Epidemiology of Taenia solium infection in the Russian Federation in the last 20 years: a systematic review.

Taenia solium is a zoonotic parasite that causes taeniasis and cysticercosis in humans (as final hosts) and cysticercosis in pigs (as intermediate hosts). The Russian Federation (RF) is traditionally considered as endemic for this zoonosis. However, the epidemiological data on T. solium infection have not been reviewed for the past 20 years, in which time dynamic economical and societal changes have occurred in the RF. The aim of this systematic review was to analyse the status of T. solium infection in RF in the 2000-2019 period. A literature search was conducted, which collected published articles, grey literature and official data on the epidemiology of T. solium taeniasis and cysticercosis in the RF published from 2000. From a total of 2021 articles and 24 official reports originally returned by the search, data were extracted from 12 full text articles and 11 official reports. Taenia solium taeniasis was continuously reported in the RF between 2000 and 2019, with a tenfold decrease in the incidence, from 0.2 per 100,000 population in 2000 to 0.023/100,000 in 2019. Also, the number of administrative units where taeniasis was detected continuously decreased. Cysticercosis in pigs had a declining trend after 2006. In conclusion, although decreasing, T. solium infection is still endemic in several regions and suspected to be endemic in most of the RF.

Pork as a source of human parasitic infection.

Foodborne zoonoses have been estimated to annually affect 10% of the global population, among which zoonotic parasites constitute an important class of aetiological agents. The major meatborne parasites include the protozoa Toxoplasma gondii and Sarcocystis spp., and the helminths Trichinella spp. and Taenia spp., all of which may be transmitted by pork. The significance of zoonotic parasites transmitted by pork consumption is emphasized by the prediction by the Food and Agriculture Organization of an 18.5% increase in world pork production over the next 10 years. Of all the porkborne parasites, the three 'T' parasites have been responsible for most porkborne illness throughout history; they are still endemic, and therefore are important public-health concerns, in developing countries. Although the risk of porkborne parasites, particularly helminths, may currently be considered insignificant in developed countries, the modern trend of consuming raw meat favours their re-emergence. This paper overviews the main parasites transmitted to humans by pork, and outlines the main lines of prevention.

Human giardiasis in Serbia: asymptomatic vs symptomatic infection.

Despite the public health importance of giardiasis in all of Europe, reliable data on the incidence and prevalence in Western Balkan Countries (Serbia, Bosnia and Herzegovina, Croatia, Montenegro and FYR Macedonia) are scarce, and the relative contribution of waterborne and food-borne, or person-to-person and/or animal-to-person, transmission of human giardiasis is not yet clear. To provide baseline data for the estimation of the public health risk caused by Giardia, we here review the information available on the epidemiological characteristics of asymptomatic and symptomatic human infection in Serbia. Although asymptomatic cases of Giardia represent a major proportion of the total cases of infection, high rates of Giardia infection were found in both asymptomatic and symptomatic populations. No waterborne outbreaks of giardiasis have been reported, and it thus seems that giardiasis mostly occurs sporadically in our milieu. Under such circumstances, control measures to reduce the high prevalence of giardiasis in Serbia have focused on person-to-person transmission, encouraging proper hygiene, but for more targeted intervention measures, studies to identify other risk factors for asymptomatic and symptomatic infections are needed.

Risk factors for Toxoplasma infection in pregnant women in FYR of Macedonia.

The aim of the study was to identify risk factors for Toxoplasma gondii infection in pregnant women in FYR of Macedonia. Retrospective analysis of serological and epidemiological data in a series of 235 pregnant women from Macedonia, tested for Toxoplasma infection between January 2004 and December 2005, showed an overall prevalence of infection of 20.4%. Exposure to transmission factors significantly increased the risk of infection (RR = 1.989, 95 % CI = 1.041-3.800, p = 0.037). The single infection transmission factor that was a predictor of infection in the whole series was exposure to soil (RR = 1.946, 95% CI = 1.026-3.692, p = 0.041). Based on prevalence and the established risk factors for Toxoplasma infection in Macedonia, the health education programme as a sustainable measure for the prevention of congenital toxoplasmosis should focus on educating women of generative age to avoid contact with soil (farming, gardening), and/to adhere to strict hygienic practices afterwards.

Toxoplasmosis in Serbia: time for an action plan.

Known for a century, Toxoplasma gondii has been studied in Serbia half this time, ever since the introduction of the Sabin-Feldman test at the Institute for Medical Research (IMR) in 1959. However, despite 50 years of continuous efforts, exact data on the frequency of acute clinical disease, acute infections in pregnancy and congenital infection in the offspring are still lacking, due to the vague regulatory provision that toxoplasmosis is subject to reporting "in case of epidemiological indications". It is, however, clear that the major Toxoplasma-induced public health issue in Serbia, like elsewhere in Europe, is congenital toxoplasmosis (CT). Continuous monitoring of particular patient groups showed a dramatic decrease in the prevalence of infection over the past two decades, and a consequently increased proportion of women susceptible to infection in pregnancy, suggesting a potential increase in the incidence of CT. Studies of risk factors for infection transmission have provided data to guide national health education campaigns. It is expected that the recent appointment of the National Reference Laboratory for Toxoplasmosis as the focal point for the collection of data from the primary level, will provide the means for accurate assessment of the measure of the problem, which is a prerequisite of an evidence-based nation-wide prevention program. In the meantime, health education of all pregnant women, focused at risk factors of major local significance, is advocated as a sound and financially sustainable option to reduce congenital toxoplasmosis.

Undercooked meat consumption remains the major risk factor for Toxoplasma infection in Serbia.

Toxoplasma gondii infection prevalence and infection risk factors were analyzed in a series of 765 women of generative age from throughout Serbia tested at the Institute for Medical Research Toxoplasmosis Laboratory between 2001 and 2005. The infection risk factors were additionally analyzed in a group of 53 women with acute infection (cases) compared to a group of seronegative women matched for age and education level (controls). The overall prevalence of infection was 33%. Infection risk factors in the whole series were undercooked meat consumption (RR = 1.77, 95% CI = 1.16-2.7, P = 0.008) and exposure to soil (RR = 1.63, 95% CI = 1.17-2.29, P = 0.004), particularly in less educated women. Moreover, undercooked meat consumption was the single predictor of infection in women with acute infection, with an 11-fold increased risk of infection in women who acknowledged consumption of undercooked meat (RR = 11.21, 95% CI = 3.10-40.53, P = 0.000). These data prompted us to analyze the significance of consumption of particular meat types as sources of infection. Of all the meat types mostly consumed in Serbia, only consumption of beef (RR = 1.006, 95% CI = 1.001-1.011, P = 0.027) was shown to influence Toxoplasma infection rates.

Synergistic effect of clindamycin and atovaquone in acute murine toxoplasmosis.

The effect of clindamycin (CLI) combined with autovaquone (ATO) was examined in a murine model of acute toxoplasmosis. Swiss Webster mice intraperitoneally infected with 10(2) or 10(4) tachyzoites of the RH strain of Toxoplasma gondii were perorally treated with either drug alone (for ATO, 5, 25, 50, or 100 mg/kg of body weight/day; for CLI, 25, 50, or 400 mg/kg/day) or both combined (for ATO plus CLI, respectively, 5 plus 25, 25 plus 25, 25 plus 50, 50 plus 50, or 100 plus 400 mg/kg/day) starting with day 1 for 14 days. Survival was monitored during 7 weeks. Residual infection was assessed by a bioassay of representative 4-week survivors and by parasite DNA detection by PCR for representative 7-week survivors. An effect of treatment was shown in all treatment groups compared to untreated control mice (P = 0.0000). Among mice infected with 10(2) parasites, ATO and CLI at any dose combination protected significantly more animals than ATO alone (P = 0.0000), but compared to CLI alone, given its good effect, the combined drugs were no more effective (P > 0.05). For mice infected with 10(4) parasites, the drugs combined at the lowest and highest doses (5 plus 25 and 100 plus 400 mg/kg/day) were, similarly, more effective than ATO alone (P = 0.035 and 0.000, respectively) but not than CLI alone (P > 0. 05). However, treatment with ATO plus CLI at 25 plus 25, 25 plus 50, and 50 plus 50 mg/kg/day protected 20, 33, and 78% of mice, respectively, compared to virtually no survivals among those treated with either drug alone (P < 0.0005), thus demonstrating a significant synergistic effect of ATO and CLI against T. gondii. Furthermore, the dose of ATO at a given dose of CLI was shown to be critical to the effect. Moreover, the absence of residual infection in some survivors shows the potential of this drug combination to eliminate the parasite.

Treatment protocol determines the efficacy of clindamycin in acute murine toxoplasmosis.

To determine the contribution to the efficacy of clindamycin in acute murine toxoplasmosis of treatment protocol variables, groups of Swiss Webster mice inoculated intraperitoneally with 10(2) RH strain Toxoplasma gondii tachyzoites were treated with peroral clindamycin at 25, 50 and 400 mg/kgBM per day for 1, 2 and 3 weeks. While the lowest drug dose applied for a single week prolonged survival time as compared to untreated animals, not even the highest dose applied for 1 or 2 weeks completely prevented mortality. Conversely, 100% protection was achieved with 3-week treatment courses at both 50 and 400 mg/kg per day. While both survival rates and survival times increased in parallel with the drug dose and treatment duration, the latter was shown to be critical to the outcome, suggesting the use of clindamycin as an antitoxoplasmic agent should be as a prolonged course.

Risk factors for Toxoplasma infection in a reproductive age female population in the area of Belgrade, Yugoslavia.

The contribution to Toxoplasma infection of known transmission risk factors such as consumption of undercooked meat, contact with soil, and contact with cats, as well as that of age, degree of education, residence in central vs. suburban city communities, and year of entry into the study, has been investigated in a group of 1157 female residents (age range 15 to 45 years) of a defined geographic area (Belgrade) during a 4-years period (1988-1991). The rate of infection increased with age, ranging from 57% to 93%, with an overall mean of 77%. However, it decreased significantly over the study period (p < 0.01). Of the potential risk factors examined, regression analysis showed that the following: age (relative risk (RR): 1.18, 95% confidence interval (CI): 1.02-1.37, p = 0.022), undercooked meat consumption (RR: 2.22, 95% CI: 1.2-2.86, p = 0.001), and the year of entry into the study (RR: 0.69, 95% CI: 0.6-0.8, p = 0.000) were significantly associated with infection. However, while the consumption of undercooked meat contributed to the frequency of infection in the whole group, its significance increased with the degree of education but decreased with age, and was greater in women residing in the suburbs. In addition, in women below age 20, exposure to soil (farming, gardening) was significantly associated with infection (RR: 1.38, 95% CI: 1.12-1.97, p = 0.037). Since cats are the single source of toxoplasma oocysts, the above finding indicates that cats are an epidemiologically significant source of environmental contamination in Belgrade. However, cat ownership itself as a criterion of contact with cats was not associated with infection (p = 0.326). In the absence of a general screening in pregnancy program in Yugoslavia, these data point out the groups of pregnant women at the highest risk of infection and provide a basis for a region-appropriate educational program to prevent congenital toxoplasmosis.

[Intestinal parasitic infections in Serbia]. / Infekcije prevnim parazitima u Srbiji.

To determine the public health significance of intestinal parasitism in Serbia today, systematic parasitologic examination of 16 regions (Kragujevac, Luchani, Zhagubica, Bor, Sjenica, Novi Pazar, Valjevo, Aleksandrovac, Pirot, Bosilegrad, Ivanjica, Golubac, Uzhice, Kladovo, Negotin, Beograd) in central Serbia were carried out over the period 1984-1993. The study involved a total of 5981 schoolchildren (2887 F, 3094 M), 7-11 years old representing 10% of the total age-matched population (N = 58,228) of the examined regions, residing in 91 settlements. Field parasitological examinations included the examination of perianal swabs for E. vermicularis and Taenia sp., and examination of a single feces sample by direct saline smear and Lugol stained smear for intestinal protozoa, and the Kato and Lörincz methods for intestinal helminths. Nine species of intestinal parasites were detected, of which five protozoan: Entamoeba histolytica (0.02%), Entamoeba hartmanni (0.02%), Entamoeba coli (1.3%), Iodamoeba bütschlii (0.02%), Giardia lamblia (6.8%), and four helminthic: Hymenolepis nana (0.06%), Enterobius vermicularis (14.7%), Ascaris lumbricoides (3.3%), Trichuris trichiura (1.8%). The overall prevalence of intestinal parasite infections amounted to 24.6% (1207/4913), with a highly significant difference (p < 0.001) between particular sites (range 14.4%-43.8%) (Figure 1). Helminthic infections (810) were significantly more frequent (p < 0.001) as compared to both protozoan (296) and combined helminthic-protozoan infections (101). Of these, two species (G. lamblia, E. vermicularis) were found in all examined regions, three (E. coli, A. lumbricoides, T. trichiura) were detected in two or more, while four species (E. histolytica, E. hartmanni, I. bütschlii, H. nana) were each found in a single region (Figure 2). The predominant species (E. coli, G. lamblia, E. vermicularis, A. lumbricoides, T. trichiura) were distributed at considerably different prevalence rates, with a significant difference between the minimal and maximal values (p < 0.01). Of 91 settlements examined, intestinal parasites were found in all but one. However, the prevalence rates in 90 settlements varied significantly (p = 0.0004), from a low of 5.9% to a high of 66.7%. Thus, according to the World Health Organization criteria [19], infections with the four clinically relevant species (G. lamblia, E. vermicularis, A. lumbricoides, T. trichiura) ranged from sporadic to endemic and hyperendemic (Figure 3). The results obtained provide the basic epidemiological data about intestinal parasite infections in Serbia, and indicate their significance in terms of both the number of species and their respective prevalence rates. Given the significant differences obtained in the frequency and distribution of particular parasite infections in different regions, a programme for the control of these infections in Serbia should obviously include a wide variety of measures.

Investigaçöes ecológicas sobre carrapatos (Acari, Ixodidae) na regiäo leste da Sérvia, com ênfase em Ixodes ricinus e Hyalomma savignyi / Ecological investigations on ticks (Acari, Ixodidae) of East Serbia, with emphasis on Ixodes ricinus and Hyalomma savignyi

Um estudo ecológico sobre carrapatos ixodídeos foi feito entre 1989 e 1995 na regiäo leste da Sérvia. Dentre as 14 espécies da família Ixodidae, nove foram identificadas: Dermacentor marginatus, Rhipicephalus bursa, Rhipicephalus sanguineus, Ixodes ricinus, Haemaphysalis punctata, Haemaphysalis sulcata, Haemaphysalis inermis, Hyalomma savignyi e Boophilus calcaratus. A composiçäo da fauna e da dinâmica populacional foram examinadas medindo-se e avaliando-se ao mesmo tempo o efeito de temperatura, umidade e precipitaçäo pluviométrica sobre a dinâmica da populaçäo dos carrapatos. A regiäo tem sido identificada como foco natural do vírus da febre hemorrágica Criméia-Congo (CCHF) e neste trabalho foi dada especial atençäo aos carrapatos Ixodes ricinus e Hyalomma savignyi vetores da CCHF e da doença de Lyme

Effects of age-targeted treatment of intestinal parasite infections in Serbia.

A survey of intestinal parasite infections in school-children throughout Serbia revealed an area of endemic infection where 31% of the children examined were found to be infected with Giardia lamblia, Enterobius vermicularis, Ascaris lumbricoides and Trichuris trichiura. All infected children were treated with metronidazole for giardiasis and mebendazole for helminthic infections. A post-chemotherapy survey was performed 3 months later to assess the efficacy of treatment, showing a decrease in the prevalence of all species, thus indicating drug efficacy of 66-100%. A second survey, performed 13 months after chemotherapy to assess the rates of reinfection, showed that only Ascaris lumbricoides prevalence returned to the pre-treatment level. The results of this field study prove chemotherapy to be an important tool in the control of intestinal parasite infections.

Specific IgM antibodies as parameters of toxoplasma infection in pregnancy.

The aim of this investigation was to determine the time of toxoplasma infection more precisely by using an indirect fluorescent antibody test and indirect hemagglutination test in 51 pregnant women whose Sabin-Feldman test and immunosorbent agglutination assay were positive. Analysis of the results of sera tested with the two additional serological assays showed that the infection was acquired during pregnancy in 19 cases, while the other pregnant women had become infected before conception.

[The effect of transcutaneous electric nerve stimulation on pain in knee arthroses]. / Uticaj transkutane elektricne nervne stimulacije na bol kod artroze kolena.

The paper deals with effects of the TENS on disappearance of pain in knee arthrosis. Relevant investigation covered 40 patients of both sexes, different occupations and various age. The group was homogeneous in respect of subjective feeling of pain, length of illness and clinical findings. The results that were obtained clearly indicate the possibility of extinguishing the pain completely or reducing its intensity by application of the TENS which is to be used in medical treatment of knee arthrosis simultaneously with common drugs and physical therapies.

High levels of IgM antibodies specific for Toxoplasma gondii in pregnancy 12 years after primary toxoplasma infection. Case report.

A case of high levels of specific IgM antibodies registered by the immunosorbent agglutination assay (ISAgA) in a pregnant woman with a history of toxoplasmosis is reported. The patient had acute lymphoglandular toxoplasmosis diagnosed serologically by increases in the specific antibody titer detected by the Sabin-Feldman test (SFT) and pathohistologically 12 years before pregnancy. In pregnancy, she had stable titers of specific antibodies registered by the SFT, enzyme-linked immunosorbent assay (ELISA), indirect fluorescent antibody test (IFAT), indirect hemagglutination test (IHAT) and direct agglutination test. Specific IgM antibodies were detected by the ISAgA but not by the IgM-IFAT, IgM-ELISA and IgM-IHAT. She had a normal pregnancy and gave birth to a clinically healthy baby who had a negative ISAgA finding at 7 days of age. This case indicates that ISAgA is not necessarily a marker of recent infection and is therefore not reliable for the diagnosis of toxoplasmosis in pregnancy.

Onset of ocular complications in congenital toxoplasmosis associated with immunoglobulin M antibodies to Toxoplasma gondii.

Four patients with congenital toxoplasmosis serologically diagnosed by the Sabin-Feldman test (SFT) and the IgM-indirect fluorescent antibody test (IgM-IFAT) in the first year of life presented with eye disease between the age of 21 months and ten years. Repeated serological testing revealed increasing levels of specific antibodies as measured by the SFT. IgM antibodies to Toxoplasma gondii were detected in all four patients by the immunosorbent agglutination assay, in two by the IgM-IFAT and in three by the IgM-indirect haemagglutination test. Findings suggest that specific IgM antibodies reappear at the time of reactivation of congenital toxoplasmosis later in life, or possibly persist for an extraordinary long period (up to ten years).

[Toxoplasmosis in pregnancy with special emphasis on laboratory diagnosis]. / Toksoplazmoza u trudnoci sa posebnim osvrtom na laboratorijsku dijagnostiku.

On the occasion of the thirty-five years of systematic research of toxoplasmosis, a review of the present knowledge of the role of toxoplasmosis in pregnancy is presented. Diagnostic procedures and the interpretation of the results of laboratory examinations are particularly stressed. The main conclusion is that in a population exposed to the infection in the way as was in the cases studied, the prevention of congenital toxoplasmosis can be achieved through a serologic follow-up of all pregnant women starting from the moment when pregnancy is established. The purpose of such screening is to identify those pregnant women who are not immunized (who are then advised to follow certain hygienic and dietetic measures) and those who are primoinfected in pregnancy. As the latter are at risk for transmitting the infection to their fetuses, they receive specific therapy and their fetuses are carefully controlled by ultrasound and other methods for the antenatal diagnosis of intrauterine infection.