Endemic Areas Research Articles

Clinical polymorphism of zoonotic cutaneous leishmaniasis: combination of the clinical and the parasitological diagnosis.

Zoonotic cutaneous leishmaniasis (ZCL) is a neglected tropical disease caused by Leishmania (L.) major. This zoonosis is characterized by a broad-spectrum clinical polymorphism and may be underestimated and poorly treated since it is a simulator of various dermatoses. The aim of our study was to analyze the clinical polymorphism of patients with ZCL. A total of 142 patients with confirmed CL based on the microscopic examination of skin lesion biopsies were included in this study. Molecular typing of Leishmania species revealed that all patients were infected with L. major.In total, 14 clinical formswere observed. Six were typical and eight were atypical. The typical ZCL forms are grouped as follows: papular (26.76%), ulcero-crusted (26.05%), ulcerated (13.38%), impetiginous (9.86%), nodular (9.15%), and papulo-nodular (5.63%) lesions. In atypical ZCL forms, we described erythematous (2.81%), erysipeloid (1.4%), sporotrichoid, (1.4%), keratotic (0.7%) lupoid (0.7%), lichenoid (0.7%), psoriasiform (0.7%), and zosteriform (0.7%) lesions. Here, the lichenoid and the keratotic forms caused by L. major were reported for the first time in Tunisia. These findings will help physicians to be aware of the unusual lesions of ZCL that could be confused with other dermatological diseases. For this reason, it will be necessary to improve the diagnosis of CL especially in endemic areas. Such large clinical polymorphism caused by L. major may be the result of a complex association between the vector microbiota, the parasite, and the host immune state, and further studies should be carried out in order to reveal the mechanisms involved in clinical polymorphism of ZCL.

Cross-sectoral role and community empowerment in controlling schistosomiasis in Indonesia

The role of cross-sectors in synergy with community empowerment in controlling schistosomiasis is a very effective model. Until mid-2017, the incidence rate of disease in humans in 28 endemic villages still ranged 0.00-2.15%. This research aims to evaluate schistosomiasis control activities that have been carried out across sectors based on a road map for schistosomiasis eradication and community empowerment in controlling schistosomiasis. The study was mixed method. Data were obtained by in-depth interview with key informants and evaluation of the results of cross-sectoral and community activities. The research was carried out in an endemic area for schistosomiasis on the Bada Plateau, Indonesia, from January to November 2019. In conclusion, the potential of cross-sector collaboration in controlling schistosomiasis has not been fully realized due to budget constraints. Community empowerment is carried out to eliminate snail foci, increase the scope of feces collection and change community behavior for the better in order to avoid infection and always try to clean up snail foci.

Examining the epidemiology of AIDS-defining and HPV-associated cancers in HIV endemic areas of south Florida for development of targeted intervention.

e22522 Background: The Miami-Dade and Broward Counties in South Florida (SF) have the highest incidence of HIV infection in the United States, with over 47,000 people living with HIV as of 2021. The epidemiology and burden of cancers associated with HIV in SF have not been fully described, hampering efforts for effective cancer control. This study examines the regional epidemiology of AIDS-defining cancers and HPV-associated cancers, for which HIV+ patients face higher risk. The results are used to develop education and community screening events targeting communities with high incidences of these cancers. Methods: The catchment area of Sylvester Comprehensive Cancer Center, consisting of Miami-Dade, Broward, Palm Beach, and Monroe Counties for a total population of six million was studied. Using the 2015-2019 data from Florida’s official cancer registry, age-adjusted incidences (AAI) for AIDS-defining cancers and HPV-associated cancers were calculated for all census tracts in SF. Geospatial hot spot analysis was then applied to identify statistically significant clusters (hot spots) of census tracts with high AAI of these cancers. Results: We identified two clusters of hot spots for AIDS-defining and HPV-associated cancers in SF. Except for penile cancer in one cluster, both clusters have HPV-associated cancer incidences that are significantly higher than the state averages. Specifically, one cluster has the highest incidence of anal cancer in SF, while the other has a notable concentration of penile cancer. Conclusions: Using the results, we have developed targeted educational and screening events for communities within the hot spots. A screening summit was recently held in a hot spot community where several screening and educational events were offered on a single day. By sharing information about the epidemiology of these cancers, we were able to facilitate community buy-in and develop working relationships with community partners to provide culturally competent and targeted intervention for a population who are less likely to undergo screening. [Table: see text]

Challenges of Severe Malaria Management in Patient Returning from Jayapura, Indonesia Presented with Severe Anemia: A Case Report

We report a 55-year-old woman who presented to the hospital with intermittent fever for a month. The patient had a history of living in a malaria endemic area (Jayapura, Papua Province, Indonesia) for approximately 15 years. The hemoglobin level was very low (4.2 mg/dL). Furthermore, we conducted a follow-up supporting examination, Malaria Rapid Diagnostic Test (RDT), the result was positive for malaria tropica (Plasmodium falciparum). Blood smear test was also carried out to confirm the diagnosis, the result was that immature trophozoites (ring shape) were found. Thus, the patient was diagnosed with severe malaria tropica with clinical manifestations indicative of severe anemia. The patient was treated for 3 days with anti-malarial drugs and supportive drugs according to the symptoms in the hospital and was advised to follow up 7 days later. This case report describe the challenges of severe malaria management in patient returning from Jayapura with severe anemia.

Histoplasmosis in Non-HIV Infected Patients: Another Neglected Infection in French Guiana.

(1) Background: Only a few studies on histoplasmosis in immunocompetent patients have been reported in French Guiana. Therefore, we conducted a detailed clinical description of hospitalized patients suffering with histoplasmosis among non-HIV patients. (2) Methods: This is a single-center, retrospective study conducted at Cayenne Hospital Center between 2008 and 2022. (3) Results: Our cohort was composed of 31 (91%) adults (>18 years of age) and 3 (9%) children, with a sex ratio, M:F, of 1:2. The median age was higher among the women than among the men (70 versus 54 years). The collection of respiratory samples constituted the majority of the performed examinations (38%). Fever (>37 °C) was found in 56% of patients. Surprisingly, the histoplasmosis was disseminated in 82% of patients with an overall case fatality rate of 14.7%. However, immunosuppressive conditions were found in 52% (16/31) of the adult patients, including lymphoid hemopathies, diabetes and immunosuppressive drugs. Conclusions: This disease, though rare and usually considered a mostly benign disease in non-HIV patients, presented a relatively high mortality rate in our cohort. Thus, histoplasmosis should be suspected, screened and investigated as a first line of defense in highly endemic areas, even in immunocompetent and non-HIV patients, especially those with fever or chronic respiratory symptoms.

Diabetes mellitus as a risk factor for severe dengue fever and West Nile fever: A meta-analysis.

Dengue fever (DF) and West Nile fever (WNF) have become endemic worldwide in the last two decades. Studies suggest that individuals with diabetes mellitus (DM) are at a higher risk of developing severe complications from these diseases. Identifying the factors associated with a severe clinical presentation is crucial, as prompt treatment is essential to prevent complications and fatalities. This article aims to summarize and assess the published evidence regarding the link between DM and the risk of severe clinical manifestations in cases of DF and WNF. A systematic search was conducted using the PubMed and Web of Science databases. 27 studies (19 on DF, 8 on WNF) involving 342,873 laboratory-confirmed patients were included in the analysis. The analysis showed that a diagnosis of DM was associated with an increased risk for severe clinical presentations of both DF (OR 3.39; 95% CI: 2.46, 4.68) and WNF (OR 2.89; 95% CI: 1.89, 4.41). DM also significantly increased the risk of death from both diseases (DF: OR 1.95; 95% CI: 1.09, 3.52; WNF: OR 1.74; 95% CI: 1.40, 2.17). This study provides strong evidence supporting the association between DM and an increased risk of severe clinical manifestations in cases of DF and WNF. Diabetic individuals in DF or WNF endemic areas should be closely monitored when presenting with febrile symptoms due to their higher susceptibility to severe disease. Early detection and appropriate management strategies are crucial in reducing the morbidity and mortality rates associated with DF and WNF in diabetic patients. Tailored care and targeted public health interventions are needed to address this at-risk population. Further research is required to understand the underlying mechanisms and develop effective preventive and therapeutic approaches.

The Implementation of the Dengue Hemorrhagic Fever (DHF) Eradication Program

Billions of people living in wet tropical climates are at risk of suffering from Dengue Hemorrhagic Fever. In 2019, until mid-December throughout Indonesia, there were 71,668 people with dengue fever, and 641 of them died. Indragiri Hulu Regency is an area with a wet tropical climate and it becomes an endemic area Rengat District. This study aims to analyze of the implementation of the Dengue Hemorrhagic Fever eradication program. The type of research is analytical qualitative with case study design. The research informant technique used purposive sampling with 11 people. From the results of research and observations, it is shown that human resources are limited in facilities, not enough infrastructure is available, funds are still limited, from fogging carried out when cases occur, Eradication of Mosquito Nests. Dengue Hemorrhagic Fever is still not actively carried out by the community, abate powder is not evenly distributed to the community, Counseling that is still interested in carrying out Eradication of Mosquito Nests for Dengue Hemorrhagic Fever. Minimally carried out and public awareness about the condition of the environment around the community which is still not clean, causing the development of dengue mosquito larvae. It can be concluded that the Dengue Hemorrhagic Fever eradication program at the Sipayung Health Center still needs to be improved. It is expected to make program innovations to increase public interest in carrying out Eradication of Mosquito Nests for Dengue Hemorrhagic Fever.

Fatal acute clinical babesiosis in an adult gelding pony living in an endemic area

Fatal acute clinical babesiosis in an adult gelding pony living in an endemic area

Seasonal dynamics of sand flies in Lençóis Maranhenses National Park: a tourist destination and endemic area for leishmaniasis.

Numerous sand fly species have been reported in Lençóis Maranhenses National Park (LMNP) in Northeast Brazil, including important Leishmania vectors, making the park an endemic area for tegumentary and visceral leishmaniasis. We evaluated sand fly abundance monthly over 7 years, correlating it with environmental variables and monthly tourist numbers in LMNP. Sand fly species were observed throughout the year, with Lutzomyia longipalpis Lutz & Neiva and Nyssomyia whitmani Antunes and Coutinho (Diptera: Psychodidae) being the most abundant species, especially from April to June. In addition to seasonal abundance patterns, Lu. longipalpis showed increasing abundance throughout 2013 until April 2014, whereas Ny. whitmani exhibited a consistent increase throughout the study period. Redundancy analysis indicated that monthly sand fly abundances increased with humidity but decreased with mean temperature and wind speed. Ecotourists mainly visit the park from May to September when interdune lagoons are full, coinciding with high-frequency vector activity during the rainy months (May-June). Tourists also visit in January and February during school holidays, when the rains begin and sand fly abundance increases, and in July, when sand fly abundance decreases. To date, no instances of infected tourists have been recorded, likely because visits to LMNP occur during the day when sand flies are inactive. However, there is a potential risk of vector exposure if tourists engage in nighttime cultural visits to villages around the park, where leishmaniasis cases occur annually.

Spatial patterns of intestinal parasite infections among children and adolescents in some indigenous communities in Argentina.

Argentina has a heterogeneous prevalence of infections by intestinal parasites (IPs), with the north in the endemic area, especially for soil-transmitted helminths (STHs). We analyzed the spatial patterns of these infections in the city of Tartagal, Salta province, by an observational, correlational, and cross-sectional study in children and adolescents aged 1 to 15 years from native communities. One fecal sample per individual was collected to detect IPs using various diagnostic techniques: Telemann sedimentation, Baermann culture, and Kato-Katz. Moran's global and local indices were applied together with SaTScan to assess the spatial distribution, with a focus on cluster detection. The extreme gradient boosting (XGBoost) machine-learning model was used to predict the presence of IPs and their transmission pathways. Based on the analysis of 572 fecal samples, a prevalence of 78.3% was found. The most frequent parasite was Giardia lamblia (30.9%). High- and low-risk clusters were observed for most species, distributed in an east-west direction and polarized in two large foci, one near the city of Tartagal and the other in the km 6 community. Spatial XGBoost models were obtained based on distances with a minimum median accuracy of 0.69. Different spatial patterns reflecting the mechanisms of transmission were noted. The distribution of the majority of the parasites studied was aligned in a westerly direction close to the city, but the STH presence was higher in the km 6 community, toward the east. The purely spatial analysis provides a different and complementary overview for the detection of vulnerable hotspots and strategic intervention. Machine-learning models based on spatial variables explain a large percentage of the variability of the IPs.

TBE In Italy

Italy is considered a low-incidence country for tick-borne encephalitis (TBE) in Europe.1 Areas at higher risk for TBE within Italy are geographically clustered in the forested and mountainous regions and provinces of the northeastern part of the country, as suggested by TBE case series published over the last decade. 2–4 A national enhanced surveillance system for TBE has been established since 2017.5 Before this, information on the occurrence of TBE cases at the national level in Italy was lacking. Both incidence rates and the geographical distribution of the disease were mostly inferred from endemic areas where surveillance was already in place, and from ad hoc studies and international literature. TBE has been recorded in Italy since 1967, with foci of infections in the northeast (Trento, Belluno and Gorizia) and central (Florence and Latina) provinces.6–9 TBE presence in central Italy has not been confirmed by further studies on ticks and serosurveys conducted afterwards,10,11 nor by human cases, posing concerns about possible misdiagnosis.

Clinical characteristics and factors affecting disease severity in hospitalized tick-borne encephalitis patients in Norway from 2018 to 2022.

To describe the clinical characteristics and factors associated with disease severity in a Norwegian cohort of hospitalized patients with tick-borne encephalitis (TBE). This observational multicenter study included hospitalized patients with TBE in the endemic area in the southeastern region of Norway from 2018 to 2022. Clinical signs and findings from laboratory tests, EEG, CT and MRI scans were recorded. Patient characteristics were compared among those with mild, moderate, and severe TBE, and factors associated with disease severity were identified. Nearly all eligible patients were included in the final cohort (153/189 participants, 81%). The median age was 56 years, 63% were men, and 7% were vaccinated against TBE; no participants were fully vaccinated. TBE presented as mild (meningeal) disease in 31% of patients and as moderate or severe (encephalitic) disease in 54% and 14% of patients, respectively. We found that 46% of the patients had a monophasic course, 64% had hyponatremia, and 7% presented with central nervous system (CNS) symptoms without pleocytosis in cerebrospinal fluid (CSF). Dysesthesia, a symptom previously not described, was reported in 10% of the patients. Most objective findings were related to the CNS. Preexisting comorbidities, CRP and CSF protein levels were predictors of more severe disease. This novel presentation of a large Norwegian cohort supports TBE as a serious disease in the southeastern region of Norway. The majority of hospitalized patients presented with encephalitis, and fewer presented with meningitis. Comorbidities, CRP and CSF protein levels were associated with more severe disease. Prosjekt #2,296,959 - The Norwegian Tick-borne Encephalitis Study - NOTES. Acute phase characteristics and long-term outcomes. - Cristin.

TBE in Finland

Finland is at the northernmost edge of the TBE endemic area in Europe. Here TBE is focally endemic. An aseptic encephalitis disease has been known in Kumlinge Island in Åland Islands since the 1940s.1 TBE is also known in Finland by name Kumlinge disease.

Loa loa and Mansonella perstans infections in non-endemic countries: a narrative review

Abstract Purpose of Review Loiasis and mansonellosis are filarial infections potentially causing a relevant impact on morbidity and mortality. In non-endemic countries, there is poor awareness on these conditions, and clinical management is not standardized. Aim of this work is to review current evidence on cases diagnosed in non-endemic areas, in order to guide clinical management. Recent Findings In non-endemic areas, a wider range of symptoms and signs have been reported for both infections, compared to endemic areas. Diagnostic tools include parasitological tests, serology and molecular methods, each one potentially playing a different role (i.e. for screening, determination of microfilarial load, etc). Treatment is not standardized, and first-line drugs might not be available everywhere. Summary Loiasis and mansonellosis can be diagnosed in non-endemic countries; here we comment on strategies for screening, diagnosis, treatment and follow-up in clinical practice.

Exposure of cattle to tick-borne encephalitis virus in the historical endemic zone in north-eastern France

BackgroundTick-borne encephalitis (TBE) is a severe human neuroinfection caused by TBE virus (TBEV). TBEV is transmitted by tick bites and by the consumption of unpasteurized dairy products from infected asymptomatic ruminants. In France, several food-borne transmission events have been reported since 2020, raising the question of the level of exposure of domestic ungulates to TBEV. In this study, our objectives were (i) to estimate TBEV seroprevalence and quantify antibodies titres in cattle in the historical endemic area of TBEV in France using the micro virus neutralisation test (MNT) and (ii) to compare the performance of two veterinary cELISA kits with MNT for detecting anti-TBEV antibodies in cattle in various epidemiological contexts. A total of 344 cattle sera from four grid cells of 100 km² in Alsace-Lorraine (endemic region) and 84 from western France, assumed to be TBEV-free, were investigated.ResultsIn Alsace-Lorraine, cattle were exposed to the virus with an overall estimated seroprevalence of 57.6% (95% CI: 52.1–62.8%, n = 344), varying locally from 29.9% (95% CI: 21.0–40.0%) to 92.1% (95% CI: 84.5–96.8%). Seroprevalence did not increase with age, with one- to three-year-old cattle being as highly exposed as older ones, suggesting a short-life duration of antibodies. The proportion of sera with MNT titres lower than 1:40 per grid cell decreased with increased seroprevalence. Both cELISA kits showed high specificity (> 90%) and low sensitivity (less than 78.1%) compared with MNT. Sensitivity was lower for sera with neutralising antibodies titres below 1:40, suggesting that sensitivity of these tests varied with local virus circulation intensity.ConclusionsOur results highlight that cattle were highly exposed to TBEV. Screening strategy and serological tests should be carefully chosen according to the purpose of the serological study and with regard to the limitations of each method.

Study on producing a LAMP kit for diagnosis of small liver fluke Clonorchis sinensisinfection in humans

Background: Clonorchis sinensis is one of the three species of small liver flukes that cause infections in humans. C. sinensis is found mainly in several Asian countries and Northern, Vietnam. The Loop-mediated isothermal amplification (LAMP) with a sensitivity and specificity comparable to that of the PCR method, which requires less complex equipment and facilities for performance. Methods:The research design describes the laboratory experiment and evaluates a LAMP kit for the diagnosis of C. sinensis in the laboratory and the small-scale field assessment, using 150 human stool samples from fascioliasis endemic areas. Results: The LAMP primer sets have been designed and selected; the conditions and components of the LAMP reaction for C. sinensisdiagnosis have been optimised. Evaluation results of the LAMP kit in the laboratory showed a sensitivity of the test was 98.63% (95% CI: 91.92-99.99%); a specificity was 100% (95% CI: 85.25-100%); the limit of detection was 26 gene copies/μl. The LAMP test kit was found to be stable within 12 months at -20±5oC, and 6 months after opening the tubes. The field assessment of the LAMP kit in Ninh Binh province showed a C. sinensis rate of 6.66%, which was similar to the rate obtained from the studies using the real-time PCR method. Conclusions: The research has successfullyproduced a LAMP kit for the diagnosis of C. sinensis that is sensitive >95% and highly specific >95%. The LAMP kit is stable within 12 months at -20±5oC and for 6 months after opening the tubes

Epidemiologic, clinicopathologic, and diagnostic findings in pet rabbits with myxomatosis caused by the California MSW strain of myxoma virus: 11 cases (2022-2023).

To determine epidemiologic features of naturally occurring myxomatosis in domestic rabbits in California and to characterize clinicopathologic and diagnostic findings. 11 client-owned rabbits, Oryctolagus cuniculus subsp domesticus. A prospective study of pet rabbits with myxomatosis seen at an exotic animal specialty clinic in Santa Cruz county, California, was conducted between January 1, 2022, and December 31, 2023. Rabbits were included in the study if they had bilateral blepharedema and were PCR positive for myxoma virus. All infected rabbits had spent time outdoors. Common clinical signs included bilateral blepharedema (11/11), anogenital edema (10/11), rectal temperature ≥ 39.7 °C (5/9), and sudden death (4/11). Eyelid biopsies from all rabbits (11/11) were positive for myxoma virus by qualitative PCR followed by Sanger sequencing (100% nucleotide identity to strain MSW, also known as California/San Francisco 1950 [Genbank accession KF148065]). Most rabbits had keratinocytes containing eosinophilic intracytoplasmic viral inclusions in biopsies of edematous skin (8/11) and lymphocyte necrosis in the spleen (10/11). Immunohistochemistry identified myxoma virus in samples of skin, heart, lung, ileum, spleen, and lymph node. Clinical signs of myxomatosis caused by the MSW strain of myxoma virus are distinctive but subtle. Cases occur regularly in the Santa Cruz and San Jose regions of California. As infection with this virus is almost 100% fatal and no vaccine is available in the US, owners of domestic rabbits in endemic areas should keep their pets indoors or behind mosquito screens. Myxomatosis is a reportable disease in the US, and the appropriate state or federal agencies should be contacted when outbreaks occur.

#2336 Hepatitis-B virus related membranous nephropathy presenting as nephrotic syndrome treated with tenofovir

Abstract Background The prevalence of Hepatitis B virus (HBV) related nephropathy particularly membranous nephropathy follows geographic HBV prevalence patterns. Hepatitis B virus infection occurs throughout the world and is endemic in developing countries such as Africa, Eastern Europe, the Middle East, Central Asia, China, Southeast Asia, the Pacific islands and the Amazon basin of South America. Vertical transmission from mother to child often predominates in endemic areas. Membranous glomerulonephritis is the most common histological renal lesion associated with hepatitis B virus infection. Treatment options for renal patients with chronic HBV infection are complex, being dictated by the overall clinical picture and best conducted by multidisciplinary approach and thorough renal monitoring. Therapeutic guidelines are very limited, mostly case series are available in this setting. Anti-viral treatment is indicated in hepatitis B surface antigen (HBsAg)-positive patients with evidence of active liver disease based on aminotransferases and serum HBV DNA levels of 2000-20 000 IU/ml have been proposed as the threshold to start treatment Aim To present a case of young healthy male with chronic HBV infection with nephrotic syndrome and Membranous Nephropathy who developed reactivation after discontinuation of Tenofovir. Case A 32-year old man presented with generalized edema 5 months ago associated with dipstick proteinuria. The swelling has progressed and now associated with walking difficulty thus sought consult and was then admitted. His mother had been hypertensive for more than a decade and work up revealed that she is positive for anti-HBS and negative for HBsAg. His father is negative for HBsAg. His childhood and past medical history is unremarkable. He is a non-smoker, non alcoholic and no history of illicit drug use. He is monogamous and not promiscuous. He has 6 siblings and two of his brothers are hypertensives and found to have chronic Hepatitis B infection. His complement levels were low, ANA and ASO titers were negative. His creatinine was 1.06 mg/dl, BUN- 11.77 mg/dl, SGPT-161 U/L (NV: < 42 U/L), albumin- 1.50 g/dl (NV: 3.5-5.0 g/dl). Total cholesterol- 443.30 mg/dl, Triglycerides 330.46 mg/dl. Urine PCR-4,369 mg/g. Hepatitis profile revealed reactive for HBsAg and HBeAg. His HBV viral load was 170 000 000 IU/ml (989 400 000 copies/ml). His HIV screening was negative. A kidney biopsy was performed which revealed Membranous Glomerulonephritis. He was given Tenofovir 300 mg daily for 6 months. His repeat HBV viral load was < 20 IU/ml (< 116 copies/ml) and his 24 h urinary protein was 1,891 mg/24H. His albumin was 4.57 g/dl and his creatinine remained stable at 0.96 mg/dl while his SGPT went back to normal at 40 U/L. A repeat HBeAg revealed 0.55 which could be a possible seroconversion. Tenofovir was discontinued for 6 months however patient came back with persistent proteinuria associated with high HBV DNA titer. A repeat 24H-urine protein showed 1,182 mg/24H. Tenofovir was resumed and Enalapril was continued. Follow up check up 3 months after revealed urine PCR was 850 mg/g and his kidney function remained stable. He is advised to continue Tenofovir with frequent follow up until he becomes HBsAg-negative. Recommendation We recommend that antiviral treatment in this subset of population requires prolong treatment until persistent seroconversion of HBeAg and persistent undetectable HBV DNA level or have lost HBsAg even if the patient does not develop hepatitis B surface antibody. This recommendation of prolong treatment are still developing and requires further investigation.

#2373 Malignant tumors of the urinary bladder and Balkan endemic nephropathy – a 45 year study

Abstract Background and Aims Balkan endemic nephropathy (BEN) is a chronic interstitial kidney disease limited geographically to specific regions. The wider importance of BEN is reflected in its associations with malignant tumors of the urothelium. For researchers, malignant tumors of the urinary bladder (MTUB) have been less studied and perhaps considered less interesting compared to malignant tumors of the upper urothelium. Balkan endemic nephropathy (BEN) is a chronic interstitial kidney disease limited geographically to specific regions. The wider importance of BEN is reflected in its associations with malignant tumors of the urothelium. For researchers, malignant tumors of the urinary bladder (MTUB) have been less studied and perhaps considered less interesting compared to malignant tumors of the upper urothelium. Method Balkan endemic nephropathy (BEN) is a chronic interstitial kidney disease limited geographically to specific regions. The wider importance of BEN is reflected in its associations with malignant tumors of the urothelium. For researchers, malignant tumors of the urinary bladder (MTUB) have been less studied and perhaps considered less interesting compared to malignant tumors of the upper urothelium. Results During the observed period, there were a total of 1447 cases of MTUB - 1109 (76.64%) male patients and 338 (33.36%) female patients. The average annual incidence rate (AAIR) of MTUB in endemic settlements for the observed period (1978-2024) is 15.64; in hypoendemic areas is 13.89, and in non-endemic areas is 14.62. The AAIR of MTUB in endemic settlements is 1.13 times higher than the rate in hypoendemic areas and 1.07 times higher compared to non-endemic settlements. It is noteworthy that in the first period of observation, the AAIR of MTUB in endemic areas is 2.24 times higher than the rate in hypoendemic areas and 4.09 times higher than the rate in non-endemic areas. However, in the second and third periods of the study, it is significantly lower compared to the rates in hypoendemic and non-endemic areas. The linear trend of MTUB for the observed period in endemic settlements is negative without statistical significance (y = −0.012x + 701; r2 = 0.048), while in non-endemic areas, it is positive and statistically significant (y = 1.340x + 0.172; r2 = 0.647). Conclusion The higher frequency of MTUB in the Jablanica district over the 45-year study of the region with BEN is limited to the first part of the research and may indicate a common nephropathogenic and carcinogenic etiological factor, confirming a positive correlation between BEN and malignant urothelial tumors. At the same time, in the last 25 years of the observed period, there has been a drastic decline in the frequency of both BEN and MTUB, as well as malignant tumors of the upper urothelium.

Surveillance of sand flies (Psychodidae, Phlebotominae) from Mexico: Altitudinal and climatic patterns after historical and new geographic records in endemic areas of leishmaniasis

This study updates knowledge on historical geographic distribution of sand fly species through identifying altitudinal and bioclimatic patterns in leishmaniasis endemic areas in Mexico. We analyze and identify sand fly specimens obtained through national efforts by the Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE, Mexico), collected between 1995 and 2001, 2008–2012, and 2017–2023, and add bibliographic information (427 additional records). After a principal components analysis of WorldClim variables and altitudinal ranges, variables that better explain the distribution of sand fly species were chosen (BIO6, BIO12, and BIO16, explaining 72 % of variation). A total of 1,187 specimens of 22 species were retrieved from eight states, providing 29 new municipalities and 48 new localities, being Lutzomyia cruciata, Micropygomyia chiapanensis, and Psathyromyia shannoni the most common species. We presented new historical records of distribution for sand fly species from Morelos (3), Oaxaca (7) and Tabasco (1). The 82.7 % of sand fly species analyzed were distributed in areas with altitudinal ranges below 420 m. The anthropophilic species Psathyromyia shannoni, and Lutzomyia cruciata showed the greatest variability regarding altitudinal range, and climatic preferences, while several wild species showed abiotic preferences. It is likely that the effect of urbanization and climate change generate new beneficial biotopes for the proliferation of the vector sand fly species. Complementary studies that consider seasonality, vegetation types, and change in land use could provide new information to better understand the spread of vector-borne diseases.