Oxyurid nematodes of pet rodents in Slovakia - a neglected zoonotic threat / Nematódeos oxiurídeos de roedores de estimação na Eslováquia - uma ameaça zoonótica negligenciada

Abstract The role of rodents as reservoirs of helminths of public health importance is not well known. The zoonotic potential of Syphacia spp. has been confirmed; therefore, the study aimed to estimate the occurrence of oxyurid nematodes in small rodents from pet shops and breeding clubs in Slovakia. Fecal samples of 586 pet rodents kept in 133 cages were collected between 2016 and 2018 and examined by Faust´s flotation method. Four species of oxyurid nematodes, Syphacia muris, S. obvelata, Aspiculuris tetraptera and Paraspidodera uncinata were detected. A. tetraptera was found in the faecal samples of all rodent species included in this survey. The number of positive boxes varied from 5.4% in hamsters to 70.0% with mice. The prevalence of Syphacia muris was highest in Mongolian gerbils where up to 75.0% boxes were positive; S. obvelata was found in 26.7% of boxes with mice, 25.0% of boxes with Mongolian gerbils and 3.2% of boxes with rats. The high prevalence of Syphacia spp. in all animal species points out the infection risk for humans. Animals offered for sale are often in close contact with human beings; therefore they should be regularly tested for parasites and then effectively dewormed.

Resumo O papel dos roedores como reservatórios de helmintos de importância para a saúde pública não é bem conhecido. O potencial zoonótico de Syphacia spp. foi confirmado; portanto, o estudo teve como objetivo estimar a ocorrência de nematóides oxiurídeos em pequenos roedores de pet shops e clubes de reprodução na Eslováquia. Amostras fecais de 586 roedores mantidos em 133 gaiolas foram coletadas entre 2016 e 2018 e examinadas pelo método de flotação de Faust. Foram detectadas quatro espécies de nematódeos oxiurídeos, Syphacia muris, S. obvelata, Aspiculuris tetraptera e Paraspidodera uncinata, A. tetraptera foi encontrado nas amostras fecais de todas as espécies de roedores incluídas nesta pesquisa. O número de gaiolas positivas variou de 5,4% em hamsters a 70,0% em camundongos. A prevalência de Syphacia muris foi maior nos gerbilos da Mongólia, onde até 75,0% das gaiolas foram positivas; S. obvelata foi encontrada em 26,7% das gaiolas com camundongos, 25,0% das gaiolas com gerbilos da Mongólia e 3,2% das gaiolas com ratos. A alta prevalência de Syphacia spp. em todas as espécies animais aponta o risco de infecção para os seres humanos. Animais oferecidos para venda estão frequentemente em contato próximo com seres humanos; portanto, eles devem ser regularmente testados quanto a parasitas e, então, efetivamente desparasitados.

Coprevalência de hanseníase em contatos com idade entre 5 e 15 anos no nordeste brasileiro / Coprevalencia de hanseniasis en contactos con edad entre 5 y 15 años en el nordeste brasileño / Hanseniasis coprevalence in contacts with age between 5 and 15 years in the northeast of brazil

Objetivo avaliar a coprevalência da hanseníase em contatos com idade compreendida entre 5 e 15 anos. Método estudo descritivo, com abordagem quantitativa, realizado no período de novembro de 2014 a julho de 2015. A população do estudo foi composta por contatos intradomiciliares e peridomiciliares de pessoas atingidas pela hanseníase, que estivessem na faixa etária de 5 a 15 anos. A amostra estudada foi constituída de 73 contatos. Resultados do total de avaliados, 30 (41,0%) foram intradomiciliares e 43 (59,0%), peridomiciliares. Entre os contatos, 27 (37,0%) foram considerados sintomáticos dermatológicos; destes, 17 (23,3%) suspeitos para hanseníase por apresentarem de uma a oito lesões, sendo a maioria mancha hipocrômica (82,3%). Conclusão entre os contatos examinados neste estudo, com idades compreendidas entre 5 e 15 anos, a coprevalência da hanseníase não foi diagnosticada, mas o número de contatos classificados como suspeitos foi elevado, o que se torna preocupante do ponto de vista epidemiológico.

Objetivo evaluar la coprevalencia de la lepra en contactos con edad comprendida entre 5 y 15 años. Método estudio descriptivo, con abordaje cuantitativo, de noviembre de 2014 a julio de 2015. Población del estudio compuesta por contactos intradomiciliares y peridomiciliares de personas afectadas por la lepra, que estuvieran en el grupo de edad de 5 a 15 años. Muestra estudiada de 73 contactos. Resultados del total de evaluados, 30 (41,0%) fueron intradomiciliares y 43 (59,0%), peridomiciliares. Entre los contactos, 27 (37,0%) fueron considerados sintomáticos dermatológicos; de estos, 17 (23,3%) sospechosos de lepra por presentar de una a ocho lesiones, siendo la mayoría mancha hipocrómica (82,3%). Conclusión entre los contactos examinados en este estudio, con edades entre 5 y 15 años, la coprevalencia de la lepra no fue diagnosticada, pero el número de contactos clasificados como sospechosos fue elevado, lo que se vuelve preocupante desde el punto de vista epidemiológico.

Objective to evaluate the co-prevalence of leprosy in contacts between the ages of 5 and 15 years. Method this is a descriptive study, with a quantitative approach, carried out from November 2014 to July 2015. The study population was composed of intradomiciliary and peridomiciliary contacts of people affected by leprosy who were in the age range of 5 to 15 years. The sample consisted of 73 contacts. Results of the total of evaluated, 30 (41.0%) were intradomiciliary and 43 (59.0%), peridomiciliary. Among the contacts, 27 (37.0%) were considered dermatological symptomatic; Of these, 17 (23.3%) suspected leprosy patients had one to eight lesions, most of them hypochromic spots (82,3%). Conclusion among the contacts examined in this study, aged between 5 and 15 years, the co-prevalence of leprosy was not diagnosed, but the number of contacts classified as suspects was high, which is worrisome from the epidemiological point of view.

Cromoblastomicosis: características clínicas y microbiológicas de una enfermedad desatendida / Chromoblastomycosis: clinical and microbiological characteristics of a neglected disease

Resumen La cromoblastomicosis es una enfermedad fúngica desatendida de curso crónico, que infecta por inoculación al tejido subcutáneo de personas con riesgo ocupacional. Comunicamos dos casos de adultos procedentes de regiones tropicales del norte del Perú, afectados con lesiones crónicas eritemato-escamosas y puntos negros múltiples, con dolor, prurito y cicatrización en áreas más antiguas de la lesión. El diagnóstico se realizó con el examen directo de escamas dérmicas con presencias de células fumagoides típicas y el aislamiento de hongos dematiáceos Fonsecaea pedrosoi y Fonsecaea sp., en el primer y segundo caso; respectivamente. Los pacientes recibieron tratamiento antifúngico con itraconazol, sin poder observar el resultado final debido al abandono del tratamiento y control médico.

Chromoblastomycosis is a neglected and chronic fungal disease, mainly affects the subcutaneous tissue in limbs of people with occupational risk. Here, we report two cases of adult patients from tropical regions of northern Peru, affected with chronic erythematous scaly lesions and multiple blackheads, pain, itching and scarring in older areas of injury. Direct examination of the dermal scales showed typical of this disease fumagoides cells; Fonsecaea pedrosoi and Fonsecaea sp. were isolated for at first and second case respectively. Patients received antifungal treatment with itraconazole; however, in both cases the final outcome was not observed due to treatment abandonment and medical care.

Lepromatous leprosy simulating rheumatoid arthritis - Report of a neglected disease

Abstract Brazil has the second largest number of leprosy cases in the world; nevertheless, late diagnosis is common. We report the case of a male patient with pain and numbness in both hands and feet for six years with positive rheumatoid factor and anticardiolipin under rheumatoid arthritis treatment for five years. Examination revealed diffuse cutaneous infiltration and leonine facies, characteristic features of lepromatous leprosy. Autoantibodies such as rheumatoid factor and anticardiolipin are markers of rheumatic autoimmune diseases, but their presence is also described in leprosy. We report the present case in order to alert health professionals to remember leprosy, even in areas where the disease is considered eliminated as a public health problem, avoiding misinterpretations of serologic findings and misdiagnosis.

Ebola virus – from neglected threat to global emergency state / Vírus ébola – de ameaça negligenciada ao estado de emergência global

SUMMARY Objective: This review aims to update knowledge about Ebola virus disease (EVD) and recent advances in its diagnosis, treatment and prevention. Method: A literature review was performed using the following databases: ISI Web of Knowledge, PubMed, IRIS, Scopus and the websites of the CDC and the WHO. Additionally, we have included articles and reports referenced in the basic literature search, and news that were considered relevant. Results: The Ebola virus, endemic in some parts of Africa, is responsible for a severe form of hemorrhagic fever in humans; bats are probably its natural reservoir. It is an extremely virulent virus and easily transmitted by bodily fluids. EVD's complex pathophysiology, characterized by immunosuppression as well as stimulation of an intense inflammatory response, results in a syndrome similar to septic shock. The diagnosis is difficult due to the initial symptoms that mimic other diseases. Despite the high mortality rates that can amount to 90%, a prophylaxis (chemical or vaccine) or effective treatment does not exist. Two vaccines and experimental therapies are being developed for the prevention and treatment of EVD. Conclusion: Although the virus is known for about 40 years, the lack of knowledge obtained and the disinterest of government authorities in the countries involved justify the state of emergency currently exists regarding this infectious agent. Only the coordination of multiple entities and the effective commitment of the international community will facilitate the control and effective prevention of EVD.

RESUMO Objetivo: esta revisão tem como objetivo atualizar os conhecimentos sobre a doença do vírus ébola (DVE) e sobre os recentes avanços nos métodos de diagnóstico, tratamento e prevenção. Método: foi realizada uma revisão de literatura, utilizando as seguintes bases de dados: ISI Web of Knowledge, PubMed, IRIS, Scopus e os sites do Centers for Disease Control and Prevention (CDC) e da Organização Mundial da Saúde (OMS). Adicionalmente, foram incluídos artigos e relatórios referenciados na pesquisa bibliográfica de base e notícias consideradas relevantes. Resultados: o vírus ébola, endêmico de algumas regiões da África, é responsável por uma forma grave de febre hemorrágica no homem, e os morcegos são provavelmente o seu reservatório natural. É um vírus extremamente virulento e de fácil transmissão pelos fluidos corporais. A complexa fisiopatologia da doença, caracterizada pela imunossupressão e pelo estímulo a uma intensa resposta inflamatória, resulta em uma síndrome semelhante ao choque séptico. O seu diagnóstico é difícil, por causa da sintomatologia inicial, que mimetiza outras doenças. Apesar das altas taxas de mortalidade, que podem alcançar os 90%, não existe profilaxia (química ou vacinal) ou tratamento eficaz. Encontram-se em desenvolvimento duas vacinas e terapias experimentais para a prevenção e o tratamento da DVE. Conclusão: apesar de ser um vírus conhecido há cerca de 40 anos, o escasso conhecimento obtido e o desinteresse das entidades governamentais de países envolvidos justificam o estado de emergência que se vive atualmente em relação a esse agente infeccioso. A coordenação por múltiplas entidades e o empenho efetivo da comunidade internacional facilitarão o seu controle e a prevenção eficaz.

Hepatotoxicity by herbs: a practical review of a neglected disease / Hepatotoxicidad por hierbas: una revisión práctica de una enfermedad subestimada

Herbs are commonly used worldwide for the treatment of various diseases, constituting a multi-billion dollar market. Unfortunately, hepatotoxicity induced by herbs is also common. The true incidence and prevalence are not known. There is need for more strict regulations andexperimental and pre-clinical studies regarding its efficacy and safety. There is no gold standard for the diagnosis of herbs-induced liver injury (HILI) and it constitutes a diagnostic challenge for the clinician, whereestablishing causality could be cumbersome. Clinical presentation varies from asymptomatic cases with mildly abnormal liver tests to fulminant liver failure requiring liver transplantation. In this review, we will discuss the epidemiology, clinical manifestations, challenges and diagnostic approach of HILI and will also present some exemplary cases from the University of Miami, Division of Hepatology.

Las hierbas y productos derivados son comúnmente usados alrededor del mundo para el tratamiento de varias enfermedades, constituyendo un mercado multibillonario. Desafortunadamente, hepatotoxidad inducida por estos productos también es común. Existe la necesidad de regulaciones más estrictas, y de estudios experimentales y pre-clínicos acerca de su eficacia y seguridad. No existe un gold-standard para el diagnóstico de injuria hepática inducida por hierbas (HILI), constituyendo un reto diagnóstico para el clínico, donde el establecer una relación de causalidad puede resultar muy difícil. La presentación clínica puede variar desde casos asintomáticos con enzimas hepáticas levemente elevadas hasta casos de falla hepática fulminante requiriendo transplante hepático. En esta revisión, discutiremos brevemente la epidemiologia, manifestaciones clínicas, retos y aproximación diagnostica de la injuria hepática inducida por hierbas y finalmente mostraremos algunos casos ejemplares extraídos de nuestro archivo en la División de Hepatología de la Universidad de Miami.

Who Neglects Neglected Tropical Diseases? - Korean Perspective

Neglected tropical diseases (NTDs) are a group of tropical infectious diseases of poorest people. Of 17 NTDs managed by WHO, two, guinea worm disease (by 2015) and yaws (by 2020) are targeted for eradication, and four (blinding trachoma, human African trypanosomiasis, leprosy, and lymphatic filariasis) for elimination by 2020. The goals look promising but 11 others are still highly prevalent. Soil-transmitted helminths (STHs) are one NTD which prevail over the world including temperate zones. They had been highly prevalent in Korea but are mostly disappearing at present through systematic and sustainable control activity. The successful experience of STH control enables Korean experts to develop many programs of NTD control in developing countries. Several programs of both official development aid and non-governmental organizations are now targeting NTDs. Most NTDs are low in health priority compared to their health threats because they are chronic, insidious, and of low mortality. No one, including the victims, raised priority of NTD control with a loud voice in the endemic field of the diseases. After the millennium development goals declared disease control over the world, NTDs are becoming less neglected globally. Even with limited resources, beginning a sustainable national program is the key for the control and elimination of NTDs. No more neglect, especially no more self-neglect, can eliminate diseases and upgrade quality of life of the neglected people.

A Case of Fasciola hepatica Infection Mimicking Cholangiocarcinoma and ITS-1 Sequencing of the Worm

Fascioliasis is a zoonotic infection caused by Fasciola hepatica or Fasciola gigantica. We report an 87-year-old Korean male patient with postprandial abdominal pain and discomfort due to F. hepatica infection who was diagnosed and managed by endoscopic retrograde cholangiopancreatography (ERCP) with extraction of 2 worms. At his first visit to the hospital, a gallbladder stone was suspected. CT and magnetic retrograde cholangiopancreatography (MRCP) showed an intraductal mass in the common bile duct (CBD) without proximal duct dilatation. Based on radiological findings, the presumed diagnosis was intraductal cholangiocarcinoma. However, in ERCP which was performed for biliary decompression and tissue diagnosis, movable materials were detected in the CBD. Using a basket, 2 living leaf-like parasites were removed. The worms were morphologically compatible with F. hepatica. To rule out the possibility of the worms to be another morphologically close species, in particular F. gigantica, 1 specimen was processed for genetic analysis of its ITS-1 region. The results showed that the present worms were genetically identical (100%) with F. hepatica but different from F. gigantica.

Cisticercosis ocular / Ocular cisticercosis

La cisticercosis establece un grupo de enfermedades zoonóticas parasitarias; cuando se aloja en el ojo y sus anexos producen una cisticercosis ocular y periocular. Constituye una de las causas de uveítis ocular y pérdida importante de la visión. El diagnóstico clínico se realiza mediante la observación directa del parásito, cuando existen opacidades de los medios, el ultrasonido se emplea como medio diagnóstico útil. Los anti helmintos asociados a esteroides forman parte de su terapéutica, sumado al tratamiento definitivo de la extracción del parásito, en este tipo de afección mediante vitrectomía vía pars plana. Se presenta un caso portador de esta condición, se describen las características más importantes del cuadro clínico, diagnóstico, manejo y curso evolutivo-terapéutico

Cysticercosis brings about a group of zoonotic parasitic diseases, when it deals with the eye and its appendices, then ocular and periocular cistercosis emerges. It is one of the causes of ocular uveÝtis and significant loss of vision. The clinical diagnosis is made by direct observation of the parasite. If there are opacities, then the ultrasound technique is the useful diagnostic means. The steroid-related antihelminthic drugs are part of the treatment together with the final extraction of the parasite through pars plana vitrectomy. The most important characteristics of the clinical picture, the diagnosis, the management and the progression and treatment of a patient suffering this disease is presented in this article

Listeriosis in the far South of Brazil: neglected infection?

Listeriosis is an under-diagnosed and under-reported infection; however, listeriosis is not a compulsorily notifiable disease in Brazil. We provide an overview of the rates of listeriosis in the United States of America (USA), Europe, Latin America, and Brazil during the past decade. We also report a case of miscarriage caused by listeriosis in which there was no suspicion of this infection. This overview and the case we report serve as reminders of the often-neglected threat of listeriosis and its potential to cause miscarriage while highlighting the necessity of recognizing listeriosis as a compulsorily notifiable disease in Brazil.

Neurocisticercosis: una enfermedad desatendida en Chile / Neurocysticercosis: an neglected disease in Chile

Neurocysticercosis (NCC) is not a notifiable disease in Chile and has received little attention on the national medical literature. In order to evaluate the relevance and clinical features of the disease, we performed a retrospective analysis in a general hospital of five cases of NCC during a 11 years period. Age ranged from 3 to 63 years and all had history of living or visiting southern Chile. Three patients had a solitary parenchymal cyst in vesicular or granulomatous stages and presented with generalized seizures. Their outcome was favorable after anticonvulsant and albendazole therapy and cysts reduced in size and calcified during follow-up. The other 2 patients had extra-parenchymal or mixed forms, including a pregnant woman with intraventricular cysts who developed endocraneal hypertension and recurrent dysfunction of her ventriculoperitoneal shunt. This patient died after discharge despite an initial favorable evolution with steroids and high-dose albendazole. This case series showed that NCC is still an epidemiological and clinical problem in Chile, affects patients within a wide range of age including children, requires multidisciplinary therapeutic interventions, and has two clinical presentations with different prognosis including one malignant form. To control this infection, a surveillance or reporting system should be initiated.

La neurocisticercosis (NCC) no es una enfermedad de notificación obligatoria en Chile y ha recibido poca atención en la literatura médica local. Para evaluar su importancia y perfil clínico se hizo un análisis retrospectivo en un hospital general. Cinco casos de NCC fueron identificados en un período de 11 años. El rango de edad fue de 3 a 63 años y todos tenían antecedentes de visita o residencia en el sur del país. Tres pacientes tenían quistes únicos parenquimatosos en etapas granulomatosas o vesiculares y se presentaron con convulsiones generalizadas. Su evolución fue favorable con terapia anticonvulsivante y albendazol y los quistes se redujeron de tamaño y calcificaron durante el seguimiento. Los otros pacientes presentaron formas extra-parenquimatosas o mixtas e incluían a una mujer embarazada con quistes intraven-triculares quien desarrolló hipertensión endocraneana y disfunción recurrente de su válvula. Ella falleció después del alta a pesar de una evolución inicial favorable con corticoesteroides y albendazol. La NCC es un problema vigente en nuestro país pero de epidemiología desconocida, afecta a un amplio grupo etario, requiere múltiples intervenciones terapéuticas y presenta dos formas de diferente pronóstico, una de ellas maligna. Para controlarla es necesario incluirla en las enfermedades notificables.