Tropical Medicine and Infectious Disease最新文献

{"title":"Time Series and Pattern of Dog Bites and Rabies in the Ashanti Region, Ghana, 2009-2019: A Call for Inter-Sectoral Collaboration in the Fight Against Rabies.","authors":"William Tasiame, Sherry Ama Mawuko Johnson, Obed Owusu Yeboah, Benjamin Emikpe, Raphael Folitse, Vitus Burimuah, Theophilus Odoom, Christian Drosten, Victor Max Corman, Philip El-Duah","doi":"10.3390/tropicalmed11090260","DOIUrl":"10.3390/tropicalmed11090260","url":null,"abstract":"<p><p>Dog-mediated human rabies is a vaccine-preventable neglected zoonotic disease, causing thousands of deaths every year across Africa and Asia. Information to generate the appropriate attention and action to avert human rabies is lacking due to disaggregation of available data. This study sought to understand the burden of dog-mediated rabies transmission and response patterns in Ghana's Ashanti Region, and analyzed dog-bite surveillance, rabies laboratory investigations, and hospital visitation data from 2009 to 2019. A total of 442 bite incidents were recorded, with most occurring in the Kumasi metropolis, particularly in the Oforikrom and Manhyia sub-metros. Many victims sought healthcare outside their bite-incident districts, often at the Manhyia Government Hospital, likely due to vaccine availability. Bite incidents were generally reported promptly within two days, although final investigations took about fourteen days. The sale of implicated dogs for human consumption during observation periods posed an additional rabies risk. There was a 67.53% positivity for animal rabies (<i>n</i> = 156/231) in laboratory investigations, and dogs accounted for most confirmed cases (141/210), though livestock and non-human primates were also affected. More than 70% of dog-bite victims were linked to rabies-positive animals, showing a significant association between bites and confirmed rabies cases. Reported dog-bite frequency varied considerably over time, with the highest monthly frequencies occurring between 2010 and 2013, and with a sustained positive seasonal effect from August to November within a year. The findings highlight that dog-mediated rabies remains a major public health threat in the region and emphasize the need for improved One Health investigations, surveillance, and public education to reduce rabies transmission and exposure risks.</p>","PeriodicalId":23330,"journal":{"name":"Tropical Medicine and Infectious Disease","volume":"11 9","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13611304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Poor Neurological Outcomes at Discharge in Tuberculous Meningitis: Disease Severity, Host Factors, and Drug Therapy.","authors":"Yuxia Yu, Huarui Liu, Huan Yang, Dan Ye, Lu Xia, Xiaoqing Ma, Jiayi Wang, Yuchong Sun, Feng Li, Yuanyuan Chen","doi":"10.3390/tropicalmed11090259","DOIUrl":"10.3390/tropicalmed11090259","url":null,"abstract":"<p><strong>Introduction: </strong>This study investigated independent factors associated with neurological prognosis at discharge in patients with tuberculous meningitis (TBM) and evaluated the impact of intensified treatment regimens.</p><p><strong>Methods: </strong>A retrospective analysis was conducted in 518 TBM patients from two Chinese medical centers. LASSO and multivariable logistic regression were used to identify independent risk factors for poor neurological outcomes. A 1:1 PSM based on intensified treatment exposure was performed to assess its association with neurological outcomes, with an exploratory outcome-based matched comparison conducted for other prognostic factors.</p><p><strong>Results: </strong>Among 518 patients, 123 (23.75%) had poor neurological outcomes. The poor-prognosis group had higher proportions of MRC stage III (30.08% vs. 8.35%, <i>p</i> < 0.001), linezolid use (58.54% vs. 40.76%, |SMD| = 0.361), and fluoroquinolone use (87.8% vs. 75.19%, |SMD| = 0.386). Multivariable analysis identified decreased muscle strength, MRC stage II/III, albumin < 30 g/L, and hydrocephalus as independent risk factors for poor neurological outcomes. After treatment-exposure-based PSM, intensified treatment was not significantly associated with neurological outcomes, while an exploratory matched analysis suggested a potential association between diabetes mellitus and unfavorable neurological outcomes.</p><p><strong>Conclusion: </strong>Neurological prognosis in TBM is influenced by both disease severity and host baseline status. Intensified therapy was not significantly associated with neurological outcome at discharge after adjustment, highlighting the importance of individualized risk management.</p>","PeriodicalId":23330,"journal":{"name":"Tropical Medicine and Infectious Disease","volume":"11 9","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13611471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Effects of Climate Variability on Diarrheal Diseases, Malaria, and Malnutrition in Children Under Five Years in Revuè Sub-Basin, Manica Province, Mozambique.","authors":"Tatiana J Marrufo, Genito A Maúre, Américo F José, Osvaldo F Inlamea, Bettencourt P S Capece, Maria-Raquel G Silva","doi":"10.3390/tropicalmed11090258","DOIUrl":"10.3390/tropicalmed11090258","url":null,"abstract":"<p><p>Transmission of water, vector, and foodborne diseases tends to increase with climate variability, disproportionately affecting vulnerable communities. Globally, this dynamic contributes to adverse health outcomes in low- and middle-income countries such as Mozambique. Nevertheless, the influence of climate variability on disease patterns remains unclear. We assessed the potential relationship between climate variables and diseases, including diarrheal diseases, malaria, and malnutrition, in four districts around the Revuè sub-basin. An ecological, longitudinal, retrospective study conducted from 2016 to 2024 used secondary weekly disease data and annual malnutrition records. We applied a Generalized Additive Model framework to evaluate non-linear associations between climate factors and disease case counts. Our main findings showed that while higher maximum temperature was associated with increased cumulative malaria case counts, cumulative and heavy rainfall (~100 mm/week) was associated with decreased diarrheal disease case counts. Higher prevalence of moderate acute malnutrition is associated with a decrease in annual mean total precipitation (<i>p</i> = 0.0062). In contrast, higher prevalence of severe acute malnutrition is associated with a decrease in annual mean temperature (<i>p</i> = 0.0312). This study contributes to understanding climate variables associated with water, vector, and foodborne diseases, enhancing our understanding of factors contributing to overall food insecurity and affecting public health.</p>","PeriodicalId":23330,"journal":{"name":"Tropical Medicine and Infectious Disease","volume":"11 9","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13611516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Three Anthelmintics on the Transcriptome of FHs 74 Int Enterocytes.","authors":"Kornkanok Nakudom, Amornrat Geadkaew-Krenc, Wansika Phadungsil, Rudi Grams","doi":"10.3390/tropicalmed11090257","DOIUrl":"10.3390/tropicalmed11090257","url":null,"abstract":"<p><p>Helminth infections continue to present a substantial public health challenge worldwide, particularly in tropical and developing areas. Despite the widespread use of anthelmintic drugs for treatment and control, their effects on host cells remain poorly understood. In this study, the three commonly used anthelmintics albendazole, ivermectin, and praziquantel were investigated by transcriptome analysis for their effects on gene activity in the human intestinal cell line FHs 74 Int after 24-h exposure. The drug concentrations used were substantially higher than in the treatment of helminthiases but did not affect cell viability after 24 h and less than 50% after 72 h. Praziquantel had negligible toxic effects on the intestinal cells at the highest achievable concentration of 1 mM whereas albendazole and ivermectin were already effective at low micromolar concentrations and were tested at 1 µM and 15 µM concentrations. Consistent with the observed cytotoxicity, transcriptome analysis showed no transcriptional changes for 1 mM praziquantel at low cutoff criteria of adjusted <i>p</i>-value (padj) ≤ 0.05, log₂ fold change ≥ 0. At the same padj but with log₂ fold change ≥ 2, 17 upregulated and 2 downregulated genes were found after treatment with 1 µM albendazole and 106 upregulated and 65 downregulated genes with 15 µM ivermectin. Analysis of these genes showed that albendazole caused a modest upregulation of cell cycle related processes, especially mitotic spindle formation, and chromosome segregation. The cells showed a stronger response to ivermectin and the data suggested inhibition of cell proliferation through downregulated transcription factors and nuclear receptors and stimulation of cell growth and cell survival mechanisms through upregulated metabolic enzymes.</p>","PeriodicalId":23330,"journal":{"name":"Tropical Medicine and Infectious Disease","volume":"11 9","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13611716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Enterococcus mundtii</i> CRL35 as a Dual-Route Treatment for Cutaneous Leishmaniasis: Preclinical Safety and Efficacy Assessment.","authors":"María A Occhionero, Daniela A Gaspar, Daniela E Barraza, María Elisa Vázquez, Brenda A Zabala, Rita A Sandoval, Lucila Saavedra, Cecilia Pérez Brandán, Natalia S Corbalán, Leonardo Acuña","doi":"10.3390/tropicalmed11090256","DOIUrl":"10.3390/tropicalmed11090256","url":null,"abstract":"<p><p>American tegumentary leishmaniasis (ATL) remains a therapeutic challenge due to the toxicity and limited effectiveness of conventional agents. This study evaluated <i>Enterococcus mundtii</i> CRL35, a food-grade lactic acid bacterium, as a dual-mechanism therapeutic platform against <i>Leishmania (L.) amazonensis</i>. Initial screening identified <i>E. mundtii</i> CRL35 as the most active strain among four enterococci tested, demonstrating high selectivity against promastigotes (SI = 95) and intracellular amastigotes (SI = 25). In a BALB/c murine model of cutaneous leishmaniasis, three treatment modalities were evaluated: topical application of cell-free supernatant (CFS-T), oral viable bacteria (LB-O), and their combination (CFS-T+LB-O). All three treatments achieved significant reductions in lesion parasite burden (approximately 2-3 orders of magnitude versus untreated controls), substantially exceeding the parasitological efficacy of amphotericin B under identical experimental conditions. CFS-T and CFS-T+LB-O additionally produced significant macroscopic lesion improvement. Importantly, no treatment was associated with adverse changes in organ indices or serum biochemical parameters. <i>E. mundtii</i> CRL35-based treatments promoted higher IgG2a/IgG1 antibody ratios compared to untreated controls and amphotericin B, generating an immune profile more favorable for intracellular parasite control. Taken together, these findings support the therapeutic potential of these modalities as safe, effective, and affordable alternatives for ATL, particularly in resource-limited endemic regions where toxicity and logistical barriers limit access to conventional therapy.</p>","PeriodicalId":23330,"journal":{"name":"Tropical Medicine and Infectious Disease","volume":"11 9","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13611227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Co-Endemic Zoonoses, Divergent Dynamics: A Comparative Spatiotemporal Analysis of Crimean-Congo Hemorrhagic Fever and Brucellosis with Implications for Integrated Surveillance.","authors":"Serdar Karakullukçu, İrem Dilaver, Murat Topbaş, Merve Erdoğan, Hüsniye Ebru Çolak, Meral Fidan Uçan","doi":"10.3390/tropicalmed11090255","DOIUrl":"10.3390/tropicalmed11090255","url":null,"abstract":"<p><p>Co-endemic zoonoses may occur in the same broad geographic settings but not necessarily the same communities or time periods. This study investigated whether Crimean-Congo hemorrhagic fever (CCHF) and brucellosis exhibit convergent or divergent spatiotemporal patterns across geographic scales in a livestock-dependent, CCHF-endemic province of Türkiye. This retrospective study analyzed confirmed human CCHF and brucellosis cases reported to the national infectious disease surveillance system between 2011 and 2024. Temporal analyses, kernel density estimation, settlement-level random labeling, and within- and cross-disease Knox tests were performed. Among the 611 eligible cases, CCHF (<i>n</i> = 442; 72.3%) and brucellosis (<i>n</i> = 116; 19.0%) accounted for 91.3%. CCHF was strongly seasonal, with 99.3% of cases occurring between April and September, whereas brucellosis occurred throughout the year. Although broad density surfaces partially overlapped, same-settlement co-occurrence was substantially lower than expected (O/E = 0.37; <i>p</i> < 0.001) and remained so in the sensitivity analysis (O/E = 0.74; <i>p</i> = 0.001). Cross-disease analysis showed no evidence that CCHF and brucellosis occurred closer together in both space and time than expected. Annualized CCHF concentration peaked in 2020-2021, whereas brucellosis peaked in 2022-2024. Integrated surveillance may use shared regional infrastructure, but interventions should be tailored to disease-specific settlements, transmission pathways, and periods of risk.</p>","PeriodicalId":23330,"journal":{"name":"Tropical Medicine and Infectious Disease","volume":"11 9","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13611055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health-Related Quality of Life of People Living with Hansen's Disease Undergoing Multidrug Therapy.","authors":"Victor Feitosa de Freitas, Liliane Lins-Kusterer, Karen Valadares Trippo, Herman Henrique Silva Santana, Fernando Martins Carvalho","doi":"10.3390/tropicalmed11090254","DOIUrl":"10.3390/tropicalmed11090254","url":null,"abstract":"<p><strong>Background: </strong>Multidrug therapy (MDT) is the cornerstone of treatment for Hansen's disease. We aimed to identify factors associated with health-related quality of life (HRQoL) of people with Hansen's disease undergoing MDT.</p><p><strong>Methods: </strong>Sixty-six people of any sex, aged 18 and older, undergoing MDT, without adverse reactions, were enrolled as outpatients at a public health service in Salvador, Brazil. A physical examination was performed, during which the Simplified Neurological Evaluation Form was used to determine the Degree of Physical Disability. The HRQoL was evaluated using the RAND-36 questionnaire and its Physical Component Summary (PCS) and Mental Component Summary (MCS).</p><p><strong>Results: </strong>The PCS and MCS were negatively associated with pain and positively associated with the Degree of Physical Disability after controlling for MDT duration, bacilloscopy, schooling, race/color, age, sex, and monthly income; the PCS was negatively associated with smoking. Patients who reported pain had a PCS 14.282 percent units lower than those who did not report it, and patients that reported pain had an MCS 6.762 units lower. Differences in such magnitude are clinically important for patients with Hansen's disease being treated with MDT.</p><p><strong>Conclusion: </strong>Pain and the Degree of Physical Disability are strongly associated with the HRQoL of patients with Hansen's disease undergoing MDT.</p>","PeriodicalId":23330,"journal":{"name":"Tropical Medicine and Infectious Disease","volume":"11 9","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13611256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dengue and Chikungunya Seroprevalence in an Urban Low-Income Cohort in Delhi: A Cross-Sectional and Nested Longitudinal Study.","authors":"Nandini Sharma, Saurav Basu, Shivani Rao, Mrunali Zode, Himanshu Bachawandia, Meenakshi Bakshi, Mongjam Meghachandra Singh","doi":"10.3390/tropicalmed11090253","DOIUrl":"10.3390/tropicalmed11090253","url":null,"abstract":"<p><p><b>Objectives:</b> The aim of this study was to ascertain the seroprevalence and determinants of dengue virus (DENV) and chikungunya virus (CHIKV) seropositivity in Delhi, India. <b>Methods:</b> This cross-sectional serosurvey with a nested longitudinal immunological sub-study was conducted in an urban resettlement and slum settlement in the North-East district of Delhi in individuals aged ≥2 years. Dengue and Chikungunya virus IgG antibodies were screened using indirect enzyme-linked immunosorbent assay (ELISA), and a longitudinal subset of 100 paired IgG-seropositive samples was further characterized via a plaque reduction neutralization test (µPRNT50) to evaluate changes in functional neutralization over time. <b>Results:</b> A total of 752 participants, including 56.65% female participants, were included in the study. Of the participants studied, 81.91% (95% CI: 78.97, 84.60; n = 616) were positive for IgG antibodies against DENV, and 28.32% (95% CI: 25.13, 31.69; n = 213) were positive for CHIKV IgG antibodies. µPRNT50 confirmed stable, near-universal CHIKV neutralization (97% baseline, 98% endline). However, DENV neutralizing antibody showed a significant contraction for DENV-3 (79% baseline, 60% endline) and DENV-4 (69% baseline, 60% endline), while DENV-1 (76%) and DENV-2 (77% to 80%) antibodies remained stable. Individuals living in households with screened windows had significantly lower odds of contracting DENV infection (AOR: 0.36; 95% CI: 0.21, 0.61) and CHIKV infection (AOR: 0.63; 95% CI: 0.43, 0.90) compared with those living in households without screened windows. Further, individuals from households with uncovered containers with stagnant water had 50% higher odds of CHIKV infection than those without such containers (AOR: 1.55; 95% CI: 1.05, 2.29). <b>Conclusions:</b> This study revealed a high burden of DENV and CHIKV exposure in this high-risk urban population. While neutralization remained stable for CHIKV, DENV-1, and DENV-2, waning DENV-3 and DENV-4 antibodies suggest differential serotype-specific immunity in the participants.</p>","PeriodicalId":23330,"journal":{"name":"Tropical Medicine and Infectious Disease","volume":"11 9","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13611423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Dengue in Children: Pathogenesis, Early Recognition, and Evidence-Informed Management.","authors":"Hsien-Yi Wang, Shih-Bin Su, Chung-Yi Li, Kow-Tong Chen","doi":"10.3390/tropicalmed11090252","DOIUrl":"10.3390/tropicalmed11090252","url":null,"abstract":"<p><p>Severe dengue remains an important cause of pediatric hospitalization, morbidity, and mortality in tropical and subtropical regions, particularly where rapid triage and pediatric critical-care capacity are limited. This structured narrative review synthesizes the evidence on the epidemiology, pathogenesis, early recognition, diagnosis, management, and prevention of severe dengue in children. Severe disease reflects interactions among viral factors, pre-existing immunity, dysregulated host responses, and microvascular endothelial injury. Antibody-dependent enhancement, inflammatory mediators, dengue nonstructural protein 1, and endothelial glycocalyx disruption contribute to vascular hyperpermeability, plasma leakage, shock, severe bleeding, and organ impairment. Because deterioration often occurs abruptly around defervescence, serial clinical assessment, hematocrit trends, urine-output monitoring, and timely recognition of warning signs are central to risk stratification. Molecular assays and NS1 antigen testing are most useful during the early febrile phase, although diagnostic performance varies with illness timing and immune status. Carefully titrated isotonic crystalloid therapy remains the cornerstone of treatment; both delayed resuscitation and excessive fluid administration may worsen outcomes. Reducing mortality requires integrated clinical and public-health strategies combining standardized pediatric management, accessible diagnostics, effective referral systems, vaccination where appropriate, surveillance, and vector control.</p>","PeriodicalId":23330,"journal":{"name":"Tropical Medicine and Infectious Disease","volume":"11 9","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13611387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated Levels of Environmental Enteric Dysfunction Biomarkers Among Rural Indonesian Infants: Associations with Water, Sanitation, Hygiene and Linear Growth.","authors":"Callum Lowe, Tony Arjuna, Mubasysyir Hasanbasri, Haribondhu Sarma, I Nyoman Sutarsa, Severine Navarro, Darren Gray, Matthew Kelly","doi":"10.3390/tropicalmed11090251","DOIUrl":"10.3390/tropicalmed11090251","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the burden of environmental enteric dysfunction (EED) and its association with water, sanitation, and hygiene (WASH) and linear growth amongst infants in rural Central Java, Indonesia. <b>Study design:</b> A longitudinal study of 119 infants aged from 5-19 months was conducted in five villages of Wonosobo District, Central Java, Indonesia. Infant length and weight were measured at baseline and 5-month follow-up and stool samples were collected for the investigation of alpha-1-antitrypsin (AAT), neopterin (NEO), and myeloperoxidase (MPO) levels. Linear mixed-effects regression (LMER) models estimated the associations between WASH and height-for-age z-score (HAZ) on biomarker concentrations. <b>Results:</b> Biomarkers increased from baseline to follow-up where AAT, NEO, and MPO were elevated in 68.7%, 79.0%, and 71.4% of infants. Breastfed infants and infants with recent diarrhoea had higher biomarker levels than non-breastfed infants. After correction for multiple testing, few significant associations between EED biomarkers and WASH variables or HAZ were detected. EED biomarkers measured at baseline or follow-up were not significantly associated with growth faltering over the follow-up period. In cross-sectional analysis, compared to infants at risk of stunting (-2 < HAZ ≤ -1), infants with HAZ > -1 had lower AAT at baseline (β = -0.43, 95% CI = -0.82 to -0.05, p_adj < 0.05). <b>Conclusions:</b> Elevated EED biomarker levels were frequently observed and had mixed associations with WASH and HAZ, highlighting the complexity of EED and need to understand EED etiology through intervention studies.</p>","PeriodicalId":23330,"journal":{"name":"Tropical Medicine and Infectious Disease","volume":"11 9","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13611734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}