Afghanistan Journal of Infectious Diseases

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

Meysam Olfatifar — 2026-07-20

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

Sayed Hussain Mosawi — 2026-07-20

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in Iran; although a national estimate of intestinal protozoan prevalence has been previously reported, it is now outdated and more recent data is required.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.

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

Nahid Ghazizada — 2026-07-20

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.

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

Sayed Hussain Mosawi — 2026-07-20

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.

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

Khwaja Mir Islam Saeed — 2026-07-20

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.

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

Aida Vafae Eslahi — 2026-07-20

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.

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

Nazifullah Sadizai — 2026-07-20

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.

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

Leila Zaki — 2026-07-20

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

Osman Saei — 2026-07-20

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.

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

Emmanuel Isegbe Oanh — 2026-07-20

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.

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

Mojibullah Jaheed — 2026-07-20

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.

Seroprevalence of Human Anti-Echinococcus granulosus Antibodies in Saveh, Central Iran

Ali Ehsan Shahbazi — 2026-01-08

Background: We aimed to investigate the seroprevalence of anti- Echinococcus granulosus (E. granulosus) antibodies in humans in Saveh, Central Iran.

Methods: A random sample of 199 participants referred to the health centers in Saveh, Markazi Province, central Iran was selected. Informed consent was obtained, and the participants completed a questionnaire. Three milliliters of venous blood were collected in the Parasitology Laboratory of Saveh University of Medical Sciences. The Pishtaz Teb ELISA kit was used to detect anti-E. granulosus antibodies, following the manufacturer’s protocol.

Results: The seroprevalence of anti-E. granulosus antibodies was 6%. The prevalence was slightly higher in men (6.9%) than in women (5.1%). The 26–40 yr age group had the highest prevalence (11.1%). Most participants were freelancers, and this group exhibited the highest seroprevalence (11.4%). There was no statistically significant association between antibody presence and age, sex, occupation, or place of residence. Among the 30 participants who kept dogs, 4 tested positive. A personal or family history of hydatid cysts was not significantly associated with seropositivity. Of the 15 participants who did not wash vegetables with disinfectants, 2 were antibody-positive. Not washing hands before eating was significantly associated with infection, with 18.5% of those who did not wash their hands testing positive (P=0.001).

Conclusion: The presence of anti-E. granulosus antibodies in Saveh indicates ongoing exposure and an elevated risk of infection. Implementing preventive measures—such as regular monitoring and screening, health education, and reducing contact with stray dogs—is essential to control hydatidosis in this region.

Trends the Future Burden of Visceral Leishmaniasis in Afghanistan, Iran, and Pakistan: A Regional Epidemiological Modeling Study

Meysam Olfatifar — 2026-01-08

Background: Visceral leishmaniasis (VL) remains one of the world’s most severe neglected tropical diseases, causing substantial morbidity and mortality in low-resource settings. Despite regional control efforts, the disease persists as a major health challenge in the Middle East and South Asia. We aimed to estimate and forecast the sex-specific and national burden of VL in three neighboring countries of Afghanistan, Iran, and Pakistan through 2040.

Methods: To estimate the future prevalence of VL we applied an illness–death model using sex-specific data from the Global Burden of Disease 2021. Historical data from 1990–2021 were used to calibrate the model and forecast national trajectories of VL prevalence to 2040.

Results: In 2023, Afghanistan had the highest age-standardized VL prevalence (0.0176), followed by Iran (0.0159) and Pakistan (0.0093). Projections indicate strikingly divergent trends by 2040: prevalence is expected to rise to 0.045 (95% CI: 0.03–0.08) in Afghanistan and 0.211 (95% CI 0.10–0.45) in Pakistan representing increases of 156% and over 2,100%, respectively while Iran is projected to experience a sustained decline to 0.002 (95% CI: 0–0), an 87% reduction compared with 2021. These patterns are consistent across both sexes, though male prevalence remains roughly twice that of females.

Conclusion: Afghanistan’s decline likely reflects under-detection due to health system fragility, while Pakistan’s surge may result from both improved surveillance and genuine spread. Iran’s continued reduction demonstrates the impact of sustained public health investment. Strengthening surveillance and incorporating health system indicators into predictive models are crucial for accurate projections and effective regional control.

Phage-Antibiotic Combination Therapy for Antibiotic-Resistant Bacteria; Synergistic Mechanisms and Clinical Applications: A Systematic Review

Seyed Jalil Mousavi — 2026-01-08

Background: Antimicrobial resistance (AMR) is a major global health challenge requiring innovative therapeutic strategies. Phage–antibiotic combination therapy has emerged as a potential approach for treating multidrug-resistant (MDR) bacterial infections. This systematic review summarizes reported synergistic effects and clinical outcomes of this combined strategy.

Methods: This review was conducted according to PRISMA guidelines. PubMed, Scopus, Web of Science, and the Cochrane Library were searched for studies published between January 2000 and December 2024 assessing combined bacteriophage and antibiotic therapy against MDR bacteria. Eligible studies focused on therapeutic synergy, bacterial resensitization, and clinical outcomes, with results synthesized narratively.

Results: A total of 25 studies were included, comprising 10 in vitro studies, 7 in vivo animal studies, and 8 clinical investigations. Phage–antibiotic combinations demonstrated synergistic effects in more than 70% of cases, resulting in enhanced bacterial eradication, improved biofilm disruption, and reduced resistance development compared with monotherapy. The mean Fractional Inhibitory Concentration Index (FIC-I) for synergistic combinations in in vitro studies was 0.29±0.11. Animal studies reported protection or survival rates ranging from 64% to 100%. Clinical reports, including case studies and one phase 2 trial, documented successful treatment of refractory MDR infections without major safety concerns, although adverse events were inconsistently reported.

Conclusion: Phage–antibiotic combination therapy appears to be a promising approach for managing MDR bacterial infections. Despite encouraging evidence of enhanced efficacy, challenges such as phage resistance, host immune responses, and variability in interactions remain. Larger, well-designed clinical trials and individualized testing are necessary to confirm clinical efficacy and optimize therapeutic application.

Comparative Analysis of Runge–Kutta and Backward Euler Methods for Modeling Monkeypox Transmission Dynamics

Zabihullah Movaheedi — 2026-01-08

Background: Monkeypox (Mpox) is a re-emerging zoonotic viral disease that poses an increasing threat to global public health. Mathematical modeling is a key tool for understanding transmission dynamics of diseases like Mpox and supporting effective control strategies. Reliable numerical methods are essential for solving the nonlinear differential equations arising from such models.

Materials: We developed a deterministic compartmental model to describe Mpox transmission between human and small mammal populations. Human compartments include susceptible, exposed, infected, isolated, and recovered individuals, with corresponding classes for small mammals. We solved the system of nonlinear ordinary differential equations using the fourth-order Runge–Kutta (RK4) method and the Backward Euler method. We validated the model using real outbreak data from the U.S. Clade II Mpox cases reported by the Centers for Disease Control and Prevention (CDC, 2025).

Results: Simulation results demonstrate that RK4 provides higher accuracy and faster convergence in non-stiff scenarios, making it suitable for short-term epidemic predictions. The Backward Euler method exhibits superior numerical stability for stiff systems, allowing reliable long-term simulations with larger time steps. Error and computational analyses confirm RK4’s efficiency, while Backward Euler ensures robustness in unstable dynamic regions. Data fitting verifies that RK4 produces closer short-term approximations, whereas Backward Euler yields smoother long-term trends.

Conclusion: Both numerical methods are effective for modeling Mpox transmission. RK4 is recommended for accurate short-term analysis, while Backward Euler is preferable for stiff epidemic dynamics requiring high stability. These results highlight the importance of appropriate numerical method selection in computational epidemiology.

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

Gopal Prasad Poddar — 2026-07-20

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.

Comparison of Laboratory Factors in COVID-19 Patients with and Without Mucormycosis

Farshid Safdarian — 2026-01-08

Background: There is increasing evidence that COVID-19 infection increases the patient's risk of secondary fungal infections. We aimed to compare the role of blood factors and inflammatory markers during COVID-19 infection in patients with and without mucormycosis.

Materials: The current research is cross-sectional and descriptive-analytical. The statistical population of this research included hospitalized patients with mucormycosis related to COVID-19 (as case group) and hospitalized patients with COVID-19 without mucormycosis (as control group) in Booali Sina and Velayat hospitals, Qazvin, Iran. Demographic information (age, gender) and laboratory findings were recorded in the prepared draft.

Results: We enrolled 69 patients as case group and 82 patients as control group. The mean age of the surveyed patients was 56.89 ± 16.06 years. Seventy-nine (52.3%) people from the patients, were male and 72 (47.7%) people were female. The mean of hemoglobin and WBC was higher in patients without mucormycosis and these differences were statistically significant (P<0.05). The trend of CRP changes in patients without mucormycosis decreased more than patients with mucormycosis (P<0.001).

Conclusion: Differences in hematologic and inflammatory markers between COVID-19 patients with and without mucormycosis suggest that routine monitoring of parameters such as WBC, hemoglobin, CRP, and blood glucose may help identify patients at higher risk for mucormycosis and enable earlier diagnosis and intervention.

COVID-19 Transmission Dynamics in Afghanistan: Insights from Compartmental Models on Vaccination and Control

Amanullah Nabavi — 2026-01-08

Background: The COVID-19 pandemic has created substantial public health challenges worldwide, with Afghanistan facing unique vulnerabilities due to limited healthcare infrastructure and uneven vaccine coverage. Understanding the transmission dynamics of COVID-19 in this context is essential for designing effective intervention strategies.

Methods: Epidemiological data, including confirmed cases, mortality, and vaccination rates, were obtained from Our World in Data. Vaccination data were available from February 22, 2021, to December 31, 2023, and mortality rate estimation was based on data spanning April 1, 2020, to June 29, 2025. We developed a deterministic SEVIR compartmental model capturing susceptible, exposed, vaccinated, infectious, and recovered populations. The model was analyzed for biological feasibility, and key parameters, including the vaccination and mortality rates, were estimated from the data. Sensitivity analyses were conducted to determine the influence of parameters on disease progression. The basic reproduction number ( ) was derived analytically, and stability analysis of the disease-free equilibrium was performed.

Results: Model simulations indicate that the current vaccination rate in Afghanistan is insufficient to eliminate COVID-19. Doubling vaccination coverage could significantly reduce infection prevalence, while achieving herd immunity would require vaccinating approximately 86% of the population. Sensitivity analyses highlighted the critical role of vaccination and transmission rates in controlling disease spread. The disease-free equilibrium is locally stable whenever , confirming the theoretical feasibility of disease elimination.

Conclusion: These findings provide comprehensive insights into COVID-19 dynamics in Afghanistan and offer evidence-based guidance for public health policymakers to optimize vaccination strategies and mitigate the ongoing impact of the pandemic.

Human Fascioliasis in Northern Iran: Clinical Features and Treatment

Abdolhossein Dalimi — 2026-01-08

Background: Fascioliasis is a zoonotic parasitic disease, caused by the liver fluke Fasciola spp.. We aimed to investigate the clinical signs of human fasciolosis before and after treatment with triclabendazole. The drug efficacy and its side effects were also assessed.

Methods: Fifty confirmed fasciolosis patients, 15 males and 35 females, were chosen for parasitological and serological examinations pre-therapy as well as 1- and 6-months post-therapy. For stool examination formalin-ether and modified Telemann methods and for Fasciola antibody detection Elisa technique was applied.

Results: Overall, 100% and 18% of patients had positive ELISA and stool exams before treatment, respectively. The most frequent sign was abdominal pain (96%). The cure rate of the patient based only on stool examination was 100% after consumption of single dose of triclabendazole (10 mg/kg of body weight). Transient abdominal pain (mild and moderate) was the most frequent adverse sign following treatment with triclabendazole.

Conclusion: A single dose of triclabendazole (10 mg/kg) proved to be a successful therapeutic intervention, effectively eliminating the infection with manageable side effects.

Acaricidal Effect of Propolis against Hyalomma Spp. Ticks and Assessment of Its Toxicity with the MTT Assay

Roghayeh Norouzi — 2026-01-08

Background: The Hyalomma species is one of the most important vectors of pathogens responsible for human and animal diseases. The use of substances of natural source has been proposed as a safe way to control ticks. We aimed to evaluate the acaricidal activity of hydroalcoholic extract of honey bee propolis against the Hyalomma spp. in vitro and to determine its toxicity by MTT assay.

Methods: The acaricidal activity of propolis in concentrations of 50, 100, 150, and 200 mg/ml was investigated after 15, 30 and 60 minutes by two spray and contact methods. The main compounds of propolis were carried out with Gas Chromatography-Mass Spectrometry (GC–MS). Then the toxicity of each concentration was evaluated by MTT assay. Data were analyzed by GraphPad Prism 6 software.

Results: The concentration of 200 mg/ml of propolis had the highest acaricidal effect (90%) in the exposure time of 60 minutes and spray method was more effective than the contact method. The GC-MS analysis identify that Hexane (CAS); n-Hexane (17.32%) is the main ingredient of propolis. The results of the MTT toxicity test showed that toxicity increases with increasing concentration, and low concentrations of propolis have very little toxicity.

Conclusion: The hydroalcoholic extract of propolis contains potent acaricidal compounds and it might be used as a natural acaricide compound to against Hyalomma spp. However, further studies are needed to evaluate the effectiveness of the propolis.

Comparative Assessment of Helicobacter pylori stool Ag and serum Antibodies Tests with Urea Breath Test among Symptomatic Patients at a Tertiary Hospital in Kabul, Afghanistan

Noor Ahmad Noori — 2026-01-08

Background: Helicobacter pylori infection is a major cause of gastrointestinal disorders. Accurate diagnosis is essential for proper management, particularly in resource-limited settings. We compared the diagnostic performance of stool antigen (Ag) and serum antibody (Ab) tests with the Urea Breath Test (UBT), the gold standard for detecting H. pylori infection, among symptomatic patients at a tertiary hospital in Kabul, Afghanistan, in 2023.

Methods: This case series study included dyspeptic patients attending the outpatient department of Cure Hospital, Kabul, Afghanistan, who had not used proton pump inhibitors in the previous two weeks or antibiotics in the past four weeks. All patients underwent stool antigen testing, serum antibody testing, and UBT. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) were calculated to assess diagnostic accuracy.

Results: Of the 66 patients enrolled (mean age = 36.4 ± 13.2 years; 68.2% were female), abdominal pain (93%) was the most common symptom. The stool antigen test showed high sensitivity (96%) and specificity (97.5%), while the serum antibody test exhibited lower sensitivity (73%) and specificity (67.5%). Sex-stratified analysis showed consistently high accuracy across for the stool antigen test across both sexes, while the performance of the antibody test varied by sex.

Conclusion: The stool antigen test shows high sensitivity and specificity and performs better than the serum antibody test for diagnosing H. pylori infection among symptomatic patients. It can be considered a reliable alternative to UBT in resource-limited settings.

Present and Future Trajectory of Tuberculosis Globally and In Afghanistan from 1990 to 2040: A Modelling Study

Majid Khosravi — 2026-01-08

Background: Tuberculosis (TB) continues to disproportionately affect vulnerable populations in conflict zones like Afghanistan, remaining a significant global health concern. We aimed to analyze TB trends in Afghanistan from 1990 to 2021 and projects the future burden to 2040, informing evidence-based public health planning.

Methods: Using sex-specific epidemiological data from the Global Burden of Disease (GBD) study (1990–2021), we projected the future prevalence of TB in Afghanistan and globally through 2040. We employed an illness-death model (IDM), calibrated to the GBD data to generate these projections.

Results: From 1990 to 2021, the global age-standardized prevalence rate (ASPR) of TB decreased by 23%, with projections indicating a further 6% decline by 2040. Afghanistan demonstrated a more substantial historical reduction of 43% and is forecast to achieve an additional 41% decrease by 2040. Although starting from a lower baseline than the global average, Afghanistan’s rate of improvement is significantly more rapid. Projections for Afghanistan are associated with greater uncertainty, largely due to unique socio-political challenges. Nonetheless, these trends highlight the considerable progress made by the country despite major operational constraints.

Conclusion: While projections suggest potential progress in TB control, recent increases in case notifications and wide uncertainty intervals highlight that epidemiological outcomes in fragile states depend on political and economic factors as much as biomedical interventions, especially where case detection is suboptimal.

Molecular Prevalence and Risk Factors of Hepatitis B Virus Infection Among the Patients Attending the Human Medical Laboratories in Kabul, Afghanistan

Muhammad Farooq Haider — 2026-01-08

Background: Hepatitis B virus (HBV) can cause acute and/or chronic hepatitis, responsible for over one million deaths annually. We aimed to estimate the prevalence of hepatitis B and its risk factors among the patients attending the Human Medical Laboratories (HML) in Kabul, Afghanistan.

Methods: This retrospective study was conducted on samples received between January 2022 and September 2023. We tested 2062 blood samples using a Geneproof Amplification Kit and Rotor-Gene Real-Time PCR. Descriptive and analytical statistics (Chi-square test and logistic regression) were analyzed using SPSS version 26.

Results: The prevalence of HBV was 51.2% (1056/2062), with 59.3% males and a mean (SD) age of 32.0 (14.9) years. The majority of the HBV-positive patients (792/1056 or 74.8%) were from the age group of 16–45 years. The highest and lowest prevalence of HBV was observed in Kandahar (29/48 or 60.4%) and Nangarhar (107/235 or 45.5%), respectively. The mean overall HBV viral load was 39,587,427.2 IU/mL, with the highest and lowest mean viral load observed in patients from Takhar (71,940,575.8 IU/mL) and Kandahar (1,419,819.0 IU/mL), respectively. The statistically significant risk factors associated with HBV were blood transfusion, dental extraction, and syringe sharing.

Conclusion: HBV is highly prevalent among the Afghans attending HML in Kabul, Afghanistan. The Afghanistan Ministry of Public Health and international donor agencies should help in conducting more studies of HBV in all 34 provinces of Afghanistan. This will help in finding the real burden and risk factors of HBV in different regions and ethnicities of Afghanistan.

Elizabethkingia meningoseptica in a Female Neonate: A Case Report from Afghanistan

Abdullah Sahar — 2025-07-20

Elizabethkingia meningoseptica is a rare and Gram-negative bacterium that can cause severe complications in neonates. Here a case of meningitis in an 18-day-old female is reported from Afghanistan. CSF analysis and culture confirmed E. meningoseptica as the causative agent. The isolate was resistant to the most antibiotics, with susceptibility only to tigecycline. This case highlights the clinical importance of early detection and the challenge of treating infections caused by this pathogen, especially in resource limited countries like Afghanistan.

Sero-Evidence Status of Toxoplasma gondii Infection in Mazandaran Province, Northern Iran: First Population-Based Regional Registry Analysis

Rabeeh Tabaripour — 2025-07-20

Background: Toxoplasma gondii is one of the most common parasitic infections in humans and other vertebrates worldwide. Regional seroprevalence data are critical for targeted interventions. Weaimed to investigate serological evidence of Toxoplasma infection among patients referred to the Iranian National Registry Center for Toxoplasmosis (INRCT) at the Mazandaran University of Medical Sciences (MAZUMS).

Methods: In this retrospective (descriptive-analytical) study, all patients referred to the INRCT, constitute the study population (underlying diseases/status) throughout 2021-2025. All data including demographic and some related characteristics were collected into a questionnaire and registered at the INRCT in Imam Khomeini Hospital, Sari, northern Iran. The existence of anti-Toxoplasma antibodies (IgG) was explored using a commercially available ELISA kit (PishtazTeb, Iran), based on the manufacturer’s protocol.

Results: Anti-Toxoplasma IgG were detected among 862/1691 patients (50.98%). The most positive anti-Toxoplasma antibodies were in infertile women and the least were in suicide. IgG seropositivity was more common in females (66.01%) than in males (33.99%) and in 31–40 yr old patients (33.41%) in urban populations (53.71%).

Conclusion: The findings highlight a high burden of T. gondii infection in northern Iran, with gender, age, and residency as key determinants. Targeted screening and preventive measures are recommended for high-risk groups, including women of reproductive age and immunocompromised populations.

Application of Nanotechnology in Treatment of Nematodes Diseases: A Review Article

Roghayeh Norouzi — 2025-07-20

Background: Nematodes were among the first known human pathogens, and many efforts have been made to develop treatments for them. These infections impose a heavy burden on human populations, especially the poor. Nowadays, intervention and treatment programs have been initiated to control and treat onchocerciasis, lymphatic filariasis, gastrointestinal nematodes, and soil-transmitted helminths. Nanotechnology is being used as a dynamic and dynamic tool in research for the treatment of diseases. Here, we review the application of nanotechnology in treatment of nematode diseases.

Methods: This narrative review was conducted using scientific sites such as Medline, Pubmed Science Direct, and Springer Link databases covering 2000 to 2025 to investigate the application of nanotechnology in nematodes diseases treatment. The terms used included: nanotechnology, nanoparticles, nematodes, nematodes treatment, and nanodrug.

Results: Twenty-eight full-text articles were assessed for eligibility, and from them, 23 selected studies on the application of nanotechnology in the treatment of nematode diseases were selected.

Conclusion: The nanodrugs and nanomedicines are future sources for the development of new drugs with therapeutic applications. Nanotechnology has the potential to be used as antinematodal drugs by modifying the biodistribution of drugs and improving bioavailability.

Knowledge and Practices Regarding Pet Ownership and Parasitic Zoonoses among Medical Students and Faculty in Kabul, Afghanistan: A Focus on Toxocariasis

Ziaulhaq Kaihan — 2025-07-20

Background: Toxocariasis is a common but often neglected parasitic zoonosis, transmitted mainly through contact with contaminated animals or soil. Despite its public health significance, awareness remains limited, particularly in Afghanistan. We aimed to assess the awareness and practices related to pet ownership and the risk of Toxocara infection among medical students and faculty members at two major private medical universities in Kabul.

Methods: This cross-sectional study surveyed 347 medical students and faculty members at Ghalib University and Cheragh Medical Educational Institute in Kabul between Oct and Dec 2023. A semi-structured questionnaire assessed sociodemographic factors, behaviors related to animal contact, and knowledge of zoonotic parasites, with a focus on Toxocara. Associations between pet ownership and knowledge or practices were examined using chi-square tests.

Results: Overall, 38.8% of participants reported owning pets. While 41.5% indicated high knowledge of zoonotic parasites, only 8.1% could name Toxocara specifically. Veterinary visits were common among pet owners. Pet ownership was significantly associated with sex, frequency of contact with stray animals, daily interactions with animals, knowledge of parasitic zoonoses, and awareness of the clinical spectrum (P<0.05). Hygiene practices after animal contact did not differ significantly between groups, although handwashing with water alone was most commonly reported. Knowledge regarding transmission routes, the ability to name parasites in general, zoonotic parasites, and Toxocara was similarly limited among both pet owners and non-owners.

Conclusion: Substantial gaps in knowledge about parasitic zoonoses, including Toxocara, were identified. Pet ownership influenced certain behaviors but did not consistently predict higher awareness. These findings underscore the need for targeted educational interventions to strengthen understanding and promote preventive measures among future healthcare professionals.

Orbital Hydatid Cyst in Pediatric Patients: Report of Two Rare Cases from Afghanistan

Jamalliden Mudafi — 2025-07-20

Orbital hydatid cyst is a rare manifestation of echinococcosis, comprising less than 1% of cystic echinococcosis. It most frequently affects the pediatric population and typically presents as a slowly enlarging orbital mass, causing progressive proptosis, restricted ocular motility, diplopia, and occasionally visual impairment. Hereby, we present two pediatric orbital cases from Afghanistan between 2021 and 2022, with one patient had right eye proptosis and diplopia: the other presented with left upper eyelid swelling and ptosis. Imaging revealed medial intraconal cystic lesions in both cases. Surgical excision via medial orbitotomy was performed; one cyst ruptured intraoperatively and was managed with scolicidal irrigation, while the other was removed intact. Parasitology and postoperative serology confirmed the diagnosis. Albendazole therapy was administered, and no recurrence was observed during 12- and 24-months follow-up. These cases underscore the importance of considering hydatid cysts in the differential diagnosis of orbital masses in endemic regions and highlight the role of early imaging and careful surgical management, and is particularly uncommon in children.

Dynamics-Informed Neural Network Modeling of COVID-19 Transmission in Afghanistan Using the SEIR-V Framework

Zabihullah Movaheedi — 2025-07-20

Background: The COVID-19 pandemic posed significant challenges for public health systems globally, particularly in resource-limited settings such as Afghanistan. Limitations in diagnostic capacity, inconsistent data reporting, and low vaccination coverage hindered timely public health responses. To support real-time decision-making, accurate and adaptive modeling frameworks are essential.

Methods: This study presents a hybrid modeling approach that integrates the classical SEIR-V (Susceptible–Exposed–Infectious–Recovered–Vaccinated) compartmental model with Dynamics-Informed Neural Networks (DINNs). The model embeds the SEIR-V system of differential equations into the loss function of a deep neural network to enable dynamic estimation of time-varying parameters. Epidemiological data from Feb 2020 to Apr 2024 were collected from multiple publicly available sources, including Worldometer, Our World in Data, the World Health Organization and the Johns Hopkins University COVID-19 repository.

Results: The proposed DINNs-SEIRV model effectively reconstructed multiple epidemic waves and generated accurate forecasts of COVID-19 transmission dynamics in Afghanistan. The model achieved high predictive performance, particularly for the infectious (I) compartment, with a coefficient of determination R² = 0.9973. It also demonstrated strong capacity in capturing vaccination trends and maintaining robustness in the presence of incomplete or noisy data.

Conclusion: The DINNs-SEIRV framework offers a powerful and flexible tool for modeling infectious disease dynamics in low-resource settings. Its ability to learn and update time-varying parameters in response to real-world data makes it valuable for informing public health strategy, forecasting outbreaks, and evaluating vaccination efforts in environments like Afghanistan

Visceral Leishmaniasis in Afghanistan: Analysis of Cases from 2018 to 2022

Khwaja Mir Islam Saeed — 2024-07-20

Background: Visceral leishmaniasis (VL) is a neglected but typically fatal vector-borne protozoan disease. It leads to substantial health problems and/or death for up to 400,000 people per year. Afghanistan is an endemic country for VL. We aimed to analyze VL cases from 2018 to 2022 and enlighten the epidemiological profile of the disease in the country.

Methods: A descriptive analysis of VL cases from 2018 to 2022 was conducted during July to September 2022. Secondary data of the VL surveillance were retrieved from Malaria and other Vector Borne Disease Control Program (MVDP) of Ministry of Public Health, Kabul, Afghanistan. while the outcome of registered cases were confirmed through phone calls. Data were managed and analyzed using MS Excel, Epi Info V.7.2.1, and GIS.

Results: Overall, 77 cases were registered and reported from 2018 to 2022. Most of the cases 48 (62%) were male, and 68 (88.3%) were aged 0-5 yr with a mean of 3.6 ± 2.1. Geographically, 28 cases (36%) were reported from Faryab Province followed by Baghlan 9 (12%) and Ghazni 1 (1.2%) provinces. Only Four (5%) and 7 (9%) cases reported family members with Cutaneous Leishmaniasis and VL respectively. Common clinical manifestations among patients were fever (96%), weight loss (96%), and splenomegaly (91%). Upon follow up, 35 (45.5%) of the cases were lost, 31 (40.2%) were cured, and 11 (14.3%) deceased. The outcome of treatment was significantly associated with treatment type, Glucantime.

Conclusion: We found higher proportion of VL among under-five males. Most of the cases were reported from the northern region and the family history of VL was reported by patients. Fever and weight loss were the frequent clinical manifestations. Early diagnosis and Glucantime had good outcome compared to late diagnosis and SSG. Awareness activities, access to diagnosis, health education and interventions are recommended in high-risk provinces. In addition, further studies are encouraged to determine the prevalence of the disease among the general population.