PLOS Neglected Tropical 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.

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.

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.

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.

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.

BackgroundThe rising burden of orally transmitted Chagas disease in South America underscores the need for a deeper understanding of this food-borne transmission route. Despite its relevance, key aspects such as transmission dynamics, epidemiology, and clinical outcomes remain insufficiently explored, limiting prevention and treatment strategies. MethodsA systematic review (PROSPERO 2024-CRD42024542461) of reported outbreaks from 1965 to 2023 was conducted. Three reviewers independently screened and selected studies using predefined criteria. Data on epidemiology, contamination sources, clinical findings, diagnostics (cardiac, serological, molecular), vector species, and parasite lineages were extracted. FindingsWe compiled data from 111 outbreaks involving 1187 cases (55% males), 77 deaths, in 6 countries. Contaminated food sources were identified in 63 outbreaks (56{middle dot}7%), with reliable confirmation in 8 (7{middle dot}2%), acai fruit being the most common source (28%). Outbreaks occurred mainly in sylvatic and tropical regions, coinciding with warm seasons and crop harvest periods. Selvatic parasite lineages predominated (98%), with Rhodnius spp. triatomines being implicated in 28%. The median incubation period was 22 days. Case fatality ratio was 6{middle dot}5%. Acute infection presented with fever (80%), facial edema (20%), altered ECG (39{middle dot}2%) and Echo (28{middle dot}9%). Despite antiparasitic treatment, cardiac alterations persisted after 1 and 4 years. A ten-year follow-up showed no chronic Chagasic cardiomyopathy, though risk markers and persistent T. cruzi-specific IgG were reported. Data reinforces gaps mainly in long-term clinical, serological and molecular follow-up. InterpretationMore integrated strategies are needed to enhance outbreak detection and management. FundingFiocruz, CNPq and Faperj (Brazil) and FOCEM/Mercosur.

Tungiasis is a neglected tropical skin disease caused by the sand flea, Tunga penetrans which penetrates the skin causing considerable pain and itching. In this cross-sectional study we aimed to assess its impact on the quality of life of school children in Kenya. School pupils (198) aged 8-14 years with tungiasis were randomly selected and interviewed using a tungiasis-specific quality of life instrument (TLQI). The caregivers of each infected pupil and 199 randomly selected caregivers of uninfected pupils were interviewed using the proxy KIDscreen52(R) to assess their childs general health-related quality of life (HR-QoL). Generalized linear models were used to assess associations between quality-of-life variables, childrens tungiasis status and other covariables. Among infected children, 62.4% had TLQI scores reflecting a moderate to very high impact, with no significant difference between mild and severe cases. Severe cases had a lower proxy-HR-QoL than uninfected pupils ({beta} -21.15, 95% CI -39.63 - -2.68, p=0.025), but this was not significant in multivariable models. For the first time, this study demonstrated for children whose caregivers were depressed, tungiasis had a higher impact on their quality of life (TLQI adjusted {beta} 0.28, 95% CI 0.08-0.49, p=0.006) and had a lower general HR-QoL (adjusted {beta} -40.34, 95%CI -55.91- -24.76, p<0.001). Conversely, if their caregiver showed them affection, tungiasis had a lower impact on their quality of life (TLQI, adjusted {beta} -0.45, 95% CI -0.70- -0.20, p<0.001). Further studies are needed to investigate the interaction of tungiasis with parenting styles, the mental health of children and their caregivers and their effect on childrens well-being. Plain English SummaryTungiasis is an extremely neglected tropical skin disease which causes immense suffering among children in resource poor communities in many tropical countries. A good quality of life is considered a Right of all people and is consequently used as the most important outcome of treatment programs. The impact on quality of life by tungiasis has only been investigated in very few studies, but evidence of impact is needed to monitor interventions. Here we assessed the impact of the disease on the quality of life of school pupils using a disease-specific instrument with children and a general health-related instrument with their caregivers. The study demonstrated the considerable impact tungiasis has on the quality of life of school-age children. Tungiasis affected childrens ability to sleep and caused feelings of sadness and shame. Tungiasis had a greater impact on children whose caregivers were depressed, and they had a lower general health-related quality of life. Conversely, tungiasis had a lower impact on quality of life for children whose caregivers showed them affection. Further research is needed to investigate the interaction of tungiasis with parenting styles and the mental health of children and their caregivers and their effect on childrens well-being.

BackgroundSleeping sickness caused by T.b. rhodesiense is a fatal disease and endemic in Southern and Eastern Africa. There is an urgent need to develop novel diagnostic and control tools in order to achieve elimination of rhodesiense sleeping sickness which might be achieved through a better understanding of trypanosome gene expression and genetics using endemic isolates. Here, we describe transcriptome profiles and population structure of endemic T. b. rhodesiense isolates in human blood in Malawi. MethodologyBlood samples of r-HAT cases from Nkhotakota and Rumphi foci were collected in PaxGene tubes for RNA extraction before initiation of r-HAT treatment. 100 million reads were obtained per sample, reads were initially mapped to the human genome reference GRCh38 using HiSat2 and then the unmapped reads were mapped against Trypanosoma brucei reference transcriptome (TriTrypDB54_TbruceiTREU927) using HiSat2. Differential gene expression analysis was done using the DeSeq2 package in R. SNPs calling from reads that were mapped to the T. brucei genome was done using GATK in order to identify T.b. rhodesiense population structure. Results24 samples were collected from r-HAT cases of which 8 were from Rumphi and 16 from Nkhotakota foci. The isolates from Nkhotakota were enriched with transcripts for cell cycle arrest and stumpy form markers, whereas isolates in Rumphi focus were enriched with transcripts for folate biosynthesis and antigenic variation pathways. These parasite focus-specific transcriptome profiles are consistent with the more virulent disease observed in Rumphi and a more silent disease in Nkhotakota associated with the non-dividing stumpy form. Interestingly, the Malawi T.b. rhodesiense isolates expressed genes enriched for reduced cell proliferation compared to the Uganda T.b. rhodesiense isolates. PCA analysis using SNPs called from the RNAseq data showed that T. b. rhodesiense parasites from Nkhotakota are genetically distinct from those collected in Rumphi. ConclusionOur results have added new insights on how clinical phenotypes of r-HAT in Malawi might be associated with differences in gene expression profiles and population structure of T. b. rhodesiense from its two major endemic foci of Rumphi and Nkhotakota. Author SummaryA better understanding of T. b. rhodesiense gene expression profiles and population structure using endemic isolate may fast track the current search for novel diagnostic and control tools for rhodesiense sleeping sickness. Here, we analysed T. b. rhodesiense transcriptome profiles from endemic isolated from peripheral blood in Nkhotakota and Rumphi foci in Malawi. In Nkhotakota focus, T. b. rhodesiense transcripts were enriched for cell cycle arrest and stumpy marker whereas in Rumphi focus, the isolates were enriched for antigenic variation and folate biosynthesis biological pathways. Furthermore, we also found that T. b. rhodesiense population structure in Nkhotakota focus is different from Rumphi focus. The differences in trypanosome gene expression profiles and population structure are consistent with a less severe and acute sleeping sickness clinical profiles in Nkhotakota and Rumphi foci respectively.

BackgroundTungiasis is a neglected tropical skin disease mostly affecting children under 15 years, the elderly and disabled people in the most resource poor populations in Latin America and Sub-Saharan Africa. While most transmission seems to occur at home inside houses, we aimed to identify factors in the school environment that may put children at increased risk of infection. MethodsAs part of a cross-sectional school-based prevalence survey of 21,466 pupils in nine counties of Kenya, observations of school infrastructure were made and the headteacher interviewed in each of 196 schools. In a subset of 97 schools, detailed observations of 322 classrooms were made and 117 teachers interviewed. Mixed effect logistic regression models were used to identify factors associated with tungiasis infection in pupils. ResultsWe found a higher odds of tungiasis infection for pupils in schools where more than 400 pupils were enrolled (aOR 2.24, 95% CI 1.12-4.50, p=0.023), where clean water was not always available (aOR 2.28, 95% CI 1.13-4.60, p=0.021); and if the school buildings were in a bad structural condition (aOR 2.15, 95% CI 1.00-4.62, p=0.050). Of the 5,102 pupils in 97 schools, 99% studied in a classroom with a concrete floor and those with a lot of loose soil or sand on top of the concrete floor had a six times higher odds of infection than those on a clean concrete floor (aOR 6.52, 95% CI 1.61-26.35, p=0.008). Only 45% of (head)teachers in affected schools knew they had infected pupils in their school or grade. Those who did, were aware of the impact it was having on the pupils and yet only three of 76 affected schools had conducted a tungiasis intervention activity within the last year. ConclusionMost schools do not pose a risk of tungiasis for pupils, instead the home environment is the main risk. However, where school buildings are not well maintained and water not always available a multisectoral approach to control tungiasis is needed involving the Department of Health as well as the school management and the Department of Education.

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.

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.

Peru is endemic for Echinococcus granulosus sensu lato (s.l.), a cestode that causes cystic echinococcosis (CE) in humans. Epidemiological and clinical research has focused extensively on the central and southern highlands, where the parasite is hyperendemic. However, the region of Arequipa, with active transmission of the parasite, has received much less attention. In 2011, a state clinical-surgical program for CE patients was launched in the city of Arequipa. Over less than two years, before program funds were reallocated, surgeons treated 177 patients. This volume underscores the urgent need to prioritize and include Arequipa in CE control programs in Peru. This study characterizes patients who underwent surgical treatment during the programs duration and investigates evidence of active E. granulosus s.l. transmission in Arequipa. We extracted socio-demographic, epidemiological, and clinical data from 129 records of CE patients treated between December 2011 and November 2013. We compared frequencies across variables, including the patients age, sex, residence, education level, and occupation. We also mapped patient origins, with 40.3% being autochthonous to the Arequipa region. Patients median age was 26 (IQR: 16-45), 55% were men, and 69% were students, farmers, or housemakers. In contrast to other reports, where hepatic cases are predominant, 70% of the cases were pulmonary. The southern highlands of Peru, including Arequipa, suffer from endemic transmission of E. granulosus s.l. Limited access to healthcare hinders timely diagnosis and treatment, exacerbating the public health burden. While implementing or reinstating clinical-surgical units in Arequipa and other endemic areas would improve care and case monitoring, these measures alone are not sufficient. Effective control requires integrated One Health approaches and intersectoral collaboration across human, animal, and environmental health sectors. Author summaryCystic echinococcosis (CE) is a neglected parasitic disease caused by Echinococcus granulosus sensu lato (s.l.), which significantly impacts human and animal health in endemic regions, including southern Peru. This study analyzed medical records of patients diagnosed with CE at a major hospital in Arequipa, Peru, aiming to describe its epidemiology and clinical characteristics, and to highlight Arequipa as a historically overlooked region in CE research and control efforts. The findings reveal that CE disproportionately affects younger populations and rural communities, with men, students, farmers, and housemakers being at higher risk. Pulmonary involvement was notably more frequent than hepatic involvement, diverging from trends reported in other studies. The results underscore the importance of strengthening clinical- surgical units in the southern highlands and the necessity of including Arequipa in national control programs. Moreover, limited access to healthcare in rural and migrant populations underscores the importance of equitable resource allocation and sustained efforts to address health disparities. We emphasize the urgency of implementing integrated control strategies that combine human, animal, and environmental health approaches within a One Health framework. These findings provide valuable insights to inform policy and guide the development of cost-effective, interdisciplinary interventions focused on reducing the burden of CE in vulnerable populations.

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.

Tungiasis is a highly neglected tropical skin disease caused by the sand flea, Tunga penetrans. The flea burrows into the skin inducing a strong inflammatory response, leading to chronic pain and discomfort with potential impacts on quality of life. Few countries implement control efforts and there are few data on the impact of the disease to support policy decisions. We conducted a survey to determine the impact of tungiasis among primary school children across nine counties of Kenya. A total of 10,600 pupils aged 8 to 14 years were randomly selected from 97 primary schools and examined for tungiasis. Those with tungiasis (83) were interviewed with respect to their quality of life using a modified dermatological quality of life index. For these cases and 576 randomly selected controls, school attendance and exam scores for maths, English and science were collected from school records. Mixed effect ordered logistic and linear models were used to assess associations between disease status and impact variables. Compared to uninfected pupils, those with tungiasis missed more days of school (adjusted Incidence Rate Ratio (aIRR: 1.50, 95% CI: 1.03-2.21) and were less likely to receive a high score in maths (aOR 0.18, 95% CI: 0.08-0.40) and other subjects. Pupils with severe disease (>10 fleas) were five times more likely to experience severe pain and itching than those with mild disease (OR 5.0, 95% CI: 2.55-10.51) and a higher category of impact on their quality of life than those with mild disease (aOR 3.52, 95% CI: 1.22-10.17) when adjusted for covariates. This study has demonstrated tungiasis has a considerable impact on childrens lives and academic achievement, equivalent to other diseases. This indicates the need for integrated disease management for school-aged children to protect their physical and cognitive development and their future prospects. Author SummaryTungiasis is one of the most neglected tropical diseases (NTDs). It is caused by a flea which burrows into the skin of the feet. The neglect has resulted in large gaps in our knowledge of the disease, how to treat and prevent infection. This is partly due to a lack of appreciation for the impact the disease has on patients lives by health officials, policymakers and the research community. In this study we aimed to determine the impact on school children in nine counties of Kenya. We found evidence that children experience considerable pain and itching which affects their ability to attend school and to concentrate on their classes. They had lower exam scores in maths, English and science than uninfected children. This study has provided evidence that tungiasis is a disease that affects children just as much as other diseases and urgently needs more attention from researchers, donors, and policy makers. Integrating tungiasis into comprehensive disease management for school-aged children will protect their physical and cognitive development and their future prospects.

BackgroundWorld Health Organization has identified 21 neglected tropical diseases (NTDs) affecting millions globally, for control or elimination. We analysed time trends and geographic distribution of hospitalizations attributed to NTDs between 2000 and 2024 in Ecuador. MethodsWe estimated hospitalization rates over the 25-year period using hospital discharge data from Ecuadorian national statistics. Time trends Joinpoint regression analysis was done for the 5 most frequent NTDs. Standardized morbidity ratios were estimated for these NTDs for census years (2001, 2010 and 2022) to explore relative changes in hospitalization rates over time and by geography. ResultsA total of 179,439 hospital discharges attributed to NTDs were recorded nationally in Ecuador. The five most frequent NTDs accounted for 97.1% of hospitalizations and included arboviral infections, dengue and chikungunya (62% of hospitalizations), snakebite envenoming (20%), soil-transmitted helminthiases (9%), taeniasis and cysticercosis (4%), and scabies and other ectoparasitoses (2%). Only 0.4% of hospitalizations resulted in death. NTD hospitalizations were more frequent in males (54%) with a median age of 19 years (Q1 9 - Q3 37). Although hospitalization rates for all NTDs increased over time, there was a downward trend in non-arboviral NTDs that was significant for snakebite (from 2014, annual percent change -7.81%, 95% CI -11.27, -5.69, P=0.006), soil-transmitted helminths (from 2000, -5.62%, 95% CI -6.56, -4.68, P<0.001), and taeniasis and cysticercosis (from 2003, -10.42%, 95% CI -14.50, -9.68, P=0.002). Relative morbidity caused by NTDs tended to be much greater in Coastal and Amazon provinces, shifting over time particularly to the Amazon region, although taeniasis and cysticercosis morbidity remained greatest in southern Andean Provinces. ConclusionHospitalization rates for non-arboviral NTDs have declined over the past 25 years in Ecuador. Populations in the Amazon region remain the most affected by NTD morbidity, highlighting the need for enhanced and appropriately targeted efforts to control and eliminate NTDs. Author SummaryNeglected tropical diseases (NTDs) are a group of diseases affecting millions worldwide, especially in poor and marginalized populations in tropical and subtropical regions of low and middle-income countries. This study analysed hospital records over a 25-year period (2000-2024) in Ecuador--a country where 40% of the population lives in poverty, where there is considerable geoclimatic diversity but where 80% of territory has a tropical or subtropical climate--to determine how hospitalisations due to NTDs have changed over this period and which regions of the country are most affected. Most hospitalisations (97%) were caused by five diseases: the arbovirus infections, dengue and chikungunya; snakebite; intestinal worms; pork tapeworm infections; and scabies. Children and adolescents and those living in the Amazon region suffered most from severe disease caused by NTDs. Over time, hospitalisations from most NTDs declined although those caused by dengue and chikungunya increased. These findings highlight an urgent need to strengthen health education, disease prevention, surveillance, and access to timely diagnosis and treatment tailored to each of these NTDs, especially in the Amazon region of the country. These data help inform the countrys progress meeting its targets for NTD control and elimination by 2030 as outlined in Sustainable Development Goal 3.3.

BackgroundLymphedema is a chronic condition characterized by fluid accumulation and tissue swelling, often complicated by recurrent acute attacks. Nodules, a common feature of chronic lymphedema, may contribute to the frequency and severity of these episodes. However, nodules as a risk factor for acute attacks remains poorly understood. This study aimed to assess the prevalence of nodules, the frequency of acute attacks, and nodule as risk factor for acute attacks among individuals with lymphedema in Addis Ababa city Administration, Ethiopia. MethodsA cross-sectional study was conducted among individuals with lymphedema in Addis Ababa city Administration. Data were collected using structured interviews and clinical examinations. The prevalence of nodules and acute attacks was determined, and logistic regression was used to assess their association. ResultsAmong the participants, 57.5% reported the presence of nodules affecting multiple areas of the lower limbs. Additionally, 41.2% experienced acute attacks, with an average of 5.89 episodes in the past six months. Logistic regression analysis revealed that individuals with nodules were 3.2 times more likely to experience acute attacks compared to those without nodules (p = 0.001). Other demographic and clinical factors, including sex and lymphedema severity, also showed trends associated with acute attack occurrence. Stigma was a significant concern, with 42.6% of participants reporting stigma from their communities (60.9%) and families (36.8%). Additionally, 34.8% of participants faced workplace challenges due to their condition. ConclusionsThe occurrence of nodules was associated with an increased risk of acute attacks. Both nodules and acute attacks were commonly observed. Many patients faced stigma from close family members and the surrounding community. Author SummaryLymphedema is a long-term condition that leads to swelling in the limbs due to fluid accumulation and impaired lymphatic function. People with lymphedema often experience recurrent acute attacks, which cause pain, inflammation, and disability. This study investigated the relationship between nodules--hardened tissue formations commonly found in chronic lymphedema--and the occurrence of acute attacks among individuals with lymphedema in Addis Ababa City Administration, Ethiopia. Our findings revealed that more than half of the participants had nodules, and over 40% experienced acute attacks, with an average of nearly six episodes in the past six months. We found that individuals with nodules were significantly more likely to suffer from acute attacks, suggesting that nodules may serve as reservoirs for bacteria or contribute to lymphatic obstruction. Additionally, many participants reported experiencing stigma from their communities and families, as well as difficulties in the workplace due to their condition. These findings highlight the need for early detection and management of nodules to prevent acute attacks, improve patient quality of life, and reduce the psychosocial and economic burden of lymphedema. Public health interventions should focus on improving self-care practices, providing accessible treatment options, and addressing stigma through education and community awareness programs. Future research should explore long-term strategies for preventing and managing nodules to reduce complications associated with lymphedema.

Zoonotic soil-transmitted helminths (STH), including Ancylostoma ceylanicum, Ancylostoma caninum, Ancylostoma braziliense, Trichuris vulpis, Trichuris suis, and Ascaris suum, are increasingly recognised as potential sources of human infection. Additionally, animals can act as carriers or reservoirs for human STH species. However, the extent of cross-host infection remains poorly understood, primarily due to reliance on morphological diagnostics. This review compiles data on the occurrence of cross-host STH infections, highlighting zoonotic STH in humans and human STH species in domestic and livestock animals. Following PRISMA guidelines, PubMed, Medline, and Web of Science were systematically searched from inception to December 2024. Inclusion criteria encompassed studies on cross-host STH infections confirmed by molecular methods. Exclusion criteria included experimental infection studies, studies involving wildlife, and those that did not find cross-host infection. Two independent reviewers assessed bias using AXIS and Joanna Briggs Institute appraisal tools. The protocol is registered with PROSPERO (CRD42024519067). The review screened 4197 titles and abstracts; and included 51 studies. Ancylostoma ceylanicum was the commonest zoonotic STH reported, predominantly in Southeast Asia. Human STH species (Ancylostoma duodenale, Necator americanus, Trichuris trichiura and Ascaris lumbricoides) were found in dogs, cats, and pigs. Studies examining both humans and animals together in shared environments showed STH presence in both populations. Case studies revealed gastrointestinal and dermatological effects in humans particularly infected with zoonotic hookworms. This systematic review highlights STH cross-host species infections underscoring the need for further One health epidemiological investigations of humans and domestic/livestock animals in sympatric environments to better understand the burden and explore the transmission dynamics of cross-host STH infections.

Introduction Schistosomiasis is one of the most pervasive neglected tropical diseases in sub-Saharan Africa as an acute and chronic disease. It presents significant public health challenges in both Madagascar and Burkina Faso. Though schistosomiasis is a high prevalence disease, the understanding of its economic burden is limited. Methods A case control study was designed to compare the out-of-pocket costs and productivity loss associated with infection. A patient-specific survey questionnaire for Cost of Illness and Health-Related Quality of Life was developed and applied in Madagascar and Burkina Faso. Multiple interviews were conducted to capture the costs incurred during the entire period of illness. Results A total of 371 participants were enrolled in this study: 224 in Madagascar and 147 in Burkina Faso. The average economic burden for individuals confirmed to be negative for schistosomiasis was US$ 6.4 in Madagascar and US$ 29.8 in Burkina Faso. For mild cases, average costs were US$ 8.4 and US$ 13.5, respectively. Severe cases with complications due to schistosomiasis incurred substantially higher costs, averaging US$ 60.0 in Madagascar and US$ 1,272 in Burkina Faso. Median Health-Related Quality of Life was significantly lower among severe cases compared with controls and mild cases. Conclusions The cost of illness for schistosomiasis is significant in both countries. This study indicates the potential economic burden of disease in Madagascar and Burkina Faso, where the existing evidence on schistosomiasis is limited. Our study can help decision makers set health policy priorities.

Helminthiases are a class of neglected tropical diseases that affect at least one billion people worldwide, with a disproportionate impact in resource-poor areas with limited disease surveillance. Geospatial methods can offer valuable insights into the burden of these infections, particularly given that many are subject to strong ecological influences on the environmental, vector-borne, or zoonotic stages of their life cycle. In this study, we screened 6,829 abstracts and analyzed 485 studies that use maps to document, infer, or predict transmission patterns for over 200 species of parasitic worm. We found that quantitative mapping methods are increasingly used in medical parasitology, drawing on One Health surveillance data from the community scale to model geographic distributions and burdens up to the regional or global scale. However, we found that the vast majority of the human helminthiases may be entirely unmapped, with research effort focused disproportionately on a half-dozen infections that are targeted by mass drug administration programs. Entire regions were also surprisingly under-represented in the literature, particularly southern Asia and the Neotropics. We conclude by proposing a shortlist of possible priorities for future research, including several neglected helminthiases with a burden that may be substantially underestimated.

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.