Update on infections with Thelazia callipaeda in European wildlife and a report in a red fox, Vulpes vulpes, in Portugal.

Thelazia callipaeda, also known as the "oriental eye worm", is a zoonotic parasitic nematode with a wide range of hosts, particularly wild and domestic carnivores, but also lagomorphs and humans. Currently, ocular thelaziosis presents an expanding distribution range throughout Europe, including Portugal. This study provides an update on T. callipaeda infection reports (30 studies) in European wildlife comprising 54 host-locality records in 10 host species from nine European countries. The prevalence of T. callipaeda varied widely, with ranges from around 1% in red foxes and European hares to almost 50% in red foxes. The lowest mean intensity was 2.7 nematodes/host in European wildcats and the highest was 38.0 nematodes/host in wolves. In addition, a massive infection with T. callipaeda in a juvenile male red fox from eastern-central Portugal is also described, representing the southernmost report in a wild animal in this country. A total of 188 nematodes (139 females and 49 males) were collected from both eyes and were submitted to morphological and molecular characterization. Collected nematodes were morphologically identified as T. callipaeda. Given the endemicity of T. callipaeda in eastern-central Portugal, surveillance system should be implemented to monitor its presence among wild and domestic animals.

First report of human Thelazia callipaeda infection in Portugal.

The zoonotic parasitic nematode Thelazia callipaeda, also known as the oriental eye worm, is endemic in several European countries, including Portugal. Infections may result in ocular disease in domestic and wild animals as well as humans, with more or less severe manifestations. We report the first human case of ocular thelaziosis by T. callipaeda in Portugal, a country where the parasite had already been found to infect dogs, cats, red foxes, wild rabbits and a beech marten. An 80-year-old patient from east-central Portugal, who had been suffering from tearing for a few years, had whitish filiform fragments removed from the left eye. Polymerase chain reaction of partial cytochrome c oxidase subunit 1 and 18S small subunit rRNA genes followed by bidirectional sequencing and BLAST analysis confirmed T. callipaeda haplotype 1, the only haplotype previously reported in Europe. The endemicity of T. callipaeda in domestic and wild animals in east-central Portugal makes it very likely that infection of the human patient had occurred locally. In east-central and other geographical areas of Portugal, veterinarians and physicians, especially ophthalmologists, should regard T. callipaeda as a cause of ocular pathology in animals and humans.

A Cross-Sectional Study of Knowledge on Ownership, Zoonoses and Practices among Pet Owners in Northern Portugal.

Pet ownership is common in modern society. In Portugal, 38% and 31% of all households own at least one dog or cat, respectively. Few studies have ascertained the knowledge of pet owners on pet ownership and zoonoses, and none have been carried out in Portugal. The aim of the present study was to assess household knowledge and practices related to pet ownership and zoonoses in northern Portugal. A face-to-face questionnaire was completed by 424 pet owners, from November 2019 to February 2020. Most respondents (97.2%) considered pets as an important part of the family, especially women (p = 0.036); 73.1% allowed their pets to live an indoor/outdoor life; 41.3% denied sharing the bed with their pets while 29% assumed they did it daily; 20.3% reported never kissing their pets/pets licking their faces. Furthermore, 73.6% considered animals as potential sources of human diseases, but only 25.9% reported knowing the definition of zoonoses; 96.9% considered the role of veterinarians important in protecting public health. The low level of knowledge of pet owners and the occurrence of high-risk behaviors indicates a need to strengthen communication between veterinarians, physicians, pet owners, and the general public towards reduce the risk of acquisition and transmission of zoonoses.

Bats, pangolins, minks and other animals - villains or victims of SARS-CoV-2?

Coronavirus disease-19 (COVID-19) is caused by the severe acute Respiratory syndrome coronavirus-2 (SARS-CoV-2), which has become unstoppable, spreading rapidly worldwide and, consequently, reaching a pandemic level. This review aims to provide the information available so far on the likely animal origin of SARS-CoV-2 and its possible hosts/reservoirs as well as all natural animal infections and experimental evidence using animal models. Horseshoe bats from the species Rhinolophus affinis seem to be a natural reservoir and pangolins (Manis javanica) appear to be an intermediate host of SARS-CoV-2. Humans remain the most likely spreading source of SARS-CoV-2 to other humans and also to domestic, zoo and farm animals. Indeed, human-to-animal transmission has been reported in cats, dogs, tigers, lions, a puma and minks. Animal-to-human transmission is not a sustained pathway, although mink-to-human transmission remains to be elucidated. Through experimental infections, other animals seem also to be susceptible hosts for SARS-CoV-2, namely ferrets, some non-human primate species, hamsters and transgenic mice, while dogs, pigs and poultry are resistant. A One Health perspective must be implemented in order to develop epidemiological surveillance and establish disease control mechanisms to limit zoonotic transmission. Moreover, research in this field is important to better understand SARS-CoV-2 and to obtain the long-awaited vaccine and specific treatment.

Systematic review on infection and disease caused by Thelazia callipaeda in Europe: 2001-2020.

Cases of thelaziosis by Thelazia callipaeda have been increasing considerably in Europe throughout the 21st century, with recent emphasis on Eastern Europe. A systematic review was conducted using defined search terms across three major databases and, additionally, with the examination of the references of the 56 articles selected. Available information about epidemiological and clinical features of all cases of thelaziosis by T. callipaeda in companion animals, wildlife and humans was extracted, evaluated and subjected to qualitative and quantitative analysis. In all cross-sectional studies about dogs, cats and red foxes, males were more frequently infected than females (dogs: p = 0.0365; cats: p = 0.0164; red foxes: p = 0.0082). Adult dogs seem to be more prone to infection (p < 0.0001), as well as large-sized dogs (p < 0.0001), and companion animals that live exclusively outdoors (p < 0.0001). Dogs and red foxes involved in these cross-sectional studies harboured significantly more female than male nematodes (p < 0.0001). Thelaziosis by T. callipaeda is far from controlled in Europe. Only through updated epidemiological data, knowledge improvement and awareness can correct diagnosis and appropriate treatment and prevention be ensured to tackle this zoonosis.

TITLE: Revue systématique de l'infection et de la maladie provoquées par Thelazia callipaeda en Europe (2001­2020). ABSTRACT: Les cas de thélaziose par Thelazia callipaeda ont considérablement augmenté en Europe tout au long du 21e siècle, l'accent étant récemment mis sur l'Europe de l'Est. Une revue systématique a été menée en utilisant des termes de recherche définis dans trois grandes bases de données, et aussi en examinant les références des 56 articles sélectionnés. Les informations disponibles sur les caractéristiques épidémiologiques et cliniques de tous les cas de thélaziose par T. callipaeda chez les animaux de compagnie, la faune et les humains ont été extraites, évaluées et soumises à une analyse qualitative et quantitative. Dans toutes les études transversales sur les chiens, les chats et les renards roux, les mâles étaient plus fréquemment infectés que les femelles (chiens : p = 0,0365; chats : p = 0,0164; renards roux : p = 0,0082). Les chiens adultes semblent être plus sujets aux infections (p < 0,0001), ainsi que les chiens de grande taille (p < 0,0001) et les animaux de compagnie vivant exclusivement à l'extérieur (p < 0,0001). Les chiens et les renards roux impliqués dans ces études transversales abritaient significativement plus de nématodes femelles que de mâles (p < 0,0001). La thélaziose par T. callipaeda est loin d'être contrôlée en Europe. Ce n'est que grâce à des données épidémiologiques mises à jour, à l'amélioration des connaissances et à la sensibilisation que l'on pourra corriger le diagnostic et assurer un traitement et une prévention appropriés pour lutter contre cette zoonose.

Thelaziosis due to Thelazia callipaeda in Europe in the 21st century-A review.

Thelazia callipaeda was first described at the beginning of the 20th century in Asia, but this eyeworm is now frequently reported in Europe in the 21st century. To date, thelaziosis has been described in the following European countries (in order of appearance): Italy, France, Germany, Switzerland, Spain, Portugal, Belgium, Bosnia and Herzegovina, Croatia, Serbia, Romania, Greece, Bulgaria, Hungary, Slovakia, the United Kingdom, Turkey and Austria. The infected vertebrate host species include domestic carnivores (dogs and cats), wild carnivores (red foxes, wolves, beech martens, wildcats and golden jackals), lagomorphs (brown hares and wild European rabbits) and humans. In Europe, 11 cases of human thelaziosis have been reported, the majority of which are autochthonous. However, some of them have been imported, a fact which highlights the importance of surveillance policies to restrict cross-border spread of the parasite. The objectives of this article are to review key aspects of the epidemiology of T. callipaeda, summarise animal and human cases in Europe and emphasise the importance of education and awareness among veterinarians, physicians (particularly ophthalmologists) and animal, in order to owners to tackle this zoonosis.

Congenital hyperreninemic hypoaldosteronism due to aldosterone synthase deficiency type I in a Portuguese patient - Case report and review of literature.

Hyperreninemic hypoaldosteronism due to aldosterone synthase (AS) deficiency is a rare condition typically presenting as salt-wasting syndrome in the neonatal period. A one-month-old Portuguese boy born to non-consanguineous parents was examined for feeding difficulties and poor weight gain. A laboratory workup revealed severe hyponatremia, hyperkaliaemia and high plasma renin with unappropriated normal plasma aldosterone levels, raising the suspicion of AS deficiency. Genetic analysis showed double homozygous of two different mutations in the CYP11B2 gene: p.Glu198Asp in exon 3 and p.Val386Ala in exon 7. The patient maintains regular follow-up visits in endocrinology clinics and has demonstrated a favourable clinical and laboratory response to mineralocorticoid therapy. To our knowledge, this is the first Portuguese case of AS deficiency reported with confirmed genetic analysis.

Congenital hyperreninemic hypoaldosteronism due to aldosterone synthase deficiency type I in a Portuguese patient - Case report and review of literature

SUMMARY Hyperreninemic hypoaldosteronism due to aldosterone synthase (AS) deficiency is a rare condition typically presenting as salt-wasting syndrome in the neonatal period. A one-month-old Portuguese boy born to non-consanguineous parents was examined for feeding difficulties and poor weight gain. A laboratory workup revealed severe hyponatremia, hyperkaliaemia and high plasma renin with unappropriated normal plasma aldosterone levels, raising the suspicion of AS deficiency. Genetic analysis showed double homozygous of two different mutations in the CYP11B2 gene: p.Glu198Asp in exon 3 and p.Val386Ala in exon 7. The patient maintains regular follow-up visits in endocrinology clinics and has demonstrated a favourable clinical and laboratory response to mineralocorticoid therapy. To our knowledge, this is the first Portuguese case of AS deficiency reported with confirmed genetic analysis.

Reset osmostat: a rare cause of hyponatraemia.

Neonatal hyponatraemia is common, and related to significant morbidity and mortality. We report a case of a preterm newborn (gestational age of 36 weeks) with hyponatraemia, and with a prenatal diagnosis of cleft lip and palate, with a normal fetal karyotype. On the seventh day of life, a biochemical evaluation for jaundice and mild signs of dehydration showed hyponatraemia of 124 mmol/L. Investigation showed normal adrenal and thyroid functions, plasma hyposmolality (258 mOsm/kg); high urinary sodium (73 mmol/L) and high urinary osmolality (165 mOsm/kg). Despite oral sodium supplementation and fludrocortisone treatment, sodium levels remained between 124 and 130 mmol/L. Cranial ultrasound, brain MRI and renal ultrasound were normal. The diagnosis of hyponatraemia was unpredicted and the investigation was suggestive of reset osmostat, a subtype of the syndrome of inappropriate secretion of antidiuretic hormone, characterised by a subnormal threshold for antidiuretic hormone secretion.

Menstruation disorders in adolescents with eating disorders-target body mass index percentiles for their resolution.

OBJECTIVE: To analyse the progression of body mass index in eating disorders and to determine the percentile for establishment and resolution of the disease. METHODS: A retrospective descriptive cross-sectional study. Review of clinical files of adolescents with eating disorders. RESULTS: Of the 62 female adolescents studied with eating disorders, 51 presented with eating disorder not otherwise specified, 10 anorexia nervosa, and 1 bulimia nervosa. Twenty-one of these adolescents had menstrual disorders; in that, 14 secondary amenorrhea and 7 menstrual irregularities (6 eating disorder not otherwise specified, and 1 bulimia nervosa). In average, in anorectic adolescents, the initial body mass index was in 75th percentile; secondary amenorrhea was established 1 month after onset of the disease; minimum weight was 76.6% of ideal body mass index (at 4th percentile) at 10.2 months of disease; and resolution of amenorrhea occurred at 24 months, with average weight recovery of 93.4% of the ideal. In eating disorder not otherwise specified with menstrual disorder (n=10), the mean initial body mass index was at 85th percentile; minimal weight was in average 97.7% of the ideal value (minimum body mass index was in 52nd percentile) at 14.9 months of disease; body mass index stabilization occurred at 1.6 year of disease; and mean body mass index was in 73rd percentile. Considering eating disorder not otherwise specified with secondary amenorrhea (n=4); secondary amenorrhea occurred at 4 months, with resolution at 12 months of disease (mean 65th percentile body mass index). CONCLUSION: One-third of the eating disorder group had menstrual disorder - two-thirds presented with amenorrhea. This study indicated that for the resolution of their menstrual disturbance the body mass index percentiles to be achieved by female adolescents with eating disorders was 25-50 in anorexia nervosa, and 50-75, in eating disorder not otherwise specified.

Menstruation disorders in adolescents with eating disorders ? target body mass index percentiles for their resolution / Distúrbios menstruais em adolescentes com transtornos alimentares ? meta de percentil de índice de massa corporal para resolução dos distúrbios menstruais

Objective To analyse the progression of body mass index in eating disorders and to determine the percentile for establishment and resolution of the disease. Methods A retrospective descriptive cross-sectional study. Review of clinical files of adolescents with eating disorders. Results Of the 62 female adolescents studied with eating disorders, 51 presented with eating disorder not otherwise specified, 10 anorexia nervosa, and 1 bulimia nervosa. Twenty-one of these adolescents had menstrual disorders; in that, 14 secondary amenorrhea and 7 menstrual irregularities (6 eating disorder not otherwise specified, and 1 bulimia nervosa). In average, in anorectic adolescents, the initial body mass index was in 75th percentile; secondary amenorrhea was established 1 month after onset of the disease; minimum weight was 76.6% of ideal body mass index (at 4th percentile) at 10.2 months of disease; and resolution of amenorrhea occurred at 24 months, with average weight recovery of 93.4% of the ideal. In eating disorder not otherwise specified with menstrual disorder (n=10), the mean initial body mass index was at 85th percentile; minimal weight was in average 97.7% of the ideal value (minimum body mass index was in 52nd percentile) at 14.9 months of disease; body mass index stabilization occured at 1.6 year of disease; and mean body mass index was in 73rd percentile. Considering eating disorder not otherwise specified with secondary amenorrhea (n=4); secondary amenorrhea occurred at 4 months, with resolution at 12 months of disease (mean 65th percentile body mass index). Conclusion One-third of the eating disorder group had menstrual disorder − two-thirds presented with amenorrhea. This study indicated that for the resolution of their menstrual disturbance the body mass index percentiles to be achieved by female adolescents with eating disorders was 25-50 in anorexia nervosa, and 50-75, in eating disorder not otherwise specified. .

Objetivo Analisar a progressão do índice de massa corporal nos transtornos alimentares e determinar o percentil para estabelecimento e resolução da doença. Métodos Estudo retrospectivo descritivo, com análise dos processos de adolescentes com transtorno alimentar. Resultados Das 62 adolescentes com distúrbio alimentar, 51 apresentavam distúrbio sem outra especificação, 10 anorexia nervosa, e uma bulimia. Vinte e uma adolescentes apresentavam distúrbios menstruais, sendo 14 amenorreia secundária, 7 irregularidades menstruais (6 distúrbio alimentar sem outra especificação e 1 bulimia). Em média, nas anoréticas: índice de massa corporal inicial - percentil 75, instalação da amenorreia secundária com um mês de doença, peso mínimo 76,6% do índice de massa corporal ideal, no percentil 4), com 10,2 meses de doença, resolução da amenorreia aos 24 meses com recuperação ponderal média de 93,4% do peso ideal. No distúrbio alimentar sem outra especificação com distúrbio menstrual (n=10), o índice de massa corporal inicial médio no percentil 85, peso mínimo, em média, 97,7% do valor de peso ideal (média no percentil 52 de índice de massa corporal), aos 14,9 meses, estabilização ponderal aos 1,6 anos, percentil médio de índice de massa corporal de 73. Na perturbação do comportamento alimentar sem outra especificação com amenorreia secundária (n=4): amenorreia secundária aos 4 meses, resolução aos 12 meses (média no percentil 65 do índice de massa corporal). Conclusão Um terço do grupo com transtornos alimentares teve distúrbios menstruais − sendo dois terços com amenorreia secundária. Este estudo indicou que, para resolução ...

Neonatal meningitis associated with osteomyelitis and epidural empyema.

Neonatal meningitis is a serious disease with significant mortality and morbidity. Its signs and symptoms are subtle, non-specific, atypical or absent. Cephalohaematoma is frequent in newborns and complications are uncommon, including local infection after haematogenous spread in the setting of bacteraemia or meningitis with a possibility of osteomyelitis, epidural abscess and subdural empyema. We report the case of a late preterm newborn, with an unremarkable pregnancy, born by vacuum-assisted vaginal delivery that presented in the fifth day of life with irritability, fever and grunting. Cerebrospinal fluid and blood cultures were positive for Escherichia coli. The patient had neurological deterioration despite adequate antibiotic therapy and brain MRI showed a right parietal epidural empyema, subcutaneous abscess, osteomyelitis and supratentorial hydrocephalus. The culture of the cephalohaematoma's abscess material was positive for E coli. Antibiotic therapy was continued for 8 weeks. The child, now 2 years old, has spastic tetraparesis with global development delay.