Tropical Medicine and Infectious Disease最新文献

{"title":"Longitudinal Surveillance of Invasive Mosquitoes at Points of Entry in Northeastern Italy.","authors":"Sara Manzi, Martina Micocci, Luca Tassoni, Stefano Vettore, Davide Bonetto, Simone Martini, Francesco Gradoni, Federica Toniolo, Giulia Iandiorio, Lidia Iustina Danca, Giulia Chiarello, Patrizia Visentin, Matteo Cecconello, Sara Carlin, Federica Gobbo, Matteo Mazzucato, Francesca Russo, Chiara Ziprani, Barbra Bucci, Sergio Iavicoli, Vincenzo Severino, Fabrizio Montarsi","doi":"10.3390/tropicalmed11090247","DOIUrl":"10.3390/tropicalmed11090247","url":null,"abstract":"<p><p><i>Aedes</i> invasive mosquito (AIM) species are expanding worldwide, increasing the risk of arbovirus introduction and transmission. Points of Entry (PoEs), including airports and seaports, represent critical gateways for the introduction and spread of invasive vectors through international passenger and cargo traffic. This study evaluated the AIM long-term dynamics at three major PoEs (Treviso Airport, Venice Airport, and Venice Port) in northeastern Italy (Veneto region) between 2018 and 2024 through an integrated entomological surveillance programme designed to collect AIMs (adults and eggs) throughout the seasonal activity (June-October). Mosquitoes were identified morphologically and, where required, by molecular analyses. <i>Aedes albopictus</i> was the dominant AIM throughout the study period (eggs N = 96,192, adults N = 14,231), being detected at all three study sites and showing consistent interannual and seasonal dynamics, with peak abundance during summer despite routine vector control interventions. <i>Aedes koreicus</i> was detected at two of the three study sites, namely Venice and Treviso airports (eggs N = 1, adults N = 3). Phylogenetic analyses based on COI indicated that these specimens belonged to a distinct European lineage, revealing genetic diversity among European populations of <i>Ae. koreicus</i>. No evidence of newly established AIMs was found during the surveillance period. These findings highlight the importance of long-term surveillance at PoEs for the early detection of AIMs, monitoring temporal changes in established vector populations, and supporting integrated control and surveillance strategies to reduce the risk of vector establishment and mosquito-borne disease transmission.</p>","PeriodicalId":23330,"journal":{"name":"Tropical Medicine and Infectious Disease","volume":"11 9","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13611688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040751","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":"Application of Genomics to Prevent and Combat Emerging Infectious Disease Threats in Latin America: Perspectives from an Overseas U.S. Navy Research Command.","authors":"Hugo O Valdivia, Maria Silva, Cristopher D Cruz, Paul Rios, Marisa E Lozano, Julia S Ampuero, Yeny Tinoco, Jeffrey Spiro, Yuliya S Johnson, Alden S Estep, Steev Loyola, Carmen Flores-Mendoza, Gissella M Vasquez, Jose A Garcia-Rivera, Henju Marjuki","doi":"10.3390/tropicalmed11090245","DOIUrl":"10.3390/tropicalmed11090245","url":null,"abstract":"<p><p>Endemic and (re)emerging infectious diseases pose a major threat to public health and military readiness in Central and South America. The high biodiversity and the differing transmission pathways require the use of highly sensitive methods to track the emergence and spread of these diseases. High-throughput sequencing technologies have become a critical resource for the field of infectious disease monitoring, specifically for tracking pathogen evolution, antimicrobial resistance, and transmission. This review provides an overview of the implementation of genomics-informed infectious disease surveillance conducted by the U.S. Naval Medical Research Unit SOUTH, focusing on operational, infrastructural, and logistical challenges in resource-limited settings and outlining strategies for building sustainable regional capacity. Selected case studies focused on prominent biothreats including dengue, Oropouche, malaria, and antimicrobial resistance demonstrate the significance and applicability of targeted and agnostic sequencing approaches to elucidate transmission pathways, pathogen discovery, and guide public health responses and field-deployable applications.</p>","PeriodicalId":23330,"journal":{"name":"Tropical Medicine and Infectious Disease","volume":"11 9","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13611510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040625","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":"Rabies in Military Personnel: Epidemiology, Clinical Challenges, and Strategies for Prevention and Management.","authors":"Elodie Monchatre-Leroy, Diana Isabela Costescu Strachinaru, Oula Itani, Sophie Wensierski, Alexandre Servat, Patrick Soentjens","doi":"10.3390/tropicalmed11090243","DOIUrl":"10.3390/tropicalmed11090243","url":null,"abstract":"<p><p>For deployed military personnel, a single exposure from a rabies-infected animal can become a death sentence. With a case fatality rate approaching 100%, rabies remains a serious, yet insufficiently acknowledged hazard for service members, for whom prevention in operational environments poses unique challenges. We conducted a systematic literature search to identify relevant studies on rabies risk in armed forces personnel. By analysing rabies-related fatalities in the military, this review highlights the operational challenges posed by animal bites during deployment, including underreporting and delayed access to care, which compromise timely post-exposure prophylaxis (PEP) administration. Special emphasis is placed on prevention strategies, including pre-exposure prophylaxis (PrEP) and animal control protocols tailored to military settings. Its aim is to provide a comprehensive, evidence-based resource for healthcare professionals involved in the protection of deployed forces against this ancient yet still deadly infectious disease.</p>","PeriodicalId":23330,"journal":{"name":"Tropical Medicine and Infectious Disease","volume":"11 9","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13611337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040815","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":"Circulating Leukocytes and Antibody Isotype Reactivity in Rats Experimentally Infected with Different Burdens of <i>Strongyloides venezuelensis</i>, Before and After Treatment with Ivermectin or Dexamethasone.","authors":"João Gustavo Mendes Rodrigues, Guilherme Silva Miranda, Genil Mororó Araújo Camelo, Caio Brandão Goes Gouveia, Deborah Aparecida Negrão-Corrêa","doi":"10.3390/tropicalmed11090242","DOIUrl":"10.3390/tropicalmed11090242","url":null,"abstract":"<p><p>Strongyloidiasis is a neglected, potentially lifelong disease caused by <i>Strongyloides stercoralis</i> that can lead to a high mortality rate in immunocompromised hosts; therefore, it is necessary to increase the accuracy of infection diagnosis. In the current study, we used Wistar rats experimentally infected with different burdens of <i>Strongyloides venezuelensis</i> to characterize circulating leukocytes and IgM, IgG, IgG1, IgG2a, and IgA reactivity before and after anthelmintic treatment or immunosuppression. Infection, especially with 500 L3, induced an increase in circulating leukocytes, particularly during the acute phase. Animals treated with ivermectin showed complete elimination of the parasite and an early reduction in circulating eosinophils. The production of IgM, IgG, and IgG1 anti-L3 (infective larvae) and anti-Sv (adult worm) antigens was significantly elevated in all infected groups but did not allow differentiation between cured and infected animals. Treatment with dexamethasone delayed worm elimination and temporarily reduced cellular response and parasite-specific IgG production but did not alter IgM reactivity. IgG2a anti-L3 and anti-Sv reactivity showed a progressive reduction, returning to baseline levels in ivermectin-treated rats. IgA anti-ES/L3 (excretory and secretory larval antigens) reactivity significantly decreased in intestinal wash after parasitological cure. These data would help the development of more efficient immunodiagnostic alternatives for human strongyloidiasis based on antibody isotype reactivity.</p>","PeriodicalId":23330,"journal":{"name":"Tropical Medicine and Infectious Disease","volume":"11 9","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13611700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040611","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":"Toward Precision Vaccinology for Mpox: Rational Antigen Design, Next-Generation Platforms, and Immune Correlates of Protection.","authors":"Yithenthrathevinair K Paramasivam, Nur Syafiqah Mohamad Nasir, Mohd Zulkifli Salleh","doi":"10.3390/tropicalmed11090244","DOIUrl":"10.3390/tropicalmed11090244","url":null,"abstract":"<p><p>Mpox has emerged as a global public health concern, highlighting the limitations of traditional vaccinia-based vaccination strategies and the urgent need for precision vaccinology approaches. Advances in structural virology and immunoinformatics have enabled the identification of conserved immunodominant antigens from both mature virion and extracellular virion forms, supporting the development of multivalent antigen combinations capable of inducing broad neutralizing antibody (nAb) responses. Emerging delivery technologies including mRNA-lipid nanoparticles, viral vectors, and self-assembling protein nanoparticles offer rapid scalability, enhanced immunogenicity, and improved safety compared with conventional live-attenuated vaccines. Addressing antigenic evolution, vaccine supply limitations, and population-specific immune variability will be crucial for optimizing vaccine effectiveness. This review synthesizes current evidence on antigen design, vaccine delivery platforms, and immunological correlates of protection to outline a framework for next-generation mpox vaccines. Precision vaccinology therefore represents a transformative strategy for developing durable, clade-specific mpox vaccines and strengthening preparedness against future orthopoxvirus outbreaks worldwide.</p>","PeriodicalId":23330,"journal":{"name":"Tropical Medicine and Infectious Disease","volume":"11 9","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13611797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040795","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":"Global Prevalence and Distribution of Human Sarcocystosis: A Systematic Review and Meta-Analysis.","authors":"Jurairat Jongthawin, Aongart Mahittikorn, Kinley Wangdi, Frederick Ramirez Masangkay, Manas Kotepui","doi":"10.3390/tropicalmed11090241","DOIUrl":"10.3390/tropicalmed11090241","url":null,"abstract":"<p><p>Human sarcocystosis is a neglected zoonotic infection caused by protozoa of the genus <i>Sarcocystis</i>. Although sporadic cases and outbreaks have been reported worldwide, the global burden of human infections has not been comprehensively synthesized. This study aimed to estimate the pooled prevalence and global distribution of <i>Sarcocystis</i> infections in humans. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420251159944). PubMed, Scopus, Web of Science, Ovid, Nursing & Allied Health Premium, and Google Scholar were used for retrieving relevant studies. Observational studies published from 2000 onward reporting human <i>Sarcocystis</i> infections confirmed by microscopic and/or molecular methods were included. A random-effects model was used to estimate pooled prevalence. Heterogeneity was assessed using the <i>I</i>² statistic. Subgroup analyses and meta-regression were performed to explore sources of heterogeneity. Seventeen studies comprising 66,329 participants met the inclusion criteria. The pooled prevalence of human <i>Sarcocystis</i> infection was 0.85% (95% confidence interval [CI]: 0.33-2.19), with substantial heterogeneity (<i>I</i>² = 98.2%). Prevalence estimates showed marked variation across continents, countries, participant groups, diagnostic methods, <i>Sarcocystis</i> species, and clinical forms of sarcocystosis. Although human <i>Sarcocystis</i> infection appears relatively rare, its prevalence is geographically heterogeneous across studies published between 2000 and 2024. The robustness of the pooled prevalence estimate is limited by the small number of studies, uneven geographical coverage, and substantial heterogeneity. Differences in diagnostic approaches, study populations, infecting species, and disease phenotypes likely contributed to this variability. Enhanced surveillance and standardized application of sensitive molecular diagnostics are essential to better define the epidemiology, burden, and public health significance of human sarcocystosis.</p>","PeriodicalId":23330,"journal":{"name":"Tropical Medicine and Infectious Disease","volume":"11 9","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13611245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040648","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":"Passive Immunization Hesitancy Among Rabies-Exposed Individuals in China: A Multicenter Cross-Sectional Study.","authors":"Qisheng Hou, Xiaoliang Xu, Si Liu, Chen Sun, Fengfeng Zhu, Yang Yang, Jianchao Shao, Yifan Wang, Yanqiang Feng, Yingxiang Liu, Yan Yan, Song Wang, Yan Wang, Cheng Liu","doi":"10.3390/tropicalmed11090238","DOIUrl":"10.3390/tropicalmed11090238","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Rabies is an almost universally fatal disease for which post-exposure prophylaxis (PEP), including passive immunization (PI) with rabies immunoglobulin or monoclonal antibodies, remains the only effective intervention. Despite established clinical guidelines, real-world PI utilization remains suboptimal. This study aimed to investigate the prevalence and determinants of PI hesitancy among previously unvaccinated patients with Category III rabies exposure in China.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This multicenter cross-sectional questionnaire study was conducted at 12 rabies PEP clinics or emergency departments in 12 provinces of mainland China. The analysis included 585 previously unvaccinated adults with Category III rabies exposure who initially hesitated to receive or declined PI. The questionnaire collected sociodemographic characteristics, exposure profiles, awareness of the early protection gap, reasons for initial PI hesitancy or refusal, the decision to receive PI during the same clinical encounter, and PI product selection. Multivariable logistic regression identified factors associated with PI treatment decisions, with results reported as adjusted odds ratios (aORs); reason-specific models used the Benjamini-Hochberg false discovery rate correction. All inferential analyses were restricted to adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 5068 eligible previously unvaccinated patients with Category III rabies exposure, 2866 (57%) initially hesitated to receive or declined recommended PI. Of 617 questionnaire respondents, 32 minors were excluded, leaving 585 adults for all inferential analyses. The leading reasons for initial hesitancy were lack of understanding of the immediate protective role of PI (199/585, 34%), belief that vaccination alone was sufficient (194/585, 33%), and high cost (178/585, 30%). During the same clinical encounter, 320/585 adults (55%) chose to receive PI. Awareness of the early protection gap (aOR 2.63, 95% CI 1.75-3.98, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and bachelor's degree or higher (aOR 1.61, 95% CI 1.07-2.43, &lt;i&gt;p&lt;/i&gt; = 0.023) were positively associated with the decision to receive PI, whereas head/face wounds were negatively associated (aOR 0.53, 95% CI 0.30-0.92, &lt;i&gt;p&lt;/i&gt; = 0.026). In reason-specific models, lack of knowledge about immediate protection was associated with higher odds of choosing PI (aOR 2.43, 95% CI 1.62-3.68, BH-FDR &lt;i&gt;p&lt;/i&gt; &lt; 0.001), whereas high cost was associated with lower odds (aOR 0.41, 95% CI 0.27-0.62, BH-FDR &lt;i&gt;p&lt;/i&gt; &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Hesitancy toward and refusal of PI were observed among previously unvaccinated adults with Category III rabies exposure, yet initial hesitation or refusal is not irreversible. Early protection gap awareness was positively associated with PI choice, whereas cost-related concern was negatively associated. Clear explanation of protection timing and attention to cost-related barriers may support informed PI t","PeriodicalId":23330,"journal":{"name":"Tropical Medicine and Infectious Disease","volume":"11 9","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13611066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040824","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":"Climate-Aware Self-Retrospective Representation Learning for Spatio-Temporal Epidemic Forecasting.","authors":"Qi Yuan, Han Shu, Yizhi Pan, Tianshuo Li, Hangyi Shen, Weiqi Jiang, Zidan Zhu, Pengpeng Zhang, Ningli Xi, Junyi Xin, Kai Li, Guanqun Sun","doi":"10.3390/tropicalmed11090240","DOIUrl":"10.3390/tropicalmed11090240","url":null,"abstract":"<p><p>Spatio-temporal epidemic forecasting aims to predict future outbreak trajectories across interconnected regions from historical epidemiological observations and meteorological covariates. However, existing approaches often fail to preserve historically salient epidemic states or to fully exploit delayed and region-varying meteorological associations, leading to unstable temporal representations and insufficient meteorological-context-aware spatio-temporal context for prediction at later forecast horizons. In this paper, we propose CASRL, a <b>C</b>limate-<b>A</b>ware <b>S</b>elf-<b>R</b>etrospective Representation <b>L</b>earning network for stable and meteorological-context-aware spatio-temporal epidemic forecasting. CASRL first employs a Self-Retrospective Epidemic Encoder (SREE) to retrospectively aggregate historically salient epidemic states through query-guided weighting and adaptive gating, thereby preserving informative historical epidemic states within the look-back window. It then introduces a Climate-Adaptive Graph Message Passing (CAGMP) module that breaks away from traditional passive feature concatenation. Instead, it constructs a separate meteorological-view predictive graph conditioned on the static spatial prior and adaptively fuses it with the incidence-associated topology to model complex cross-regional predictive associations. By integrating self-retrospective epidemic representations with meteorological-view spatio-temporal interactions, CASRL produces forecasts with improved predictive stability at later forecast horizons. Extensive experiments on two public influenza benchmarks show that CASRL is competitive at shorter forecast horizons and provides clearer advantages at later forecast horizons, particularly in phase-alignment-related evaluation and 15-week-ahead forecasting.</p>","PeriodicalId":23330,"journal":{"name":"Tropical Medicine and Infectious Disease","volume":"11 9","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13611530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040569","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":"Reply to Asgarian et al. Comment on \"Nejati et al. Spatiotemporal Patterns and Historical Overview of <i>Aedes</i> Mosquitoes in Iran: A Systematic Review. <i>Trop. Med. Infect. Dis.</i> 2026, <i>11</i>, 131\".","authors":"Jalil Nejati, Abedin Saghafipour, Rubén Bueno-Marí","doi":"10.3390/tropicalmed11090239","DOIUrl":"10.3390/tropicalmed11090239","url":null,"abstract":"<p><p>We thank Asgarian et al [...].</p>","PeriodicalId":23330,"journal":{"name":"Tropical Medicine and Infectious Disease","volume":"11 9","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13611474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040807","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":"Deciphering the \"Doxycycline Deficiency Syndrome\": Defining the Characteristic Clinical, Laboratory and Imaging Findings in Patients Presenting with Leptospirosis, Q Fever and Rickettsial Diseases in Far North Queensland, Tropical Australia.","authors":"Hayley Stratton, Callum Pownell, Megan Sandeman, Patrick Rosengren, Cody Price, Alexandra G A Stewart, Roderick Gavey, Toni Kinneally, Kathy Petoumenos, Simon Smith, Josh Hanson","doi":"10.3390/tropicalmed11090237","DOIUrl":"10.3390/tropicalmed11090237","url":null,"abstract":"<p><p><b>Background</b>: The \"doxycycline deficiency syndrome\" is a colloquial term used in tropical Australia to describe the overlapping, non-specific findings seen in leptospirosis, Q fever, and the rickettsial diseases scrub typhus and Queensland tick typhus (QTT). A laboratory confirmed diagnosis is frequently delayed, however, early differentiation of these potentially life-threatening infections has important implications for clinical management. <b>Methods</b>: We examined consecutive laboratory-confirmed cases of leptospirosis, Q fever, and rickettsial diseases managed at a referral centre in tropical Australia. The patients' symptoms, clinical signs and simple laboratory and radiology investigations at presentation were compared. <b>Results</b>: There were 111 cases of leptospirosis, 59 cases of Q fever, and 34 cases of rickettsial disease (17 cases of QTT and 17 of scrub typhus). Patients with leptospirosis had a shorter duration of symptoms and were more likely to have gastrointestinal symptoms, arthralgia, haemoptysis, hypotension, conjunctival suffusion and abnormal chest auscultation at presentation than patients with the other infections. They were more likely to have renal impairment and an elevated creatine kinase but less likely to have an elevated serum ferritin and serum lactate dehydrogenase. Patients with leptospirosis were more likely to have alveolar and multilobar changes on chest imaging. Patients with Q fever were more likely to have abnormal liver function tests at presentation but were more likely to have preserved renal function and normal chest imaging. Patients with rickettsial disease were more likely to have a rash, an eschar, lymphadenopathy and splenomegaly. Overall, 76/204 (37%) required ICU admission, of whom 56 (74%) had leptospirosis, but all 204 patients survived to hospital discharge. <b>Conclusions</b>: Leptospirosis, Q fever, and rickettsial diseases can have a similar presentation, but simple clinical, laboratory and imaging findings can help distinguish these infections and expedite their optimal management.</p>","PeriodicalId":23330,"journal":{"name":"Tropical Medicine and Infectious Disease","volume":"11 9","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13611417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040727","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}