Evidence of human neurocysticercosis in Slovenia.

To assess the prevalence of Taenia solium cysticercosis in patients with neurological disorders in Slovenia, serum/cerebrospinal fluid (CSF) samples from 348 suspected patients were collected between the beginning of January 2001 and the end of December 2012 and analysed serologically for the presence of anti-T. solium IgG antibodies. Of 20 patients whose samples tested positive or equivocal by enzyme-linked immunosorbent assay (ELISA), samples of 7 patients were confirmed positive by Western blot (WB). The overall seroprevalence rate of T. solium infection in patients with neurological disorders included in the study was 2.0%. Serological results of positive patients corresponded to clinical and/or imaging findings concerning their brain cysts. Based on their personal data, it was ascertained that neurocysticercosis (NCC) positive patients had immigrated or came to Slovenia from the former Yugoslav republics. Since the disease is believed not to be endemic in Slovenia we assume that all of the NCC-positive patients had acquired the infection before immigration to Slovenia or visiting or being visited by their relatives infected with an adult T. solium parasite. The present results represent the first insight into the prevalence of NCC in patients with neurological disorders in Slovenia.

Cutaneous myiasis caused by Hypoderma lineatum.

Cutaneous myiasis is a temporary parasitic infestation of the skin of domestic and wild animals and occasionally of humans by the larvae of flies. Larvae of many flies from various geographic areas can cause myiasis: in Central and South America, human cutaneous myiasis is mainly caused by the larvae of Dermatobia hominis; in Africa, by the larvae of Cordylobia anthropophaga; in the northern hemisphere (North America, Europe, Africa and Asia), by the larvae of Hypoderma spp. A case of cutaneous myiasis in a 47-year-old woman, co-author of the present report, is described. She returned to Slovenia from a three-week trip to Ladakh in Northern India. The parasite, nested in tumor-like swelling about 1-2 cm in diameter and 0.5 cm high in her neck, was removed. The parasite was identified by its morphological characteristics as the larva of Hypoderma lineatum. After the removal of the larva, which was yellowish-white, oval-shaped and about 6 mm long and 1.5 mm wide, the lesion healed in two weeks without further treatment. Clinical and laboratory staff will need to be alert in the future, not only to myiasis caused by Dermatobia and Cordylobia larvae from tropical and subtropical areas but also to Hypoderma larvae from the Himalayan area from where the patient returned to Slovenia.

Serological evidence for human cystic echinococcosis in Slovenia.

BACKGROUND: Cystic echinococcosis (CE) is caused by the larva of tapeworm Echinococcus granulosus. Dogs and other canids are the primary definitive hosts for this parasite. CE may develop after accidental ingestion of tapeworm eggs, excreted with the feces of these animals. In the intestine, the larvae released from the eggs are nested in the liver, lungs or other organs of livestock as intermediate hosts and humans as aberrant hosts. The aim of this study was to examine serologically whether some of the patients in Slovenia, suspected of CE by imaging findings in the liver or lungs had been infected with the larva of Echinococcus granulosus. METHODS: Between January 1, 2002 and the end of December 2006, 1323 patients suspected of having echinococcosis were screened serologically by indirect haemagglutination assay (IHA). For confirmation and differentiation of Echinococcus spp. infection, the sera of IHA-positive patients were then retested by western blot (WB). RESULTS: Out of 127 IHA-positive sera, 34 sera were confirmed by WB and considered specific for CE. Of 34 sera of CE-positive patients sera, 32 corresponded to the characteristic imaging findings of a liver cysts and 2 to those of lung cysts. The mean age of CE-positive patients was 58.3 years. No significant differences were found between the CE-positive patients in regard to their sex. CONCLUSION: In the study, it was found out that CE was mostly spread in the same area of Slovenia as in the past, but its prevalence decreased from 4.8 per 105 inhabitants in the period 1956-1968 to 1.7 per 105 inhabitants in the period 2002-2006. In spite of the decreased prevalence of CE in the last years, it is suggested that clinicians and public health authorities, especially in the eastern parts of Slovenia where the most CE patients come from, should pay greater attention to this disease in the future.

Cutaneous myiasis caused by Cordylobia anthropophaga.

Cutaneous myiasis is a temporary parasitic infestation of the skin of human and other vertebrates by fly larvae, primarily species of the flies Dermatobia and Cordylobia. In Central and South America cutaneous myiasis is mainly caused by the larvae of Dermatobia hominis; in Africa it is mostly due to the larvae of Cordylobia spp. We describe a case of cutaneous myiasis in a family who returned to Slovenia from a three-week trip to Ghana. The parasites, in tumor-like swellings about 1-2 cm in diameter and 0.5-1 cm high, were removed from the back of the 48-year-old man, the nose, shoulder and wrist of his 47-year-old wife, and the back of their 14-year-old daughter. The parasites were identified as larvae of the fly C. anthropophaga. After removal of the larvae, which were oval-shaped and about 8 mm long, the lesions healed in two weeks without further treatment. Human cases of cutaneous myiasis are most probably underreported because many remain undiagnosed or unpublished. Because of increasing travel to tropical and subtropical areas, clinical and laboratory staff will need to be more alert to the possibility of Cordylobia myiasis in patients with furuncle-like lesions, particularly in individuals who have recently returned from tropical Africa.

Seroprevalence of Toxocara antibodies among patients suspected of ocular toxocariasis in Slovenia.

Ocular toxocariasis named also ocular larva migrans is caused by larvae of the roundworm Toxocara spp. The purpose of this study was to find out the seroprevalence of Toxocara antibodies in patients suspected of ocular toxocariasis. Between January 2001 and December 2003, sera from 239 ocular patients, aged 3 to 80 years, were examined by ELISA and confirmed by Western blot test. Out of the 239 patients, 172 (72%) were seronegative and 67 (28%) were Toxocara seropositive; 95% CI (22-34%). The median age of Toxocara seropositive patients was 37.6 years. There was no significant difference in the number of Toxocara positive sera between the younger age group (< or = 14 years) and the older age group (> 14 years), p > 0.05. A high rate of Toxocara seropositivity in ocular patients should alert the ophthalmologists in Slovenia to include toxocariasis in the differential diagnosis of eye diseases more frequently.

Cryptosporidiosis associated with animal contacts.

Transmission of Cryptosporidium sp. within the general public was studied. We were looking for a possible risk of infection associated with animal contacts. Investigation of the animal contacts of affected individuals led to the formulation of the hypothesis that animals are a source of cryptosporidiosis. The research was done in the Region of Ljubljana, an area with 587,000 inhabitants during a period of three years. Stool specimens of 338 persons with acute enteric diseases were positive for Cryptosporidium sp. Diagnosis was done with an immunofluorescence test and modified Ziel-Neelsen staining. Processing of statistical data was done with the medical software application EPI INFO 6. According to our questionnaire, direct contact with animals occurred in 49 of the 338 cases of cryptosporidiosis, and was more frequently registered in males (Odds ratio = 1.96). Subgenotyping analysis revealed the presence of two subgenotypes of Cryptosporidium parvum bovine (GPB and GPC) in humans. These data indicate that genetic heterogeneity in C. parvum bovine genotype exists in a localized area and that farm animals can be a source of infection.

Prevention of congenital toxoplasmosis in Slovenia by serological screening of pregnant women.

A programme for the prevention of congenital toxoplasmosis in Slovenia involving the screening of pregnant women for Toxoplasma infection is presented. Of 21,270 pregnant women screened for toxoplasmosis between, 1996 and the end of 1999, 13,987 (66%) were seronegative, 7,151 (34%) seropositive and 132 had primary infection; approximately 9/1,000 women were at risk of acquiring the primary infection. One hundred live-born infants of primary infected women were available for follow-up. Nine infected but asymptomatic children were born to mothers who were screened and treated in time and two congenitally infected babies were born to mothers in whom infection was detected too late in pregnancy and who therefore received no adequate treatment. It is suggested that the results obtained in this study outweigh the cost of screening for toxoplasmosis in pregnancy. Pregnant women should always be tested at the beginning of pregnancy and, in cases of seronegativity, should be re-tested in the second and third trimesters of the pregnancy. Toxoplasma primary infected pregnant women and neonates should be treated as soon as possible. However, long-term follow-up of children born to primary infected women would be necessary for an accurate evaluation of the effectiveness of the screening because of the possibility of late onset of symptoms.