Tropical Medicine & International Health最新文献

{"title":"Decline in Calmette-Guérin Bacillus Vaccination Coverage and Change in the Spatiotemporal Pattern of Extrapulmonary Tuberculosis in Children and Adolescents in Brazil: An Ecological Study, 2004-2023.","authors":"Alice Ramos-Silva, Luiza Silva Trigueiro de Oliveira, Marcos Daniel Souza da Costa, Matheus Daudt-Lemos, Luis Phillipe Nagem Lopes, Elisangela Costa Lima, Claudete Aparecida Araújo Cardoso, Clemax Couto Sant'Anna, Andrea Alice Silva, Fabiana Rabe Carvalho","doi":"10.1111/tmi.70198","DOIUrl":"https://doi.org/10.1111/tmi.70198","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between municipal BCG vaccination coverage and extrapulmonary tuberculosis (EPTB) notification rates among children and adolescents in Brazil and to describe their temporal, spatial, and spatiotemporal patterns from 2004 to 2023.</p><p><strong>Methods: </strong>We conducted an ecological study using national Brazilian administrative databases. Temporal trends in EPTB notification rates were assessed using Joinpoint regression and spatiotemporal clusters using retrospective space-time scan statistics. The association between municipal BCG coverage and EPTB notification rates was examined using municipality-year negative binomial models with an offset for the population aged 0-19 years. The main model adjusted for calendar year, primary health care team density, and municipal Human Development Index, with sensitivity analyses incorporating urbanicity, HIV case mix, and a CNES-based proxy of registered diagnostic infrastructure. Factors associated with extrapulmonary versus pulmonary presentation were evaluated using multivariable logistic regression.</p><p><strong>Results: </strong>EPTB notification rates declined overall but increased among children aged 0-4 years. Mortality showed a U-shaped temporal pattern, with a nadir around 2013. Local spatial autocorrelation identified high-high clusters concentrated mainly in the Southeast, Northeast, and North. Space-time scan analyses identified recurrent high-risk clusters, including a large early cluster in 2004-2007, a localized cluster in 2015-2016, and a recent cluster in 2019-2023. Higher municipal BCG coverage was associated with lower EPTB notification rates after adjustment (IRR per 10-percentage-point increase, 0.9755; 95% CI, 0.9646-0.9864). Urbanicity had minimal impact, whereas inclusion of registered diagnostic infrastructure shifted estimates toward the null. At the individual level, extrapulmonary presentation was associated with ages 5-9 and 10-14 years, male sex, and HIV positivity.</p><p><strong>Conclusions: </strong>Lower municipal BCG coverage was associated with higher EPTB notification rates among children and adolescents in Brazil. The association was modest and sensitive to contextual adjustment, particularly to indicators of diagnostic and service infrastructure.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virological Suppression Rate and Drug Resistance in Children and Adolescents Receiving Dolutegravir-Containing Antiretroviral Therapy in Ndop Health District, Cameroon.","authors":"Precious Nkam Ache, Herbert Afegenwi Mbunkah, Wijnand Mambi, Bella A Sama, Damian Nota Anong","doi":"10.1111/tmi.70196","DOIUrl":"https://doi.org/10.1111/tmi.70196","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed at evaluating the rate of virological suppression and profiles of HIV-1 drug resistance in HIV-positive children and adolescents taking Dolutegravir-based antiretroviral therapy in the Ndop health district of Cameroon.</p><p><strong>Methods: </strong>This hospital-based, cross-sectional study was carried out from February to May 2025. Children and adolescents (5-19 years) living with HIV-1, who had been taking Dolutegravir-based regimens for at least a year, were included in the study. Participants with virological failure (viral load > 1000 copies/mL) underwent HIV-1 genotypic resistance testing (RNA extraction, cDNA synthesis, nested PCRs and Sanger sequencing) targeting the reverse transcriptase and integrase regions of the pol gene. Mutations were interpreted using the Stanford HIV drug resistance database.</p><p><strong>Results: </strong>Out of 82 eligible participants receiving Tenofovir-Lamivudine-Dolutegravir (TLD) regimen, 75 (91.5%) achieved virological suppression (VL < 1000 copies/mL). Among 7 virally unsuppressed individuals, 5 (6.1%) were successfully genotyped. The major integrase resistance mutation G140GRS was detected in one participant (1/5; 20%). Univariate analysis to identify potential risk factors associated with drug resistance revealed no statistically significant associations. However, it was observed that major or accessory DRMs were more common in males, participants in secondary school and those taking antiretroviral drugs for a duration of 3-5 years.</p><p><strong>Conclusions: </strong>The TLD regimen remains highly effective in viral suppression, with very low resistance rates observed. Targeted adherence support for high-risk adolescents like those in secondary school is critical to preserve treatment efficacy.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resurgence of Typhoid Fever in Ghana: A Scoping Review of Epidemiology, Antimicrobial Resistance Patterns, Geographic Distribution, and Public Health Interventions.","authors":"Stephen Twumasi, Richard Owusu Ansah, Abdul Wasid Abubakari, Allwell Adofo Ayirebi, Bright Opoku Dankwah, Angela Opoku","doi":"10.1111/tmi.70202","DOIUrl":"https://doi.org/10.1111/tmi.70202","url":null,"abstract":"<p><strong>Background: </strong>Typhoid fever remains a major public health threat in Ghana, where the intensification of a long-standing endemic challenge is driving a re-emergence of the disease. This resurgence is fuelled by a complex interplay of escalating antimicrobial resistance (AMR), inadequate water and sanitation (WASH) infrastructure, and persistent diagnostic limitations. This scoping review provides a comprehensive synthesis of the current evidence on the epidemiology, AMR patterns, diagnosis, treatment and public health interventions for typhoid fever in Ghana.</p><p><strong>Methods: </strong>A systematic scoping review of peer-reviewed literature, national surveillance data and public health reports from January 2010 to August 2025 was conducted using databases including PubMed, Scopus and institutional repositories.</p><p><strong>Results: </strong>The incidence of typhoid fever remains high, with significant outbreaks in regions like Oti linked to environmental degradation from illegal mining. A critical shift in antimicrobial resistance is observed, with widespread resistance to first-line agents now compounded by emerging resistance to ciprofloxacin and decreased susceptibility to third-generation cephalosporins. Diagnostics remain a major challenge, with an over-reliance on the unreliable Widal test and underutilization of blood culture, which fuels a cycle of misdiagnosis and inappropriate antibiotic use. While public health interventions like WASH improvements and typhoid conjugate vaccine (TCV) rollouts are underway, they face significant logistical and financial hurdles to full implementation.</p><p><strong>Conclusion: </strong>The re-emergence of typhoid fever in Ghana is a complex public health crisis demanding an integrated response. Addressing this challenge requires strengthening diagnostic capacity, enforcing antimicrobial stewardship, accelerating TCV implementation, and making sustained investments in WASH infrastructure to break the cycle of transmission.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eco-Epidemiological Study of Seropositivity Against Rickettsia and Leptospira Agents in Rural Areas of Urabá, Colombia.","authors":"Mariana Torres-Bustamante, Omar Cantillo-Barraza, Albert I Ko, Elsio A Wunder, Juan C Quintero-Vélez","doi":"10.1111/tmi.70200","DOIUrl":"10.1111/tmi.70200","url":null,"abstract":"<p><strong>Introduction: </strong>Rickettsioses and leptospirosis are infectious diseases often underdiagnosed due to limited knowledge about their epidemiology, pathophysiology, and clinical aspects.</p><p><strong>Objectives: </strong>To characterize the seroprevalence and seroincidence of Rickettsia and Leptospira agents and determine their associated factors in rural areas of Urabá, Antioquia, Colombia.</p><p><strong>Methods: </strong>Analysis of seropositivity of a prospective study exploring sociocultural and ecological aspects of Rickettsia and Leptospira infection. A multinomial mixed logistic regression model analysed factors linked to seroprevalent cases, with descriptive analyses of seroincident cases.</p><p><strong>Results: </strong>Concomitant seroprevalence against Rickettsia and Leptospira was 9.38% (95% CI: 6.08%-13.37%). Associated factors included age (ORa = 1.02; 95% CI 1.007-1.03), male gender (ORa = 3.06; 95% CI: 1.75-5.37), fever history (ORa = 1.71; 95% CI: 1.06-2.77), presence of breeding pigs (ORa = 2.29; 95% CI 1.36-3.88), peridomicile yucca crops (ORa = 2.5; 95% CI 1.1-5.62), and deforestation practices (ORa = 1.74; 95% CI 1.06-2.87). Concomitant seroincidence was 1.09% (3/274) (95% CI: 0.29%-4.05%). All seroincident cases were female, median age 31.83 years (IQR: 8.69-56.99), with similar housing characteristics (soil floors, wooden walls, zinc roofs) and exposure to domestic and synanthropic animals.</p><p><strong>Conclusions: </strong>There is evidence of concomitant seroprevalent and seroincident cases against both microorganisms in rural Urabá, Colombia. These findings can improve public health surveillance systems in preventing, detecting, and managing clinical cases caused by these pathogens.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391838","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":"Performance of Tuberculin Skin Testing Compared With Interferon-Gamma Release Assays Foreign-Born Individuals.","authors":"Andrés Marco, Neus Solé, Raquel Prieto-García, Indiana Jesús Abdo, Joan Pau Millet, Elisabet Turu","doi":"10.1111/tmi.70183","DOIUrl":"https://doi.org/10.1111/tmi.70183","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the prevalence of Mycobacterium tuberculosis infection among foreign-born individuals entering prison and to evaluate the performance of the tuberculin skin test (TST) in vaccinated individuals (Bacillus Calmette-Guérin vaccine, BCG), using interferon gamma release assays (IGRAS) as the reference standard.</p><p><strong>Methods: </strong>We conducted a prospective observational study including foreign-born individuals admitted to prisons in Catalonia (Spain) between 1 March 2023 and 30 June 2023. A TST was performed if there was no prior positive TST or prior TB infection, or if the TST was negative for more than 1 year. Current TB was excluded by clinical and radiological evaluation. BCG vaccination status was assessed using medical records, identification of a vaccination scar, and the BCG World Atlas. TST positivity was analysed according to BCG vaccination status. Among BCG-vaccinated individuals with a positive TST, IGRA results were used to estimate the positive predictive value (PPV) of the TST overall and by TST induration diameter.</p><p><strong>Results: </strong>Among 1075 foreign-born individuals admitted during the study period, 32 (3.0%) had a previous diagnosis of active TB. Of the remaining 1043, 86.4% were classified as BCG-vaccinated. Overall, 45.2% had a positive TST, with no significant difference between vaccinated individuals and unvaccinated individuals (46.1% vs. 39.9%; p = 0.08). Among BCG-vaccinated individuals with a positive TST, IGRA testing was performed in 71%, yielding an overall TST PPV of 65%. The PPV increased with induration diameter, from 51.6% (10-14 mm) to 81.8% (≥ 20 mm).</p><p><strong>Conclusions: </strong>Foreign-born individuals entering prison show a high prevalence of M. tuberculosis infection. In BCG-vaccinated individuals, the TST shows limited predictive value, particularly at lower induration thresholds. While further studies are needed, these findings support the preferential use of IGRA-based strategies for LTBI screening in this setting.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Co-Occurrence of Malaria, Pneumonia, and Diarrheal Disease Among Households: A Cohort Study in Rural Western Uganda.","authors":"Annika K Gunderson, Abel Bwambale, Emmanuel Baguma, Dana Giandomenico, Bonnie E Shook-Sa, Raquel Reyes, Moses Ntaro, Edgar M Mulogo, Ross M Boyce","doi":"10.1111/tmi.70188","DOIUrl":"10.1111/tmi.70188","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to identify patterns associated with clustering and co-occurrence of malaria, pneumonia, and diarrhoea, the leading causes of death in children under age five in sub-Saharan Africa, in western Uganda to generate evidence for integrated prevention and control measures.</p><p><strong>Methods: </strong>We conducted a prospective longitudinal study complemented by passive surveillance at local clinics. All households in the three selected villages were eligible to participate. Household-level socioeconomic and geographic data were linked to clinically diagnosed disease outcomes. Co-occurrence of diseases within households, defined as the diagnoses of two of the three diseases of interest (malaria, pneumonia, and diarrhoea) within a four-week period, was assessed using a Poisson model with a log link. Multinomial logistic regression models were fit to assess the association between patterns of malaria and pneumonia occurrence with socioeconomic and geographic factors.</p><p><strong>Results: </strong>A total of 399 households were enrolled and completed baseline surveys. The smallest village accounted for 68.5%, 43.2%, and 38.1% of malaria, pneumonia, and diarrhoea cases, respectively. After adjusting for village, socioeconomic status, and the mean age of children in the home, households in Kasanzi had a higher relative risk of having both malaria and pneumonia versus neither disease compared to households in Bunyangoni (RRR: 33.84, 95% CI: 7.10, 161.24). For models replacing village with elevation, households in at higher elevations had a higher relative risk of having both malaria and pneumonia versus neither disease compared to households in at lower elevations (RRR: 26.59, 95% CI: 2.53, 279.84). No clear associations were found between malaria and pneumonia co-occurrence and SES.</p><p><strong>Conclusions: </strong>Findings demonstrate that within small geographic areas, disease burden can vary dramatically across communities. Targeted, community-level interventions, rather than broad regional programs, are essential to address the distinct transmission dynamics and overlapping risks faced by high-burden communities.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377239","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":"Dried Serum Spots for External Quality Assurance of Scrub Typhus IgM Serology: A Multicentre Pilot Study From India.","authors":"Haripriya Sivakumar, Dinakaran Vasudevan, Ratchagadasse Vimal Raj, Ferdinamarie Sharmila Philomenadin, Harmanmeet Kaur, Rahul Dhodapkar","doi":"10.1111/tmi.70132","DOIUrl":"10.1111/tmi.70132","url":null,"abstract":"<p><strong>Objective: </strong>Scrub typhus, caused by Orientia tsutsugamushi , is a significant contributor to acute undifferentiated febrile illness in South and Southeast Asia. Laboratory confirmation of infection has a crucial role in timely management; nevertheless, lack of standardisation in inter-laboratory performance of IgM enzyme-linked immunosorbent assay (ELISA) has been a long-standing challenge. In resource-constrained countries, quality assurance schemes have an important role in improving laboratory performance. The aim of this pilot study was to assess the applicability of dried serum spots (DSS) as a suitable sample format for quality assurance schemes of O. tsutsugamushi IgM ELISA in India.</p><p><strong>Methods: </strong>Well-characterised positive and negative serum samples were processed into DSS panels and were systematically validated for homogeneity and short-term stability according to ISO/IEC 17043 and ISO 13528 using two commercially available IgM ELISA kits (InBios International Inc. and J. Mitra Scrub Typhus IgM Microlisa). Distribution was done for 10 participating laboratories across India. The laboratories tested DSS panels under routine diagnostic conditions using standardised protocols. The results were evaluated for qualitative accuracy, inter-laboratory concordance and overall performance.</p><p><strong>Results: </strong>DSS panels exhibited a high degree of homogeneity and stability under simulated transport and storage conditions, thereby not requiring cold chain distribution. On initial testing, 8 of 10 laboratories (80%) showed complete qualitative concordance across the five-sample panel. Following repeat testing and procedural review, all laboratories achieved concordant qualitative results, with minor disagreement noted only in borderline reactive samples.</p><p><strong>Conclusions: </strong>Dried serum spots are a feasible, reliable and cost-effective alternative to conventional liquid serum for external quality assurance of O. tsutsugamushi IgM ELISA. The initial discordance observed underscores the importance of EQA in identifying procedural variability, while the final concordance confirms the robustness and suitability of DSS for EQA implementation in resource-limited, endemic settings like India.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"868-874"},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Donor Fatigue and Its Impact on Vaccination Coverage in Africa: Challenges and the Path Forward.","authors":"Michael Sarfo, Daniel Akuamoah Asirifi, John Kwame Agbenyeavu, Kwaku Obeng Boateng, Nelson Obeng, Sandra Konadu Bonnah, Betelhem Abebe Andargie, Gilbert Eshun","doi":"10.1111/tmi.70139","DOIUrl":"10.1111/tmi.70139","url":null,"abstract":"","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"769-771"},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two Decades of Dengue in Bangladesh (2001-2024): Epidemiologic Trends, Geographic Spread and Climatic Drivers.","authors":"Awnon Bhowmik, Mahmudul Hasan, Goutam Saha, Huaiping Zhu","doi":"10.1111/tmi.70136","DOIUrl":"10.1111/tmi.70136","url":null,"abstract":"<p><p>Bangladesh has experienced a marked escalation in dengue since 2001, culminating in 321,179 reported cases and 1705 deaths in 2023. The objective of this narrative review is to analyse 24 years of surveillance data to describe temporal trends, the transition from urban-centric to nationwide endemicity and the influence of climatic drivers. This review synthesises national surveillance and published reports from 2001 to 2024 to assess demographic risk, geographic spread and environmental factors. Young adults (21-30 years) consistently account for the largest share of infections (28.82% in 2024). In contrast, adults over 50 years suffer disproportionate mortality (15.65% of deaths in 2024) despite a smaller share of infections (7.15%). Since 2019, transmission has extended beyond urban centres such as Dhaka into peri-urban and other districts. This geographical diffusion is driven by the rapid urbanisation of other peripheries, infrastructure development that creates new vector habitats and accelerated population mobility which connects hyper-endemic urban hubs with susceptible rural communities. We identify priority actions such as targeted risk communication for young adults, improved access to healthcare for older adults and climate-adaptive vector control strategies integrated with urban services and strengthened surveillance. It is essential to address these factors to reduce the dengue burden and improve health outcomes in Bangladesh to control mosquito populations. Lessons are transferable to other dengue-affected countries when adapted to local demographic and environmental contexts and embedded in regional collaboration and climate-responsive policy.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"772-795"},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serious Bacterial Infections in Hospitalized Neonates in Eastern Ethiopia: Investigating the Emerging Pathogen Pantoea dispersa Compared With Klebsiella pneumoniae.","authors":"Yunus Edris, Faisel A Hassen, Desalegn A Ayana, Fami Ahmed, Haleluya Leulseged, Dadi Marami, Jabir Aliye, Belete G Alem, Zelalem T Mariam, Gezahang Mengesha, Nega Assefa, Alexander M Aiken, J Anthony G Scott, Lola Madrid","doi":"10.1111/tmi.70140","DOIUrl":"10.1111/tmi.70140","url":null,"abstract":"<p><strong>Background: </strong>Serious bacterial infections (SBIs) are major contributors to neonatal morbidity and mortality in low-income countries. We describe the aetiology and risk factors for neonatal bacteraemia and in-hospital mortality in eastern Ethiopia, focusing on Pantoea dispersa, a rarely studied pathogen, and Klebsiella pneumoniae .</p><p><strong>Methods: </strong>Prospective surveillance was conducted at Hiwot Fana Comprehensive Specialized Hospital (HFCSH), Harar, from December 2021 to November 2023. Blood for culture was drawn from neonates admitted with the WHO clinical definition of possible-SBI (pSBI). Isolates were identified using API kits and antimicrobial susceptibility tested by Kirby-Bauer method.</p><p><strong>Findings: </strong>Among 1375 neonates with pSBI, blood was cultured from 1335 (97%), and 356 (27%) cultured pathogens. The commonest infections were Pantoea species (n = 145, 40.7%) and K. pneumoniae (n = 63, 17.7%); 128 Pantoea isolates were identified as P. dispersa by Matrix-Assisted Laser Desorption Ionization-Time of Flight. Case-fatality-ratios were 25% (32/128), 19% (9/47) and 19% (30/160) for P. dispersa , K. pneumoniae and other monomicrobial infections, respectively. P. dispersa showed resistance to ampicillin (99%) and cefotaxime (85%) but was otherwise broadly susceptible, while K. pneumoniae showed resistance to cefotaxime (100%) and gentamicin (89%), remaining susceptible only to amikacin and meropenem. Compared to non-bacteraemic admissions, P. dispersa bacteraemia was associated with health-facility delivery outside HFCSH (aOR 1.9 [95% CI, 1.21-2.97]), low birth weight (aOR 2.1 [95% CI,1.22-3.47]), and the dry season (aOR 9.7, [95% CI, 4.61-20.31]). K. pneumoniae bacteraemia was associated with health-facility delivery outside HFCSH (aOR, 2.2, [95% CI, 1.09-4.27]) alone. Among admissions with pSBI, death was associated with low birth weight and P. dispersa bacteraemia.</p><p><strong>Interpretation: </strong>Bacteraemia was prevalent among neonates admitted with pSBI to HFCSH. P. dispersa and K. pneumoniae predominated and both had high mortality risks. Rigorous diagnostics and epidemiological associations support the interpretation of P. dispersa as a pathogen, necessitating local investigation into transmission and infection control interventions.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"933-943"},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783094","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}