delays in care. Methodology/principal findingsThis ethnographic study was conducted in rural districts of northern Ethiopia, Tigrai, using ethnographic field observations, in-depth interviews, and focus group discussions with affected individuals, caregivers, Health Extension Workers (HEWs), and Community Advisory Group (CAG) members. Findings reveal that CL is widely perceived as a condition linked to divine punishment, impurity, or ancestral curses. These beliefs contribute to stigma, emotional distress, and restricted social participation, especially among women and children. Structural barriers including economic hardship, limited access to biomedical care, and poor health literacy further exacerbate the disease burden. While HEWs and CAGs attempt to address misconceptions and promote treatment uptake, their efforts are constrained by systemic resource limitations and community resistance. Conclusions/significanceCL in rural Ethiopia, Tigrai, is not only a biomedical issue but also a socially constructed and culturally embedded affliction. Addressing the disease requires a holistic public health response that integrates ethnographic insights, respects local belief systems, and prioritizes stigma reduction and community engagement. These findings contribute to a growing body of literature emphasizing the need for culturally sensitive, equity-driven approaches in global NTD programming. Author summaryCL is a skin disease caused by parasites and transmitted by sandflies. While it may not cause death, it often leads to visible skin scars that have serious emotional, social, and economic impacts especially in rural areas with limited access to healthcare. In this study, we explored how people living in rural Ethiopia, Tigrai region, experience and understand CL. Through interviews, focus group discussions, and field observations, we found that many community members believe CL is caused by supernatural forces, divine punishment, or moral wrongdoing. These beliefs cause people with CL to be stigmatized and socially excluded, particularly women and children. People often turn to traditional remedies instead of modern treatment, which delays recovery. We also learned that community health workers try to educate people and support treatment, but they face many challenges. Our study shows that treating CL should involve more than just medicine it must include efforts to reduce stigma, engage communities, and understand local beliefs. These findings can help improve public health programs for CL and similar neglected diseases.

IntroductionScabies, caused by Sarcoptes scabiei, is a neglected tropical disease that disproportionately affects underserved rural communities, where transmission is commonly sustained through prolonged close contact and sharing of personal items. This study assessed household scabies experience and associated factors during a past outbreak in Nyasa District. MethodsA retrospective community-based cross-sectional study was conducted among 198 households from four villages. Data were collected using an AfyaData-digitized, expert-validated questionnaire aligned with the International Alliance for the Control of Scabies criteria to improve syndromic specificity. Quantitative data were analyzed using univariable and multivariable logistic regression. Open-ended responses (Q24-Q26) were analyzed thematically and triangulated with regression findings. ResultsOverall, 60.6% (120/198) of households reported scabies experience during the outbreak period. In multivariable analysis, higher odds of household scabies experience were associated with sharing personal items (Rarely AOR = 4.059; Frequent AOR = 4.688) and receiving treatment during the outbreak (AOR = 4.705). Non-collaboration with healthcare personnel showed increased odds but was not statistically significant (AOR = 2.035; p = 0.098). Lower odds were observed among households reporting "not sure" responses for prior scabies history (AOR = 0.235) and treatment (AOR = 0.249), suggesting uncertainty-related misclassification. Qualitative themes mapped to these determinants: sharing items aligned with laundry/bedding and clothing hygiene practices ("...kufua... na kuzidisha usafi"); treatment aligned with effectiveness concerns and access/availability barriers ("madawa... hayatibu"; "matibabu mbali"); collaboration aligned with requests for outreach/education and follow-up ("watoa huduma hawakufika..."); and "not sure" responses aligned with misconceptions and uncertainty ("tulifikiri... tumerogwa"). ConclusionThe study demonstrates a substantial household burden of scabies and highlights the need for coordinated outbreak responses that prioritize household-level prevention (reducing sharing of personal items), improved access to effective treatment, and stronger health system-community engagement. Triangulation of regression results with community narratives supports AfyaDatas value for standardized, criteria-informed investigation and targeted public health action in Tanzania. Author SummaryScabies is a contagious skin disease caused by tiny mites that burrow into the skin and cause intense itching and rash. It spreads mainly through prolonged skin-to-skin contact and by sharing personal items such as clothes and bedding. Scabies is common in many low-resource settings, but local evidence is often limited, which makes it difficult to plan effective prevention and outbreak response. We investigated a scabies outbreak that occurred in Nyasa District, southern Tanzania, in September 2022. We interviewed 198 households in four villages using a mobile data collection tool (AfyaData) and a standardized questionnaire informed by international scabies guidance. We found a high household burden of scabies experience. Quantitative analysis showed that households reporting scabies were more likely to report sharing personal items and seeking/receiving treatment during the outbreak, and they also reported weaker collaboration with healthcare personnel. Open-ended responses supported these patterns: participants described the importance of washing clothes and bedding, concerns that medicines were ineffective or difficult to access, and a need for health worker outreach, education, and follow-up. Some responses reflected uncertainty and misconceptions about the cause of illness. Our findings show that scabies outbreak control in rural settings requires household-focused prevention, timely access to effective treatment, and stronger coordination between communities and health services. The study also demonstrates how digital tools can support standardized outbreak investigation and guide targeted public health action aligned to control scabies and other neglected tropical diseases.

In the population at risk of gambiense human African trypanosomiasis (gHAT), the prevalence of extravascular parasite carriage remains unclear. Here, we conducted an observational clinical study in the hypo-endemic gHAT foci of Sinfra and Bonon in Cote dIvoire from 2019 to 2022. A total of 74 individuals were enrolled, including 45 suspects previously found positive at least once in a serological test for gHAT and followed by the national elimination programme of Cote dIvoire, as well as 29 seronegative controls. No significant differences between groups were observed for any epidemiological parameters and any clinical parameters at enrolment. Whereas trypanosome DNA was detected in the blood of 0/29 controls and 2/45 suspects, the presence of extravascular dermal trypanosomes was assessed by immuno-histochemistry (fixed trypanosome cells) and/or PCR (trypanosome DNA) in about 1/3 of the suspects (14/45, 31%). However, no gambiense-specific test was found positive in the present study. Hence, the skin could represent an anatomical reservoir for African trypanosomes sustaining a low level of transmission in hypo-endemic foci. Author summaryIn the population at risk of sleeping sickness, the number of people bearing trypanosome parasites in their skin remains unclear. Here, we conducted an observational clinical study in the hypo-endemic transmission foci of Sinfra and Bonon in Cote dIvoire from 2019 to 2022. A total of 74 individuals were enrolled, including 45 suspects previously found positive at least once in a test on blood and followed by the national elimination programme of Cote dIvoire, as well as 29 negative controls. No significant differences between groups were observed for any epidemiological parameters and any clinical parameters at enrolment. Whereas trypanosome DNA was detected in the blood of 0/29 controls and 2/45 suspects, the presence of dermal trypanosomes was assessed by immuno-histochemistry (fixed trypanosome cells) and/or molecular biology (PCR to detect trypanosome DNA) in about 1/3 of the suspects (14/45, 31%). However, no gambiense-specific test was found positive in the present study. Hence, the skin could represent an anatomical reservoir for African trypanosomes sustaining a low level of transmission in hypo-endemic foci.

Chagas disease remains a major public health concern in Latin America, with Bolivia reporting one of the highest burdens of infection. While congenital transmission has become the predominant route of new infections in several countries, vectorial transmission persists in rural and peri-urban regions. Postrervalle, in the department of Santa Cruz, is officially classified as a low-infestation area; however, updated community-level data remain limited. MethodsWe conducted a cross-sectional study in July 2023 involving 58 mothers and 104 of their children in Postrervalle. Participants underwent serological screening using three diagnostic assays, and epidemiological data were obtained through structured maternal questionnaires. Logistic regression models were used to assess associations between child Trypanosoma cruzi seropositivity and maternal or household exposures during pregnancy. ResultsSeroprevalence was 15.5% among mothers and 3.8% among children. Notably, all seropositive children were born to mothers who tested seronegative, suggesting non-congenital transmission. In multivariable analysis, living in houses with mud walls during pregnancy was strongly associated with child seropositivity (adjusted OR = 225.44), while older child age also increased the odds of infection. Other maternal exposure variables showed elevated but imprecise associations. ConclusionDespite its classification as a low-infestation area, Postrervalle shows evidence of ongoing transmission of T. cruzi linked to domestic structural conditions that facilitate triatomine colonization. These findings highlight the importance of integrating entomological surveillance with household-level risk assessments to better characterize and prevent Chagas transmission in rural communities. AUTHORS SUMMARYChagas disease is caused by the parasite Trypanosoma cruzi and is mostly spread by insects known as "kissing bugs," which can live in the cracks of walls and roofs in some homes. Although several Latin American countries have reduced transmission through long-term vector control programs, Chagas disease continues to affect many rural and peri-urban communities in Bolivia. Postrervalle, where this study was carried out, is officially classified as a low-risk area, and little recent information exists about local transmission patterns. We screened mothers and their children for Chagas disease and asked the mothers about their living conditions and past exposure to kissing bugs. We found that none of the infected children had mothers who were infected, which suggests that these children did not acquire the disease during pregnancy. Instead, they were likely infected after birth through contact with infected insects in their homes. We also found that children who lived in houses with mud walls were more likely to be infected, indicating that certain types of housing may make it easier for kissing bugs to enter or hide inside homes. These findings show that Chagas transmission can still occur in places thought to be low-risk. Strengthening vector surveillance and improving housing conditions could help reduce infections in similar communities.

BackgroundLeptospirosis is an emerging zoonotic disease with high incidence in tropical regions such as the Peruvian Amazon. Although it affects individuals of all ages, knowledge about its clinical and epidemiological behavior in children under five years old remains limited. This population may present atypical clinical forms, nonspecific symptoms, and a milder course, increasing the risk of underdiagnosis and delayed treatment. MethodologyA descriptive and retrospective study was conducted by reviewing medical records and epidemiological forms of all MAT-confirmed patients from 2022 to 2024 in primary health centers in Belen, the district with the highest historical prevalence in Loreto. A total of 400 cases out of 1666 reported were included. Among children under five (n=28), clinical presentation was predominantly nonspecific, with malaise (78.6%) and fever (71.4%) being most frequent. Nearly half (46%) sought care within the first three days of symptoms, and 50% lived in flood-prone areas. Nutritional status showed a significant association, with a predominance of underweight (p<0.001), remaining significant in multivariate analysis (OR=0.051; 95%CI: 0.011-0.233; p<0.001). Additionally, each additional day of illness was associated with an increased likelihood of belonging to this age group (OR=1.366; 95%CI: 1.135-1.644; p=0.001). Regarding serovars, Panama showed significant association with children under five (p=0.024), whereas Hurstbridge was absent. ConclusionChildren under five with leptospirosis exhibit a distinctive clinical and epidemiological profile, characterized by nonspecific symptoms, higher frequency of underweight, and earlier healthcare-seeking behavior. Associations with malaise, poor nutritional status, and specific serovars like Panama suggest a less typical presentation, potentially hindering diagnosis at the primary care level. These findings highlight the need for tailored surveillance, diagnostic, and management strategies for this age group, particularly in endemic regions such as the Peruvian Amazon. Author summaryLeptospirosis is a disease transmitted through contact with water or soil contaminated by animal urine, especially in tropical regions like the Peruvian Amazon. While it can affect people of any age, little is known about how it presents in children under five. In our study, we analyzed 400 confirmed cases from health centers in Belen, one of the most vulnerable districts in the region. We found that children under five often had vague symptoms like general discomfort and fever, which are easy to miss or confuse with other common infections. These children were also more likely to be underweight and live in areas affected by seasonal flooding. Unlike older patients, they tended to visit health centers earlier after symptom onset, possibly because caregivers noticed changes quickly. We also found that a specific type of bacteria (the Panama serovar) was more common in this age group. These findings suggest that leptospirosis may behave differently in young children, which can make diagnosis and treatment more challenging. Recognizing these differences can help improve detection and care for young children in endemic regions.

BackgroundTo monitor the progress of lymphatic filariasis (LF) elimination programmes, field surveys to assess filarial antigen (Ag) prevalence require access to reliable, user-friendly rapid diagnostic tests. We aimed to evaluate the performance of the new Q Filariasis Antigen Test (QFAT) with the currently recommended Filariasis Test Strip (FTS) for detecting the Ag of Wuchereria bancrofti, the causative agent of LF, under field conditions. Methodology/Principal FindingsDuring an LF survey in Samoa, 344 finger-prick blood samples were tested using FTS and QFAT. Microfilariae (Mf) status was determined from blood slides prepared from Ag-positive samples. Each test was re-read at 1 hour and the next day to determine the stability of results over time. Overall Ag-positivity by FTS was 29% and 30% by QFAT. Concordance between the two tests was 94% (Kappa=0.85). Of the 105 Mf slides available, 38.1% were Mf-positive, and all were Ag-positive by both tests. Darker test line intensities from Ag-positive FTS were found to predict Mf-positivity (compared to same/lighter line intensities). QFAT had significantly higher reported test result changes than FTS, mostly reported the next day. The field laboratory team preferred QFAT over FTS due to the smaller blood volume required, better usability, and easier readability. Conclusion/SignificanceQFAT could be a suitable and user-friendly diagnostic alternative for use in the monitoring and surveillance of LF in field surveys based on its similar performance to FTS under field conditions. Author SummaryLymphatic filariasis (LF) is a debilitating tropical disease caused by an infection with parasitic filarial worms that are transmitted by mosquitoes. Long-term infection can lead to stigmatising chronic conditions like lymphoedema and elephantiasis. The World Health Organization initiated the global programme to eliminate lymphatic filariasis (GPELF) in 2000, which focuses on the mass administration of anti-LF drugs to stop transmission in endemic countries. However, to monitor the success of this programme and to make informed decisions to stop costly mass drug administrations, it is crucial to have access to accurate and reliable rapid diagnostics. Here, we evaluated the performance of a new rapid antigen test called the Q Filariasis antigen test and compared it to the currently recommended filariasis test strip under field conditions in Samoa. This study showed that the new rapid test could be a suitable alternative to the currently recommended test for use in GPELF-related activities with more user-friendly features.

BackgroundScrub typhus is a potentially fatal acute febrile illness caused by bacteria in the genus Orientia. Though cases have been documented, a comprehensive body of evidence has not previously been compiled to give an overview of scrub typhus in Indonesia. This study aimed to address this key knowledge gap by mapping and ranking geographic areas based on existing data on the presence or absence of the pathogen in humans, vectors, and host animals. Methodology/Principal FindingsWe performed searches on local and international electronic databases, websites, libraries, and collections including Embase, Medline, and Scopus to gather relevant evidence (including grey literature). After extracting data on the presence and absence of the pathogen and its vectors, we ranked the evidence based on the certainty for the presence of human infection risk. The country was divided into subnational units, and each were assigned a score based on the evidence available for that unit. We presented this in an evidence map. Orientia tsutsugamushi presence has been identified on all the main islands (Sumatra, Java, Borneo, Celebes, Papua). About two thirds of the data points were collected before 1946. South Sumatra and Biak had the strongest evidence for sustaining infectious vectors. There was only one laboratory confirmed case in a human identified but 2,780 probable cases were documented. The most common vector was Leptotrombidium deliense. Conclusions/SignificanceOur review highlights the concerning lack of data on scrub typhus in Indonesia, the fourth most populous country in the world. The presence of seropositive samples, infected vectors and rodents confirm O. tsutsugamushi is widespread in Indonesia and likely to be causing significant morbidity and mortality. There is an urgent need to increase surveillance to better understand the burden of the disease across the archipelago and to inform national empirical fever treatment guidelines. Author summaryScrub typhus is a febrile illness common in the Asia Pacific area. It is caused by bacteria in the genus Orientia and spread via the bite of Trombiculid mites. While we know that scrub typhus is present in Indonesia, there is very limited information on how widespread the problem is. To address this problem, this study aimed to create a map of geographic areas that are at risk of scrub typhus by analysing existing data on human, mites, and other animals. By doing so, we hope to provide a better understanding of the extent and distribution of scrub typhus in Indonesia. Evidence of Orientia tsutsugamushi, has been reported from all the five main islands of Indonesia. South Sumatra and Biak had the strongest evidence. However, there was no evidence of presence or absence in about two thirds of the regions and most of the data points were collected before 1946. While the available data suggest that scrub typhus is prevalent in Indonesia, up-to-date information is lacking. Therefore, it is crucial to increase scrub typhus surveillance to improve our understanding of its burden and distribution, and eventually inform treatment strategies.

Female genital schistosomiasis (FGS) is characterized by a pattern of lesions which manifest at the cervix and the vagina, such as homogeneous and grainy sandy patches, rubbery papules in addition to neovascularization. A tool for quantification of the lesions is needed to improve FGS research and control programs. Hitherto, no tools are available to quantify clinical pathology at the cervix in a standardized and reproducible manner. This study aimed to develop and validate a cervical lesion proportion (CLP) measure for quantification of cervical pathology in FGS. A digital imaging technique was applied in which a grid containing 424 identical squares was positioned on high resolution digital images from the cervix of 70 women with FGS. A CLP was made for each image by counting the total number of squares containing at least one type of pathognomonic lesions. For validation of inter- and intra-observer reliability, three different observers estimated CLP independently. In addition, a rubbery papule count (RPC) was determined in a similar manner. The intraclass correlation coefficient was 0.94 (excellent) for the CLP inter-rater reliability and 0.90 (good) for intra-rater reliability and the coefficients for the RPC were 0.88 and 0.80 (good), respectively. The CLP facilitated a reliable and reproducible quantification of the surface of the cervix affected by FGS pathognomonic lesions. Grading of cervical pathology by CLP can provide insight into the natural course of schistosome egg-induced pathology of the cervix. Moreover, CLP provides a measure for the efficacy of treatment. Author summaryFemale genital schistosomiasis (FGS) is characterized by development of egg-induced chronic inflammatory lesions of the cervix and the vagina. FGS causes various symptoms such vaginal discharge, dyspareunia and post-coital bleeding, and the disease is further associated with reproductive complications such as ectopic pregnancy and infertility. Moreover, FGS is today considered as a major risk factor for transmission of HIV in Sub-Saharan Africa. General prevention directed against Schistosoma infection and use of praziquantel as anthelmintic drug therapy are cornerstones in the FGS control strategy. In that overall context, we have developed an important new digital image tool for quantitative assessment of FGS evoked cervical lesions, which enables evaluation of treatment outcome at individual as well as community level. The tool will also provide new information in understanding the natural history of FGS including development of clinical pathology.

BackgroundScrub typhus is a severely ignored tropical disease and a leading cause of undifferentiated febrile illness worldwide caused by infection of an obligate intracellular bacteria Orientia tsutsugamushi. It has been rapidly expanding in South Asian countries, although clear epidemiological information is not available from Nepal. After the 2015 earthquake in Nepal, a sudden upsurge in scrub typhus cases was reported. The objective of this study was to investigate scrub typhus and its causative agents in human, rodent and chigger mites to better understand the ongoing transmission ecology. MethodsScrub typhus cases with confirmed diagnosis throughout the country were included in the analysis. Studies were concentrated in the Chitwan district, the site of a major outbreak in 2016. Additional country-wide data from 2015 to 2017 was made available from the government database to analyse the disease distribution using geographical mapping. ResultsDuring 2015-2017, 1,239 scrub typhus cases were confirmed with the largest outbreak occurring in 2016 with 831 (67.1%) cases. The remainder 267 cases were reported in 2017. The case fatality rate was 5.7% in 2015 and declined to 1.1% in 2017. Nationwide outbreak of scrub typhus was identified as the cases were found from 52 of the 75 districts of Nepal. A seasonal trend was observed with a peak during August and September (p = 0.01). In addition to the human cases, the presence of O. tsutsugamushi was also confirmed in rodents and chigger mites from the outbreak areas of southern Nepal. ConclusionThe detection of O. tsutsugamushi in human, rodent, and chigger mites from outbreak locations and wide-spread reports of scrub typhus throughout the country over two years confirms the ongoing transmission of O. tsutsugamushi with a firmly established ecology in Nepal. The countrys health system needs to be strengthened for systematic surveillance, early outbreaks detection, and immediate response actions including treatment and preventive measures. Author SummaryScrub typhus is a disease caused by a bacteria called Orientia tsutsugamushi and transmitted to people through bites of infected chiggers (larval mites). After the 2015 Gorkha earthquake in Nepal, a sudden upsurge in scrub typhus cases was reported with repeated outbreaks from different parts of the country. This study has documted epidemiology of scrub typhus and its causative agents in human, rodent and chigger mites confimring the local transmission O. tsutsugamushi with a firmly established ecology in Nepal. The local transmission of the diseases from most parts of the country demands strengthening for systematic surveillance, early outbreaks detection, and immediate response actions including treatment and preventive measures.

Neglected tropical diseases (NTDs) comprise 20 chronic and debilitating conditions that affect over 1.7 billion people worldwide, predominantly in marginalized and impoverished communities. In Somalia, the prevalence of NTDs is fueled by limited access to clean water, inadequate sanitation, and insufficient healthcare infrastructure, which disproportionately affect vulnerable groups such as women, children, and rural populations. Prolonged political instability has further impeded efforts to conduct research and establish effective surveillance systems for NTDs. Unlike its neighboring countries, Somalia lacks a comprehensive master plan for NTD prioritization. This scoping review mapped the existing research on NTDs in Somalia, identified knowledge gaps, and proposed future research and policy priorities. We included 36 studies published between January 1968 and July 2025, which reported eight neglected tropical diseases, with visceral leishmaniasis (38.9%) and schistosomiasis (33.4%) being the most studied. Other diseases, such as soil-transmitted helminthiases, chikungunya, rabies, and mycetoma, remain severely under-researched. Despite being a WHO priority country for leprosy, only two studies on this disease were identified. The studies predominantly used descriptive designs, with 52.8% led by authors outside Somalia, highlighting gaps in local research capacity. The review underscores the urgent need for systematic epidemiological studies, enhanced surveillance systems, and integration of NTD research into Somalias health policies. Addressing these gaps requires building local research infrastructure, promoting community-based interventions, and fostering collaborations between the government, Somali researchers, and international organizations. This evidence-based approach is vital to mitigating the burden of NTDs and improving health outcomes for Somalias underserved populations.

BackgroundScabies remains a significant public health concern in sub-Saharan Africa, particularly among children and the elderly. It is mostly found in developing countries, and it has health effects due to its discomfort and secondary bacterial infection. In Zambia, there is limited data on the burden and determinants of scabies, particularly in high-risk areas like Zumbe Health Post (HP) in Mafinga District. Therefore, the purpose of this study was to determine the prevalence of scabies and its associated risk factors among children under five years old in Mafinga District, Zambia. MethodologyA cross-sectional study design was employed. Two sampling techniques were used: purposive and simple random to select 307 under-five children and their caregivers. Scabies diagnosis was based on clinical examination set by the International Alliance for the Control of Scabies (IACS, 2020), and data on associated risk factors was collected via structured questionnaire. Univariable and multivariable regression analyses were conducted to identify associations between scabies and risk factors. ResultsThe prevalence of scabies was 5.21% (16/307; 95% CI: 2.8%-7.6%). Most cases (68.75%) were mild. Multivariable analysis identified that caregivers who took longer to fetch water had significantly higher odds of scabies among their children (AOR: 3.8; 95% CI: 2.61-5.82; p< 0.001). Higher caregiver education levels were associated with lower scabies risk (AORs: 0.02- 0.03), and high knowledge of scabies among caregivers was significantly associated with lower scabies prevalence (p = 0.02). ConclusionScabies prevalence in Zumbe Health Post was moderate. This Moderate highlights the need for targeted interventions in the community. Efforts should focus on improving caregiver education and access to clean water to help reduce the incidence of this condition among children. Provision of health education and improvement of hygiene practices are suggested. These strategies can empower caregivers with the knowledge and resources necessary to prevent scabies transmission. Author summaryThis study was carried out in the Zumbe catchment area in Mafinga district, Zambia. It aimed to assess the prevalence of scabies and associated risk factors among under five-year-old children. The study involved guided questionnaire and clinical skin examination for scabies. Finding revealed moderate prevalence of Scabies and access to water on time taken and knowledge level as associated risk factors of scabies. There is a need to improve on hygiene practice and community health promotion to protect the children from Scabies.