Asian Journal of Research in Infectious Diseases

Fatal Paradoxical Reaction Following Antibiotic Initiation in Centrofacial Buruli Ulcer in an Immunocompetent Adult: A Case Report from Côte d'Ivoire

Wardatou Dine Mourtada — 2026-09-21

Background: Buruli ulcer, caused by Mycobacterium ulcerans, is the third most common mycobacterial infection in immunocompetent individuals and is endemic in West Africa. Lesions predominantly involve the limbs and are characteristically painless; head and neck involvement is rare and reported mainly in children. Paradoxical reactions, defined as clinical worsening of existing lesions or appearance of new lesions during or after antibiotic therapy, occur in a substantial minority of treated patients and are associated with high baseline bacterial load and large lesions. We report a fatal centrofacial Buruli ulcer in an adult in which a severe paradoxical reaction appears to have been precipitated by the simultaneous withdrawal of corticosteroid-containing chemotherapy and the initiation of specific antimycobacterial therapy.

Case Presentation: A 25-year-old immunocompetent Ivorian woman living in a swampy, Buruli-endemic area of Abidjan presented with a five-month history of a painful, febrile, rapidly extending ulceronecrotic lesion of the midface, corresponding to World Health Organization category III. Noma was diagnosed and treated with debridement and antibiotics without benefit. By week 7 the upper maxilla was almost entirely destroyed. Klebsiella rhinoscleromatis was isolated, but rhinoscleroma was excluded histologically. Because of fulminant progression and suspected extranodal NK/T-cell lymphoma, empirical chemotherapy with cyclophosphamide, vincristine and prednisone was started at week 12; the lesion stabilised for the first time since admission. At week 15, M. ulcerans DNA was detected by PCR targeting the IS2404 insertion sequence. Chemotherapy was discontinued after two cycles and rifampicin plus clarithromycin were started. Twenty-seven days after initiating antimycobacterial therapy, the lesion resumed rapid destructive extension, nutritional status deteriorated, and the patient died at week 24 from terminal cachexia.

Conclusions: Centrofacial Buruli ulcer may occur in adults and present atypically as a painful, febrile, necrotising lesion closely mimicking noma and other midfacial destructive lesions. A positive molecular result obtained from a chronically superinfected wound must be interpreted alongside clinical and histopathological coherence. In extensive lesions at critical anatomical sites, abrupt withdrawal of immunosuppression at the time antimycobacterial therapy is initiated may precipitate a fatal paradoxical reaction, and corticosteroid cover should be maintained or tapered rather than stopped abruptly.

Beyond Fever: A Case Series Highlighting the Varied Clinical Manifestations of Scrub Typhus

M. Prince Rueban — 2026-09-23

Background: Scrub typhus is an important infectious disease in India and can affect multiple organ systems. Although fever and eschar are useful clinical clues, they may be absent, leading to diagnostic challenges and potential delays in treatment. This case series was undertaken to highlight the varied presentations of scrub typhus and emphasise the need to consider it in patients with unexplained multisystem illness, even in the absence of classical features.

Aim: To report a case series of six patients with varied manifestations of scrub typhus affecting different organ systems.

Presentation of the Case: We describe six patients with diverse manifestations of scrub typhus, including meningoencephalitis, pneumonitis, acute kidney injury, multiorgan dysfunction syndrome with jaundice mimicking obstructive jaundice, a cholangitis-like presentation, and severe encephalopathy without fever. Serum scrub typhus IgM was positive in all patients, with CSF IgM also positive in the patient with meningoencephalitis. An eschar was identified in two patients, while two patients presented without fever. In patients with hepatobiliary involvement, marked jaundice and elevated liver enzymes were observed despite the absence of biliary obstruction on imaging. Renal involvement ranged from mild dysfunction to severe AKI, with a maximum creatinine level of 6.5 mg/dL. All patients received doxycycline and azithromycin for 7–14 days and showed gradual clinical improvement.

Conclusion: This case series highlights the diverse manifestations of scrub typhus, with neurological, respiratory, renal, hepatic, and multiorgan involvement. The absence of fever or an eschar should not exclude scrub typhus, particularly in endemic regions, as such presentations may mimic other infectious and systemic conditions. A high index of suspicion, careful clinical examination, and appropriate serological testing are essential for diagnosis. All six patients showed gradual clinical recovery following appropriate anti-rickettsial therapy. These findings emphasise the importance of considering scrub typhus in patients with unexplained multisystem illness in endemic areas.

Genomic Surveillance to Tackle Antimalarial and Insecticide Resistance in Malaria Control: A Narrative Review

Esiere RoseMary Kaiso — 2026-09-16

Background: Malaria control depends on the continued efficacy of antimalarial drugs and insecticide-based vector control, both of which are increasingly compromised by the evolving genetic capacity of Plasmodium falciparum and Anopheles mosquitoes to resist these tools. Genomic surveillance offers a faster and more spatially resolved alternative to traditional phenotypic monitoring, which is the focus of this review.

Methods: This narrative review was conducted using a systematic search of PubMed/MEDLINE, Scopus, Web of Science, medRxiv, and bioRxiv (2014-2026) for primary studies reporting genomic or molecular surveillance of antimalarial resistance, pfhrp2/pfhrp3 diagnostic-escape deletions, or insecticide resistance, with findings described narratively and grouped by thematic domain.

Results: Included studies revealed significant geographical heterogeneity: rising kelch13 markers in East Africa contrasted with their near-absence in southern Africa and Angola, while the Greater Mekong subregion showed an established multidrug-resistant lineage combining kelch13 mutations with plasmepsin2/3 amplification. Pfhrp2/3 diagnostic-escape deletions were spreading under active positive selection in the Horn of Africa. In Anopheles vectors, target-site (kdr/Vgsc) and metabolic (cytochrome P450-mediated) resistance were widespread and often co-occurred within the same populations. Portable, cost-effective sequencing platforms are increasingly enabling downstream, in-country surveillance, although integration into routine decision-making remains uneven.

Conclusion: Genomic surveillance is reshaping resistance monitoring, but its public-health value depends on sustained investment in decentralized sequencing capacity, data-sharing infrastructure that respects national data sovereignty, and stronger links between genomic findings and revisions to treatment and vector-control policies.

Dengue Vaccines, Antiviral Therapeutics and Emerging Diagnostic Biomarkers: Advances, Constraints and Translational Priorities

Manoj Kumar — 2026-09-24

Dengue control is entering a period in which vaccination, direct-acting antiviral development and increasingly sophisticated diagnostics can no longer be evaluated as separate technical domains. Vaccine performance is shaped by baseline dengue serostatus, circulating serotype and duration of follow-up; antiviral efficacy depends on treatment early in a brief viraemic phase; and diagnostic or prognostic biomarkers must function across changing immune backgrounds created by prior infection and vaccination. This critical narrative review integrates evidence on dengue vaccines, therapeutic development and emerging biomarkers, with emphasis on clinical translation rather than platform novelty alone. Literature published from 1 January 2009 to 19 July 2026 was considered, alongside earlier seminal work where necessary, using major biomedical and multidisciplinary scholarly sources, regional Latin American indexes and authoritative public-health documents. The strongest vaccine evidence supports meaningful protection against virologically confirmed and hospitalised dengue, but also demonstrates that apparent aggregate efficacy can conceal serotype- and serostatus-specific uncertainty. The legacy of CYD-TDV established the importance of baseline immunity for benefit-risk assessment; TAK-003 has accumulated long-term randomised and real-world evidence, while residual uncertainty in dengue-naive recipients against some serotypes remains relevant to programme design; and single-dose Butantan-DV has produced encouraging five-year efficacy data against circulating DENV-1 and DENV-2, although absence of field efficacy data for DENV-3 and DENV-4 and a 2026 precautionary programme interruption in Brazil require careful interpretation. Therapeutic research has moved beyond largely negative repurposing trials towards potent replication-complex inhibitors, with mosnodenvir providing clinical proof of antiviral activity in a controlled human infection model, but efficacy for treatment of naturally acquired dengue remains unestablished. Diagnostic evidence confirms the time-dependent complementarity of RT-PCR, NS1 antigen and serology, while transcriptomic, metabolomic, mast-cell, endothelial and cytokine markers show promise for early severity stratification without yet meeting the evidentiary standard for routine triage. The principal translational priority is therefore integration: diagnostics that identify infection and risk early enough to guide antiviral use, vaccine strategies calibrated to serotype and immune context, and prospective biomarker validation against clinically actionable decisions.

Clinical Decision Support for Antimicrobial Resistance Prediction and Antibiotic Prescribing: Integrating Antimicrobial Stewardship Review into the Medication-Use Pathway

Priyankar Bhooshan — 2026-09-30

Antimicrobial resistance complicates the selection of timely, effective, and appropriately narrow-spectrum antibiotic therapy. Clinical decision support systems can combine the suspected infection syndrome, illness severity, prior microbiology, recent antimicrobial exposure, local epidemiology, rapid organism identification, resistance markers, phenotypic susceptibility, organ function, allergies, and drug-interaction data. This capability can support empirical prescribing, accelerate the response to blood-culture results, and identify opportunities for dose optimisation, de-escalation, intravenous-to-oral conversion, and discontinuation. Yet a recommendation generated by software should not function as an autonomous prescription, particularly when it concerns reserve antibiotics, complex combination therapy, or incomplete microbiological evidence. This narrative review synthesises evidence on clinical decision support for antimicrobial resistance prediction and antibiotic prescribing and proposes a stewardship-governed medication-use pathway. Under the proposed model, requests for institutionally restricted antimicrobials require antimicrobial stewardship team authorisation before routine pharmacy release and administration. A documented emergency override protects patients with sepsis, septic shock, meningitis, febrile neutropenia, or another time-critical infection from harmful delays in treatment. A bloodstream-infection scenario involving New Delhi metallo-beta-lactamase-producing Enterobacterales illustrates the framework. Because metallo-beta-lactamases spare aztreonam while co-produced serine beta-lactamases may hydrolyse it, aztreonam-avibactam or ceftazidime-avibactam administered with aztreonam may be appropriate in selected cases. The system must not infer treatment from the resistance gene alone. It should integrate organism identification, infection source, source control, susceptibility evidence, renal and hepatic function, allergy history, pharmacokinetic feasibility, drug availability, and local guidance before routing an explainable recommendation for expert review. Effective implementation requires interoperable data, local validation, prioritised alerts, clear accountability, cybersecurity controls, and continuous measurement. Clinical decision support can make antimicrobial decisions faster and more consistent, but safe use depends on microbiology expertise, clinician judgement, and stewardship governance.

Bacterial Ecology and Antibacterial Resistance Patterns: A Cross-sectional Study in the Internal Medicine Unit of Centre Médico-Chirurgical des Armées de Bamako, Mali

Lassina Diallo — 2026-09-02

Background: Antibacterial resistance (ABR) is a major public health threat, particularly in low- and middle-income countries where hospital surveillance data remain limited. This study aimed to describe bacterial ecology, antimicrobial resistance patterns, and factors associated with multidrug-resistant bacteria (MDRB) in the Internal Medicine ward of Centre Médico-Chirurgical des Armées de Bamako, Mali.

Aim: This study aimed to characterise bacterial ecology and antimicrobial resistance patterns in this department and to identify factors associated with multidrug resistance.

Methods: We conducted a descriptive and analytical cross-sectional study from January 2023 to December 2024. Among 840 hospitalised patients, 102 cases with microbiologically confirmed bacterial infections were included. Bacterial identification and antimicrobial susceptibility testing were performed using standard microbiological techniques. Multidrug resistance was defined as resistance to at least one agent in three or more antimicrobial classes. Associations between MDRB and clinical factors were analysed using chi-square tests.

Results: Urinary tract infections accounted for 78.4% of cases, followed by bloodstream infections (12.7%), purulent samples (6.9%), and stool cultures (2.0%). The mean age was 55.5 years, with patients ≥60 years representing 47.1%. Males predominated (72.5%; sex ratio 2.6).

The most frequently isolated pathogens were Escherichia coli (52.9%), Klebsiella pneumoniae (13.7%), Staphylococcus aureus (6.9%), Acinetobacter baumannii (4.9%), and Enterococcus faecium (4.9%).

High resistance rates were observed to ampicillin, amoxicillin–clavulanic acid, cotrimoxazole, fluoroquinolones, and third-generation cephalosporins. Imipenem, ertapenem, and amikacin showed the lowest resistance rates. Overall, 51.0% of isolates were multidrug resistant. MDRB were significantly associated with HIV infection (p < 0.001), prior antibiotic use (p < 0.001), prolonged hospitalisation (p = 0.004), but not with urinary catheterisation or venous catheter use.

Conclusions: A high burden of multidrug-resistant bacteria was identified in the Internal Medicine ward of Centre Médico-Chirurgical des Armées. Strengthening antimicrobial stewardship, infection prevention and control, and routine AMR surveillance is urgently needed.

Antimicrobial Susceptibility Patterns among Urinary Bacterial Isolates: A Descriptive Analysis of Ten Consecutive Clinical Cases

Haider Abbas Hadi Al-Mhanaa — 2026-09-04

Background: Antimicrobial resistance (AMR) is an emerging clinical problem among urinary pathogens and poses a challenge to empirical therapy. This descriptive analysis summarised antimicrobial susceptibility testing of 10 consecutive bacterial isolates obtained from urine samples at a single diagnostic microbiology laboratory.

Methods: The methods consisted of a review of 10 de-identified antimicrobial susceptibility testing (AST) reports of urinary isolates. Data on organism identification, minimum inhibitory concentration (MIC), and susceptibility interpretation, based on Clinical and Laboratory Standards Institute (CLSI) breakpoints, were retrieved and analysed descriptively.

Results: The isolates comprised 6 Gram-negative organisms (Klebsiella pneumoniae (n=3), Escherichia coli (n=2), Proteus spp. (n=1)) and 4 Gram-positive cocci (Staphylococcus aureus (n=2), S. haemolyticus (n=1), S. epidermidis (n=1)). Methicillin resistance was observed in all four staphylococcal isolates, and all were susceptible to linezolid, teicoplanin, and tigecycline. Among the Gram-negative isolates, 4/6 (66.7%) had an extended-spectrum beta-lactamase (ESBL)-like phenotype (resistance to cefotaxime, ceftazidime, and/or cefepime). One Klebsiella pneumoniae isolate was resistant to ceftazidime-avibactam and intermediate to imipenem, while no carbapenem resistance was observed. Trimethoprim-sulfamethoxazole resistance was common in both groups. The most active agents against the Gram-negative isolates, as in the Gram-positive isolates, were aminoglycosides, tigecycline, and carbapenems.

Conclusions: This small case series highlights a substantial degree of methicillin resistance among uropathogenic staphylococci and a high frequency of an ESBL-like phenotype among the Enterobacteriaceae; carbapenems, aminoglycosides, tigecycline, linezolid, and teicoplanin were generally active. Larger prospective surveillance studies linked to demographic data are necessary to validate these results and inform local empirical prescribing.

Computational Identification of Dengue-Associated Comorbidities and Key Regulatory Genes from Peripheral Blood Mononuclear Cell Transcriptomes

Adrita Alam — 2026-09-05

Dengue fever remains a major health concern, and variation in host immune responses contributes to differences in clinical severity. This study computationally investigated peripheral blood mononuclear cell (PBMC) transcriptomes to identify highly expressed sample-specific genes, potential dengue-associated comorbidities, and key regulatory genes across dengue fever, dengue haemorrhagic fever, dengue with plasma leakage, and dengue without plasma leakage. Publicly available RNA-seq datasets were collected, processed, and integrated. Highly expressed sample-specific genes were identified after excluding housekeeping genes, followed by Gene Ontology, KEGG pathway, and Disease Ontology enrichment analyses. Protein–protein interaction networks were then used to identify hub genes associated with enriched disease terms. The analyses identified BCL2, MYC, TNF, and TYMS as key genes linking the examined dengue conditions with distinct disease categories. Leukaemia-related disease terms were prominent in dengue fever and dengue haemorrhagic fever, with BCL2 identified in both conditions and MYC additionally identified in dengue haemorrhagic fever. In dengue with plasma leakage, TNF was associated with rheumatic and autoimmune disease terms. In dengue without plasma leakage, TNF was linked with rheumatic and tuberculosis-related terms, while TYMS was associated with multiple myeloma-related molecular patterns. These findings describe condition-specific gene–disease overlaps in PBMC transcriptomes and provide computational candidates for further investigation. Experimental and clinical validation is required before these predicted associations can be considered for diagnostic or therapeutic application.

Study of Toxoplasma gondii Infection in Iraqi Women Visiting Health Facilities in Al-Najaf: A Cross-sectional Study with Follow-up Serology

Zainab W. Kermasha — 2026-09-07

Aim: This study aimed to examine the serostatus of T. gondii infection among women, estimate the prevalence of past and current infection, and assess associations with age.

Study Design: This was an epidemiological cross-sectional study conducted among 90 women.

Place and Duration of Study: The study was conducted at Al-Zahra Teaching Hospital and Al-Hakim General Hospital between January and March 2026.

Methodology: Serum samples were tested for anti-Toxoplasma IgG and IgM antibodies using an enzyme-linked fluorescent assay (ELFA), and specimens were considered positive when the IgG level was greater than 8.0 IU/mL or the IgM level was above 0.65 IU/mL. Participants were initially classified into three groups: no serologic evidence of infection, previous infection, and current infection. Paired serology was performed for the 9 IgM-positive women. Eighteen control participants were selected (nine IgG-positive and nine IgG-negative), of whom 16 completed follow-up; IgG avidity testing was performed for all IgM-positive samples.

Results: Initial classification identified 56 women (62.2%) as seronegative, 25 (27.8%) with previous infection, and 9 (10.0%) with current infection among 90 participants (median age, 27 years). Of the 9 IgM-positive women, 4 (44.4%) had acute infection, 3 (33.3%) had chronic infection with persistent IgM antibodies, and 2 (22.2%) had false-positive IgM results on paired serology. After paired testing, 4.4% (4/90) had acute infection, 31.1% (28/90) had previous/chronic infection, and 63.3% (57/90) had no serologic evidence. Overall seroprevalence, defined as previous or confirmed acute infection, was 35.6% (32/90). Seropositivity was significantly associated with age group (p = 0.041), with the highest proportion among women aged 31-40 years (60.0%).

Conclusion: A substantial proportion of participants had serological evidence of T. gondii infection. Paired serology and avidity testing reclassified more than half of the initially IgM-positive cases as chronic infection with persistent IgM or false-positive IgM results. Further studies are needed to confirm these findings.

Survey on the Proper Use of Antibiotics and Bacterial Resistance among Prescribing Students at the UFR of Health Sciences of Thiès, Senegal

Maimouna Sidibé — 2026-09-14

Background: Antimicrobial resistance is a major public health concern, and appropriate antibiotic use is essential to preserve therapeutic effectiveness. This study assessed knowledge, attitudes, practices, and perceptions regarding antibiotic use and bacterial resistance among prescribing medical students at the UFR of Health Sciences of Thiès, Senegal.

Methods: A descriptive, analytical, cross-sectional survey was conducted using an anonymised, self-administered, semi-structured questionnaire. Of 855 students, 147 participated, representing a participation rate of 17.2%.

Results: Antibiotic use during the previous 12 months was reported by 74.8% of respondents. Although most students recognised the antibacterial role of antibiotics and the risk of resistance associated with inappropriate use, only 63.3% reported using antibiotics exclusively on medical prescription. Antibiotic prescribing most frequently concerned urinary and respiratory infections. Practice habits, limited access to an antibiogram, and fear of complications were prominent factors influencing antibiotic choice. The mean overall knowledge, attitudes, and perceptions score was 11.82 ± 2.173 out of 15; 52.38% of students had an average overall score and 42.86% had a good score. Recent antibiotic consumption was significantly associated with the overall score (p < 0.001).

Conclusion: The findings indicate comparatively strong theoretical knowledge but less consistent attitudes and practices. Strengthening practical training in rational prescribing, improving access to microbiological guidance, and reinforcing supervision during clinical training may help promote more appropriate antibiotic use.

Mathematical Modeling of Malaria Transmission and Intervention Scale-Up in the Federal Capital Territory, Nigeria

Maryam Edmond — 2026-09-15

Malaria is highly endemic in Nigeria despite the widespread implementation of proven control interventions, including insecticide-treated nets (ITNs), indoor residual spraying (IRS), seasonal malaria chemoprevention (SMC), intermittent preventive treatment in pregnancy (IPTp), and artemisinin-based combination therapies (ACTs). The persistence of transmission suggests that the combined impact of these interventions may be insufficient to reduce transmission below elimination thresholds. Mathematical modelling provides a rigorous framework for understanding transmission dynamics and evaluating intervention effectiveness in complex epidemiological settings. This study aimed to develop and analyse an age-structured SEIR–SEI mathematical model of malaria transmission that incorporates key intervention strategies and to evaluate their impact on the basic and effective reproduction numbers in the Federal Capital Territory (FCT), Nigeria. A deterministic compartmental model was formulated to describe malaria transmission between humans and mosquitoes. The human population was stratified into children, adults, and pregnant women, each divided into susceptible, exposed, infectious, and recovered compartments, with additional protected classes representing intervention coverage (SMC and IPTp). The mosquito population was modelled using susceptible, exposed, and infectious compartments. Model parameters were informed by literature and FCT-specific data. The basic reproduction number (R₀) was derived using the next-generation matrix approach, and sensitivity analysis was conducted to identify key transmission drivers. Intervention scenarios were simulated to assess their impact on transmission dynamics and elimination thresholds. The model demonstrates that malaria transmission remains robust under baseline conditions, with R₀ exceeding unity. Vector control interventions, particularly ITNs and IRS, significantly reduce transmission by decreasing mosquito biting rates and increasing mosquito mortality. However, single interventions were insufficient to reduce the effective reproduction number (Rₜ) below one. Combined intervention strategies incorporating vector control, chemoprevention, and effective treatment were required to achieve substantial reductions in transmission. Sensitivity analysis identified mosquito biting rate, mosquito mortality, and treatment rate as dominant parameters influencing transmission dynamics. Malaria persistence in the FCT is driven by the combined effects of high transmission intensity and suboptimal interaction of interventions. Achieving elimination requires integrated intervention packages that target both vector and human components of transmission. The proposed model provides a robust framework for evaluating intervention strategies and supports evidence-based malaria elimination planning in high-burden settings.

Screening of Hepatitis B and C Viral Infection among Pregnant Women in Fallujah Teaching Hospital for Maternity and Children

Mohammed Sabah Dawood — 2026-09-16

Background: Viral hepatitis is a global health burden and an endemic infection in Iraq, with its incidence previously documented.

Aim: This study aimed to delineate the current prevalence of hepatitis during pregnancy in comparison with previous local data and to determine plausible risk factors associated with the outcome.

Methods: A total of 1273 participants were recruited in this hospital-based cross-sectional study from 1 February to 30 June 2024. The cohort consisted of pregnant women aged 14–45 years. Demographic data were collected using a short questionnaire to assess potential risk factors for viral hepatitis. Blood samples were collected to screen for hepatitis B surface antigen (HBsAg) and antibodies to hepatitis C virus (anti-HCV) using Combo Rapid Test Strips.

Results: The results revealed that the overall prevalence of viral hepatitis infection among pregnant women was 1.02%, with HBV occurring more frequently than HCV. The seroprevalence of HBsAg among pregnant women was 0.94% (12/1273). The current study reported a notable decline in HBV and HCV infection among pregnant women compared with a previous local study (0.94% vs 4.42% for HBV and 0.08% vs 1.15% for HCV). Logistic regression analysis revealed that both family history of hepatitis and abortion were associated with significantly higher odds of HBV (OR = 12.77 at P = 0.001 and OR = 9.24 at P = 0.0009) compared with their counterparts.

Conclusion: Family history of hepatitis and history of abortion were significantly associated with HBV seropositivity among pregnant women, supporting the implementation of robust prenatal screening procedures and greater awareness of disease outcomes.

Metabolic Syndrome among People Living with HIV on Antiretroviral Therapy at the National Hospital of Niamey, Niger

Moussa Saley Sahada — 2026-09-17

Background: Metabolic syndrome (MetS) is a cluster of interrelated cardiometabolic risk factors, including central obesity, dyslipidaemia, hypertension and hyperglycaemia, that affect an estimated 28% of adults worldwide and predispose them to type 2 diabetes and atherosclerotic cardiovascular disease. People living with HIV (PLHIV) on antiretroviral therapy (ART) are at increased risk of MetS compared with the general population, yet data from Niger remain scarce.

Aim: To determine the prevalence of metabolic syndrome and describe its associated epidemiological, clinical, biological and therapeutic factors among PLHIV receiving ART and followed at the National Hospital of Niamey (HNN), Niger.

Methodology: This was a descriptive, prospective, cross-sectional study conducted over a 7-month period at the day hospital of the HNN. All consenting HIV-positive adults (≥18 years; no children were included) who had received ART for at least 3 months and met the International Diabetes Federation (IDF, 2005) criteria for MetS were enrolled using exhaustive (consecutive) sampling of all eligible patients seen during the study period; no formal sample-size calculation was performed because of this exhaustive approach. Data were analysed using EpiInfo software, version 7.2.2.6.

Results: Of 954 PLHIV seen during 1,380 consultations over the study period, 103 met the IDF criteria for MetS, giving a prevalence of 10.8%. Patients were predominantly female (80.6%), with a mean age of 45.5 ± 8.4 years (range: 26–65 years). Hypertension was present in 39.8%, abdominal obesity in 75.9%, and 39.8% were overweight or obese. HDL hypocholesterolaemia (58.3%), hypertriglyceridaemia (47.6%) and total hypercholesterolaemia (31.1%) were the leading lipid abnormalities. HIV-1 accounted for 99% of infections, and most patients (77.7%) were receiving a two-NRTI plus one-NNRTI regimen.

Conclusion: Metabolic syndrome affects roughly one in nine PLHIV receiving ART at the HNN, with a marked female predominance and a high burden of dyslipidaemia and abdominal obesity. These findings support the systematic integration of clinical and biological metabolic screening into routine HIV care in Niger.

Malaria Prevalence and in vitro Antimalarial Drug Sensitivity of Plasmodium falciparum Isolates in Gombe North, Gombe State, Northeastern Nigeria

M. Ishaku — 2026-09-18

Background: Malaria remains a significant public health challenge in Nigeria, which accounted for approximately 25.9% of estimated global malaria cases in 2023. In Gombe State, the transition to artemisinin-based combination therapies (ACTs) was necessitated by emerging resistance to older antimalarial drugs.

Objectives: This study assessed the prevalence of malaria and the in vitro sensitivity profile of Plasmodium falciparum isolates to selected antimalarial drugs in Gombe North, Gombe State, Nigeria.

Methodology: A cross-sectional, laboratory-based experimental design was employed, involving 1,152 participants across Gombe, Funakaye and Kwami Local Government Areas (LGAs). Malaria was diagnosed using thick blood films. In vitro drug sensitivity was assessed using a modified WHO microtest technique. Data were analysed using non-linear regression and chi-square tests. Drugs were categorised as sensitive or showing reduced sensitivity by comparing the results with IC₅₀ thresholds reported by the World Health Organization.

Results: Of the 1,152 individuals examined, 719 were positive for malaria parasites, giving an overall prevalence of 62.41%. Infection was highest among children aged 6-10 and 0-5 years (65.97% and 65.79%, respectively), although differences across age groups were not statistically significant (P = 0.182). Male participants showed a significantly higher prevalence (67.34%) than females (57.95%) (P = 0.001). Spatial variation in prevalence was also significant (P = 0.005), with Kwami recording the highest prevalence (69.01%), followed by Funakaye (60.16%) and Gombe (58.07%). In vitro sensitivity assays revealed sustained susceptibility of P. falciparum isolates to artesunate, with IC₅₀ values < 10 nM in all study locations. Chloroquine and pyrimethamine demonstrated reduced sensitivity across all study areas, whereas amodiaquine remained sensitive in Funakaye and Kwami, with IC₅₀ values of 6.3 ± 0.1 nM and 29.0 ± 0.8 nM, respectively, but showed reduced sensitivity in Gombe, with an IC₅₀ value of 30.0 ± 1.2 nM. Relative potency analysis further identified artesunate as the most potent antimalarial agent, whereas chloroquine and pyrimethamine displayed markedly diminished potency.

Conclusion: The findings indicate that malaria remains highly prevalent in Gombe North and that P. falciparumisolates show reduced sensitivity to older antimalarial drugs. Artesunate remained highly active in the in vitro assays, while continued surveillance of antimalarial drug sensitivity is essential to support evidence-based malaria control strategies in the region.

Mpox Outbreak in Côte d'Ivoire during 2024: Epidemiological, Clinical, Virological and Outcome Features of Hospitalised Cases in Abidjan

Adama Doumbia — 2026-09-19

Aims: To describe the epidemiological, clinical, virological and outcome features of Mpox patients hospitalised at the referral centre in Abidjan during the 2024 outbreak in Côte d'Ivoire, which totalled 89 confirmed cases nationwide.

Study Design: Descriptive observational study.

Place and Duration of Study: Department of Infectious and Tropical Diseases (SMIT), Treichville University Hospital, Abidjan, Côte d'Ivoire, between June and October 2024.

Methodology: We included all patients hospitalised at the SMIT with Mpox confirmed by real-time polymerase chain reaction (PCR) on skin lesion samples. Sociodemographic, clinical, virological (subclade typing by genomic sequencing at the Institut Pasteur de Côte d'Ivoire) and outcome data were collected using a standardised questionnaire. Qualitative variables were described as counts and percentages, and quantitative variables as medians with interquartile range (IQR). The in-hospital case fatality rate was estimated with its exact 95% confidence interval (CI).

Results: Twenty-three patients were included (median age: 20 years [IQR: 11–40]; 18 males, sex ratio: 3.6), originating from four geographical clusters: Dianra in the north (n = 11), Abidjan in the south (n = 6), Sakassou in the centre (n = 4) and Iboké in the south-west (n = 2). No patient had been vaccinated against smallpox. The main features were skin rash (100%), fever (95.7%), headache (91.3%) and arthralgia (82.6%). Lesions were of moderate grade (10–99 lesions) in 19 patients (82.6%). Subclade IIa was identified in 22 patients (95.7%) and subclade IIb in one patient (4.3%). The median hospital stay was 13 days (IQR: 7–15). Bacterial superinfection was the main complication (21.7%). The in-hospital case fatality rate was 4.3% (95% CI: 0.1–21.9).

Conclusion: In one of the first descriptions from Côte d'Ivoire, the outbreak was both rural and urban, affected young unvaccinated patients, was dominated by subclade IIa and had a generally favourable outcome. Surveillance, decentralised diagnosis and access to vaccination all need strengthening.

Poverty and Socioeconomic Determinants of Malaria among Pregnant Women Attending Selected Health Facilities in Benue State, Nigeria

Itiav Igber Wueseter — 2026-10-01

Background: Malaria remains an important cause of maternal and adverse pregnancy outcomes in Nigeria, with pregnant women particularly vulnerable to infection because of physiological and immunological changes during pregnancy. Socioeconomic deprivation may further increase this vulnerability by limiting access to preventive measures, adequate housing, nutritious food and timely healthcare.

Aim: This study assessed the prevalence of malaria and examined the relationship between poverty and selected socioeconomic factors among pregnant women attending selected health facilities in Benue State, Nigeria.

Methods: A cross-sectional study was conducted among 400 pregnant women attending antenatal services in selected health facilities across Benue State between September 2025 and April 2026. Participants were selected using a multistage sampling approach. Data on demographic and socioeconomic characteristics were collected using a structured questionnaire, while malaria infection was assessed using rapid diagnostic testing and microscopy. Data were analysed using descriptive statistics and appropriate inferential tests, with statistical significance set at p<0.05.

Results: Of the 400 pregnant women screened, 204 (51.0%) were positive for malaria parasites, while 196 (49.0%) were negative. Malaria positivity was highest among women aged 31–40 years, with 69 (17.25%) positive cases, followed by those aged 21–30 years with 66 (16.5%). Married women accounted for 189 (47.25%) of malaria-positive participants. Business was the most common occupation, and women engaged in business activities recorded a high number of positive cases. Low-income participants, particularly those reporting a monthly income of ₦5,000, accounted for 137 (34.25%) malaria-positive cases. Women who reported difficulty affording mosquito nets or repellents, poor housing conditions, restricted access to healthcare because of poverty and delayed treatment because of lack of money also recorded substantial malaria positivity.

Conclusion: The study found a high malaria prevalence among pregnant women attending selected health facilities in Benue State. The findings indicate that economic deprivation and related social conditions may increase vulnerability to malaria by restricting access to preventive measures, adequate housing and timely treatment. Malaria control programmes should therefore incorporate socioeconomic interventions alongside conventional biomedical measures.