ABSTRACT
This case-series describes the 6 human infections with Onchocerca lupi, a parasite known to infect cats and dogs, that have been identified in the United States since 2013. Unlike cases reported outside the country, the American patients have not had subconjunctival nodules but have manifested more invasive disease (eg, spinal, orbital, and subdermal nodules). Diagnosis remains challenging in the absence of a serologic test. Treatment should be guided by what is done for Onchocerca volvulus as there are no data for O. lupi. Available evidence suggests that there may be transmission in southwestern United States, but the risk of transmission to humans is not known. Research is needed to better define the burden of disease in the United States and develop appropriately-targeted prevention strategies.
Subject(s)
Communicable Diseases, Emerging , Dog Diseases/epidemiology , Onchocerca/isolation & purification , Onchocerciasis , Zoonoses , Adolescent , Animals , Cats , Child , Child, Preschool , Communicable Diseases, Emerging/diagnosis , Communicable Diseases, Emerging/epidemiology , Communicable Diseases, Emerging/parasitology , Communicable Diseases, Emerging/transmission , Cost of Illness , Dog Diseases/diagnosis , Dog Diseases/parasitology , Dogs , Female , Humans , Infant , Male , Middle Aged , Onchocerca/genetics , Onchocerciasis/diagnosis , Onchocerciasis/parasitology , Onchocerciasis/transmission , Onchocerciasis/veterinary , Southwestern United States/epidemiology , United States/epidemiology , Zoonoses/diagnosis , Zoonoses/epidemiology , Zoonoses/parasitology , Zoonoses/transmissionABSTRACT
Fractures and other skeletal injuries are common in childhood. Most are the result of falls, motor vehicle accidents, and other forms of accidental trauma. However, skeletal trauma is present in a significant number of abused children. Age and developmental abilities are key components in raising clinical suspicion for child abuse. Children who are unable to provide their own history because of age or developmental delay require increased attention. Younger children are more likely to have abusive fractures, whereas accidental fractures increase with age and developmental abilities. The consequences of missing abuse are high because children returned to their homes without intervention are likely to face further abuse and have an increased mortality risk. Because of the potentially high cost of undiagnosed child abuse, diagnosis of a skeletal injury is incomplete without diagnosing its etiology. All health providers for children should be able to recognize patterns of skeletal injury secondary to abusive trauma and understand the process for initiating Child Protective Services (CPS) investigations when necessary. Although they can occur accidentally, fractures in nonmobile children should always increase the clinician's concern for abusive trauma. In light of the significant consequences for children when abuse is missed by a primary care provider, abuse should be on the differential diagnosis for all presenting childhood injuries.
