Ectoparasites infesting animals living in close contact with human beings: a real trouble for One Health perspective? / [Ectoparasitos infestando animais que vivem em contato próximo com seres humanos: um problema real para a perspectiva Saúde Única?]

The number of domestic animals living with human beings is rapidly increasing in parallel with an enhanced risk of transmission of their parasites and the pathogens they might carry. The aim of this study was to assess the occurrence of hematophagous arthropods infesting domestic animals from Northeastern Brazil and to remark the implications of their occurrence on the epidemiology and control of selected veterinary and human diseases. From January 2017 to April 2019, ectoparasites infesting domestic cats, dogs and horses were collected for their respective hosts and identified. Overall, ectoparasites were sampled from 86 domestic animals, living in different anthropic settings. A total of 401 specimens (344 ticks and 57 fleas) were collected from different hosts [i.e., 10 (2.49%), 96 (23.94%) and 295 (73.57%) from cats, dogs and horses, respectively]. Two flea (i.e., Ctenocephalides canis and Ctenocephalides felis) and 5 tick species (i.e., Amblyomma ovale, Amblyomma sculptum, Dermacentor nitens, Rhipicephalus microplus and Rhipicephalus sanguineus sensu lato) were identified. This study provides data on the ectoparasite fauna infesting domestic animals from Northeastern Brazil. The diagnosis and treatment of these parasites should not be underestimated, considering the role that hematophagous arthropods display as vectors of pathogens of medical and veterinary concern.(AU)

O número de animais domésticos infestados por ectoparasitos vivendo em estreito contato com seres humanos está aumentando, elevando o risco de infecção pelos patógenos transmitidos por vetores. Objetivou-se neste estudo avaliar a ocorrência de ectoparasitos infestando animais do nordeste do Brasil e discutir as implicações desse parasitismo na epidemiologia e no controle de doenças de importância médico-veterinária. De janeiro de 2017 a abril de 2019, artrópodes foram coletados de gatos, cães e cavalos, e identificados morfologicamente. Ectoparasitos foram removidos de 86 animais infestados provenientes de áreas urbanas e rurais. Foram identificados 401 espécimes (344 carrapatos e 57 pulgas) coletados de diferentes hospedeiros (10 (2,49%), 96 (23,94%) e 295 (73,57%) de gatos, cães e cavalos, respectivamente. Duas espécies de pulgas (Ctenocephalides canis e Ctenocephalides felis) e cinco espécies de carrapatos (Amblyomma ovale, Amblyomma sculptum, Dermacentornitens, Rhipicephalus microplus e Rhipicephalus sanguineus sensu lato) foram identificadas. Este estudo fornece informações sobre a ectofauna de animais domésticos do nordeste do Brasil. Portanto, o diagnóstico e o tratamento desses parasitos não devem ser subestimados, considerando que os artrópodes aqui relatados podem veicular patógenos de importância médico-veterinária.(AU)

Filaroidosis Infection in an Immunocompetent Adult Dog from France.

A dog from Paris (France) was referred with a 2-week history of dry cough, intermittent acute onset of dyspnoea, and acute abdominal pain. A generalised bronchoalveolar infiltrate with a patchy distribution was observed at chest x-rays and computed tomography (CT) scans. Negative results were obtained through several faecal examinations for cardiorespiratory nematodes by using the Baermann technique and at two blood analysis with a commercially available test for the detection of A. vasorum antigen (the first one at the first visit and second one at the control visit, one month later). PCR methods for the identification of A. vasorum and C. vulpis were also accomplished. At the control visit, nematode L1s were found during direct microscopic examination of bronchoalveolar lavage fluid (BALF). Thus, a different antigen-based assay for the detection of A. vasorum was performed with a positive result. Moreover, based on morphology, isolated larvae were identified as Filaroides hirthi. The dog was treated with fenbendazole (50 mg/kg per os once daily) for two consecutive weeks. After five months, the dog was referred again for the intermittent acute onset of dyspnoea and was found to be still positive for F. hirthi larvae at BALF examination. A 15-day treatment regimen with fenbendazole in combination with three subcutaneous injections of ivermectin (0.4 mg/kg, once every two weeks), was then performed. No larvae were detected at two BALF microscopical examinations performed one month apart. Results from this case report underline the importance of including F. hirthi infections in the differential diagnosis of dog bronchopneumonia.

The European wildcats (Felis silvestris silvestris) as reservoir hosts of Troglostrongylus brevior (Strongylida: Crenosomatidae) lungworms.

The increasing reports of Troglostrongylus brevior lungworm in domestic cats from Italy and Spain raised questions on its factual distribution and on the role wildcats play as reservoirs of these parasites. Carcasses of 21 wildcats were collected in natural parks of southern Italy (i.e., Catania, Sicily n=5 and Matera, Basilicata n=16) and biometrically and genetically identified as Felis silvestris silvestris, but two as hybrids. Troglostrongylus brevior and Eucoleus aerophilus lungworms were found in 15 (71.4%) and 7 (33.3%) individuals, respectively, being five (23.8%) co-infected by the two species. Both lungworms showed an aggregated distribution in the host population, assessed by k-index (i.e., 0.69 for T. brevior and 0.42 for E. aerophilus). Although no statistical significant difference was recorded among age, gender and geographical location of wildcats, a larger rate of infection by T. brevior was assessed in yearlings (85.7%) than adults (64.3%). This is the first epidemiological study reporting T. brevior infection in the European wildcat and discusses the potential threat this may represent for the conservation of this endangered species of felids. In addition, given the large frequency of lungworm infection herein recorded, the role of wildcats as reservoir hosts of these parasites to domestic cats is discussed.

Clinical correlates of akathisia in acute psychiatric inpatients.

This study identified acute and chronic akathisia in acute psychiatric inpatients receiving conventional antipsychotic medication, and evaluated the clinical characteristics, risk factors and clinical implications of the condition. Akathisia and other movement disorders were systematically assessed in patients consecutively admitted to an acute psychiatric ward over one year. Akathisia was diagnosed in 15 (21%) of 72 patients. Akathisia, developing as an acute condition in seven patients, generally presented with the subjective experience of dysphoria and unease without restless movements. This acute akathisia developed during the first few days of hospitalization and was associated with both a higher average dose of antipsychotic medication and a greater increase in dosage. In the remaining eight cases, akathisia was already present on admission, and thus classified as chronic. Those patients with chronic akathisia exhibited both subjective restlessness and the characteristic restless movements. Chronic akathisia was unrelated to antipsychotic dosage. The proportion of patients with akathisia who discontinued drug treatment was significantly higher than that for patients without the condition. Patients with acute akathisia tended to drop-out of treatment and those with the chronic form tended to have treatment withdrawn by the prescribing clinician. One interpretation is that the subjective distress of acute akathisia may be particularly difficult for patients to tolerate and leads them to stop medication, while patients with more chronic akathisia may have become more accepting of the experience. Repetitive movements of the legs were observed more commonly in those with chronic rather than acute akathisia, and may represent a way of achieving some limited respite.

The role of HIV type 1 phenotype and genotype in long-term responders to zidovudine therapy.

We performed a cross-sectional and partly retrospective virological evaluation of 31 long-term responders (LTRs) to zidovudine (ZDV) (persistent increase in the CD4+ cell counts without progression of HIV infection throughout a period of ZDV therapy > 3 years) and 17 well-matched controls who developed a marked immunological deterioration over a 24-month period of ZDV therapy. The biological phenotype of HIV-1 was assessed by testing the capacity of the isolates to replicate in the MT-2, HUT-78, C-8166, and U-937 T cell lines, and mutations at codons 215 and 41 of RT were checked in proviral DNA from uncultured PBMCs. Show/low non-syncytium-inducing (S/L-NSI) and rapid/high syncytium-inducing (R/H-SI) variants were detected in 25 (81%) and 2 (6%) LTRs, respectively. HIV-1 could not be isolated in the remaining four LTRs (13%). Conversely, 12 of 17 (71%) controls yielded R/H-SI variants. Conversion from the S/L-NSI to R/H to R/H-SI phenotype occurred in 5 controls but in none of the 18 LTRs tested. Mutant sequences in proviral DNA from control PBMCs were consistently detected (94%), while a wild-type sequence of the residues investigated was found in the majority of LTRs (77%). In our series, patients who received immunological and clinical benefits even after prolonged ZDV treatment had S/L-NSI viruses and a low risk to develop ZDV resistance. Conversely, subjects who demonstrated an immunological and clinical deterioration yielded R/H-SI variants or shifted from S/L-NSI to R/H-SI phenotypes and were at higher risk to develop mutations indicating ZDV resistance.

Polymerase chain reaction for non-invasive diagnosis of brain mass lesions caused by Mycobacterium tuberculosis: report of five cases in human immunodeficiency virus-positive subjects.

To investigate whether the polymerase chain reaction (PCR) on the IS6110 sequence of Mycobacterium tuberculosis could permit the early and non-invasive diagnosis of tuberculous brain lesions without meningeal involvement in acquired immunodeficiency virus patients, we examined retrospective cerebrospinal fluid (CSF) samples from five patients diagnosed as having cerebral lesions caused by M. tuberculosis. M. tuberculosis deoxyribonucleic acid was detected in CSF samples obtained from each of the patients studied, but in none of the controls. The PCR results coincided with M. tuberculosis isolation from CSF in two patients. In an additional two subjects, culture for M. tuberculosis on CSF was negative, and the diagnosis of central nervous system tuberculosis was achieved by response to specific therapy. In the last patient the PCR result on CSF was confirmed by isolation of M. tuberculosis from brain biopsy. Interestingly, in this patient the CSF did not yield M. tuberculosis isolation when cultured. The data show the value of PCR as a potentially useful approach for the early and rapid diagnosis of cerebral tuberculosis even without meningitis.

Detection of HCV RNA in serum and seminal fluid from HIV-1 co-infected intravenous drug addicts.

The presence of hepatitis C virus (HCV) RNA in serum and seminal fluid was investigated in eleven drug addicts coinfected with HIV-1 and HCV. Serum and seminal fluid were taken from each patient at the same time point. HCV RNA was found in ten of the eleven serum samples tested, but only in one of the semen samples. No relationship was observed between CD4 cell counts, the stage of HIV infection, extent of liver damage and the presence of HCV RNA in serum and semen. The results indicate that HCV is not usually present in the semen and provide further evidence against sexual transmission as an important mode of transmission of HCV infection.

Rapidity of onset of the antidepressant effect of parenteral S-adenosyl-L-methionine.

A possible method of reducing the delay in antidepressant response is to use S-adenosyl-L-methionine (SAMe), a naturally occurring compound that appears to have a rapid onset of effect in the treatment of depression. In this open, multicenter study, 195 patients were given 400 mg of SAMe, administered parenterally, for 15 days. Depressive symptoms remitted after both 7 and 15 days of treatment with SAMe, and no serious adverse events were reported. Further studies with a double-blind design are needed to confirm this preliminary indication that SAMe is a relatively safe and fast-acting antidepressant.

[Neuroleptic-induced dysphoric response in non-schizophrenic patients]. / Effetti disforizzanti dei neurolettici in pazienti non schizofrenici.

In 50 psychiatric inpatients treated with neuroleptics we observed neuroleptic-induced dysphoria in 4% and neuroleptic-induced akathisia in 18% of the cases. In our sample there was no schizophrenics among dysphoric responders. We discuss the implication of the findings and the relationship between dysphoric response and subjective phenomena of akathisia.

A physician incentive compensation program in a staff model HMO.

A physician incentive program was developed at an established staff model HMO. Differential compensation, which augments a salary scale that reflects years of experience and service, is based on productivity and utilization of laboratory and x-ray services. Productivity is objectively measured on a relative-value-scale for time utilized for a range of types of visits. Laboratory and x-ray utilization is measured against recent historical practice patterns. A case mix adjustment stratifies for age in the adult patient encounters.

Development of antibody to hepatitis C virus (HCV) in acute and chronic non-A, non-B post-transfusion hepatitis.

The antibody to hepatitis C virus (anti-HCV) was measured by an immunoassay in 507 serum samples from 94 patients with acute and chronic post-transfusion non-A, non-B hepatitis (NANB) and in 436 healthy blood donors. Anti-HCV was found in 70.8 of patients with acute hepatitis, in 78.2 with chronic hepatitis, and in 1.4 of healthy blood donors. In acute hepatitis, anti-HCV appeared in the serum from 4 to 34 weeks after transfusion and from 1 to 30 weeks after the onset of the overt disease. Three patients with resolving hepatitis (21%) and 2 who developed chronic hepatitis (10%) lost anti-HCV during a mean follow-up period of 28 months. Among the 36 patients with chronic hepatitis, 2 (6%) lost anti-HCV after 12 months and 8 years respectively. These data indicate that in recent years HCV has been the major etiologic agent of acute and chronic transfusion-associated hepatitis (TAH) in our geographical area. The late appearance of anti-HCV from the onset of clinical and biochemical signs of acute hepatitis in more than 70% of patients limits the diagnostic utility of this assay for an earlier serological diagnosis of acute NANB hepatitis. Additional studies are required to determine the diagnostic significance of this antibody in chronic NANB hepatitis.

Emotional profiles of families with a heart-operated patient: a pilot study.

Family interaction is a basic factor in determining the quality of life of patients undergoing heart surgery. The present study investigates the emotional attitudes in the relatives of 10 heart-operated patients. The results indicate that a high amount of relatives' emotional overinvolvement and warmth tends toward a correlation with lower anxiety and depression scores, and with a better 12-month outcome of the illness.

Hepatitis B virus clearance from serum and liver after acute hepatitis delta virus superinfection in chronic HBsAg carriers.

Clinical, virological, and histological findings in four HBsAg chronic carriers who cleared HBV markers from both serum and liver following HDV superinfection are described. The patients were long-term HBsAg carriers and all were HBV-DNA/HBeAg positive. Liver biopsy, obtained from three of the patients between 5 and 15 months prior to HDV superinfection, showed chronic persistent hepatitis in two and chronic active hepatitis in one. During the follow-up of 9-19 months, the patients completely recovered from acute delta hepatitis with termination of HBsAg carriage and regression of the histological feature of chronic liver damage. These data demonstrate that sometimes HDV is able to induce a permanent inhibition of its helper virus. HDV superinfection probably enhances the immune clearance of infected cells during the replicative phase of chronic HBV infection.

A combination of hypothalamic phospholipid liposomes with trazodone for treatment of depression. An open controlled study.

In an open controlled trial of 48 patients with major depression illness (according to DSM-III), the patients were randomly assigned to 2 groups. One group of 25 patients was treated with 200-300 mg/day of trazodone and a second group of 23 patients was treated with 200-300 mg/day trazodone plus 1 ampoule (corresponding to 1000 gamma of lipidic phosphorous) twice daily of hypothalamic phospholipids (HPL). The effectiveness of treatment was evaluated by the Hamilton Rating Scale for Depression (HRSD). Side effects of treatment with trazodone were looked for by measuring systolic and diastolic blood pressure and heart rate and from EEG made before and on the 7th and 30th days of treatment. Combination with HPL shortened the typical latency of action of the antidepressant trazodone, definitely improved the subjective symptoms, especially the psychosomatic symptoms, on the HRDS and decreased the incidence of such side effects of trazodone as hypertension, reflex tachycardia and asthenia.

[New long-acting treatment of anxiety and its different forms of somatization: low-dose fluspirilene]. / Un nuovo trattamento long-acting dell'ansia e delle differenti forme della sua somatizzazione: fluspirilene low-dose.

After pharmacological considerations on fluspirilene, a diphenylbutylpiperidinic neuroleptic with a tranquillizing action in neurotic syndromes, the Authors refer on 24 patients with a normal social behaviour treated with low dosage. I.M. weekly dosages of 1.5 mg have been used for 6 weeks with semi-quantitative evaluation of 1-5 psychic items, 10 neurovegetative items and 36 miscellaneous. A significant improvement was obtained for nearly all symptoms and did not cause variations in bodyweight, pressure values and pulse frequency or local or systemic intolerance. Positive results reached 77.3% of treated cases, in agreement with those reported by numerous foreign Authors.