Molecular prevalence of Trypanosoma spp. in wild rodents of Southeast Asia: influence of human settlement habitat.

SUMMARY: This study investigated the molecular prevalence of Trypanosoma lewisi and T. evansi in wild rodents from Cambodia, Lao PDR and Thailand. Between 2008 and 2012, rodents (and shrews) were trapped in nine locations and 616 of these were tested using three sets of primers: TRYP1 (amplifying ITS1 of ribosomal DNA of all trypanosomes), TBR (amplifying satellite genomic DNA of Trypanozoon parasites) and LEW1 (amplifying ITS1 of ribosomal DNA of T. lewisi). Based on the size of the PCR products using TRYP1, 17% were positive for T. lewisi and 1·0% positive for Trypanozoon. Results were confirmed by sequencing PCR products and by using more specific primers (LEW1 and TBR). The specificity of TRYP1 primers, however, failed as rodent DNA was amplified in some instances, giving unexpected product sizes. Using LEW1 primers, 13·3% of the samples were confirmed positive for T. lewisi, both by PCR and sequencing. In Thailand, T. lewisi was found in Rattus tanezumi, R. exulans and Berylmys; in Lao PDR, in R. tanezumi and R. exulans, and in Cambodia in R. tanezumi, R. exulans and R. norvegicus. Using TBR, 1·3% of the samples tested positive for Trypanozoon by PCR and sequencing; T. evansi is the only species of the Trypanozoon subgenus possibly present in wild Asian rodents. These results confirmed its presence in rodents from Thailand (R. tanezumi), Lao PDR (R. tanezumi, R. nitidus) and Cambodia (R. tanezumi, Niviventer fulvescens, Maxomys surifer). Based on the information related to rodent trapping, it was found that rodent species trapped in and around human dwellings had a higher prevalence of T. lewisi infection. R. tanezumi and R. exulans, two synanthropic species, were mainly found infected in this habitat suggesting a role as a reservoir and thus a potential source of T. lewisi for human infection.

Molecular demonstration of Trypanosoma evansi and Trypanosoma lewisi DNA in wild rodents from Cambodia, Lao PDR and Thailand.

In this study, we investigated the molecular evidence of Trypanosoma evansi in wild rodents from Cambodia, Lao PDR and Thailand. Between November 2007 and June 2009, 1664 rodents were trapped at eight sites representative of various ecological habitats. Of those animals, 94 were tested by direct microscopic blood examination, 633 using the Card Agglutination Test for Trypanosomes (CATT/T. evansi) and 145 by Polymerase Chain Reaction (PCR) with two sets of primers: TRYP1 (amplifying ITS1 of ribosomal DNA of all trypanosomes) and TBR (amplifying satellite genomic DNA of Trypanozoon parasites). Using TRYP1, based on the size of the PCR products, 15 samples from the three countries were positive for Trypanosoma lewisi (two were confirmed by sequencing), and three were positive for Trypanozoon (one was confirmed by sequencing and three by TBR primers); the specificity of the primers failed as rodent DNA was amplified in some cases. Using TBR, six samples were positive for Trypanozoon (one was confirmed by sequencing); as T. evansi is the only species of the Trypanozoon sub-genus possibly present in Asian rodents, these results confirmed its presence in rodents from Thailand (Rattus tanezumi) and Cambodia (R. tanezumi, Niviventer fulvescens & Maxomys surifer). Further investigations are necessary to establish the situation in Lao PDR. None of the 16 samples most strongly positive to the CATT proved to be positive for Trypanozoon by PCR. The merits of the CATT for such studies were not confirmed. Studying the urban and rural circulation of these parasites in rodents will enable an evaluation of human exposure and infection risk, as human infections by T. evansi were recently described in India and by T. lewisi in India and Thailand. As sequencing PCR products is expensive, the development of new molecular and serological tools for rodents would be very useful.

[Periodic fever, aphthous stomatitis, pharyngitis, and lymphadenopathy: a pediatric caseload]. / Febbre periodica, stomatite aftosa, faringite, linfoadenopatia (PFAPA): una casistica pediatrica.

We report 5 patients (3F; 2M; age 19-60 months) affected by a syndrome characterized by recurrent episodes of abrupt onset of fever, aphtous stomatitis, pharyngitis and cervical adenopathy named by the acronym PFAPA (periodic fever, aphtous stomatitis, pharyngitis and adenopathy). The episodes had clockwork periodicity (3-4 weeks) and the fever was unaccompanied by remarkable respiratory signs or symptoms. All children were doing well between episodes. The inflammatory markers were elevated only during attacks in all children. Steroid therapy was highly effective in controlling symptoms in 5/5 patients and tonsillectomy was associated with remission in two of five patients. In one child the syndrome resolved spontaneously, in two patients resolved after tonsillectomy and in two children persisted. No long-term sequelae were observed.

[Retrospective analysis of Henoch-Schonlein purpura in children: diagnostic difficulties and renal outcome]. / Analisi di una casistica pediatrica di porpora di Schönlein-Henoch: difficoltà diagnostiche iniziali e follow-up a distanza.

OBJECTIVE: To assess clinical presentation, diagnostic difficulties, natural history and prognostic indicators of renal involvement of Henoch Schönlein Purpura, a ten-years retrospective analysis of all patients case records was performed. METHODS: After a variable interval of 1 to 10 years following the vasculitic episode all the children came to the outpatient clinic for history taking, clinical examination, blood pressure measurements, urine analysis and renal function assessment. RESULTS: 54 children, mean age 5.9 +/- 2.5, were identified. The purpuric rash was associated with arthritis in 46 patients (85%), abdominal pain in 28 (51.8%), temperature > 38 degrees C in 11 (20%). The purpuric rash was present at on presentation in 39 subjects (72%) whereas in 15 children (28%) it followed the subsequent signs or symptoms that were arthritis in 8 (53.3%), joint pain in 2 (13.3%), abdominal pain in 5 (30.3%). Abdominal pain was the only symptom of presentation in 5 patients; two of them underwent surgical laparotomy.

[Predictive factors of etiology (bacterial or viral) in acute gastroenteritis in childhood]. / Fattori predittivi dell'eziologia (batterica o virale) nelle gastroenteriti acute dell'infanzia.

The aim of the study was to identify immediate clinical and/or laboratory findings able to differentiate bacterial from viral etiology of acute gastroenteritis in pediatric patients. We studied 52 children, aged between 5 months and 12 years, consecutively admitted to hospital with acute diarrhoea lasting less than 5 days. All the patients were divided into 4 groups according to etiologic agent, subsequently demonstrated by culture: salmonellae (group A), rotavirus (group B); combined salmonellae and rotavirus (group C) and no pathogen (group D). The contemporary presence of fever > 39 degrees C, number of daily liquid stools > 6, presence of bloody diarrhoea, positivity of C-reactive protein and hyponatremia (< 135 mEq/l) allowed to recognize the etiology (viral or bacterial) before results of culture (sensitivity was 71% and specificity was 97%). In particular, hyponatremia resulted significantly lower in group A and C than in group B and D. We concluded that hyponatremia can be considered a marker for acute gastroenteritis caused by salmonellae.

[Evaluation of diosmectite in acute diarrhea in children]. / Valutazione della diosmectite nella diarrea acuta in età pediatrica.

The aim of this case-control study, was to estimate clinical effects, safety and parents' assessment of Diosmectite, in acute infantile diarrhoea. Thirty-five children aged 0-5 years, with acute diarrhoea from at least 5 days received alternatively oral rehydration solution (ORS) and Diosmectite (3 g/day for 3 days in children aged under 3 years and 6 g/day for 3 days in children aged over 3 years) (16 cases) or ORS only (19 cases). At discharge, parents' opinion concerning satisfaction for treatment received was evaluated through a questionnaire. Differences in the amount of liquid intake, weigh recovery, resolution of fever, resolution of vomiting and number of loose stools in the first 48 hours of hospitalization were not significant. Diosmectite was well tolerated and no major side effects were found. Parents' satisfaction for therapy resulted higher in the treated group than in the control group, even if differences were not significant. Treatment with ORS and Diosmectite allowed to shorten the mean duration of hospitalization by 0.4 days/children in the treatment group compared to the control group. Further studies with more cases and with higher does of the drug are necessary to confirm our results.

[Prevalence of Chlamydia pneumoniae in respiratory infections in children: an ambulatory diagnostic problem]. / Prevalenza di Chlamydia pneumoniae nelle infezioni respiratorie del bambino: un problema diagnostico ambulatoriale.

It has been recently suggested that Chlamydia Pneumoniae infection is a common finding among children with acute respiratory diseases. Chlamydia cell culture is difficult and time-consuming to perform. Polymerase chain reaction (PCR) is a more rapid but also more expensive technique used to identify Chlamydia in pharyngeal swab, but it can be performed only in few specialized laboratories. We tested a rapid enzyme immuno-assay to detect Chlamydia in 20 children with respiratory infections (mean age 3.29 years; male:female ratio = 12:8) and in 21 healthy children (mean age 4.70 years male:female ratio = 15:6). Prevalence of Chlamydia isolation from pharyngeal swab was very high in both patients and healthy children without a significative difference in the two considered groups (45% vs 42%, p = 0.8). Specific Chlamydia IgG antibodies were undetectable in all patients and healthy children. Nine out of 20 patients affected by acute respiratory disease were Chlamydia-positive and 11 out 20 were Chlamydia-negative: these two groups didn't differ in regard to clinical and laboratory features, whereas duration of symptoms was significantly longer in Chlamydia-positive patients (9.3 vs 5.5 days, p = 0.014). Our study suggests a high prevalence of Chlamydia pharyngeal swab positivity in both healthy and sick children. Diagnosis of Chlamydia infection was not feasible on the basis of the considered clinical and laboratory findings.

Sonography versus continuous 24 hours oesophageal pH-monitoring in the diagnosis of infant gastroesophageal reflux.

Forty infants with suspected gastroesophageal reflux (GOR) underwent continuous 24 hour esophageal pH-metry and sonography of the gastroesophageal junction. In 29 out of 40 cases (72.5%) GOR was confirmed by the 24 hour pH-monitoring, because of a percentage of total time of reflux of 10% or more. The positive and negative predictive value of sonography versus the result of continuous 24 hour pH-monitoring was 80% and 50% respectively. Sonography cannot be considered a faithful diagnostic tool in screening for GOR in infants.