Recent US policy decisions affecting domestic and global health funding have renewed debate on the United States' disproportionate influence over global health governance, institutions, and priorities. Although some scholars call for defending existing frameworks and others advocate reimagining global health beyond US-centric paradigms, these discussions often remain focused on immediate geopolitical developments. We place these debates in a broader historical context by examining Latin America, where US-led political and economic interventions interacted with domestic elites to shape health policy trajectories. Drawing on the traditions of Latin American social medicine and collective health, we analyze how global and national political-economic forces reshaped health systems in Chile and Brazil. Neoliberal reforms emerged through the convergence of international financial pressures, domestic elite coalitions, and policy diffusion. These reforms occurred through 3 interconnected processes: the depletion of public health capacity, the marketization and fragmentation of services, and the weakening of community-based care models. Latin America's experience demonstrates how neoliberal governance commodified health while also fostering enduring traditions of resistance and rights-based care, offering lessons for reimagining social medicine and global health today. (Am J Public Health. Published online ahead of print July 23, 2026:e1-e8. https://doi.org/10.2105/AJPH.2026.308564).
Decaprenylphosphoryl-β-d-ribose 2'-epimerase (DprE1) is a key flavoenzyme required for mycobacterial cell wall biosynthesis and represents an important molecular target for antitubercular drug discovery. In this study, a novel set of 1,4-dihydropyrimidinone derivatives was rationally designed and synthesized as potential DprE1 inhibitors. The target compounds (3a-3d and 4a-4 k) were prepared through a concise multistep synthetic route involving O-alkylation, Biginelli-type cyclocondensation, and S-alkylation, and were fully characterized by spectroscopic and analytical methods. Several derivatives exhibited promising in vitro antimycobacterial activity against Mycobacterium tuberculosis in the low-micromolar range. Enzymatic assays indicated DprE1 inhibitory activity, with compounds 3a-3d displaying IC50 values of 11.74-13.90 μM; compound 3d showed activity comparable to the reference inhibitor TCA-1. In addition, cytotoxicity evaluation against WI-38 human lung fibroblast cells suggested low cytotoxicity and favorable selectivity indices relative to whole-cell antimycobacterial activity, providing preliminary support for the safety profile of the synthesized compounds. Molecular docking, 100 ns molecular dynamics simulations, and MM-PBSA analysis provided supportive evidence for favorable accommodation within the catalytic site and favorable binding energetics. These findings suggest that the 1,4-dihydropyrimidinone scaffold represents a promising noncovalent framework for further structural optimization toward the development of novel DprE1-targeted antitubercular agents.
Continuous video is difficult to obtain during field studies of sprint sled dogs, limiting analysis of stride-to-stride variation during load-pulling gallop. We developed an acceleration-based pipeline to identify recurrent stride states from harness-mounted tri-axial accelerometers without manual gait labels. Using multivariate dynamic time warping, manifold embedding, and density-based clustering, we analyzed more than 20,000 strides from a 10-dog team and identified recurrent, dog-specific stride states. In one previously annotated individual, acceleration-derived states were broadly consistent with manually labeled gallop patterns. Across dogs, transitions between stride states were frequent, with substantial inter-individual variation and limited evidence of strong team-level coordination. A simple logistic model based on local tugline-force timing and magnitude had weak predictive power for transition events. These results suggest that sprint sled dog gallop occupies a variable set of nearby stride states and that local tugline-force fluctuations alone do not explain the observed switching.
Gestational Diabetes Mellitus (GDM) is one of the most prevalent medical and metabolic disorders which may lead to high-risk pregnancy. As per recommendation from the American Diabetes Association approximately 30 min of physical exercise on most of the days can improve glycemic control among women with GDM. This study has evaluated the efficacy of resistance and aerobic exercises to maintain optimal glycemic control and improve maternal outcomes among gestational diabetic mothers. A quasi-experimental study was conducted among 132 study participants with GDM, as diagnosed by obstetricians and met the inclusion criteria. Participants were selected through purposive sampling and subsequently assigned to groups using random allocation. The biochemical parameters of the study participants were analyzed in the hospital laboratory. In the intervention group was exposed to training in aerobic and resistance exercises in addition to the standard hospital care. The study findings revealed that the FBS, PPBS and HbA1c level were significantly lower in the intervention group compared to the control group (p < 0.05). Eta square results showed exercise have a moderate effect on glycemic parameters. There was a significant difference in the maternal outcomes such as Preeclampsia and operative inference (p < 0.05). The relative risk (RR) of developing preeclampsia in the intervention group was found to be RR <1, whereas in the control group the relative risk was greater than 1. But all the maternal outcomes were non-significant (P > 0.05). Aerobic and resistance exercises were effective among women with GDM to maintain optimal glycemic control and improving maternal outcomes.
Corrosion resistance and self-healing capabilities of epoxy coatings that have been enhanced with cellulose nanofiber (CNF)-loaded ammonium molybdate (NH4)2MoO4 and applied to mild steel substrates were investigated in this work. Additive concentrations 1, 2.5, and 5 wt% were added to the coating system to investigate the electrochemical behavior and healing efficiency in a 3.5% NaCl environment at room temperature. Electrochemical measurements, including open circuit potential (OCP), electrochemical impedance spectroscopy (EIS), and potentiodynamic polarization, revealed that increasing additive concentration resulted in a significant improvement in corrosion resistance. The results showed a considerable decrease in corrosion current density and corrosion rate, as well as an increase in polarization resistance, with the 5% addition sample having the greatest value. Anodic and cathodic processes were both reduced by the inhibitor-modified coatings' mixed inhibitory behavior. The electrochemical results were validated by optical microscope analysis, which showed decreased corrosion damage and the development of a compact protective layer at scratched locations, especially in samples containing 2.5% and 5% additive. With the 5% addition system, the self-healing efficiency rose to 97.80% from 91.92% for the clean epoxy coating. The findings show that the CNF-molybdate system controls inhibitor release and creates a protective barrier in situ, greatly increasing corrosion resistance and durability in harsh settings, making it a good self-healing coating.
Objectives. To assess racial and territorial inequalities in food insecurity at the municipal level in Rio de Janeiro, Brazil, examining whether disparities persist across income strata and territories. Methods. We performed a population-based cross-sectional analysis of the first Municipal Food Insecurity Survey (2024), with a sample of 2000 households across 5 zones. Moderate to severe food insecurity (MS-FI) was measured using the Brazilian Food Insecurity Scale. Relative risk ratios (RRRs) were estimated using multinomial logistic regression with complex survey design, adjusting for per capita income. Results. Households headed by Black individuals showed lower education, higher informal employment, lower income, and greater residence in slums and lower-development zones. MS-FI affected 22.9% of households headed by Black women versus 9.4% of those headed by White women. Among households earning one quarter or less of the minimum wage, MS-FI reached 57.7% in homes headed by Black individuals versus 29.8% in homes headed by White individuals. Disparities persisted at higher income levels. Adjusted RRRs remained elevated for households headed by Black individuals, particularly in the North (RRR = 2.83) and West (RRR = 2.68) zones. Conclusions. In Rio de Janeiro, MS-FI reflects structural racial and territorial inequalities beyond poverty alone. (Am J Public Health. Published online ahead of print July 23, 2026:e1-e10. https://doi.org/10.2105/AJPH.2026.308566).
The TRPV1 channel is activated by noxious heat and capsaicin and is expressed in primary nociceptive fibers, where it plays a key role in pain perception and inflammation. Although vanilloid compounds can induce topical analgesia, their systemic use is limited by thermoregulatory side effects. Zoledronic acid (ZOL), a bisphosphonate widely used to treat bone disorders and cancer-associated bone loss, has reported analgesic properties, although its effects on TRPV1 remain incompletely understood. To determine whether ZOL modulates TRPV1 channel function and to elucidate the mechanism underlying its analgesic effects. We combined behavioral assays of thermal nociception in mice and Drosophila melanogaster, Ca2+ imaging in primary dorsal root ganglion neurons, electrophysiological recordings from TRPV1 expressed in Xenopus laevis oocytes, and acute hippocampal slice recordings to assess TRPV1-dependent synaptic plasticity. Systemic ZOL administration significantly reduced thermal nociceptive behaviors in both models without affecting locomotion or core temperature. In vitro, ZOL decreased capsaicin-evoked Ca2+ responses in dorsal root ganglion neurons and markedly reduced TRPV1-mediated currents in excised membrane patches from oocytes. In hippocampal slices, ZOL prevented TRPV1-dependent synaptic depression without altering basal transmission. Loss of inhibition under asymmetric ionic strength conditions suggests a pore-blocking mechanism. Our findings identify a previously unrecognized pore-blocking mechanism by which zoledronic acid inhibits TRPV1 channel activity, providing a mechanistic explanation for its analgesic effects. These results support a potential role for bisphosphonates as scaffolds for the development of novel analgesics and as tools to probe TRPV1-mediated pain pathways.
The delayed effects of radiation exposure on the heart often manifest as cardiac fibrosis and diastolic dysfunction, which can develop years after exposure. However, no Food and Drug Administration-approved serological biomarker is available to assess an individual's risk of developing radiation-related heart disease (RRHD). The authors hypothesize that the risk of RRHD can be assessed using serum pro-N-cadherin (PNC), a promising marker for predicting subclinical heart failure in the general population. We examined 46 male nonhuman primates (NHPs) that survived total-body irradiation and 10 unirradiated controls. NHPs exhibited cardiac fibrosis scores ranging from less severe (F0-1) to more severe (F2-3). Cardiac tissue samples collected at necropsy, with a median of 6.8 years post-irradiation, were stained for PNC by immunohistochemistry. PNC was quantified in longitudinal serum samples collected 2, 1, and 0 years before necropsy. The associations of serum PNC levels with cardiac fibrosis scores and echocardiographic parameters were examined. Histological examinations showed aberrant localization of PNC in NHPs with cardiac fibrosis. Elevated serum PNC levels were associated with severe cardiac fibrosis (F2-3) (area under the curve = 0.81, P = 0.006) and echocardiogram parameters of diastolic dysfunction, including lateral e' and lateral E/e' (P < 0.05). Cardiac fibrosis was associated with the greatest elevation in serum PNC among measured comorbidities. Our findings from this radiation late effects cohort of NHPs reveal a strong association between elevated serum PNC and cardiac injury. These findings pave the way for future clinical studies to develop serum PNC as a biomarker of RRHD in humans.
The co-evolution of land-use carbon emissions and fine particulate matter (PM2.5) pollution is increasingly used to inform differentiated regional governance, yet its temporal asynchrony, spatial clustering, and causal pathways remain insufficiently quantified. This study develops a multi-stage framework to diagnose carbon-pollution synergy across 113 district-county units in the Fenwei Plain, China, from 2013 to 2023. A process-sensitive synergistic evolution index (SEI) is constructed by integrating dynamic time warping (DTW) and a coupling coordination degree (CCD) metric to capture lag-aware co-movement and coordination. The results reveal pronounced spatial polarization in synergy performance, with significant global and local clustering patterns. Bayesian network analysis further identifies heterogeneous pathways and highlights the mediating role of urban expansion in linking ecological and anthropogenic drivers to synergy outcomes. Density-based clustering delineates four governance zones with distinct stability and enhancement potential, providing an empirical basis for spatially tailored carbon-pollution mitigation strategies.
Recently, the development of magnetic nanoparticles coated with covalent organic frameworks (MNPs@COFs) has received substantial attention from researchers. Herein, we introduced a straightforward route for the construction of MNPs@COF containing trifluoroacetate (MNPs@COF-TFA), which acts as a heterogeneous catalyst. The synthesized catalyst was characterized using several methods such as Fourier-transform infrared (FT-IR) spectroscopy, field emission scanning electron microscopy (FE-SEM), energy-dispersive X-ray spectroscopy (EDS), elemental mapping analysis, transmission electron microscopy (TEM), X-ray diffraction analysis (XRD), thermogravimetric analysis/derivative thermogravimetry analysis (TGA/DTG), N2 adsorption-desorption analysis and vibrating-sample magnetometry (VSM). Conjunction of the potential application of Fe3O4 and hydrazone-linked COF decorated by trifluoroacetic acid (TFA) propels MNPs@COF-TFA as a robust, stable, recoverable and highly active catalyst for the Doebner reaction. This research underscores the high catalytic activity, easy recovery and reusability of MNPs@COF-TFA, with short reaction times and high yields of target molecules.
Respiratory distress (RD) in newborns is a major cause of neonatal morbidity and mortality. Evaluating fetal lung maturity before labor is therefore essential, particularly in high-risk pregnancies where early termination may be considered. A key clinical challenge is identifying fetuses at risk for respiratory distress syndrome (RDS) to optimize the timing of delivery. This prospective study included pregnant women between 28 and 40 weeks of gestation. Doppler ultrasound was performed within 72 hours of delivery, assessing the fetal main pulmonary artery (MPA) parameters including resistance index (RI), pulsatility index (PI), and the acceleration-to-ejection time (At/Et) ratio. Scans were conducted using advanced ultrasound systems equipped with modern obstetric and fetal echocardiography software. After birth, neonates were evaluated for RD based on birth weight, APGAR score, clinical signs (such as tachypnea, chest retractions, grunting, and wheezing), and need for neonatal intensive care unit (NICU) admission. The At/Et ratio of the fetal pulmonary artery showed significant predictive value for the occurrence of neonatal RDS. Among the Doppler indices assessed, the At/Et ratio demonstrated the highest sensitivity and specificity in predicting fetal lung maturity and the risk of neonatal respiratory distress. The At/Et ratio measured in the fetal pulmonary artery is a promising non-invasive marker for assessing fetal lung maturity and predicting the development of neonatal RDS. Larger studies are warranted to validate its clinical utility and potential as an alternative to amniocentesis in the prevention of neonatal RDS.
While survival outcomes in multiple myeloma (MM) have improved with contemporary combination therapies, predicting disease trajectories for individual patients at diagnosis remains a significant challenge. We investigate the prognostic value of a noninvasive biomarker-cell-free DNA (cfDNA)‑derived 5-hydroxymethylcytosine (5hmC) signature-in newly diagnosed MM, aiming to improve risk stratification at diagnosis. In this prospective cohort study, 321 patients with newly diagnosed MM were enrolled between 2010 and 2017, with follow-up through 2022. We profiled genome-wide 5hmC modifications (gene bodies) in cfDNA collected at diagnosis. We applied elastic net regularization to a Cox proportional hazards model to identify 5hmC signatures associated with overall survival (OS) and progression-free survival (PFS). A weighted prognostic score (wp-score), based on 18 key 5hmC-modified genes, was developed through machine learning and validated in the validation set, controlling for clinical prognostic factors. During a median follow-up of 70.5 months, 127 deaths occurred. The cfDNA 5hmC at diagnosis reflected the 5hmC in bone marrow‑derived tumor cells and differed across clinical subgroups. The wp-score showed strong prognostic ability for OS (hazard ratio [HR], 2.9 [95% CI, 1.7 to 4.9]; P < .0001) and PFS (HR, 1.8 [95% CI, 1.3 to 2.5] P = .00014) in the validation set, controlling for known prognostic factors, including stage, lactate dehydrogenase levels, and treatment type. The wp-score calculated at diagnosis remained associated with OS and PFS at 24-, 48-, and 72-month follow-up periods. This prospective study suggests that cfDNA-derived 5hmC signatures at diagnosis provide independent prognostic information for OS and PFS in MM. These findings support further investigation and independent validation of noninvasive epigenomic biomarkers within contemporary MM risk stratification frameworks.
Fat stigma is a qualitative health research problem because fat bodies encounter persistent moral surveillance in daily life. In response, many fat people present a socially acceptable 'front' to clinicians and researchers. Existing qualitative approaches are therefore somewhat limited to capturing frontstage performances rather than participants' more personal 'backstage' reflections. In response, this methodological paper introduces transformational dramaturgical longitudinalism (TDL), a novel qualitative methodology synthesising Goffman's dramaturgical theory with longitudinal, participant-led design. Comprising a three-stage design, involving two interview cycles and asynchronous written correspondence, TDL was developed via an 18-month study with eight self-identified fat women. This development advances qualitative health research via participant-led pacing and narrative sovereignty; emotional and structural reflexivity as methodological resources; Goffman's dramaturgical architecture operationalised as a design principle not analytic vocabulary; and ongoing consent and narrative revision rights as core ethical architecture. Scope conditions support transferability of TDL to future research projects involving stigma.
While neonates may suffer from alloimmune or secondary autoimmune diseases caused by placental transfer of maternal antibodies, primary neonatal autoimmune disease is extremely rare. We present a newborn girl with fetal-onset autoimmune disease, featuring prenatal hydrothorax, progressive Coombs-positive autoimmune hemolytic anemia, and autoimmune thrombocytopenia secondary to autoantibodies against glycoprotein IIb/IIIa, which were not present in the mother. Red blood cells and platelets were repeatedly transfused during the first 5 weeks after birth. At 6 months of life, the infant displayed elevated liver enzymes and vitamin K deficiency coagulopathy due to giant cell hepatitis. There was a partial response to systemic steroids, intravenous immunoglobulins, and anti-CD20 antibodies. Complete genome analysis failed to detect a genetic cause. This rare case indicates that infantile Evans syndrome can already evolve during fetal development.
The development of efficient optical probes for the detection of biologically and environmentally important metal ions remains a significant research challenge. Herein, we report a Schiff base-derived colorimetric probe, (E)-2-((2-hydroxy-3-methoxybenzylidene)amino)benzamide (P), for the selective detection of Cu2+ and Fe3+ ions in a DMSO-H2O (1:9, v/v) medium. Probe P exhibits distinct colorimetric responses toward the target ions, accompanied by the appearance of new absorption bands at 409 nm for Cu2+ and 690 nm for Fe3+, enabling naked-eye discrimination. The sensing response arises from coordination-induced electronic redistribution within the probe framework. The probe displays high sensitivity, with detection limits of 0.83 μM for Cu2+ and 0.62 μM for Fe3+. A 1:1 binding stoichiometry was supported by Job's plot and ESI-MS analyses, while FTIR studies provided additional evidence for the proposed binding mode. Furthermore, density functional theory (DFT) calculations provided insight into the electronic features of the resulting complexes. The practical utility of the probe was demonstrated through the determination of Cu2+ and Fe3+ ions in water samples with satisfactory recoveries. In addition, the probe was employed to construct molecular logic operations, including INHIBIT and YES gates. These results highlight probe P as a simple, sensitive, and effective platform for dual-ion sensing and molecular logic applications.
Acute coronary syndrome complicated by cardiogenic shock (ACS-CS) remains associated with high mortality despite advances in percutaneous coronary intervention (PCI) and increasing attention to mechanical circulatory support (MCS). This study aimed to evaluate temporal trends in patient risk profiles, treatment strategies, and in-hospital outcomes among patients undergoing PCI for ACS-CS. From 2009 to 2019, 24,527 consecutive PCI procedures were recorded in the Keio Interhospital Cardiovascular Studies-PCI registry, including 870 cases (3.5%) with ACS-CS. Patients were categorized into 4 time periods (T1: 2009-2011; T2: 2012-2013; T3: 2014-2016; T4: 2017-2019). Temporal changes in risk profiles were evaluated using National Cardiovascular Data Registry Catheterization PCI mortality and bleeding risk scores. Trends in MCS use, in-hospital mortality, and post-PCI complications were analyzed. Predicted in-hospital mortality and bleeding risk remained stable over time, at approximately 20% (P for trend = 0.053) and 40% (P for trend = 0.39), respectively. Overall MCS use declined from 66.5% in T1 to 56.7% in T4, primarily due to reduced intra-aortic balloon pump use (46.5% to 31.2%). Despite these changes in management, crude and National Cardiovascular Data Registry risk-adjusted in-hospital mortality remained persistently high at approximately 30% throughout the study period. Among patients with ACS-CS selected for PCI in a multicenter Japanese registry, management strategies changed substantially over the past decade, particularly regarding MCS utilization. However, no significant temporal improvement in in-hospital mortality was observed, underscoring the persistent clinical challenges of this high-risk PCI-treated population.
Survivors of suicide loss (SLSs) represent a unique group that faces a heightened risk of developing complications related to grief, often characterized by ruminating on the reasons behind their loved one's suicide, which can affect their supportive social networks. Grief rumination is considered a transdiagnostic risk factor for mental health diseases, including prolonged grief. We evaluated the psychometric and reliability of the Iranian Utrecht Grief Rumination Scale (UGRS) among SLSs. This cross-sectional study, conducted between 2023 and 2024, investigated the psychometric properties of the Persian version of the UGRS. The scale was adapted for the Iranian population through a rigorous translation process encompassing forward translation, reconciliation, and back-translation. A sample of 170 suicide survivors, recruited via convenience and snowball sampling, completed a battery of instruments, including the UGRS, the Prolonged Grief Disorder scale - 13 (PG-13-R), the Hospital Anxiety and Depression Scale (HADS), and the Ruminative Response Scale (RRS). Confirmatory factor analysis (CFA), alongside assessments of concurrent, convergent, and divergent validity, was employed to evaluate the construct validity of the UGRS. Reliability was assessed using Cronbach's alpha and test-retest reliability over a 4-week interval. Data analysis was performed utilizing SPSS 26 (IBM, USA), Amos 26 (IBM, USA), and Mplus 8.3 (Muthén & Muthén, USA. The results of CFA showed that the second-order five-factor hierarchy had more appropriate fit indices than the five correlated factors in suicide survivors (ΔCFI = -0.014, ΔTLI = -0.021, ΔRMSEA = -0.012; ΔSRMR = -0.014). UGRS exhibited a moderate correlation with brooding, indicating a convergent validity, and an HTMT index of less than. 090 in all subscales, indicating its divergent validity. UGRS exhibited a positive correlation with prolonged grief and anxiety and depression, which confirms its concurrent validity. Internal consistency was supported by Cronbach's alpha and McDonald's omega for all subscales; test-retest reliability was also acceptable (ICC = 0.85). The Persian UGRS exhibited good psychometric properties, validating its application to assess grief rumination among suicide-loss survivors in both clinical and research contexts.
Coronary artery bypass grafting (CABG) is one of the most effective treatments for coronary artery disease (CAD). However, its long-term success largely depends on patients' adherence to treatment and engagement in self-care behaviors. Patient-centered self-management programs can enhance health behaviors and improve these outcomes. This study aims to evaluate the effectiveness of the 5A self-management model on treatment adherence and self-care among patients undergoing CABG. This randomized clinical trial will be conducted on 60 patients undergoing CABG at a specialized cardiac hospital in Isfahan, Iran. Eligible participants will be randomly assigned to two intervention (n = 30) and control (n = 30) groups. The intervention group will receive a self-management program based on the 5A model, which includes the stages of assess, advise, agree, assist, and arrange. The control group will receive routine care. Data will be collected at three stages before, immediately, and 2 months after the intervention using the Modanloo treatment adherence questionnaire and self-care questionnaire for patients undergoing CABG. Data analysis will be performed with SPSS version 26, using descriptive statistics, Chi-square test, independent and paired t-tests, and repeated-measures ANOVA. This study will examine the effect of the 5A self-management model on treatment adherence and self-care in CABG patients. The main strength of the study lies in its use of an evidence-based framework. However, its short-term follow-up, single-center design, and reliance on self-reported data represent key limitations. Findings may contribute to the development of policies aimed at improving cardiac patient care, strengthening self-management programs within healthcare systems, and providing an evidence-based framework for designing similar interventions in other patient populations.
Buffalo milk is favoured by consumers due to its higher nutritional components, as well as its rich and mellow flavour. However, research on the molecular mechanisms underlying the formation of lactation traits in buffalo remains limited. In this study, we systematically investigated the regulatory effects of estrogen receptor alpha (ESR1) on lactation-related functions in buffalo mammary epithelial cells (BMECs) using overexpression and small interfering RNA (siRNA)-mediated silencing strategies. Our results demonstrated that ESR1 knockdown via siRNA significantly suppressed BMEC viability and proliferation and downregulated the expression of genes associated with lipid transport and secretion (PPARG, LPL, PLIN2, VLDLR, ADFP, CD36), milk protein synthesis (CSN1S1, CSN1S2, RPS6, RHEB, EIF4E, AKT1), and cell proliferation (STAT5A, MTOR, ELF5, CCND1, EGF, IGF1). Concurrently, silencing ESR1 markedly upregulated pro-apoptotic genes (BAX, CASP9) and downregulated the anti-apoptotic gene BCL2. Conversely, ESR1 overexpression exerted opposite effects on BMECs, further validating the critical role of ESR1 in modulating BMEC proliferation and milk component synthesis. In conclusion, ESR1 expression enhances buffalo lactation traits by promoting milk fat and milk protein synthesis, stimulating BMEC proliferation, and inhibiting cellular apoptosis. These findings provide novel insights into the molecular mechanisms governing buffalo lactation and offer valuable references for the development and utilization of lactation-related genetic resources in buffalo breeding.
Rickettsioses are zoonotic infections caused by obligate intracellular gram-negative bacteria of the genus Rickettsia. Although they commonly present as an acute febrile illness with rash, central nervous system involvement is uncommon and may be associated with severe morbidity and mortality. A previously healthy 28-year-old man presented with fever and acute gastrointestinal symptoms followed by the development of a centrifugal macular rash involving the trunk, extremities, palms, and soles. He subsequently developed progressive somnolence and language disturbances, progressing to severe neurological impairment requiring mechanical ventilation. Laboratory studies revealed thrombocytopenia, acute kidney injury, hyponatremia, and hepatic dysfunction. Brain computed tomography (CT) demonstrated subtle loss of gray-white matter differentiation and mild sulcal effacement, findings suggestive of diffuse cerebral edema. Cerebrospinal fluid analysis, blood cultures, and multiplex polymerase chain reaction (PCR) testing for common bacterial, viral, and fungal pathogens were unrevealing. Further examination identified an inoculation eschar on the left lower extremity. Conventional serum PCR testing was positive for Rickettsia spp., supporting the diagnosis of rickettsial meningoencephalitis, although species-level identification was not available. Intravenous doxycycline was initiated in addition to empiric antimicrobial therapy; however, the patient developed progressive multiorgan failure and failed to demonstrate meaningful neurological recovery. This case highlights the importance of considering rickettsiosis in the differential diagnosis of meningoencephalitis in endemic regions, particularly when fever, rash, and neurological manifestations coexist. Early recognition and prompt initiation of doxycycline remain essential to reduce the risk of severe neurological complications and poor clinical outcomes.