Afghanistan Journal of Infectious Diseases

Lupus Vulgaris of the External Nose in a Young Male Child Causing Cosmetic Disfigurement: An Uncommon Presentation

2025-11-09T16:24:45+0430

Lupus vulgaris is the most commonly encountered form of cutaneous tuberculosis. It is a chronic and progressive infection typically seen in individuals with moderate immune function. It constitutes approximately 0.1–2% of cutaneous tuberculosis cases in India. In Europe, face is the most usually affected site, but in India, chest, upper back, lower back and buttock are more commonly involved. Lupus vulgaris over face affecting nose, is rarely reported in India. We report here an unusual case of lupus vulgaris affecting the external nose of a young male child causing cosmetic disfigurement.

Precision Public Health Approaches to Intestinal Parasitic Infections in Children under Five: A Policy Brief

2026-05-20T10:59:50+0430

The majority of the burden of childhood disease and delayed development worldwide is attributed to one of the most neglected diseases, intestinal parasitic infections (IPIs). Helminth and protozoan infections continue to disproportionately affect under 5-year-old children, especially in low and low-middle income countries. These infections contribute to childhood diarrhea, malnutrition, growth failure, anemia, poor cognitive development, and preventable death. Nearly a third of all under 5 children globally have IPIs; however, this estimate could actually be significantly underestimated given low diagnostic sensitivity. This policy brief provides a comprehensive review of existing evidence on the global burden and causes of IPIs among under-fives, and identifies a range of evidence-based policy actions for governments, international organizations and development partners. Three proposed interconnected policy priorities are targeted geographically specific mass drug administration (MDA) and surveillance in high burden hotspots; climate-smart and context specific Water and sanitation and hygiene (WASH) interventions; and enhanced diagnostic and surveillance capacity for improved burden estimation and targeting resources. Despite the need for it, implementation is severely hampered by insufficient funding, under-developed health systems, inadequate inter-sectoral coordination, continuing environmental transmission environments, and under-diagnosis arising from use of low-sensitivity diagnostics. The challenge posed by IPIs in children under five will necessitate a shift from broad-based control plans to more precision public health approaches. These will include the implementation of hotspot targeting, environmentally tailored WASH interventions and enhanced diagnostic surveillance.

Prevalence of Intestinal Protozoan Parasites Among Food Handlers in Iran: A Systematic Review and Meta‑Analysis

2026-07-01T09:04:56+0430

Background: Intestinal protozoa are significant causes of foodborne diseases in food handlers who may also act as carriers of no signs of infection. Food handling is an important occupation in Iran; although a national estimate of intestinal protozoan prevalence has been previously reported, it is now outdated and more recent data is required. Therefore, we aimed to determine the pooled prevalence of intestinal protozoan parasites and examine geographic variation among food handlers in Iran.

Methods: A systematic literature search was conducted using PubMed, Scopus, Embase, Web of Science, and Google Scholar up to 2025. Cross‑sectional studies reporting the prevalence of intestinal protozoa among Iranian food handlers were included. Pooled prevalence with 95% confidence intervals (CIs) was calculated using a random‑effects model.

Results: Twenty‑four studies with 110,404 food handlers were included. The overall pooled prevalence of intestinal protozoan infection was 14.1% (95% CI: 9.2% – 21.0%). Blastocystis hominis was the most common parasite (11.2%), followed by Entamoeba coli (8.2%), Giardia lamblia (5.4%), and Chilomastix mesnili (5.4%).

Conclusion: Approximately one in seven food handlers in Iran harbors intestinal protozoan parasites, with profound geographic disparities. Targeted interventions, including periodic stool screening and hygiene training, are urgently needed, particularly in high‑prevalence provinces.

The Role of Herpes Simplex Virus in the Etiology of Bell's Palsy

2026-04-06T13:12:48+0430

Background: Bell's palsy, the most common cause of acute peripheral facial paralysis, is strongly associated with reactivation of latent herpes simplex virus type 1 (HSV-1) in the geniculate ganglion. Through PRISMA-guided review we evaluated the molecular and clinical evidence for this association.

Methods: A systematic search of major electronic databases (PubMed, ScienceDirect, Google Scholar) was conducted for studies published up to December 2025. The PICO framework guided inclusion criteria, focusing on studies assessing HSV infection in Bell's palsy patients compared to controls, and reporting on HSV-1 DNA detection or antiviral efficacy. Molecular methods including PCR and serological assays were acceptable. The quality was assessed using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool.

Results: Twenty-three studies met the inclusion criteria. Molecular analyses consistently detected HSV-1 DNA in the geniculate ganglia and peripheral fluids of patients, with detection rates up to 79% in endoneurial fluid. Epidemiological data confirmed a strong association (odds ratio: 6.49; 95% CI: 5.96-7.05). However, evidence regarding the efficacy of adjuvant antiviral therapy combined with corticosteroids remained inconsistent. Major systematic reviews demonstrated no significant clinical benefit for the general population, with combination therapy increasing recovery by a maximum of 7%.

Conclusion: Strong molecular and epidemiological evidence supports HSV-1 reactivation as a major etiological factor in Bell's palsy. However, the routine clinical benefit of concomitant antiviral therapy remains unproven for the overall population. Future management should prioritize diagnostic stratification using viral PCR testing and severity classification to identify virus-induced cases benefiting most from targeted antivirals.

Forecasting the Future Burden of Typhoid Fever: Global Projections and Afghanistan Estimates to Inform Public Health Planning Through 2040

2026-07-01T09:09:48+0430

Background: Typhoid fever remains a significant public health challenge in many low- and middle-income countries, particularly in regions with inadequate water, sanitation, and hygiene (WASH) infrastructure. The Global Burden of Disease (GBD) study estimates that typhoid caused more than 6 million infections and more than 71,000 deaths globally in 2023. Understanding future trajectories of disease burden is essential for guiding public health policy and resource allocation.

Methods: We extracted age-standardized prevalence rates (ASPR) for typhoid fever from the GBD 2023 for both global and Afghanistan-specific estimates, disaggregated by sex, from 1990 to 2023. A cubic spline regression model was fitted to historical data using a least squares technique and used to project ASPR through 2040. Confidence intervals (95% UI) are reported for all estimates.

Results: In 2023, the global ASPR for typhoid fever stood at 5.34 per 100,000 for both sexes combined, with males experiencing a greater burden (5.68 per 100,000) compared to females (4.98 per 100,000). Afghanistan recorded an ASPR of 1.29 per 100,000 for both sexes. On a global scale, the ASPR is forecasted to fall to 1.68 per 100,000 by 2040, representing a 68.5% decrease from the 2023 level, whereas Afghanistan's ASPR is projected to drop to 0.43 per 100,000, a 67.0% reduction.

Conclusion: Typhoid fever prevalence is projected to continue its long-term decline through 2040 in both global and Afghanistan settings. However, the pace of decline may decelerate compared to historical trends, and sex-based differences may persist in some settings. Continued investments in WASH infrastructure and accelerated typhoid conjugate vaccine introduction are essential to sustain progress.

Prevalence and Associated Risk Factors of Soil-Transmitted Helminthiasis among School-Aged Children in Jos North and Jos South, Plateau State, Nigeria

2026-04-06T12:50:00+0430

Background: Soil-transmitted helminth (STH) infections remain a public health concern among children in low-resource settings. We aimed to assess the prevalence and associated risk factors of STH infections among school-aged children in Jos North and Jos South Local Government Areas, Plateau State, Nigeria.

Methods: This cross-sectional study was conducted between August 2022 and November 2024 among 1,200 pupils selected following the WHO guidelines. Stool samples were examined using the formal-ether concentration technique, and structured questionnaires were used to assess potential risk factors. Data were analyzed using chi-square tests and logistic regression at a 95% confidence level.

Results: The overall prevalence of STH infection was 2.5%. Ascaris lumbricoides (1.7%) was the most prevalent species, followed by hookworm (0.8%). No statistically significant associations were observed between infection and sex or age (P > 0.05), although children aged 9–12 years had the highest prevalence (2.9%). Multivariate analysis identified access to well water as a significant protective factor against infection (OR = 0.11, 95% CI: 0.02–0.56, P = 0.01).

Conclusion: Despite the relatively low prevalence, ongoing transmission risks remain. Strengthening WASH interventions alongside targeted school-based health education is essential to sustain progress toward the WHO 2030 STH control targets.

Comparative in vitro anti-leishmanial activity of Thymus vulgaris-mediated silver nanoparticles against Leishmania tropica and L. infantum

2026-04-15T12:00:53+0430

Background: Leishmaniasis remains a significant global health concern, with current treatments often limited by toxicity, cost, and emerging drug resistance. We aimed to evaluate the antileishmanial potential of eco-friendly silver nanoparticles synthesized using Thymus vulgaris extract (TSNPs) against Leishmania tropica and L. infantum in vitro.

Methods: The antileishmanial effects were evaluated against the promastigote stages of L. tropica and L. infantum using cell counting, MTT assay, and flow cytometry techniques. Cytotoxic effects on RAW 264.7 macrophages were determined by the MTT assay, and the half-maximal inhibitory concentration (IC₅₀) values were calculated for both species.

Results: TSNPs exhibited a characteristic plasmon resonance peak at 440 nm and spherical morphology with an average size of 18 nm. Treatment with TSNPs significantly reduced promastigote viability in a dose- and time-dependent manner. The IC₅₀ values after 72 h were 2.27 ppm for L. tropica and 2.04 ppm for L. infantum. Flow cytometry revealed induction of apoptosis in promastigotes, with 56.78% and 59.27% apoptotic cells for L. tropica and L. infantum, respectively, at 25 ppm. Macrophage cytotoxicity was observed only at higher concentrations (≥25 ppm).

Conclusion: Thyme-derived silver nanoparticles demonstrate potent and selective antileishmanial activity against both L. tropica and L. infantum, primarily through the induction of apoptosis. These findings highlight TSNPs as a promising green therapeutic candidate for leishmaniasis, warranting further in vivo investigation.

The Level of Awareness among Dental Students at Herat University Faculty of Stomatology Regarding HIV Prevention and Transmission

2025-12-12T11:28:31+0430

Background: HIV poses significant public health challenges in Afghanistan due to stigma, fragmented health systems, and inadequate education. In dental settings, where exposure to blood and body fluids is unavoidable, comprehensive knowledge of HIV transmission, universal precautions, and ethical responsibilities is essential for safety.

Methods: This cross-sectional study assessed HIV knowledge among the 191 male dental students, selected via systematic random sampling, at Herat University in 2023-2024. A validated questionnaire evaluated general HIV/AIDS awareness, transmission modes, and infection prevention/control. Data were analyzed using ANOVA and Tukey's post hoc tests in SPSS v25. Female students were excluded due to sociocultural barriers, representing a study limitation.

Results: The overall mean knowledge score was 66.47% (general knowledge: 71.41%, transmission: 63.69%, and prevention: 64.32%). Only 31.68% of students reported receiving formal HIV education through university curricula. A significant knowledge decline occurred among third-year (42.77%) and fourth-year (46.06%) students, whereas fifth-year students scored highest (69.35%), revealing a mid-study "valley of knowledge." The differences between academic years were statistically significant (P<0.001).

Conclusion: Despite moderate awareness, significant educational gaps persist. The lack of structured HIV education compromises the clinical competence and ethical preparedness of future dentists. Integrating mandatory, updated HIV modules; covering biomedical, psychosocial, and infection control components, into the Afghan dental curriculum is essential.

Clinical and Epidemiological Profile of Hydatid Cyst in Baghlan Province, Afghanistan

2026-06-11T11:27:54+0430

Background: Hydatid cyst is a neglected zoonotic disease caused by the larval stage of the tapeworm Echinococcus granulosus. While Afghanistan is a known endemic country, detailed epidemiological data from specific provinces remain scarce. We aimed to describe the demographic, clinical, and cyst‑related characteristics of patients diagnosed with hydatid cyst in Baghlan Province. Afghanistan

Methods: This retrospective study reviewed the medical records of 26 patients with confirmed hydatid cyst disease, treated at four hospitals in Baghlan Province from March 2022 to December 2025. Information on demographic characteristics (including age, sex, and place of residence), cyst localization, and clinical manifestations was collected and assessed using descriptive statistical methods.

Results: Among 26 patients, the majority were female (n=17, 65.4%). The mean age was 32.5 years (range 7–80 years old). The liver was the predominant site of involvement, either as a single organ or as part of multiple organ involvement (n=25, 96.2%). Among liver cysts, the right upper quadrant was the most frequent location (n=24, 92.3%). The most common symptoms included abdominal pain (n=24, 92.3%), fever (n=20, 76.9%), nausea (n=5, 19.2%), and anorexia (n=4, 15.4%). Unusual cyst locations were observed in three patients: lung (n=1), spleen (n=1), and uterus (n=1). No patient had documented central nervous system or orbital involvement.

Conclusion: Hydatid cyst in Baghlan Province predominantly affects young to middle‑aged females and most frequently involves the liver. The presence of extra‑hepatic localizations, albeit rare, underscores the need for a high index of suspicion in endemic regions. Public health interventions should target rural farming communities where livestock rearing is common.

Assessing the Prevalence & Clinical Features of Crimean-Congo Hemorrhagic Fever in Herat Regional Hospital, Afghanistan in 2024

2026-06-15T11:29:07+0430

Background: Crimean-Congo Hemorrhagic Fever (CCHF) is a severe viral infection caused by the Crimean-Congo Hemorrhagic Fever Virus (CCHFV). We aimed to assess the prevalence of CCHFV among individuals with clinical symptoms indicative of CCHF at the Herat regional hospital, Afghanistan in 2024, which provides diagnostic and treatment services to suspected CCHF patients in western Afghanistan.

Methods: We used secondary data collected by Surveillance Department of the Afghanistan Ministry of Public Health (MoPH). Samples were collected from the provinces of Herat, Farah, Badghis, and Ghor. A retrospective cross-sectional design was employed. Participants were categorized into two groups (29 and 115 cases in each group) based on their CCHFV test results. Data included demographic information, clinical symptoms, and exposure history related to tick bites and contact with infected individuals. Statistical analysis was performed using IBM SPSS Statistics Version 25, employing Chi-square tests for categorical variables and t-tests for continuous variables.

Results: Among the 144 participants, 29 (19.7%) tested positive for CCHFV, with the highest incidence occurring in July. The demographic profile indicated that 65.5% of positive cases were male, with a mean age of 33.2 years. Notably, 24.1% of the positive cohort reported tick bites, indicating a possible association between tick exposure and infection rates. All participants reported headaches and fever. Statistically significant differences (P-value < 0.05) were observed in three symptoms among positive group: epistaxis (55.2% ), conjunctival hemorrhage (3.4%), and vaginal bleeding (13.8%). Additionally, 93.1% of the positive group and 96.5% of the negative group received antiviral therapy.

Conclusion: The findings underscore the need for targeted public health interventions, including enhanced surveillance and community education on tick prevention.

Seroprevalence of TORCH Infections and Associated Influential Factors among Pregnant Women in Khost Province, Afghanistan: A Cross-Sectional Study

2026-05-05T08:37:55+0430

Background: TORCH infections (Toxoplasma gondii, Rubella virus, Cytomegalovirus, and Herpes simplex virus) are major causes of adverse outcomes in pregnancy. Data on seroprevalence and associated risk factors are limited in Afghanistan. We aimed to assess the seroprevalence of TORCH infections (IgG/IgM) and associated risk factors among pregnant women in Khost Province, Afghanistan.

Methods: This cross-sectional study was performed on 369 pregnant women attending antenatal services in Khost Province, Afghanistan, from 01 January 2024 to 30 December 2024. All participants answered a questionnaire on demographic, behavioral, and obstetric data. Sera were tested for IgG and IgM antibodies for current or past TORCH infections. Significant associations between risk factors and seropositivity were tested with Chi-square and Mann-Whitney U tests, and predictors of IgM seropositivity were identified by binary logistic regression.

Results: Overall, IgG seropositivity was 62.6%, IgM positivity 49.6%. Toxoplasma was the most prevalent (IgG 38.5%; IgM 22.2%), followed by CMV (IgG 19.0%; IgM 19.2%) and rubella (IgG 5.1%; IgM 6.5%). Significant factors for IgG seropositivity: cat presence, poor hygiene, raw meat consumption (all P<0.05). For IgM positivity, significant associations were cat presence and husband’s occupation (P<0.05). Logistic regression identified cat ownership (OR=0.64, 95%CI [0.42–0.98], P=0.039) and raw meat consumption (OR=0.62, 95%CI [0.40–0.95], P=0.029) as independent predictors of lower likelihood of recent IgM positivity. There was a correlation with age and parity with regard to history of abortion, but none with TORCH serology.

Conclusion: TORCH infections (especially toxoplasmosis and CMV) were common among the pregnant women in Khost, driven by environment, feeding habits, and living standards. Maternal age and parity mattered, but abortion history did not. Combating these infections in southeastern Afghanistan calls for hygiene/food safety education, improved living conditions, and better antenatal screening.

Knowledge, Attitude, and Practice of Community towards Cholera in High-risk Districts of Kandahar Province Afghanistan

2026-06-03T10:24:21+0430

Background: Afghanistan remains highly vulnerable to cholera outbreaks because of limited access to safe water, poor sanitation, and low community awareness. Kandahar Province experiences recurrent seasonal outbreaks. We aimed to assess the community knowledge, attitudes, and practices (KAP) regarding cholera in four high-risk districts.

Methods: A descriptive cross-sectional survey was conducted in 2022 in Dand, Daman, Spin Boldak, and Panjwai districts, Afghanistan using probability-based cluster sampling. A structured, pretested questionnaire was administered to 852 adults. Data were analyzed using Epi Info 7.2.3 and Stata 18. Descriptive statistics, chi-square tests, and logistic regression were performed, with P<0.05 considered statistically significant.

Results: Among 852 respondents, most were male (62.44%), married (87.79%), unemployed (77.46%), and illiterate (69.84%). Awareness of diarrheal diseases was high (88.33%), but misconceptions remained: 59.74% believed cholera is transmitted by insects and 56.57% by direct person to person contact. Most recognized contaminated water (79.81%) and food (76.52%) as transmission routes, but only 60.56% identified cholera as contagious. Although attitudes were generally positive, preventive practices were inadequate: only 34.97% boiled drinking water, 60.09% practiced open defecation, and 26.52% did not wash hands after toilet use. Only 30% achieved higher overall KAP scores. Female gender, higher education, and employment were significantly associated with better KAP.

Conclusion: Important gaps in cholera knowledge and preventive practices persist in high-risk districts of Kandahar. Despite generally positive attitudes, unsafe water use, poor sanitation, and misconceptions continue to hinder cholera control. Targeted health education and strengthened interventions are needed to improve community resilience and reduce cholera transmission.