Eimeria species (Apicomplexa: Eimeriidae) infecting Eliomys quercinus in an Alpine habitat.

Coccidian parasites were detected in an Alpine population of the garden dormouse (Eliomys quercinus), and 55-82% of the fecal samples collected during a two-year study (2000 and 2002) contained one or two eimerian species. We report the presence of Eimeria myoxi and confirm for the first time the presence of Eimeria melanuri in the garden dormouse. These Eimeria species can be considered common parasites of the garden dormouse and the Asian garden dormouse. The high prevalence might be due to group hibernation by the dormice.

A phase II study of sequential 5-fluorouracil, epirubicin and cyclophosphamide (FEC) and paclitaxel in advanced breast cancer (Protocol PV BC 97/01).

Sequential administration of the association of 5-fluorouracil, epirubicin and cyclophosphamide (FEC) and paclitaxel could be better tolerated than the association of an anthracycline and paclitaxel while having a similar antitumour effect. 69 patients with advanced breast cancer previously untreated with anthracyclines or paclitaxel entered a phase II multicentre study in which FEC was followed by paclitaxel. Both regimens were administered 4 times every 21 days. The median follow-up is 20 months and 38/69 patients have died. Grade III-IV toxicity was acceptable. Leukopenia occurred in 26% of patients, thrombocytopenia in 2% and anaemia in 4%. One patient had reversible heart failure during FEC therapy. Peripheral neuropathy and arthralgia-myalgia occurred in 9% and 4% of patients, respectively and one patient had respiratory hypersensitivity during paclitaxel treatment. 9 patients did not complete therapy because of: treatment refusal (n = 1), cardiac toxicity (n = 1), early death during FEC chemotherapy (n = 1), major protocol violations (n = 4), hypersensitivity reaction (n = 1) and early death during paclitaxel chemotherapy (n = 1). The overall response rate was 65% (95% CI = 53-76), and 7% of patients had stable disease. Therapy was defined as having failed in 28% of patients because they were not evaluable (13%) or had progressive disease (15%). The median time to progression and survival are 13.2 and 23.5 months, respectively. Sequential FEC-paclitaxel is a suitable strategy for patients with metastatic breast cancer who have not been previously treated with anthracyclines and/or taxanes. In fact, it avoids major haematologic toxicity and has a good antitumour effect.

Monitoring of infections by protozoa of the genera Nematopsis, Perkinsus and Porospora in the smooth venus clam Callista chione from the North-Western Adriatic Sea (Italy).

Marketable smooth venus clams Callista chione from natural banks of Chioggia (Venice) and Goro (Ferrara), North-Western Adriatic Sea (Italy), were examined for protozoan parasites from November 1996 to November 1998. Out of the 375 bivalves examined, 149 (39.7%) were infected by Nematopsis sp. and 325 (86.7%) by Porospora sp. Oocysts of Nematopsis sp. were present with a prevalence that varied from 100% in November 1996 to 5% in June 1998; cystic and naked sporozoites of Porospora sp. were very common, with a prevalence of 100%. Out of the 229 bivalves examined between January and November 1998, 63 (27.5%) were also infected by Perkinsus sp.; the prevalence of Perkinsus sp. varied from 9.1% in January to 50% in February. To our knowledge this is the first report of Porospora sp. and Perkinsus sp. in C. chione.

Doubling of the epirubicin dosage within the 5-fluorouracil, epirubicin and cyclophosphamide regimen: a prospective, randomized, multicentric study on antitumor effect and quality of life in advanced breast cancer.

In metastatic breast cancer (MBC) doubling the epirubicin (EPI) dose intensity (DI) within the FEC (5-fluorouracil, EPI, cyclophosphamide) regimen could increase the response rate (RR) and ameliorate the quality of life (QoL) over standard FEC. From May, 1995, 74 consecutive patients with MBC were randomly treated with 6 courses of two FEC regimens containing 60 (60FEC) or 120 (120FEC, supported by primary G-CSF) mg/m2 of EPI. Drugs were administered every 21 days. The QoL was assessed over and after treatment by the EORTC QLQ-C30 (VER 2.0) and QLQ-BR23 questionnaires, compiled by the patient, and the Spitzer's QL-index, compiled by the physician. The study was prematurely closed in May, 1997, due to RR and QoL data of 4th interim analysis. The delivered EPI DI was 20.0 and 37.9 mg/m2/week in 60- and in 120FEC, respectively. Among the two regimens, there was no statistically significant difference in RR or in improvement of baseline overall QoL. With respect to 60FEC patients, the 120FEC patients had longer time to progression (19.2 vs 13.1 mos, p=0.04). Over baseline, the 120- but not the 60FEC patients had significantly greater pain decrease and lower deterioration of body image. In MBC, both 60- and 120FEC regimens furnished the same RR and improvement in overall baseline QoL. With respect to 60FEC patients, the 120FEC patients experienced longer time to progression. Over baseline, pain decrease and preservation of body image were also greater in these patients.

Pitfalls and difficulties in histological diagnosis of human dirofilariasis due to Dirofilaria (Nochtiella) repens.

The authors have conducted a histologic study of over 90 cases of Dirofilaria infection in man due to Dirofilaria repens, the most extensive study of its kind in the world. On the basis of their findings, they illustrate the diagnostic difficulties that may arise when regressive phenomena render the parasite's morphologic characteristics largely or completely unrecognizable. These phenomena are due to the death of the filaria inside the inflammatory nodule weeks or months prior to surgical removal, and to the consequent invasion of inflammatory cells. They start at the nematode's natural orifices (mouth, vulva, anus, cloaca) and gradually spread throughout its body. In cases of difficult diagnosis, therefore, it is recommended that the nodule be sectioned at different points comprising caudal, cephalic and middle body aspects, so as to reveal the few morphologic features that are still recognizable and which may afford a correct diagnosis. The authors present examples of histologic sections in color plates in which the nematode was in an excellent state of preservation and others illustrating the full range of regressive phenomena, from slight to total disintegration of the bodily structure.

Myeloprotective effect of early primary granulocyte-colony stimulating factor during six courses of intensified 5-fluorouracil, epirubicin and cyclophosphamide (120FEC) chemotherapy for advanced breast cancer. Cooperative Group of Study and Treatment of Breast Cancer.

AIMS AND BACKGROUND: The neutropenia induced by six courses of an intensified FEC regimen is expected to be checked by early primary administration of G-CSF which is stopped eight days before the next chemotherapy course. Less information is available about megakaryocytic and erythroid toxicity over six courses. METHODS AND STUDY DESIGN: Sixty-six consecutive patients with metastatic breast cancer completed six courses of a randomized treatment with two FEC regimens administered every 21 days, in which 600 mg/m2 of cyclophosphamide and 5-FUwas associated with 60 or 120 mg/m2 of epirubicin (60FEC, 35 patients, vs 120FEC, 31 patients). 120FEC was supported by early primary G-CSF (days 4 to 13). Blood counts were obtained seven times during each course. RESULTS: The non-hematologic toxicity over 364 courses was similar in 60FEC and 120FEC. No cumulative hematologic toxicity was observed for white blood cells (WBC) and platelets (PLT), while for hemoglobin (Hb) a somewhat higher cumulative toxicity was observed with 120FEC than with 60FEC. WBC, PLT and Hb grade III-IV toxicity occurred in 40.1% and 45.6% (P=ns), in 23.1% and 0.8% (P <.0001) and in 15.6% and 3.0% (P <.005) of the two regimens, respectively. There were no febrile or hemorrhagic episodes. The epirubicin relative dose intensity delivered was 1.95 in 120FEC with respect to 60FEC. CONCLUSIONS: Our G-CSF schedule permitted to deliver six courses of 120FEC without any clinically relevant side effects. Grade III-IV leukopenia was similar with 120FEC and 60FEC, while grade III-IV thrombocytopenia and anemia occurred more often with 120FEC than with 60FEC.

Prevalence of Mytilicola intestinalis (Copepoda: Mytilicolidae) and Urastoma cyprinae (Turbellaria: Hypotrichinidae) in marketable mussels Mytilus galloprovincialis in Italy.

Marketable mussels Mytilus galloprovincialis traded with commercial certification from production sites in Italy and abroad (France, Spain) were examined for the presence of Mytilicola intestinalis (Copepoda: Mytilicolidae) and Urastoma cyprinae (Turbellaria: Hypotrichinidae) from October 1994 to February 1996. The prevalence of M. intestinalis was 4.1% and 4.7% respectively in mussels from Lerici (La Spezia) and S. Pietro in Volta (Venice), whereas it rose to 57.9% in the samples from Spain. M. intestinalis was absent in mussels from Chioggia (Venice), Ganzirri (Messina), Taranto, Trieste and France. The prevalence of U. cyprinae varied considerably, ranging from 0.3% in mussels from Trani (Bari) to 33.2% and 86.3% respectively in those from Chioggia and Trieste. It was 85.7% in samples from France and 63.7% in those from Spain.

The species of the genus Dirofilaria, Railliet & Henry, 1911.

Some authors divide the genus Dirofilaria into two subgenera. The subgenus Dirofilaria consists of 5 apparently valid species (D. ailure, D. freitasi, D. immitis, D. lutrae, D. spectans) and 7 species of questionable validity (D. fausti, D. indica, D. louisianensis, D. magalhaesi, D. nasuae, D. pongoi, D. spirocauda). The subgenus Nochtiella consists of 22 apparently valid species (D. acutiuscula, D. bonnei, D. cancrivori, D. corynodes, D. genettae, D. granulosa, D. incrassata, D. linstowi, D. macacae, D. macrodemos, D. magnilarvatum, D. minor, D. pagumae, D. panamensis, D. repens, D. sachsi, D. striata, D. subdermata, D. sudanensis, D. tawila, D. tenuis, D. ursi) and 8 species of questionable validity (D. aethiops, D. andersoni, D. conjunctivae, D. desportesi, D. hystrix, D. schoutedeni, D. spinosa, D. subcutanea). Actually, 10 species of the genus Dirofilaria (D. asymmetrica, D. digitala, D. kuelzii, D. ochmanni, D. pauliani, D. roemeri, D. scapiceps, D. timidi, D. uniformis, D. websteri) are attributed to other genus.

Human dirofilariasis in Greece: a review of reported cases and a description of a new, subcutaneous case.

A superficial analysis of Greek reports of human cases of dirofilariasis indicated that this zoonosis is rare in Greece. However, a more detailed review of the international literature revealed several more cases, diagnosed and recorded in other countries following infection during holidays in Greece. Overall, at least 20 individuals are now known to have been infected in Greece, in all regions of the country. A new, subcutaneous case of dirofilariasis is described; the infection occurred in a 45-year-old male living in Piraeus (Athens), and was localized in the abdominal wall. Histology revealed a female Dirofilaria (Nochtiella) repens in the reactive nodule.

Experience with poorly myelosuppressive chemotherapy schedules for advanced myeloma. The Cooperative Group of Study and Treatment of Multiple Myeloma.

In a multicentre study, 83 patients with advanced and previously uniformly treated multiple myeloma (MM) were randomised between cyclophosphamide (600 mg m-2) and epirubicin (70 mg m-2), administered every 3 weeks for three courses and both associated with prednisone and interferon-alpha2b. Both regimens were administered on an outpatient basis and had low haematological toxicity. Clinical results were similar. Overall response rate (43%) and median response and survival (5.9 and 14.1 months respectively) compare well with those obtained with more aggressive chemotherapy schedules.

Human dirofilariasis due to Dirofilaria (Nochtiella) repens: a review of world literature.

For some Dirofilaria spp. of zoonotic importance, such as D.immitis, D.tenuis, D.ursi, reviews of human cases were often published. For D. repens there is no published information giving a picture of the importance of the problem and of the geographical distribution of the parasite in the world. From a study of the international literature and from direct experience (our workgroup observed 75 cases in Italy) we have ascertained that the condition associated with D. repens is the most frequent and the most widely distributed in the world, of the dirofilariases of medical relevance: comprehensively 397 cases were recorded in 30 countries, exclusively in the Old World, with endemic foci in Southern and Eastern Europe, Asia Minor, Central Asia and Sri Lanka. Apparently, the most affected country is Italy with a total of 168 cases. The most common localisations are the subcutaneous (normally nodular) and the submucosal (nodular or not). The most affected areas are the head, the thoracic wall and the upper limbs. However, 15 cases with internal localisations are recorded (9 of them being pulmonary) which were always diagnosed erroneously as malignant neoplasiae. Clinical diagnosis for the other localisations was also generally wrong with the exception of the subconjunctival cases, where because of the transparency of the bulbar conjunctiva, it is possible to see the parasite directly. The correct diagnosis is usually histological, based on the identification of the nematode using the morphological characters of the species to differentiate it from the other dirofilariae or other erratic nematodes. It is possible that the zoonosis in man is more frequent than shown by the literature: many cases are not diagnosed, viz. not published, others recover spontaneously without medical intervention.

Zoonotic filaria of possible American origin in Italy.

From a 31 year old man, resident in Monfalcone (Venezia Giulia) a nodule in the right temporal region was surgically removed in January 1992 containing a filiform living nematode. On the basis of the morphological characters, the nematode proved to be Dirofilaria sp. subgenus Nochtiella but the exact species was not possible to define. The medical history indicated that the patient had spent the last summer in Florida.

[Human subcutaneous dirofilariasis: 8 new cases in northern Italy]. / Dirofilariasi sottocutanea umana: 8 nuovi casi in Italia Settentrionale.

Eight new cases of Human Dirofilariasis in people living in Northern Italy were recorded: 3 from the province of Asti and 2 from Alessandria (Piedmont), 1 from Corsico (Miland, Lombardy) and 2 from Ravenna (Emilia-Romagna). All the patients were adults, 42 to 66 years old, 4 men and 4 women. The localization of the nematode in all the cases was subcutaneous. Signs and symptoms were always mild and consisted in the growth of a 1 to 2 cm large nodule associated with occasional localized itching and oedema, sometimes with reddening. In one case, the sting of a non-specified winged insect was recorded in the anamnesis, in the same spot where the nodule developed. In another case, the nematode came out spontaneously from the lesion. The aetiological agent was always identified as Dirofilaria repens. These 8 new cases confirm the comparatively frequent presence of Human Dirofilariasis in regions of Northern Italy, namely in the Po Valley.

[Human dirofilariasis: extraction of the living nematode from the upper lip]. / Dirofilariasi umana: estrazione del nematode vivente da nodulo del labbro superiore.

Calabar swellings appearing on the head during 2 months in a 53 year old man, living in Casale Monferrato (Piedmont), were followed by the formation of a nodule 2 x 1 cm wide, in the upper lip. A mobile filiform, 12 cm long, nematode was recovered from the excised nodule. It was diagnosed as Dirofilaria repens. The region where the case occurred, is to be considered as one of the most affected areas by this parasitic zoonosis in Europe.

[Human dirofilariasis in Italy]. / La dirofilariose humaine en Italie.

Since 1971, at the Laboratory of Parasitology, Faculty of Veterinary Medicine, University of Bologna, 30 cases of human dirofilariasis were observed out of the 101 cases reported in Italy. The causative agent was identified in nearly all the cases as Dirofilaria repens (Nematoda, Filarioidea) a parasite relatively common in the dog in Italy. 23 cases were localized in the subcutaneous tissue, 4 in the submucosa and 3 in the lungs. In the majority of the cases the diagnosis had been misinterpreted, the lesions being first seen as malignant or benign tumours or foreign-body granuloma. The parasite was histologically recognized. In 3 cases the parasite could be extracted intact from the nodule. The authors believe that human dirofilariasis is more frequent than reported by the relevant scientific literature in that many cases are likely to recover spontaneously while others would remain undetected.

[Human dirofilariasis in Italy: a new palpebral case with spontaneous healing in Abruzzo]. / Dirofilariasi umana in Italia: un nuovo caso palpebrale con guarigione spontanea in Abruzzo.

One case of human palpebral dirofilariasis by Dirofilaria repens, in Abruzzo, is described. It is the first case reported in this region. The parasite was released following the energetic rubbing of the palpebral area, with the result in the spontaneous recovery of the patient.

[Enterobius gregorii Hugot, 1983: its presence in man in Italy and in the Central African Republic]. / Enterobius gregorii Hugot, 1983: sua presenza nell'uomo in Italia e in Repubblica Centro Africana.

The presence of E. gregorii, a species recently identified by Hugot in France in man, is signaled by the authors in Italy and in the Central African Republic. The diagnosis was based on the differential morphological characters reported by Hugot and Tourte-Schaefer in 1985.

[Palpebral dirofilariasis in man: a case in Sardinia]. / Dirofilariasi palpebrale nell'uomo: un caso in Sardegna.

Human palpebral dirofilariasis: a case in Sardinia. One case of human palpebral dirofilariasis, in Sardinia, is described. The nematode, Dirofilaria repens, during its permanence in the host caused local signs of an allergic type and migrated in the subcutaneous tissues from the left lower eyelid to the neck, the axillary region, the abdominal wall, reappearing in the right lower eyelid, from where it was removed.