Yaw Shin Ooi, Jonathan Cattrall, Oliver Brady, Shirin Kalimuddin, Jue Tao Lim, Eduardo Lopez-Medina, Stephen J Thomas, Sophie Yacoub, Eng Eong Ooi
{"title":"Dengue virus infection.","authors":"Yaw Shin Ooi, Jonathan Cattrall, Oliver Brady, Shirin Kalimuddin, Jue Tao Lim, Eduardo Lopez-Medina, Stephen J Thomas, Sophie Yacoub, Eng Eong Ooi","doi":"10.1038/s41572-026-00744-4","DOIUrl":"https://doi.org/10.1038/s41572-026-00744-4","url":null,"abstract":"<p><p>Dengue is an acute febrile disease caused by the Aedes mosquito-borne dengue viruses (DENV-1 to DENV-4). Annually, approximately 100 million people fall ill with dengue, which can cause debilitating pain and discomfort, reducing both physical functioning and quality of life. Some patients progress to life-threatening inflammation-driven circulatory failure. Disease burden remains primarily in urban centres; however, factors including increased travel and climate change are rapidly expanding the geographical distribution of dengue to rural and peri-urban environments. Dengue is diagnosed based on compatible clinical features, detection of viral RNA or antigens, or serological testing, depending on the phase of illness. There is no licensed antiviral or host-directed therapy for dengue; management is supportive, with close clinical monitoring and judicious fluid replacement to prevent circulatory failure while avoiding fluid overload. Thus, there is an increasing need for clinicians to be familiar with the clinical features, disease burden and management of dengue, along with the newly recognized post-acute sequelae. Although dengue vaccines have been licensed in several countries, their use has been restricted by uncertainties in dengue pathogenesis. Attention should be focused on how to use currently available vaccines to create the foundation of a larger strategy to mitigate dengue transmission and maximize public health impact.</p>","PeriodicalId":18910,"journal":{"name":"Nature Reviews Disease Primers","volume":"12 1","pages":""},"PeriodicalIF":79.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Valsamma Eapen, Harvey S Singer, Carol A Mathews, Davide Martino, Jennifer Vermilion, Andrea E Cavanna, Peristera Paschou
{"title":"Tourette syndrome.","authors":"Valsamma Eapen, Harvey S Singer, Carol A Mathews, Davide Martino, Jennifer Vermilion, Andrea E Cavanna, Peristera Paschou","doi":"10.1038/s41572-026-00742-6","DOIUrl":"10.1038/s41572-026-00742-6","url":null,"abstract":"<p><p>Tourette syndrome is characterized by the presence of motor and phonic tics. Individuals with Tourette syndrome can have a spectrum of related behaviours including attention deficit hyperactivity features, obsessions, compulsions, impulsions and complex tics. The pathophysiology of Tourette syndrome is thought to reflect genetic influences on the development and function of cortical-striatal-thalamic-cortical and broader cortical-subcortical circuitry implicated in motor and inhibitory control and interoceptive processing, which may contribute to the characteristic 'urge-tic-relief' cycles. Shared genetic risks resulting in pleiotropy and overlapping neurocircuitry could explain some of the psychiatric comorbidities of Tourette syndrome. Management typically includes education, psychosocial support and behavioural therapy alongside pharmacotherapy for those with more severe tics or those unresponsive to behavioural therapy. Deep brain stimulation is used in severe, incapacitating and treatment-refractory cases persisting into adult life. Approaches aimed at improving quality of life and management of psychiatric comorbidities are also critically important. Future research should include considering refining the diagnostic criteria and delineating functional tic disorders, as well as the tic-related obsessive-compulsive behaviours, as this may have implications for treatment, understanding the underlying neurobiology, and the development of personalized interventions focusing on core tic-related features, psychiatric comorbidities and improving quality of life.</p>","PeriodicalId":18910,"journal":{"name":"Nature Reviews Disease Primers","volume":"12 1","pages":""},"PeriodicalIF":79.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lin Chang, Maura Corsetti, William D Chey, Alexander C Ford, Max J Schmulson, Andrea Shin, Giovanni Barbara, Sarah Ballou, Emeran A Mayer, Kewin T Siah, Magnus Simrén, Heidi Staudacher, Anthony J Lembo
{"title":"Irritable bowel syndrome.","authors":"Lin Chang, Maura Corsetti, William D Chey, Alexander C Ford, Max J Schmulson, Andrea Shin, Giovanni Barbara, Sarah Ballou, Emeran A Mayer, Kewin T Siah, Magnus Simrén, Heidi Staudacher, Anthony J Lembo","doi":"10.1038/s41572-026-00741-7","DOIUrl":"https://doi.org/10.1038/s41572-026-00741-7","url":null,"abstract":"<p><p>Irritable bowel syndrome (IBS) is one of the most prevalent disorders of gut-brain interaction, characterized by recurrent abdominal pain or abdominal discomfort associated with altered bowel habits in the absence of identifiable structural disease. IBS affects ~4-11% of the global population and is associated with substantial healthcare utilization, impaired quality of life and considerable socioeconomic burden. IBS is increasingly recognized as a heterogeneous condition caused by dysregulated bidirectional communication within the gut-brain axis. Altered gastrointestinal motility, visceral hypersensitivity, epithelial barrier dysfunction, neuroimmune activation, gut microbiome and metabolome changes, central pain amplification, stress and autonomic dysregulation, and sex-related biological influences underlie pathophysiological mechanisms. IBS can develop after a gastrointestinal infection and can frequently co-occur with other disorders of gut-brain interaction, chronic pain conditions, psychological disorders and organic gastrointestinal disorders such as inflammatory bowel disease and coeliac disease. Diagnosis relies on a positive symptom-based approach using the Rome V criteria, supported by clinical assessment and limited testing to exclude differential diagnoses. Management focuses on improving symptoms and quality of life through an individualized, stepwise approach that involves patient education, dietary interventions, pharmacological therapies and gut-brain behaviour therapies. Emerging biomarkers, multi-omics approaches, digital health tools and precision medicine strategies may enable mechanism-based diagnosis and targeted treatment in the future.</p>","PeriodicalId":18910,"journal":{"name":"Nature Reviews Disease Primers","volume":"12 1","pages":""},"PeriodicalIF":79.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrew T Hale, Douglas L Brockmeyer, William C Davalan, A Graham Fieggen, Gerald A Grant, Eric M Jackson, Adam J Kundishora, David D Limbrick, Cormac O Maher, Brandon G Rocque, Jennifer M Strahle, Dominic M Thompson, Alexander M Tucker, Kristopher T Kahle
{"title":"Chiari I malformation.","authors":"Andrew T Hale, Douglas L Brockmeyer, William C Davalan, A Graham Fieggen, Gerald A Grant, Eric M Jackson, Adam J Kundishora, David D Limbrick, Cormac O Maher, Brandon G Rocque, Jennifer M Strahle, Dominic M Thompson, Alexander M Tucker, Kristopher T Kahle","doi":"10.1038/s41572-026-00739-1","DOIUrl":"https://doi.org/10.1038/s41572-026-00739-1","url":null,"abstract":"<p><p>Chiari I malformation (CM1), the most common structural hindbrain disorder in humans, is traditionally characterized by the downward displacement of the cerebellar tonsils through the foramen magnum. However, this definition does not reflect the variability in clinical presentation, natural history and treatment response of this disorder. Some individuals with minimal tonsillar descent have severe neurological symptoms and syringomyelia, whereas others with extensive descent remain asymptomatic. Emerging evidence from neuroimaging, developmental biology and human genetics indicates that CM1 is not a single anatomical entity but a spectrum of disorders resulting from disruptions in coordinated growth and homeostasis across the cerebellum, posterior fossa, craniocervical junction, cerebrospinal fluid and neurovascular systems. CM1 may be best understood as a disorder of disrupted developmental scaling, in which the tightly regulated relationships between cerebellar growth and cranial accommodation are altered within a dynamic neurovascular and cerebrospinal fluid environment. In this context, tonsillar herniation is a geometric consequence rather than the primary disease process. This Primer synthesizes current knowledge on the epidemiology, mechanisms, diagnosis and management of CM1 across the lifespan. We highlight advances in neuroimaging, genomics and phenomics that support a shift from anatomy-based definitions towards an integrated genomic-phenomic classification.</p>","PeriodicalId":18910,"journal":{"name":"Nature Reviews Disease Primers","volume":"12 1","pages":""},"PeriodicalIF":79.8,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Darren M Roberts, Úna Nic Ionmhain, Satariya Trakulsrichai, John Victor Peter, Hossein Hassanian-Moghaddam, David M Wood
{"title":"Toxidromes.","authors":"Darren M Roberts, Úna Nic Ionmhain, Satariya Trakulsrichai, John Victor Peter, Hossein Hassanian-Moghaddam, David M Wood","doi":"10.1038/s41572-026-00736-4","DOIUrl":"https://doi.org/10.1038/s41572-026-00736-4","url":null,"abstract":"<p><p>Poisoning is an important and prevalent concern, occurring owing to many drugs, chemicals or natural poisons. Prompt diagnosis and treatment optimize outcomes. Initial management involves concurrently assessing the history of exposure, performing a clinical examination and resuscitation when required. The integration of symptoms and clinical signs, and possibly investigations and/or the response to an antidote, can enable the identification of a potential toxidrome. Toxidromes are important in the assessment and management of patients with poisoning. Each toxidrome may be caused by a particular group of poisons, so diagnosis of a toxidrome may indicate what a patient was exposed to, guiding further clinical assessment and management. Identifying a toxidrome can be especially informative when a history cannot be obtained, for example in patients who are drowsy or extremely agitated. Additionally, a toxidrome may help to confirm the accuracy of the history of exposure, when this is available, facilitating further assessment and management. Classic poisoning-related toxidromes include the opioid, sympathomimetic, serotonergic, antimuscarinic, muscarinic and nicotinic toxidromes. Other toxidromes that are common and require careful clinical consideration include bradycardia with hypotension, 'knockdown', mushroom poisoning, neuroleptic malignant and uncoupling of oxidative phosphorylation syndromes. Multiple toxidromes can occur together following exposure to certain single xenobiotics or to multiple xenobiotics, which can complicate clinical decision-making. Future directions include refining diagnostic tools including bedside and/or laboratory investigations to complement clinical assessments, improving access to region-specific toxidrome data, and developing targeted therapies to enhance outcomes and address current gaps in care.</p>","PeriodicalId":18910,"journal":{"name":"Nature Reviews Disease Primers","volume":"12 1","pages":""},"PeriodicalIF":79.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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