{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T18:47:18Z","timestamp":1774896438778,"version":"3.50.1"},"update-to":[{"DOI":"10.1371\/journal.pntd.0014100","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000}}],"reference-count":67,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Hospital and Homes of St. Giles","award":["ITCRZM25"],"award-info":[{"award-number":["ITCRZM25"]}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Erythema nodosum leprosum (ENL) is a severe immunological complication of leprosy, characterised by painful nodules, fever, arthralgia, oedema, and systemic symptoms. Temporal classifications\u2014acute, recurrent, and chronic\u2014are inconsistently applied, complicating data comparisons. Standardised and agreed definitions are essential to ensure consistency in diagnosis, research, and clinical management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine how temporal classifications of ENL are used in modern literature and compare them to descriptions from the pre-corticosteroid era.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a semi-systematic review of historical and contemporary literature. Historical texts published before 1940, prior to the introduction of sulfone antibiotics and corticosteroids, were purposively selected to capture descriptions of the natural history of ENL. For modern studies, we systematically searched PubMed, EMBASE, LILACS, SciELO, Scopus, African Index Medicus, Cochrane, and ClinicalTrials.gov from May 2024 to March 2025. The systematic review identified 572 articles after de-duplication, and 41 met inclusion criteria for providing definitions of ENL subtypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five historical treatises were selected. Their clinical observations of nodular skin lesions with systemic symptoms\u2014ranging in duration from weeks to months or even years\u2014align with contemporary understandings of ENL. 41 studies included, at least one of the three temporal classifications (acute, recurrent, or chronic). The six-month criterion distinguishing acute and chronic ENL is used in all current definitions. However, definitions for recurrent and chronic ENL frequently overlapped, both referring to prolonged or multiple episodes after initial treatment, underscoring a lack of conceptual clarity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The absence of standardised ENL terminology impedes data comparison, meta-analysis, and clinical guideline development. A Delphi consensus process and longitudinal observational studies are recommended to refine, standardise agreed ENL classifications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0014100","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T17:42:49Z","timestamp":1774287769000},"page":"e0014100","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Descriptions of the natural history of erythema nodosum leprosum to inform clinical classification \u2013 A semi-systematic review"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5382-8165","authenticated-orcid":true,"given":"Barbara","family":"de Barros","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saba","family":"Lambert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivianne Lopes","family":"Antonio Dias","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana N.J.","family":"Lockwood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen L.","family":"Walker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,3,23]]},"reference":[{"issue":"3","key":"pntd.0014100.ref001","doi-asserted-by":"crossref","first-page":"321","DOI":"10.47276\/lr.89.3.321","article-title":"The incidence of erythema nodosum leprosum in india: a retrospective follow-up of the infir cohort","volume":"89","author":"SL Walker","year":"2018","journal-title":"LEPROSY"},{"issue":"5","key":"pntd.0014100.ref002","doi-asserted-by":"crossref","first-page":"868","DOI":"10.4269\/ajtmh.2006.74.868","article-title":"Clinical course of erythema nodosum leprosum: an 11-year cohort study in Hyderabad, India","volume":"74","author":"L Pocaterra","year":"2006","journal-title":"Am J Trop Med Hyg"},{"issue":"9","key":"pntd.0014100.ref003","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0004065","article-title":"ENLIST 1: An International Multi-centre Cross-sectional Study of the Clinical Features of Erythema Nodosum Leprosum","volume":"9","author":"SL Walker","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"issue":"4","key":"pntd.0014100.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0004502","article-title":"A Randomized Controlled Double Blind Trial of Ciclosporin versus Prednisolone in the Management of Leprosy Patients with New Type 1 Reaction, in Ethiopia","volume":"10","author":"SM Lambert","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014100.ref005","doi-asserted-by":"crossref","first-page":"233","DOI":"10.3389\/fimmu.2017.00233","article-title":"A Systematic Review of Immunological Studies of Erythema Nodosum Leprosum","volume":"8","author":"A Polycarpou","year":"2017","journal-title":"Front Immunol"},{"key":"pntd.0014100.ref006","doi-asserted-by":"crossref","first-page":"100","DOI":"10.47276\/lr.91.1.100","article-title":"Health-related quality of life associated with erythema nodosum leprosum in Purulia, West Bengal, India","volume":"91","author":"J Darlong","year":"2020","journal-title":"Leprosy Review"},{"key":"pntd.0014100.ref007","doi-asserted-by":"crossref","first-page":"499","DOI":"10.47276\/lr.88.4.499","article-title":"The impact of erythema nodosum leprosum on health-related quality of life in Rio de Janeiro","volume":"88","author":"AM Sales","year":"2017","journal-title":"Leprosy Review"},{"issue":"4","key":"pntd.0014100.ref008","doi-asserted-by":"crossref","first-page":"488","DOI":"10.47276\/lr.88.4.488","article-title":"Health-Related Quality of Life amongst people affected by Erythema Nodosum Leprosum in Bangladesh: a Cross Sectional Study","volume":"88","author":"B Bowers","year":"2017","journal-title":"LEPROSY"},{"issue":"6","key":"pntd.0014100.ref009","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0010476","article-title":"Understanding leprosy reactions and the impact on the lives of people affected: An exploration in two leprosy endemic countries","volume":"16","author":"AI Putri","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pntd.0014100.ref010","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0003431","article-title":"Household costs of leprosy reactions (ENL) in rural India","volume":"9","author":"DJ Chandler","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014100.ref011","volume-title":"How to recognise and manage leprosy reactions. 62","year":"2002"},{"key":"pntd.0014100.ref012","author":"World Health Organization, Regional Office for South-East Asia","year":"2017"},{"issue":"2","key":"pntd.0014100.ref013","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0004149","article-title":"Comparison of Efficacy and Safety of Ciclosporin to Prednisolone in the Treatment of Erythema Nodosum Leprosum: Two Randomised, Double Blind, Controlled Pilot Studies in Ethiopia","volume":"10","author":"SM Lambert","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014100.ref014","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1489\/1544-581X(2004)72<480:MIRE>2.0.CO;2","article-title":"Methotrexate in Resistant ENL","volume":"72","author":"BR Kar","year":"2004","journal-title":"International Journal of Leprosy and Other Mycobacterial Diseases"},{"issue":"4","key":"pntd.0014100.ref015","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1111\/bjd.18233","article-title":"Apremilast in chronic recalcitrant erythema nodosum leprosum: a report of two cases","volume":"182","author":"T Narang","year":"2020","journal-title":"Br J Dermatol"},{"issue":"2","key":"pntd.0014100.ref016","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1590\/S0100-879X2007000200011","article-title":"Double-blind trial of the efficacy of pentoxifylline vs thalidomide for the treatment of type II reaction in leprosy","volume":"40","author":"AM Sales","year":"2007","journal-title":"Braz J Med Biol Res"},{"issue":"7","key":"pntd.0014100.ref017","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1056\/NEJMc052955","article-title":"Treatment of recurrent erythema nodosum leprosum with infliximab","volume":"355","author":"WR Faber","year":"2006","journal-title":"N Engl J Med"},{"key":"pntd.0014100.ref018","doi-asserted-by":"crossref","DOI":"10.47276\/lr.87.2.221","article-title":"The use of steroids and thalidomide in the management of erythema nodosum leprosum; 17 years at the Hospital for Tropical Diseases, London","volume":"87","author":"L Nabarro","year":"2016","journal-title":"Leprosy Review"},{"issue":"2","key":"pntd.0014100.ref019","doi-asserted-by":"crossref","first-page":"211","DOI":"10.47276\/lr.87.2.211","article-title":"Experiences with Thalidomide for Erythema Nodosum Leprosum\u2013 a retrospective study","volume":"87","author":"J Darlong","year":"2016","journal-title":"Lepr Rev"},{"issue":"3","key":"pntd.0014100.ref020","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0002690","article-title":"The mortality associated with erythema nodosum leprosum in Ethiopia: a retrospective hospital-based study","volume":"8","author":"SL Walker","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014100.ref021","doi-asserted-by":"crossref","first-page":"68","DOI":"10.47276\/lr.90.1.68","article-title":"Retrospective study of the morbidity associated with Erythema Nodosum Leprosum in Brazilian leprosy patients","author":"D Neves","year":"2019","journal-title":"Leprosy Review"},{"issue":"2","key":"pntd.0014100.ref022","doi-asserted-by":"crossref","first-page":"142","DOI":"10.47276\/lr.90.2.142","article-title":"A Systematic Review of Adverse Drug Reactions associated with Thalidomide in the treatment of Erythema Nodosum Leprosum","volume":"90","author":"M Mahmoud","year":"2019","journal-title":"LEPROSY"},{"key":"pntd.0014100.ref023","article-title":"Adverse events in patients with leprosy on treatment with thalidomide","volume":"52","author":"M Drummond PL de","year":"2019","journal-title":"Rev Soc Bras Med Trop"},{"key":"pntd.0014100.ref024","doi-asserted-by":"crossref","first-page":"396","DOI":"10.47276\/lr.83.4.396","article-title":"International workshop on erythema nodosum leprosum (ENL)--consensus report; the formation of ENLIST, the ENL international study group","author":"SL Walker","year":"2012","journal-title":"Leprosy review"},{"issue":"11","key":"pntd.0014100.ref025","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-037700","article-title":"Methotrexate and prednisolone study in erythema nodosum leprosum (MaPs in ENL) protocol: a double-blind randomised clinical trial","volume":"10","author":"B de Barros","year":"2020","journal-title":"BMJ Open"},{"issue":"7","key":"pntd.0014100.ref026","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0005716","article-title":"A leprosy clinical severity scale for erythema nodosum leprosum: An international, multicentre validation study of the ENLIST ENL Severity Scale","volume":"11","author":"SL Walker","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014100.ref027","doi-asserted-by":"crossref","DOI":"10.5888\/pcd10.120239","article-title":"Defining and measuring chronic conditions: imperatives for research, policy, program, and practice","volume":"10","author":"RA Goodman","year":"2013","journal-title":"Prev Chronic Dis"},{"issue":"2","key":"pntd.0014100.ref028","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1128\/CMR.19.2.338-381.2006","article-title":"The continuing challenges of leprosy","volume":"19","author":"DM Scollard","year":"2006","journal-title":"Clin Microbiol Rev"},{"issue":"2","key":"pntd.0014100.ref029","first-page":"80","article-title":"Leprosy reactions. New knowledge","volume":"46","author":"B Naafs","year":"1994","journal-title":"Trop Geogr Med"},{"issue":"1","key":"pntd.0014100.ref030","first-page":"97","article-title":"Current views on reactions in leprosy","volume":"72","author":"B Naafs","year":"2000","journal-title":"Indian J Lepr"},{"key":"pntd.0014100.ref031","first-page":"237","article-title":"Clinical leprosy.","volume-title":"Leprosy","author":"RE Pfalzgraff","year":"1994"},{"issue":"2","key":"pntd.0014100.ref032","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1489\/1544-581X(2004)072<0125:ECOLRY>2.0.CO;2","article-title":"Epidemiological characteristics of leprosy reactions: 15 years experience from north India","volume":"72","author":"B Kumar","year":"2004","journal-title":"Int J Lepr Other Mycobact Dis"},{"issue":"3","key":"pntd.0014100.ref033","doi-asserted-by":"crossref","first-page":"254","DOI":"10.47276\/lr.79.3.254","article-title":"Erythema nodosum leprosum in Nepal: a retrospective study of clinical features and response to treatment with prednisolone or thalidomide","volume":"79","author":"M Feuth","year":"2008","journal-title":"Lepr Rev"},{"key":"pntd.0014100.ref034","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1365-3156.2006.01561.x","article-title":"Treatment of leprosy: science or politics?","author":"B Naafs","year":"2006","journal-title":"Tropical Medicine and International Health"},{"key":"pntd.0014100.ref035","volume-title":"A lepra: estudos realizados em 40 paizes (1924-1927)","author":"HC de Souza-Araujo","year":"1929"},{"issue":"3","key":"pntd.0014100.ref036","first-page":"190","article-title":"Reactions in leprosy: an epidemiological study of 386 patients in west Nepal","volume":"65","author":"WH Van Brakel","year":"1994","journal-title":"Lepr Rev"},{"key":"pntd.0014100.ref037","first-page":"1013","article-title":"\u00dcber erythema nodosum leprosum","author":"M Murata","year":"1912","journal-title":"Japanese Journal of Dermato-Urology"},{"key":"pntd.0014100.ref038","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.jbusres.2019.07.039","article-title":"Literature review as a research methodology: An overview and guidelines","volume":"104","author":"H Snyder","year":"2019","journal-title":"J Bus Res"},{"key":"pntd.0014100.ref039","first-page":"298","article-title":"The Promin Treatment of Leprosy (1943 Reprint)","volume":"34","author":"GH Faget","year":"1966","journal-title":"International Journal of Leprosy and Other Mycobacterial Diseases"},{"issue":"2","key":"pntd.0014100.ref040","first-page":"137","article-title":"The effects of adrenocorticotropic hormone (ACTH) in lepromatous lepra reaction","volume":"19","author":"M Roche","year":"1951","journal-title":"Int J Lepr"},{"key":"pntd.0014100.ref041","volume-title":"Trait\u00e9 de la spedalskhed ou \u00e9l\u00e9phantiasis des Grecs","author":"DC Danielssen","year":"1848"},{"key":"pntd.0014100.ref042","volume-title":"Leprosy in its clinical & pathological aspects","author":"GA Hansen","year":"1895"},{"key":"pntd.0014100.ref043","article-title":"Letter to the Editor: on Murata\u2019s Early Description of Erythema Nodosum Leprosum, with Summary of Murata\u2019s Paper","volume":"29","author":"WH Jopling","year":"1958","journal-title":"Leprosy Review"},{"issue":"2","key":"pntd.0014100.ref044","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/S0035-9203(31)90038-2","article-title":"The treatment of leprosy","volume":"25","author":"E Muir","year":"1931","journal-title":"Transactions of the Royal Society of Tropical Medicine and Hygiene"},{"key":"pntd.0014100.ref045","volume-title":"Om Spedalskhed","author":"DC Danielsson","year":"1847"},{"key":"pntd.0014100.ref046","volume-title":"Leprosy: Survey made in fourty countries (1924-1927)","author":"HC de Souza-Araujo","year":"1929"},{"key":"pntd.0014100.ref047","volume-title":"Globalizing leprosy title: a transnational history of production and circulation of medical knowledge, 1850s-1930s","author":"M Vollset","year":"2013"},{"key":"pntd.0014100.ref048","first-page":"57","article-title":"Treatment of lepromatous erythema nodosum with chloramphenicol: comparison with thalidomide","author":"P Saint-Andre","year":"1981","journal-title":"Acta Leprologica"},{"issue":"7","key":"pntd.0014100.ref049","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1111\/ijd.14895","article-title":"Epidemiological profile and severity of erythema nodosum leprosum in Brazil: a cross-sectional study","volume":"59","author":"C Baima de Melo","year":"2020","journal-title":"Int J Dermatol"},{"issue":"1","key":"pntd.0014100.ref050","first-page":"29","article-title":"Comparative efficacy of four treatment regimens in Type 2 Leprosy Reactions (Prednisolone alone, Thalidomide alone, Prednisolone plus Thalidomide and Prednisolone plus Clofazimine)","volume":"88","author":"HK Kar","year":"2016","journal-title":"Indian J Lepr"},{"issue":"3","key":"pntd.0014100.ref051","doi-asserted-by":"crossref","first-page":"177","DOI":"10.4103\/ijp.ijp_946_21","article-title":"Thalidomide and steroid in the management of erythema nodosum leprosum","volume":"54","author":"SR P K Mishra","year":"2022","journal-title":"Indian J Pharmacol"},{"issue":"4","key":"pntd.0014100.ref052","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1592\/phco.23.4.481.32115","article-title":"Thalidomide for erythema nodosum leprosum and other applications","volume":"23","author":"MC Okafor","year":"2003","journal-title":"Pharmacotherapy"},{"issue":"2","key":"pntd.0014100.ref053","first-page":"135","article-title":"Results of a double blind study of the influence of thalidomide on the lepra reaction","volume":"37","author":"J Sheskin","year":"1969","journal-title":"Int J Lepr Other Mycobact Dis"},{"issue":"2","key":"pntd.0014100.ref054","doi-asserted-by":"crossref","first-page":"208","DOI":"10.47276\/lr.88.2.208","article-title":"A prospective randomised, double-blind, placebo controlled trial on the effect of extended clofazimine on Erythema Nodosum Leprosum (ENL) in multibacillary (MB) leprosy","volume":"88","author":"A Maghanoy","year":"2017","journal-title":"LEPROSY"},{"issue":"4","key":"pntd.0014100.ref055","first-page":"227","article-title":"Clinical observations on erythema nodosum leprosum (E.N.L.)","volume":"29","author":"IA Susman","year":"1958","journal-title":"Lepr Rev"},{"key":"pntd.0014100.ref056","first-page":"418","article-title":"Necrotizing reactions in lepromatous leprosy. a clinical and histologic study","volume":"31","author":"MF Waters","year":"1963","journal-title":"Int J Lepr"},{"issue":"3","key":"pntd.0014100.ref057","first-page":"181","article-title":"Anabolic steroid as an adjuvant in the treatment of chronic lepra reaction and ENL under corticosteroid therapy","volume":"48","author":"S Choudhury","year":"1977","journal-title":"Lepr Rev"},{"issue":"3","key":"pntd.0014100.ref058","first-page":"318","article-title":"ENL reactions in the multibacillary cases of the AMFES cohort in central Ethiopia: incidence and risk factors","volume":"71","author":"P Saunderson","year":"2000","journal-title":"Lepr Rev"},{"key":"pntd.0014100.ref059","article-title":"Conceito Atual de Rea\u00e7\u00e3o Leprotica","volume":"17","author":"L de Souza Lima","year":"1949","journal-title":"Revista Brasileira de Leprologia"},{"issue":"1","key":"pntd.0014100.ref060","first-page":"1","article-title":"The etiology of erythema nodosum leprosum","volume":"35","author":"JH Pettit","year":"1967","journal-title":"Int J Lepr Other Mycobact Dis"},{"key":"pntd.0014100.ref061","volume-title":"Leprosy in Theory and Practice","author":"RG Cochrane","year":"1966"},{"key":"pntd.0014100.ref062","volume-title":"Leprosy","author":"Dharmendra","year":"1978"},{"key":"pntd.0014100.ref063","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.smim.2018.06.003","article-title":"Correlates of immune exacerbations in leprosy","author":"A Geluk","year":"2018","journal-title":"Seminars in Immunology"},{"issue":"2","key":"pntd.0014100.ref064","doi-asserted-by":"crossref","first-page":"190","DOI":"10.25259\/IJDVL_143_20","article-title":"Increased serum levels of interleukin-6 in erythema nodosum leprosum suggest its use as a biomarker","volume":"87","author":"FR Vilani-Moreno","year":"2021","journal-title":"Indian J Dermatol Venereol Leprol"},{"issue":"1","key":"pntd.0014100.ref065","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/s40744-017-0089-8","article-title":"A Retrospective Analysis of Corticosteroid Utilization Before Initiation of Biologic DMARDs Among Patients with Rheumatoid Arthritis in the United States","volume":"5","author":"CA Spivey","year":"2018","journal-title":"Rheumatol Ther"},{"issue":"9","key":"pntd.0014100.ref066","doi-asserted-by":"crossref","DOI":"10.1093\/rheumatology\/keac260","article-title":"The 2022 British Society for Rheumatology guideline for the treatment of psoriatic arthritis with biologic and targeted synthetic DMARDs","volume":"61","author":"L Tucker","year":"2022","journal-title":"Rheumatology (Oxford)"},{"issue":"4","key":"pntd.0014100.ref067","doi-asserted-by":"crossref","first-page":"116","DOI":"10.5662\/wjm.v11.i4.116","article-title":"Delphi methodology in healthcare research: How to decide its appropriateness","volume":"11","author":"P Nasa","year":"2021","journal-title":"World J Methodol"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0014100","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014100","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T17:45:47Z","timestamp":1774892747000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014100"}},"subtitle":[],"editor":[{"given":"Elsio A","family":"Wunder","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,3,23]]},"references-count":67,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0014100","relation":{},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,23]]}}}