Autochthonous Human Dirofilaria repens Infection in Austria

Purpose This report describes a rare autochthonous case of human D. repens infection in Austria. Dirofilariosis is a mosquito-borne parasitic infection that predominantly affects dogs. Human D. repens infections have primarily been reported in Mediterranean countries, but are emerging throughout Central and Northern Europe. Methods The worm was removed surgically and identified using PCR and DNA sequencing. The consensus sequences were compared against reference sequences of Dirofilaria repens from GenBank. Results The 56-year-old woman acquired the infection, which presented as a subcutaneous nodule, in Vienna, Austria. This is the second autochthonous case of human D. repens infection in Austria. Conclusion The reasons for the emergence of D. repens and other parasitic infections in Central and Northern Europe are manifold, including climate change and globalization. This case demonstrates that with the growing number of D. repens infections, health care professionals must place further emphasis on emerging infectious diseases to ensure appropriate diagnostics and treatment in the future.

A Multidisciplinary Approach to the First Autochthonous Case of Tularemia Reported in Portugal

Francisella tularensis, a Gram-negative coccobacillus, is a highly virulent pathogen responsible for several zoonotic outbreaks in Europe in the last few decades. The authors report the case of a 46-year-old male who developed fever, myalgias and headache a week after having contact with animal feed contaminated by rodents. Serological tests were positive for Francisella tularensis. This first case of autochthonous tularemia in Portugal led to an intensive investigation involving several healthcare services and national governmental authorities. The authors address the possible underdiagnosis of this infection in the country.

Canine visceral leishmaniasis in Rondônia, Brazil: a report of an autochthonous case

Visceral Leishmaniasis (VL), also known as kala-azar, is a disseminated protozoan infection caused by the Leishmania donovani complex. Traditionally, the definitive diagnosis is made by detecting amastigotes in biological tissue samples. In August 2015, an apparently healthy, young adult, female, mongrel dog from the Zoonosis Control Center of the Rolim de Moura,Rondônia, was subjected to the canine visceral leishmaniasis diagnosis. The diagnosis was conducted using bone marrow aspirate smears and popliteal lymph node smears by Fine-needle aspiration biopsy (FNAB); stained slides with Diff-Quick screened for Leishmania amastigotes by means of direct optical microscopic examination (100×). Lymph node and bone marrow aspirates were used to investigate the presence of Leishmania infantum chagasi DNA by real-time PCR. The popliteal lymph node positive result was observed in typical amastigotes, presenting nucleus and kinetoplasts associated with lymphoblastic proliferation, reactive macrophages, plasmocytes (commonly Mott cells), eosinophils, and lymphoglandular hyperplasia. A positive bone marrow sample resulted from the observation of amastigotes in the monocyte cytoplasm or free on the smear background. The presence of the L. infantum kDNA was detected in lymph node and bone marrow FNAB samples. This research note describes the autochthonous case of CVL recorded in the state of Rondônia, Brazil, a non-endemic area for VL. According to the data, future studies must include a larger number of animals to elucidate the parasite’s epidemiological resource in Rondônia.

Autochthonous case of Canine Visceral Leishmaniasis and presence of sand flies in a high altitude area

Visceral leishmaniasis (VL) is a disease that affects dogs. The aim of this study was to describe an autochthonous case of VL and to report the presence of sand flies in a high-altitude area of Northeastern Brazil. In February 2019, a sampling was performed of a suspected animal (n=1), and the presence of sand flies was investigated using CDC light traps. The dog scored positive for Leishmania infantum, and four specimens of sand flies were captured and classified as Lutzomyia evandroi. This study detected the first autochthonous case of canine visceral leishmaniasis (CVL) in an area of high altitude were only L. evandroi has been collected.

Skin maculae, chronic diarrhea, cachexia, and splenomegaly—Late presentation of the first autochthonous case of visceral leishmaniasis in Tanzania

A 20-year-old man from Simanjiro district in northern Tanzania presented with a 3-year history of splenomegaly, fatigue, cachexia, skin maculae, and recent onset of watery diarrhea at Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. Due to laboratory findings of pancytopenia, diagnostic workup included bone marrow aspiration cytology and biopsy. Although the rapid test (IT LEISH, rK39 RDT) was negative, blood smear showed amastigote forms of leishmaniasis in macrophages. Repeat bone marrow aspiration and PCR eventually confirmed visceral leishmaniasis (VL). The patient denied travel to known endemic areas of VL. Treatment was initiated with Amphotericin B, but the patient died on the fourth day of treatment from respiratory insufficiency. An autopsy revealed massive organ manifestations of VL. This is the first reported autochthonous case of VL in Tanzania. Clark and colleagues detected the vector Phlebotomus martini in Northern Tanzania in 2013, in a region bordering the district of our patient. The negative rapid test draws attention to the fact that sensitivity and specificity were found to be low in East African VL patients as displayed earlier by a Kenyan study. Therefore, tissue samples (spleen or bone marrow) remain necessary for diagnosis. The variety of symptoms in this presented case was remarkable, including the occurrence of post-kala-azar dermal leishmaniasis (PKDL) and VL at the same time. This has been described in East African VL cases before as well as the occurrence of chronic diarrhea. An elongated undiagnosed period likely led to a mixed clinical picture that included hepato-splenomegaly, PKDL, cachexia, and diarrhea.