161982 20260430141010.0 doi 10.1016/j.cmi.2025.04.007 sideral 144625 ART-2025-144625 eng Pellejero-Sagastizábal, Galadriel Delayed correct diagnoses in emerging disease outbreaks: historical patterns and lessons for contemporary responses 2025 Access copy available to the general public Unrestricted Background The gap between early diagnostic assumptions and final diagnoses in disease outbreaks represents a persistent challenge in global health despite advancements in diagnostic and response capabilities. Objectives To analyse the unfolding 2025 outbreak in the Democratic Republic of Congo (DRC) through the lens of historical cases where initial misattributions contributed to delayed recognition of novel or unexpected threats with varying public health consequences; identifying patterns from past outbreaks that can inform current diagnostic approaches and response strategies. Sources We selected illustrative examples from peer-reviewed publications, focusing on cases with initial diagnostic uncertainties that highlight specific diagnostic patterns relevant to the current DRC outbreak. For the ongoing DRC outbreak, we analysed official World Health Organization Africa bulletins and communications from the DRC Ministry of Health through February and early March 2025. Content As of beginning of April 2025, health authorities continue investigating clusters of unexplained acute febrile illness in Équateur Province with clinical features that were initially being suggestive of a viral haemorrhagic fever. Primary viral haemorrhagic fever pathogens have now been excluded. From selected historical and recent outbreaks, it can be deduced that diagnostic challenges extend beyond individual cognition to include structural biases in global health systems, methodological limitations and sociocultural factors. Implications We identified five evidence-informed interventions to mitigate diagnostic delays: systematic consideration of multiple working hypotheses, development of sustainable local diagnostic capacity, enhancement of clinician-to-public-health communication networks, implementation of cognitive debiasing strategies, and strengthening of One Health surveillance platforms. Historical misdiagnoses offer crucial lessons for transforming outbreak response from reactive to anticipatory, potentially averting future epidemics through earlier, more accurate recognition of emerging pathogens within their complex ecological and social contexts. info:eu-repo/semantics/openAccess by https://creativecommons.org/licenses/by/4.0/deed.es info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Bulescu, Casandra Gupta, Nitin Jokelainen, Pikka Gkrania-Klotsas, Effrossyni Barac, Aleksandra Goorhuis, Abraham Jacob, Shevin T. Agnandji, Selidji T. Ntoumi, Francine Mora-Rillo, Marta Paño-Pardo, José Ramón Universidad de Zaragoza (orcid)0000-0002-9600-8116 Lescure, F.-Xavier Grobusch, Martin P. 1007 610 Universidad de Zaragoza Dpto. Medicina, Psiqu. y Derm. Area Medicina 31, 8 (2025), 1298-1306 Clin. microbiol. infect. Clinical Microbiology and Infection 1198-743X 359814 http://zaguan.unizar.es/record/161982/files/texto_completo.pdf Versión publicada 2791418 http://zaguan.unizar.es/record/161982/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:161982 articulos driver 2026-04-30-14:05:36 ARTICLE