The use of insecticides remain the most effective vector control approach for mosquito borne diseases like malaria, dengue fever, chikungunya, and Zika virus disease; however, their increasing resistance has complicated the management. Mutations in kdr, ace-1/ace-2, rdl, and nAChR, are involved in target-site mediated resistance and prevent the binding of pyrethroids and dichlorodiph enyltrichloroethane, organophosphorus pesticide, carbamates and cyclodienes, respectively. Here, we review the current knowledge on target-site mediated insecticidal resistance mechanisms in major mosquito vectors and the techniques used to identify these mutations. The results showed that kdr mutations are frequently reported in mosquito species, indicating the overuse of pyrethroid in mosquito control. Report on ace mutations is very limited, primarily detected in Anopheles and Culex, with extremely low detection rate in Aedes, despite the wide application of organophosphates in their control. Notably, reports of rdl mutations and changes in nAChR are rare, which provides an opportunity to exploit these target sites, particularly in the event of disease outbreaks. Among various detection methods such as RFLP, TaqMan, Multiplex PCR and FRET, allele-specific PCR is mostly employed, especially in detecting kdr mutation. However, allele-specific PCR cannot detect novel mutation. As a result, there is an urgent need to develop a scalable, cost-effective tool that can be widely applied especially as these mutations are genetic markers for early detection of insecticide resistance. Robust monitoring methods remain critical to manage insecticide resistance and effective control of mosquito-borne diseases.

Objective: To determine the overall and pooled prevalence of Leishmania (L.) infantum in sandfly vectors in Iran.

Methods: The present research conducted a systematic review and meta-analysis and searched regional databases such as PubMed, Scopus, Web of Science (WoS), Embase, PAHO Iris, LILACS, WHO Iris, and local databases named: SID, Magiran, Civilica, and also grey literatures. The current research included studies that were conducted in Iran and examined L. infantum in different sandfly vectors. The studies’ quality assessment/risk of bias assessment was evaluated by the Joanna Briggs Institute Critical Appraisal Checklist for prevalence data studies, and the data were analyzed by Stata 14 software. In addition, we examined 22 primary studies to estimate the overall prevalence of L. infantum among various vectors of visceral leishmaniasis.

Results: According to the meta-analysis, the pooled prevalence of Phlebotomus (Ph.) tobbi, Ph. alexandri, Ph. kandelaki, Ph. perfiliewi, Ph. major, Ph. keshishiani were 5.34%, 4.36%, 2.23%, 1.79%, 4.37% and 1.18%. Ph. tobbi has the highest infection rate (25.00%) of L. infantum among the sandfly vectors.

Conclusions: Visceral leishmaniasis is widespread in Fars, Ardebil, and East-Azerbaijan provinces, which are the most important endemic regions in Iran.

Objective: To evaluate the immunodiagnostic potential of crude Fasciola gigantica-worm (FWA) and egg antigen (FEA) in detecting anti-Schistosoma (S.) haematobium antibodies in sera and urine samples.

Methods: This is a cross-sectional diagnostic study. Employing an indirect ELISA, antibodies against these antigens were assessed in samples from infected and non-infected individuals in both schistosomiasis endemic (NE) and non-endemic (NNE) areas, using microscopy as the diagnostic standard.

Results: FWA-sera exhibited excellent diagnostic accuracy with an area under the curve (AUC) of 0.957, a sensitivity of 93.75%, and a specificity of 85.42% for discriminating between infected and non-infected individuals in non-endemic areas. FWA-urine also demonstrated robust performance, achieving AUC>0.95, sensitivity>97.0%, and specificity>85.0% in both NE and NNE categories. Notably, S. haematobium-specific antibody levels against FWA were significantly elevated in infected individuals in both endemic and non-endemic areas. FEA-sera exhibited outstanding diagnostic performance with sensitivity exceeding 90% and an AUC of 0.968 in non-endemic samples but not in FEA-urine.

Conclusions: FWA-based ELISAs, applicable to both sera and urine, emerge as promising tools for S. haematobium diagnosis in resource-limited settings, offering advantages of high sensitivity and specificity with shared antigens with Fasciola. The superior diagnostic metrics of urine samples suggest their potential as a noninvasive biological sample for diagnostic purposes.

Objective: To investigate and compare the demographic characteristics, clinical findings, and laboratory results of pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) patients, among Turkish citizens, and foreign nationals.

Methods: This study included patients aged 18 and over, both Turkish citizens and foreign nationals, diagnosed with PTB or EPTB between 2016 and 2022. All patients were divided into PTB and EPTB group, and demographic characteristics, clinical findings, and laboratory results were compared. Patients with both PTB and EPTB were not included in the comparison. Multivariate logistic regression analysis was conducted to identify potential risk factors for PTB.

Results: Among the 261 TB cases included, 46 patients (17.6%) had PTB, and 188 (72%) had EPTB. The percentage of female patients was significantly higher (P=0.003) in EPTB compared to PTB group. While the prevalence of diabetes mellitus (P=0.002), hypertension (P=0.017), coronary obstructive pulmonary disease (P=0.001), congestive heart failure (P=0.005), coronary artery disease (P=0.001) and immunosuppressive medication use (P=0.017) were significantly higher in PTB patients than in EPTB patients. Multivariate logistical analysis reveals that male (OR 2.6, 95% CI 1.3-5.5, P=0.009), diabetes mellitus (OR 2.7, 95% CI 1.2-6.1, P=0.015), and asthma (OR 6.3, 95% CI 1.2-33.9, P=0.032) were associated with an increased risk of PTB. Social security coverage (P<0.001) and regular employment status (P<0.001) were found to be lower and the presence of multidrug resistance (P=0.002), isoniazid resistance (P=0.012), and rifampin resistance (P=0.012) were found to be significantly higher in foreign-national TB patients comparing with Turkiye citizens.

Conclusions: Patients with PTB need to be evaluated for comorbidities and PTB should be investigated in men, in patients with diabetes mellitus or asthma if there are clinical findings suspicious for TB. TB screening for foreign nationals upon entry into the country is essential for TB control and elimination.

Rationale: Nocardia is a soil saprophyte, which can cause disseminated infection in immunocompromised patients. Early diagnosis and treatment can greatly improve prognosis.

Patient concern: A 26-year-old male presented with repeated episodes of fever, cough and breathlessness for 3 months.

Diagnosis: Mixed infection of Nocardia (N.) farcinica and N. cyriacigeorgica with diabetes and Cushing’s syndrome.

Interventions: N. cyriacigeorgica was isolated from empyema fluid and N. farcinica from blood. Based on antimicrobial susceptibility, he was treated with imipenem, cotrimoxazole and amikacin.

Outcome: Patient expired due to infection and delayed diagnosis.

Lesson: Several cases of infection due to N. farcinica or N. cyriacigeorgica have been reported. But mixed infection caused by these two species is rare. Pulmonary and disseminated nocardiosis is associated with high mortality, especially in immunocompromised hosts. So early diagnosis and prompt treatment is needed.