The current status of neglected tropical diseases in Japan: A scoping review.

Little attention has been paid to neglected tropical diseases (NTDs) in high-income countries and no literature provides an overview of NTDs in Japan. This scoping review aims to synthesize the latest evidence and information to understand epidemiology of and public health response to NTDs in Japan. Using three academic databases, we retrieved articles that mentioned NTDs in Japan, written in English or Japanese, and published between 2010 and 2020. Websites of key public health institutions and medical societies were also explored. From these sources of information, we extracted data that were relevant to answering our research questions. Our findings revealed the transmission of alveolar echinococcosis, Buruli ulcer, Chagas disease, dengue, foodborne trematodiases, mycetoma, scabies, and soil-transmitted helminthiasis as well as occurrence of snakebites within Japan. Other NTDs, such as chikungunya, cystic echinococcosis, cysticercosis, leishmaniasis, leprosy, lymphatic filariasis, rabies, and schistosomiasis, have been imported into the country. Government agencies tend to organize surveillance and control programs only for the NTDs targeted by the Infectious Disease Control Law, namely, echinococcosis, rabies, dengue, and chikungunya. At least one laboratory offers diagnostic testing for each NTD except for dracunculiasis, human African trypanosomiasis, onchocerciasis, and yaws. No medicine is approved for treatment of Chagas disease and fascioliasis and only off-label use drugs are available for cysticercosis, opisthorchiasis, human African trypanosomiasis, onchocerciasis, schistosomiasis, and yaws. Based on these findings, we developed disease-specific recommendations. In addition, three policy issues are discussed, such as lack of legal frameworks to organize responses to some NTDs, overreliance on researchers to procure some NTD products, and unaffordability of unapproved NTD medicines. Japan should recognize the presence of NTDs within the country and need to address them as a national effort. The implications of our findings extend beyond Japan, emphasizing the need to study, recognize, and address NTDs even in high-income countries.

The pipeline for drugs for control and elimination of neglected tropical diseases: 1. Anti-infective drugs for regulatory registration.

The World Health Organization 'Ending the neglect to attain the Sustainable Development Goals: A road map for neglected tropical diseases 2021-2030' outlines the targets for control and elimination of neglected tropical diseases (NTDs). New drugs are needed to achieve some of them. We are providing an overview of the pipeline for new anti-infective drugs for regulatory registration and steps to effective use for NTD control and elimination. Considering drugs approved for an NTD by at least one stringent regulatory authority: fexinidazole, included in WHO guidelines for Trypanosoma brucei gambiense African trypanosomiasis, is in development for Chagas disease. Moxidectin, registered in 2018 for treatment of individuals ≥ 12 years old with onchocerciasis, is undergoing studies to extend the indication to 4-11-year-old children and obtain additional data to inform WHO and endemic countries' decisions on moxidectin inclusion in guidelines and policies. Moxidectin is also being evaluated for other NTDs. Considering drugs in at least Phase 2 clinical development, a submission is being prepared for registration of acoziborole as an oral treatment for first and second stage T.b. gambiense African trypanosomiasis. Bedaquiline, registered for tuberculosis, is being evaluated for multibacillary leprosy. Phase 2 studies of emodepside and flubentylosin in O. volvulus-infected individuals are ongoing; studies for Trichuris trichuria and hookworm are planned. A trial of fosravuconazole in Madurella mycetomatis-infected patients is ongoing. JNJ-64281802 is undergoing Phase 2 trials for reducing dengue viral load. Studies are ongoing or planned to evaluate oxantel pamoate for onchocerciasis and soil-transmitted helminths, including Trichuris, and oxfendazole for onchocerciasis, Fasciola hepatica, Taenia solium cysticercosis, Echinococcus granulosus and soil-transmitted helminths, including Trichuris. Additional steps from first registration to effective use for NTD control and elimination include country registrations, possibly additional studies to inform WHO guidelines and country policies, and implementation research to address barriers to effective use of new drugs. Relative to the number of people suffering from NTDs, the pipeline is small. Close collaboration and exchange of experience among all stakeholders developing drugs for NTDs may increase the probability that the current pipeline will translate into new drugs effectively implemented in affected countries.

Novel Diagnostics for Kaposi Sarcoma and Other Skin Diseases in Resource-Limited Settings.

In resource-limited settings, point-of-care diagnostic devices have the potential to reduce diagnostic delays and improve epidemiologic surveillance of dermatologic conditions. We outline novel-point-of care diagnostics that have recently been developed for dermatologic conditions that primarily affect patients living in resource-limited settings, namely, Kaposi sarcoma, cutaneous leishmaniasis, leprosy, Buruli ulcer, yaws, onchocerciasis, and lymphatic filariasis. All of the technologies described in this article are prototypes, and some have undergone field testing. These devices still require validation in real-world settings and effective pricing to have a major impact on dermatologic care in resource-limited settings.

Neglected tropical disease as a 'biographical disruption': Listening to the narratives of affected persons to develop integrated people centred care in Liberia.

BACKGROUND: Integrated disease management, disability and inclusion (DMDI) for NTDs is increasingly prioritised. There is limited evidence on the effectiveness of integrated DMDI from the perspective of affected individuals and how this varies by differing axes of inequality such as age, gender, and disability. We used narrative methods to consider how individuals' unique positions of power and privilege shaped their illness experience, to elucidate what practical and feasible steps could support integrated DMDI in Liberia and beyond. METHODS: We purposively selected 27 participants affected by the clinical manifestations of lymphatic filariasis, leprosy, Buruli Ulcer, and onchocerciasis from three counties in Liberia to take part in illness narrative interviews. Participants were selected to ensure maximum variation in age, gender and clinical manifestation. Narrative analysis was grounded within feminist intersectional theory. FINDINGS: For all participants, chronic illness, morbidity and disability associated with NTDs represented a key moment of 'biographical disruption' triggering the commencement of a restitution narrative. Complex health seeking pathways, aetiologies and medical syncretism meant that adoption of the 'sick role' was initially acceptable, but when the reality of permanency of condition was identified, a transition to periods of chaos and significant psycho-social difficulty occurred. An intersectional lens emphasises how biographical disruption is mediated by intersecting social processes. Gender, generation, and disability were all dominant axes of social inequity shaping experience. SIGNIFICANCE: This is one of the first studies to use narrative approaches to interrogate experience of chronic disabling conditions within LMICs and is the only study to apply such an analysis to NTDs. The emotive power of narrative should be utilised to influence the value base of policy makers to ensure that DMDI strategies respond holistically to the needs of the most marginalised, thus contributing to more equitable people-centred care.

Pierre Richet (1904-1983), fighting onchocerciasis and totalitarism.

While Eugène Jamot's name is associated with the combat against sleeping sickness, Pierre Richet is permanently linked to the battle against river blindness, which he first reported in 1936 in two neighboring households in Garango (Burkina Faso). Onchocerciasis remained a continuous interest, through his last article "The OCCGE and Onchocerciasis", written in 1983. Nonetheless over the course of these five decades, Richet's trajectory was far from that of a specialist dedicating his life to a single disease. After a decade essentially spent fighting trypanosomiasis, came a decade of war in which the specialist in endemism joined the Free French Army and put his organizational know-how at General Lerclerc's disposal, from Morocco to Indochina, via Germany. On his return to Africa in 1953, he extended the principle of mobile teams to the other major endemic diseases accessible to treatment and to vaccines. Richet organized first the combat against leprosy and launched vaccination programs. In 1955, he returned to the battle against onchocerciasis and deployed the first large-scale insecticide program in Chad. The intermediate term failure of this prototype fermented his scientific, interdisciplinary, and organizational thought, which flourished at Bobo-Dioulasso. At the dawn of the independence of French-speaking African countries, and against the political tides of the time, he obtained in 1960 the creation of a supranational organization, the OCCGE, common to 8 countries of West Africa, and he headed it for a decade. Drawing lessons from the past and in the absence of effective pharmaceutical treatment, Richet the physician played the entomological card with one hand, with technical support from Orstom (IRD); this detailed work enabled the development of a strategy. With the other hand, he played the multilateral card, which led in 1974 to the launching of the extraordinary Onchocerciasis Control Program (OCP). If it is Jamot who awakened Africa, Richet is the person who restored its view but also millions of hectares of cultivable land.

Reconocimiento de las enfermedades tropicales desatendidas a partir de los cambios en la piel. Guía pedagógica dirigida al personal de salud de primera línea

[INTRODUCCIÓN]. La piel de un paciente es la primera estructura del cuerpo, y la más visible, que percibe todo profesional de salud en el curso de una exploración clínica. Para el paciente, la piel también es sumamente evidente, y toda enfermedad que la afecta es notoria y repercutirá sobre su bienestar personal y social. Por consiguiente, la piel es un punto de acceso importante tanto para el diagnóstico como para el tratamiento. Muchas enfermedades de los seres humanos se asocian con alteraciones de la piel, cuyos síntomas van desde el prurito hasta las modificaciones del color, la sensación táctil y la apariencia. Las principales enfermedades tropicales desatendidas (ETD) suelen producir estas alteraciones cutáneas, que refuerzan los sentimientos de aislamiento y estigmatización que sufren los pacientes afectados. De hecho, con frecuencia estos son los primeros signos que percibirán los pacientes, incluso antes de que ocurran trastornos en los órganos internos o en otros sistemas. Todas las ETD analizadas a continuación provocan alteraciones notorias de la piel en alguna etapa en su evolución. En la presente guía de capacitación se explica cómo reconocer los signos y los síntomas de las enfermedades tropicales desatendidas de la piel a partir de sus características visibles. También contiene información sobre cómo diagnosticar y tratar los problemas frecuentes de la piel que puede encontrar el personal de salud de primera línea.

[INTRODUÇÃO]. A pele do paciente é a primeira e mais visível estrutura do corpo com a qual todo profissional de saúde se depara durante um exame. É também muito visível para o paciente, e qualquer doença que a afete será notada e afetará o bem-estar pessoal e social. Portanto, a pele é um importante ponto de partida tanto para o diagnóstico quanto para o manejo. Muitas doenças dos seres humanos são associadas a alterações cutâneas, que variam de sintomas como prurido a alterações de cor, textura e aparência. Com frequência, as principais doenças tropicais negligenciadas (DTNs) produzem essas alterações cutâneas, reforçando os sentimentos de isolamento e estigmatização dos pacientes afetados. Na verdade, com frequência esses são os primeiros sinais que os pacientes notam, até mesmo antes que haja alteração de órgãos internos ou de outros sistemas. Todas as DTNs apresentadas adiante causam alterações cutâneas proeminentes em algum estágio da evolução. Este guia de treinamento explica como identificar os sinais e sintomas das doenças tropicais negligenciadas da pele por meio de suas características visíveis. Contém ainda informações sobre métodos de diagnóstico e manejo de problemas cutâneos comuns que os profissionais de saúde da linha de frente podem encontrar.

Nanopharmaceuticals as a solution to neglected diseases: Is it possible?

The study of neglected diseases has not received much attention, especially from public and private institutions over the last years, in terms of strong support for developing treatment for these diseases. Support in the form of substantial amounts of private and public investment is greatly needed in this area. Due to the lack of novel drugs for these diseases, nanobiotechnology has appeared as an important new breakthrough for the treatment of neglected diseases. Recently, very few reviews focusing on filiarasis, leishmaniasis, leprosy, malaria, onchocerciasis, schistosomiasis, trypanosomiasis, and tuberculosis, and dengue virus have been published. New developments in nanocarriers have made promising advances in the treatment of several kinds of diseases with less toxicity, high efficacy and improved bioavailability of drugs with extended release and fewer applications. This review deals with the current status of nanobiotechnology in the treatment of neglected diseases and highlights how it provides key tools for exploring new perspectives in the treatment of a wide range of diseases.

Enfermedades infecciosas desatendidas en las Américas: Historias de éxito e innovación para llegar a los más necesitados / Neglected infectious diseases in the Americas: Success stories and innovation to reach the neediest

[Prologo]. Este informe revela que varios países de las Américas han eliminado con éxito la transmisión de varias EID en todos sus territorios o parte de ellos, lo que muestra qué debe y puede lograr cada país de la Región donde las enfermedades infecciosas desatendidas son endémicas. Sin embargo, para que las Américas puedan alcanzar las metas regionales y mundiales de eliminar más de una docena de EID, cada país donde exista esa endemicidad debe efectuar ahora un esfuerzo concertado a fin de conseguir que enérgicas medidas de salud pública lleguen a quienes más las necesiten. Es preciso adoptar medidas para tratar a todos los niños en riesgo de contraer infecciones helmintiásicas transmitidas por el contacto con el suelo; proteger a cada niño y madre embarazada de las picaduras de mosquitos que transmiten la malaria y de otros insectos que transmiten la enfermedad de Chagas y la leishmaniasis; tratar eficiente y oportunamente a los niños pequeños y sus familiares con medicamentos de gran calidad y seguros contra las enfermedades infecciosas desatendidas; y garantizar que todas las personas que lleguen a un hospital con leishmaniasis, esquistosomiasis, fascioliasis o tracoma causante de ceguera reciban una atención adecuada para que abandonen el hospital curadas y con buena salud y sus familias puedan seguir fácilmente su progreso con el apoyo de unidades locales de atención de salud.

Neglected infectious diseases in the Americas: Success stories and innovation to reach the neediest / Enfermedades infecciosas desatendidas en las Américas. Historias de éxito e innovación para llegar a los más necesitados

Neglected infectious diseases (NID), which include Chagas disease, fascioliasis, soil-transmitted helminthiases, leprosy, leishmaniasis, lymphatic filariasis, onchocerciasis, plague, human rabies transmitted by dogs, schistosomiasis, congenital syphilis, neonatal tetanus and trachoma, affect the poorest of the poor. These diseases impose a nearly indescribable set of burdens on communities and individuals, not only because of the pain and suffering they cause, but also because of the loss of income and the chronic stigma and discrimination associated with their sequelaes, irreversible in many cases. These can include blindness, chronic anemia, tissue loss and physical disfigurement, and permanent disability leading affected families to an even more challenging and limited quality of life-style...

Onchocerciasis, an undiagnosed disease in Mozambique: identifying research opportunities.

BACKGROUND: The objective of this paper is to summarise and critically review the available data about onchocerciasis in Mozambique, in order to report epidemiological and clinical aspects related to the disease and identify gaps in knowledge. The paper is intended to raise awareness of the existence and importance of this disease and to define research priorities. METHODS: We examined the scarce epidemiological data at our disposal: two diagnostic studies in 1997 and 1998 (first reports on the existence of onchocerciasis in Mozambique), and two Rapid Epidemiological Mapping of Onchocerciasis (REMO) surveys in 2001 and 2007. We examined differences in study designs and methodologies as well as the differing geographical locations to explain the divergence in findings among the studies. RESULTS: Evidence indicates that onchocerciasis is hypoendemic in Mozambique (with national and imported cases), but still largely remains an undiagnosed illness. There is no awareness of the clinical aspects of the disease and nor of the differential diagnosis with lepromatous leprosy and dermatitis caused by Scabies spp. The use of skin biopsy and a symptom screening questionnaire, combined with nodule rate, in the first two studies may have captured even atypical or subacute presentations. Both REMO surveys relied solely on nodule detection and in the six years between the two studies, the prevalence of nodules detected more than doubled. CONCLUSIONS: The epidemiology and clinical aspects of the disease are unknown in Mozambique. Since the last REMO took place in 2007 and since the population is subject to large-scale movement and displacement, it is important to develop tools to identify and analyse populations that are at high risk for onchocerciasis. Cases of onchocerciasis may be misdiagnosed as leprosy or scabies that fail to improve despite being subjected to treatment against leprosy. Techniques to enable a differential diagnosis need to be established by training health professionals on the recognition of this undiagnosed disease. It is equally necessary to identify the blackfly vectors and where they breed.

Plan estratégico para la prevención, atención,control y eliminación de enfermedades infecciosas desatendidas en Guatemala

En Guatemala existen retos y oportunidades en la prevención, control y eliminación de enfermedades infectocontagiosas. Un conjunto importante de la morbilidad actual de enfermedades transmisibles se relaciona con la situación económica, las inequidades en salud y los determinantes sociales. Las enfermedades desatendidas son infecciones parasitarias y bacterianas muy comunes bajo condiciones de pobreza. Se estima que en Latinoamérica 200 millones de personas están expuestas a riesgo. Las seis enfermedades que son objetivo del abordaje integral propuesto en este plan estratégico integrado para la prevención, atención, control y -- eliminación de enfermedades. - infecciosas desatendidas (plan EID) son: enfermedad de Chagas,- geo helmintiasis, leishmaniasis, lepra, - oncocercosis y tracoma…

Anti-desmoglein-1 antibodies in onchocerciasis, leishmaniasis and Chagas disease suggest a possible etiological link to Fogo selvagem.

Pemphigus foliaceus (PF) and the endemic form Fogo Selvagem (FS) are mediated by pathogenic antibodies to the EC1-2 domains of desmoglein-1. There is a preclinical phase with antibodies to only EC5. Based on geographic clustering of cases, FS is thought to have an, as yet unidentified, environmental trigger. In this study we have searched for anti-desmoglein-1 antibodies in sera from parasitic (leishmaniasis, Chagas, and onchocerciasis), and infectious diseases (leprosy and South American (SA) blastomycosis), which are prevalent in the same geographic regions of Brazil as FS. A specific and sensitive desmoglein-1 ELISA detected antibodies in 34 of 41 onchocerciasis (83%), 38 of 88 leishmaniasis (43%), 18 of 31 Chagas disease (58%), 7 of 28 SA blastomycosis (25%), and 14 of 83 leprosy sera (17%). These sera recognized epitopes restricted to the EC5 domain. These findings identify several etiological factors for FS. It is hypothesized that a component of insect vector saliva, rather than the parasite itself may trigger an antibody response to EC-5. In persons with the known HLA susceptibility alleles and living in endemic areas, a response to the EC1-2 domains may subsequently develop by epitope spreading with associated clinical signs of FS.

[Overseas disease: comparative studies of onchocerciasis in Latin America and Africa]. / Doença de além-mar: estudos comparativos da oncocercose na América Latina e Africa.

Round worm is a parasite, Onchocera, and is transmitted by a black fly, simulidae; it can cause blindness. Originally from the African continent, where it is widespread, in Latin America it was first discovered in Guatemala in 1917; later instances were recorded in Mexico, Venezuela, Colombia and Brazil. The establishment of this disease in the Americas has intrigued scientists since then and today it is an open question. The multidisciplinary project described in this research note aims to investigate historical aspects of the arrival and spread of the disease in Latin America and, to make comparative studies of the history of the disease on both continents. The increasing importance of the disease has meant greater value being attributed to collections of simuliídeo, whose Brazilian species were first studied by Adolpho Lutz at the beginning of the 20th century.

Doença de além-mar: estudos comparativos da oncocercose na América Latina e Africa / Overseas disease: comparative studies of onchocerciasis in Latin America and Africa

Objetiva investigar os aspectos históricos da introduçäo e disseminaçäo da oncocercose na América Latina, e realizar estudos comparativos sobre a história da doença nos dois continentes. A importância que adquiriu acarretou a revalorizaçäo das coleçöes de simuliídeos, cujas espécies brasileiras começaram a ser estudadas por Adolpho Lutz no início do século XX.

Coleçäo de simuliídeos (Diptera - Simuliidae) de Adolpho Lutz, sua história e importância / Adolpho Lutz`s collection of black flies (Diptera - Simuliidae), its history and importance

Apresenta as espécies de simuliídeos que pertencem à coleçäo de Adolpho Lutz depositadas no Laboratório de Simuliídeos e Oncocercose do Departamento de Entomologia do Instituto Oswaldo Cruz (IOC). Pioneiro no estudo desses dípteros, Lutz descreveu cerca de 25 espécies de diferentes localidades do Brasil. Vetor da oncocercose, os simuliídeos tiveram sua importância médico-sanitária reconhecida em fins da década de 1920.

Doença de além-mar: estudos comparativos da oncocercose na América Latina e Africa / Overseas disease: comparative studies of onchocerciasis in Latin America and Africa

Objetiva investigar os aspectos históricos da introduçäo e disseminaçäo da oncocercose na América Latina, e realizar estudos comparativos sobre a história da doença nos dois continentes. A importância que adquiriu acarretou a revalorizaçäo das coleçöes de simuliídeos, cujas espécies brasileiras começaram a ser estudadas por Adolpho Lutz no início do século XX. (AU)