Human dirofilariosis in Austria: the past, the present, the future

Abstract Background Dirofilariosis is a vector-borne parasitosis caused by filarial nematodes of the genus Dirofilaria. In humans, who represent accidental hosts, dirofilariosis is mostly caused by Dirofilaria repens and Dirofilaria immitis. In Austria, the first reported case occurred in 1978. Since then, several (case) reports have been published. Methods A systematic and retrospective review of collected published cases and new, unpublished confirmed cases of human dirofilariosis occurring in Austria was performed. A nematode was extracted from the eyelid of a previously unreported case and subsequently characterized histologically and using molecular biology techniques. Results Data on a total of 39 cases of human dirofilariosis in Austria occurring between 1978 and 2020 are summarized. Over the past four decades the incidence has markedly increased, in particular after 1998. Of the 39 patients, men and women were equally affected, and the mean age was 47.1 years. The area most frequently affected was the head (38.5% of cases). Confined ocular involvement was observed in 23.1% of cases, and nematodes were isolated from the neck/trunk, extremities and the genito-inguinal area in 25.6, 15.4 and 15.4% of patients, respectively. Microfilariae were detected in two cases. Of the 39 patients, only 73.9% tested positive for anti-filarial antibodies and 56.3% for eosinophilia, despite successful isolation of a nematode; consequently, these measures did not represent reliable markers for dirofilariosis. Most patients had a travel history to countries endemic for Dirofilaria species. One patient who had not traveled abroad represented the only autochthonous case recorded to date. Dirofilaria repens was the predominant species, identified in 89.7% of cases. In the newly reported case of subcutaneous dirofilariosis, a live non-gravid Dirofilaria repens adult female of 12 cm length was isolated from the eyelid of the patient, and a video of the extraction is provided. Conclusions The incidence of human dirofilariosis cases has increased strikingly over the last four decades in Austria. More cases can be expected in the foreseeable future due to changes in human behavior and (travel) activities as well as climate changes and the associated alterations in the availability of the natural reservoir, the vectors and the intrinsic characteristics of the parasite.

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Human dirofilariosis: The report of subcutaneous Dirofilaria repens infection in the Slovak Republic

Helminthologia ◽

10.2478/s11687-011-0003-9 ◽

2011 ◽

Vol 48 (1) ◽

pp. 13-16 ◽

Cited By ~ 3

Author(s):

E. Nováková ◽

J. Kinčeková ◽

K. Adamicová ◽

J. Kompaníková ◽

V. Švihrová ◽

...

Keyword(s):

Histological Examination ◽

Dirofilaria Immitis ◽

Slovak Republic ◽

Dirofilaria Repens ◽

Vector Borne Disease ◽

The Third ◽

Human Dirofilariosis ◽

Vector Borne ◽

The Right ◽

Surgical Extirpation

AbstractDirofilariosis is a vector-borne disease that is spreading in Europe from the southern endemic regions to the northern countries, including Slovakia. The dog parasites Dirofilaria immitis and D. repens are zoonotic agents, responsible for the development of human pulmonary and subcutaneous dirofilariosis, respectively. The present paper reports the third case of human dirofilariosis in Slovakia caused by D. repens. The pacient, a 41-year-old woman, was referred with tumour process in the subcutaneous area of the right forearm. Within 14 days the USG confirmed the rapid increase of the nodule from 20 × 10 mm to 30 × 25 mm. The surgical extirpation of the tumour was indicated. Histological examination revealed the formation with eosinofilic rime and the presence of a worm in the centre, detected as D. repens.

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Vector-Borne Blood Parasites of the Great-Tailed Grackle (Quiscalus mexicanus) in East-Central Texas, USA

Microorganisms ◽

10.3390/microorganisms9030504 ◽

2021 ◽

Vol 9 (3) ◽

pp. 504

Author(s):

Andrew J. Golnar ◽

Matthew C. I. Medeiros ◽

Katlyn Rosenbaum ◽

Justin Bejcek ◽

Sarah A. Hamer ◽

...

Keyword(s):

Blood Parasites ◽

Past Century ◽

East Central ◽

The Past ◽

Filarial Nematodes ◽

Central Texas ◽

Vector Borne ◽

High Level ◽

First Time ◽

Plasmodium Cathemerium

Great-tailed grackles (Quiscalus mexicanus) have dramatically expanded into North America over the past century. However, little is known about the blood that parasites they support. Here, for the first time, we document an assemblage of trypanosome, haemosporida, and filarial nematodes co-circulating in invasive great-tailed grackles. Between February and July, 2015, 61 individuals were captured in an urban environment of College Station, Texas. Field microscopy and molecular diagnostics indicate that 52% (24/46) were visually infected with filarioid nematodes, 24% (11/46) with avian trypanosomes, and 73% (n = 44/60) with haemosporida parasites, such as Haemoproteus (Parahaemoproteus) and Plasmodium cathemerium. Overall, 87% of great-tailed grackles were infected with blood parasites. Although 50% of individuals hosted parasites from multiple phylum, no patterns of parasite assembly were observed. Results indicate that great-tailed grackles can support a relatively high level of blood parasitism. However, the consequences for avian health remain to be determined.

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Partial Adrenal Suppression with Prolonged Use of Depo-Provera

Journal of Clinical and Health Sciences ◽

10.24191/jchs.v4i1.7284 ◽

2019 ◽

Vol 4 (1) ◽

pp. 64

Author(s):

Nur Aisyah Zainordin ◽

Fatimah Zaherah Mohamed Shah ◽

Rohana Abdul Ghani

Keyword(s):

Weight Gain ◽

Medroxyprogesterone Acetate ◽

Side Effect ◽

Case Reports ◽

Adrenal Incidentaloma ◽

Adrenal Suppression ◽

Private Pharmacy ◽

Significant Weight Gain ◽

The Past ◽

Depo Provera

A 49-year old patient presented with symptoms of adrenal suppression following an attempt to withdraw Depo-Provera or Depot Medroxyprogesterone Acetate (DMPA) injection. She had been receiving DMPA injections for the past 16 years for contraception. She was initially prescribed DMPA by her gynaecologist but later on began obtaining the medication directly from a private pharmacy without prior consultation from her gynaecologist. Clinically, she had been experiencing significant weight gain and appeared cushingoid. Blood investigations confirmed partial adrenal suppression with presence of an adrenal incidentaloma. This case reports a known side effect of DMPA but occurring at a much lower dose than previously described. It also highlights the need to increase the awareness of the insidious side effect of DMPA and to avoid unsupervised use of the drug.

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Scrub typhus (Orientia tsutsugamushi), A rapidly spreading epidemic in Chennai - A standalone lab experience

International Journal of Bioassays ◽

10.21746/ijbio.2016.09.0021 ◽

2016 ◽

Vol 5 (09) ◽

pp. 4896

Author(s):

Sripriya C.S.* ◽

Shanthi B. ◽

Arockia Doss S. ◽

Antonie Raj I. ◽

Mohana Priya

Keyword(s):

Scrub Typhus ◽

Clinical Symptoms ◽

Clinical Manifestations ◽

Febrile Illness ◽

Orientia Tsutsugamushi ◽

The Past ◽

Igm Elisa ◽

The Mean ◽

Specific Symptoms ◽

Symptoms And Signs

Scrub typhus (Orientia tsutsugamushi), is a strict intracellular bacterium which is reported to be a recent threat to parts of southern India. There is re-emergence of scrub typhus during the past few years in Chennai. Scrub typhus is an acute febrile illness which generally causes non-specific symptoms and signs. The clinical manifestations of this disease range from sub-clinical disease to organ failure to fatal disease. This study documents our laboratory experience in diagnosis of scrub typhus in patients with fever and suspected clinical symptoms of scrub typhus infection for a period of two years from April 2014 to April 2016 using immunochromatography and IgM ELISA methods. The study was conducted on 648 patients out of whom 188 patients were found to be positive for scrub typhus. Results also showed that pediatric (0 -12 years) and young adults (20 – 39 years) were more exposed to scrub typhus infection and female patients were more infected compared to male. The study also showed that the rate of infection was higher between September to February which also suggested that the infection rate is proportional to the climatic condition. Statistical analysis showed that the mean age of the patients in this study was 37.6, standard deviation was 18.97, CV % was 50.45.

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Analysis of Clinical, Imaging, and Pathologic Features of 36 Patients with Primary Intraspinal Primitive Neuroectodermal Tumors: A Case Series and Literature Review

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0041-1723810 ◽

2021 ◽

Author(s):

Xuefeng Wei ◽

Xu Zhang ◽

Zimu Song ◽

Feng Wang

Keyword(s):

Literature Review ◽

Single Case ◽

Case Reports ◽

Case Series ◽

Subtotal Resection ◽

Study Cohort ◽

Primitive Neuroectodermal Tumors ◽

Pathologic Features ◽

Neuroectodermal Tumors ◽

The Mean

Abstract Background and Study Aims Primary intraspinal primitive neuroectodermal tumors (PNETs) account for ∼0.4% of all intraspinal tumors, but information about these tumors in the medical literature is limited to single case reports. We report four cases of primary intraspinal PNETs and present a systematic literature review of the reported cases. Materials and Methods We retrospectively reviewed and analyzed the clinical data of 4 patients with primary intraspinal PNETs who underwent neurosurgical treatment at our clinic between January 2013 and January 2020, and of 32 cases reported in the literature. Results The female-to-male ratio was 2.6:1. The mean patient age was 21.42 ± 15.76 years (range: 1–60 years), and patients <36 years of age accounted for 83.30% of the study cohort. Progressive limb weakness and numbness were the chief symptoms (accounting for ∼55.6%). The mean complaint duration was 0.89 ± 0.66 months for males and 2.72 ± 3.82 months for females (p = 0.028). Epidural (41.7%) was the most common site, and thoracic (47.3%) was the most frequent location. Most PNETs were peripheral, and magnetic resonance imaging (MRI) appearance was isointense or mildly hypointense on T1-weighted images and hyperintense on T2-weighted images. Homogeneous contrast enhancement was observed. The 1-year survival rate of patients who underwent chemoradiation after total or subtotal lesion resection was better compared with patients who did not undergo chemotherapy, radiotherapy, or total or subtotal resection. The modality of treatment was associated with survival time (p = 0.007). Conclusion Primary intraspinal PNETs mainly occur in young people with a female preponderance. In patients with a rapid loss of lower limb muscle strength and large intraspinal lesions on MRI, PNETs should be considered. Surgical resection and adjuvant radio chemotherapy are key prognostic factors.

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Digital Glomus Tumor: Bibliographic Review of the Studies Published over the Past 10 Years

Revista Iberoamericana de Cirugía de la Mano ◽

10.1055/s-0041-1730392 ◽

2021 ◽

Vol 49 (01) ◽

pp. 046-055

Author(s):

Victoria Hernández ◽

Tania Lena ◽

Eliana Camacho ◽

Matías Craviotto

Keyword(s):

Glomus Tumor ◽

Case Reports ◽

Low Frequency ◽

Benign Neoplasm ◽

Surgical Excision ◽

Soft Tissue Tumors ◽

Glomus Tumors ◽

The Past ◽

Pubmed Search ◽

Magnetic Resonance Imaging Mri

AbstractGlomus tumors are a mostly benign neoplasm that constitutes less than 4% of upper-limb soft-tissue tumors. Its unspecific clinical presentation, added to its low frequency, leads to a late diagnosis.The objective of the present study is to update the clinical-paraclinical approach and the surgical technique used in the treatment.We carried out a literature review from 2014 to 2019 on digital glomus tumor in the hand in adult patients using the PubMed search engine.In most of the publications analyzed, the diagnosis was clinical, with a delay of 1 to 10 years. Plain radiography is the most requested study; of the 16 articles reporting its indication, only half evidenced compatible changes. Magnetic resonance imaging (MRI) was requested in 15 articles, presenting normal results in 3 of them. The treatment of choice was surgical excision using a transungual approach. Only 4 articles report recurrence after excision.Although there is diversity in the approach to these tumors, we conclude that the diagnosis is clinical, and the treatment surgical, and there is no consensus regarding the paraclinical indication. The information available comes mainly from case reports, publications that contribute to the generation of evidence for the clinical practice in rare diseases such as this one.

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Molecular Identification of New Cases of Human Dirofilariosis (Dirofilaria repens) in Italy

Pathogens ◽

10.3390/pathogens10020251 ◽

2021 ◽

Vol 10 (2) ◽

pp. 251

Author(s):

Simona Gabrielli ◽

Valentina Mangano ◽

Federica Furzi ◽

Alessandra Oliva ◽

Serena Vita ◽

...

Keyword(s):

Molecular Diagnosis ◽

Central Italy ◽

Research Work ◽

Pulmonary Nodules ◽

Elisa Test ◽

Future Research ◽

Worldwide Distribution ◽

Human Dirofilariosis ◽

Vector Borne ◽

Etiological Agents

(1) Dirofilariosis is a vector-borne parasitic disease mainly in domestic and wild carnivores caused by Dirofilaria (Noctiella) repens, which is endemic in many countries of the Old World, and D. immitis, which has a worldwide distribution. In recent years, an increase in the number of human cases has been reported, suggesting that dirofilariosis is an emergent zoonosis. Here, we describe further cases (N = 8), observed in Central Italy during the years 2018–2019. (2) Molecular diagnosis was performed on: (i) live worms extracted from ocular conjunctiva, cheek, and calf muscle; (ii) histological sections of surgically removed nodules from parenchymal lung, coccyx, and breast. (3) Sequence analysis (650-bp) of the mitochondrial cytochrome oxidase subunit I gene (mtDNA cox1) showed a match of 100% with the sequences of D. repens previously deposited in GenBank. ELISA test to detect IgG against filarial antigens was performed on four patients’ sera and resulted positive in two patients who showed ocular and subcutaneous dirofilariosis, respectively. Microfilariae have been never detected in the peripheral blood of the patients. (4) The occurrence of N = 8 new cases of human D. repens-infections observed in a two-year period suggests an increased circulation of the parasite in Italy. Therefore, dirofilariosis should be included in differential diagnosis in patients presenting subcutaneous and/or pulmonary nodules. Molecular diagnosis of the etiological agents is fundamental. Specific serological diagnosis needs to be improved in future research work.

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797. Management of Patients with Multiple Clostridioides difficile Infection Recurrences using a Tapered-Pulsed Fidaxomicin Strategy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.987 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S441-S442

Author(s):

Xing Tan ◽

Andrew M Skinner ◽

Benjamin Sirbu ◽

Larry H Danziger ◽

Dale N Gerding ◽

...

Keyword(s):

First Episode ◽

Initial Symptom ◽

Once Daily ◽

The Past ◽

Clostridioides Difficile ◽

Time To Recurrence ◽

Clostridioides Difficile Infection ◽

The Mean ◽

Systemic Antibiotics

Abstract Background There is a paucity of data assessing outcomes of alternate fidaxomicin strategies in patients with recurrent Clostridioides difficile infection (rCDI). The objective of our study is to evaluate a tapered-pulsed (T-P) fidaxomicin regimen that was administered immediately following a course of CDI treatment with initial symptom resolution in patients with multiple rCDI. Methods We reviewed the characteristics and outcomes of 46 consecutive patients who received T-P fidaxomicin between January 1, 2014-June 30, 2019 in a specialty CDI clinic. The first episode in which fidaxomicin T-P was administered was analyzed. Failure was defined as the persistence of diarrhea and/or the need for additional CDI treatment at any time on T-P fidaxomicin. Sustained clinical cure (SCC) was defined as resolution of diarrhea without recurrence. Recurrence was defined as the return of diarrhea requiring retreatment with CDI therapy after completion of T-P fidaxomicin. Both SCC and recurrence were evaluated at 30 and 90 days after completion of T-P fidaxomicin. Results The mean±SD age of the 46 patients was 63.2±19.9 years, 71.7% were female, and the mean±SD CDI episodes within the past year was 3±1.4 . Most patients (73.9%) had previously failed a vancomycin tapered and/or pulsed regimen. Prior to administering T-P fidaxomicin, a treatment regimen was given to ensure resolution of symptoms. The CDI treatment most commonly used (58.7%) was vancomycin. The T-P fidaxomicin regimen used consisted of 200 mg given once daily for 7 days followed by 200 mg every other day for a median (min-max) duration of 33 (6-120) days. Two patients (4%) failed to respond to T-P fidaxomicin; 34 (74%) and 28 (61%) achieved SCC at 30 and 90 days, respectively. Among the 44 patients that successfully completed the T-P fidaxomicin regimen, recurrence developed in 10 (22.7%) and 16 (36.4%) of patients at 30 and 90 days, respectively, with a median (min-max) time to recurrence of 20 (3-87) days (Figure 1). Four patients with recurrence had received subsequent systemic antibiotics. Figure 1. Course of CDI therapy and follow-up Conclusion A tapered-pulsed fidaxomicin strategy may be effective in patients with multiply rCDI who are refractory to other treatments, including a vancomycin tapered and pulsed regimen. Disclosures Larry H. Danziger, PharmD, Merck (Speaker’s Bureau)

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Ocular manifestations in Herpes Zoster Ophthalmicus

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v3i2.5271 ◽

1970 ◽

Vol 3 (2) ◽

pp. 165-171 ◽

Cited By ~ 16

Author(s):

LR Puri ◽

GB Shrestha ◽

DN Shah ◽

M Chaudhary ◽

A Thakar

Keyword(s):

Herpes Zoster ◽

Young Patients ◽

Ocular Involvement ◽

Post Herpetic Neuralgia ◽

Visual Disability ◽

Herpes Zoster Ophthalmicus ◽

Cross Sectional ◽

Ocular Manifestations ◽

Visual Status ◽

The Mean

Background: Ocular complications of herpes zoster ophthalmicus (HZO) may lead to substantial visual disability, severe post-herpetic neuralgia and rarely fatal cerebral complications. Aim: To identify the pattern of ocular manifestation in herpes zoster ophthalmicus. Materials and methods: A cross-sectional descriptive study was under taken including the clinically diagnosed cases of HZO. All of them underwent a complete ophthalmological evaluation. Results: Sixty-eight cases of HZO were examined, of which 37 (54.4 %) were male and 31 (45.6%) female. The mean age was 48.7 ± 18.5 years. Most of the patients (64.7 %) were above the age of 40 years. 77.94 % of the patients had some form of ocular involvement. Pain (77.9 %) was the commonest ocular complaint. In young patients less than 35 years, HIV was the most common risk factor (19.3 %).Visual status was good in the majority (73.5 %) of patients at presentation. Lid and adnexal findings (45.8 %) were most common ocular involvement followed by conjunctivitis (41.1 %). Corneal complication was seen in 38.2 % of cases, uveitis in 19.1 % and post-herpetic neuralgia (PHN) and secondary glaucoma each in 5.8 %. Conclusion: Eyelid and ocular adnexal involvement is most commonly found in patients with herpes zoster ophthalmicus followed by corneal complication and uveitis. There needs to be awareness of ocular involvement, which can be sight threatening, among the HZO patients and other medical departments and an increased emphasis on regular ophthalmic examination. Key words: herpes virus, herpes zoster, conjunctivitis, keratitis DOI: http://dx.doi.org/10.3126/nepjoph.v3i2.5271 Nepal J Ophthalmol 2011; 3(2): 165-171

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Increasing author counts in neurosurgical journals from 1980 to 2020

Journal of Neurosurgery ◽

10.3171/2021.1.jns204257 ◽

2021 ◽

pp. 1-5

Author(s):

Tyler S. Cole ◽

Mark A. Pacult ◽

Michael T. Lawton

Keyword(s):

Scientific Productivity ◽

Academic Journals ◽

Publication Type ◽

Medical Specialties ◽

The Past ◽

The Mean ◽

Scopus Database ◽

Publication Volume ◽

Over Time ◽

Number Of Authors

OBJECTIVE Scientific productivity, as assessed by publication volume, is a common metric by which the academic neurosurgical field assesses its members. The number of authors per peer-reviewed article has been observed to increase over time across a broad range of medical specialties. This study provides an update to this trend in the neurosurgical literature. METHODS All publications from January 1, 1980, to April 30, 2020, were queried from four neurosurgical journals: Neurosurgery, Journal of Neurosurgery (JNS), JNS: Pediatrics, and JNS: Spine. Publication information was acquired from the National Center for Biotechnology Information Entrez database and reconciled with the Scopus database. Publication type was limited to articles and excluded editorials, letters, and reviews. The number of authors and affiliation counts were determined based on structured abstract fields provided in the two databases. RESULTS Between January 1, 1980, and April 30, 2020, the overall increase in author count for the four neurosurgical journals was 0.12 to 0.18 authors per year (p < 0.001). For Neurosurgery, the mean (SD) author count increased from 2.81 (1.4) in 1980–1985 to 7.97 (4.92) in 2016–2020 (p < 0.001). For the JNS, the mean (SD) author count increased from 2.82 (1.04) in 1980–1985 to 7.6 (3.65) in 2016–2020 (p < 0.001). The percentage of articles with more than 10 authors increased from 0.2% to 22.3% in Neurosurgery and from 1.9% to 17.5% in JNS. Only 28% of the author count variation was explained by an increasing number of institutional or departmental affiliations. CONCLUSIONS Author counts for peer-reviewed articles in neurosurgical academic journals have increased significantly during the past 4 decades, with large increases in the numbers of articles with more than 10 authors in the past 5 years. A total of 28% of the variation in this increase can be explained by an increase in multiinstitutional or multidepartmental studies.

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