Spectrum and burden of neglected tropical diseases observed in an infectious and tropical diseases unit in Florence, Italy (2000-2015)

Intestinal parasitic infections in children from marginalised Roma communities: prevalence and risk factors

BACKGROUND

Intestinal parasitic infections remain a significant global health issue, particularly affecting poor and marginalised populations. These infections significantly contribute to children's diseases, malnutrition, poor school performance, cognitive disorders, and future economic losses. This study aimed to explore and compare the occurrence of intestinal parasites in early childhood among the group of infants from the Slovak majority population and from marginalised Roma communities (MRCs). Furthermore, it aimed to explore the health complaints of children with and without intestinal parasitic infection in the past month and assess the effect of various risk factors on the occurrence of intestinal parasitic infection in infants from MRCs.

METHODS

We obtained cross-sectional data from mothers and stool samples of their children aged 13-21 months using the first wave of the longitudinal RomaREACH study. A total of 181 stools from infants were analysed: 105 infants from the Slovak majority population and 76 from MRCs.

RESULTS

Infants from MRCs are significantly more often infected by Ascaris lumbricoides, Trichuris trichiura and Giardia duodenalis than their better-off peers from the majority population. Infection rates are 30% in infants from MRCs vs. 0% in the majority population (p < 0.001). Single and mixed infections were observed in children from MRCs. Infants with intestinal parasitic infections suffer significantly more often from various health complaints, particularly cough, stomach ache, irritability, and diarrhoea. Within MRCs, the risk of parasitic infections in infants is significantly increased by risk factors such as the absence of flushing toilets in households (OR = 4.17, p < 0.05) and contact with un-dewormed animals (OR = 3.61, p < 0.05). Together with the absence of running water in the household, these three factors combined increase the risk more than ten times (p < 0.01).

CONCLUSION

Maintaining hygienic standards in conditions of socioeconomic deprivation in MRCs without running water and sewage in the presence of un-dewormed animals is problematic. These living conditions contribute to the higher prevalence of parasitic infections in children from MRCs, causing various health complaints and thus threatening their health and healthy development.

Chorioretinitis among Immigrant and Travellers. Comment on Mansour et al. Presumed Onchocerciasis Chorioretinitis Spilling over into North America, Europe and Middle East. Diagnostics 2023, 13, 3626

We read, with interest, the paper by Mansour et al [...].

A Questionnaire Integrated with the Digital Medical Record Improved the Coverage of a Control Program for Congenital Chagas Disease in Tuscany, Italy

The leading route of Chagas disease transmission in nonendemic countries is congenital. However, policies concerning screening, prevention, and management of congenital Chagas disease are rare in these settings. Since 2012, serological screening for Chagas disease should be provided for pregnant women at risk in Tuscany, Italy according to a Regional resolution. Due to difficulties in the implementation, in November 2019, a checklist aimed at identifying pregnant women at risk for Chagas disease was introduced in digital clinical records at Careggi University Hospital, Florence, Italy. In order to evaluate the effectiveness of the "Chagas checklist", data about the number of deliveries by women at risk and their screening coverage between 2012 and June 2022 were collected. Out of 1348 deliveries by women at risk, 626 (47%) Trypanosoma cruzi serology tests were performed during the study period. The annual screening coverage increased from an average of 40.3% between 2012 and 2019 to 75.7% between 2020 and June 2022, underlining the big impact of the checklist. Four Chagas disease serological tests out of 626 (0.6%) resulted positive, corresponding to 2 affected women. No cases of congenital transmission occurred. The study showed that a simple digital tool led to a tangible improvement in the coverage of the screening program; its application in a setting where digital charts are available will contribute to the control and elimination of congenital Chagas disease.

Emerging Infectious Diseases in Pregnant Women in a Non-Endemic Area: Almost One Out of Four Is at Risk

We report the results of a targeted testing strategy for five emerging infectious diseases (Chagas disease, human T-lymphotropic virus 1 infection, malaria, schistosomiasis, and Zika virus infection) in pregnant women accessing an Italian referral centre for infectious diseases in pregnancy for unrelated reasons. The strategy is based on a quick five-question questionnaire which allows the identification of pregnant women at risk who should be tested for a specific disease. One hundred and three (24%) out of 429 pregnant women evaluated in a 20 month period were at risk for at least one emerging infectious disease. Three (2.9%, all from sub-Saharan Africa) out of 103 at-risk women resulted in being affected (one case of Plasmodium falciparum malaria, two cases of schistosomiasis) and were appropriately managed. Prevalence of emerging infectious disease was particularly high in pregnant women from Africa (three out of 25 pregnant women tested, 12%). The proposed strategy could be used by health care professionals managing pregnant women in non-endemic setting, to identify those at risk for one of the five infection which could benefit for a targeted test and treatment.

Evidence of Low Prevalence of Cystic Echinococcosis in the Catanzaro Province, Calabria Region, Italy

Cystic echinococcosis (CE) is one of the neglected tropical diseases recognized by the WHO. Echinococcus granulosus sensu lato affects more than 1 million people worldwide and is responsible for high costs in the healthcare system. A clear knowledge of the prevalence of CE and its clinical characteristics could have an important impact on the approach to its diagnosis and to the public health planning of treatment and control interventions. We performed a prevalence study in four municipalities of Catanzaro Province, South Italy. This area is considered to be at high risk of CE because of ovine breeding. We screened by abdominal ultrasound 2,426 volunteers, four of whom had abdominal CE. Given the need for prevention and control programs for CE in endemic areas of Italy, a detailed mapping of prevalence of CE, to complement data obtained through hospital discharge records, appears imperative.

Understanding leprosy in a nonendemic area: a pilot study on knowledge, attitudes, beliefs of medical professionals from North-Western Italy

Background:

Describing knowledge, attitudes and beliefs about leprosy amongst Medical Professionals in a nonendemic area (Parma Province, North-Western Italy).

Methods:

A cross-sectional study was carried among a sample of Medical Professionals (MP; No. 242) during June and July 2019 as an on-line self-administered questionnaire including 21 true/false items about epidemiology, diagnosis, and clinical characteristics of leprosy. Effectors of better knowledge status (KS) and higher risk perception (RP) were assessed through calculation of respective multivariate odds ratios (OR) and 95% confidence intervals (95%CI) in two logistic regression analysis models.

Results:

A total of 102 questionnaires were retrieved (participation rate 42.1%; 67.6% of respondents <50 year-old). Of them, 10.8% had previously interacted with at least one leprosy case. Knowledge status (KS) was unsatisfying (59.7% correct answers), and also RP was relatively low, as 91.2% of them acknowledged leprosy as a severe disease, but only 42.2% identified leprosy as highly communicable. Knowledge gaps affected particularly understanding of epidemiology and non-dermatological issues. Moreover, 30.4% of respondents ignored that a treated leprosy case may remain in the community before disease eradication. The main effector of KS was having interacted with a leprosy case (OR 4.881 95%CI 1.245-36.905), while RP was negatively associated with a better KS (OR 0.094 95%CI 0.027-0.334), and working as general practitioner (OR 0.133 95%CI 0.031-0.562).

Conclusions:

While individual expertise of European MP on leprosy slowly disappears, significant knowledge gaps and the high share of misconceptions collectively stress that refresher training may improve early diagnosis and management of incident cases. (www.actabiomedica.it)

Hospitalization for Chagas disease, dengue, filariasis, leishmaniasis, schistosomiasis, strongyloidiasis, and Taenia solium taeniasis/cysticercosis, Italy, 2011-2016

PURPOSE

To analyze epidemiology and burden of Neglected Tropical Diseases (NTDs) in Italy.

METHODS

We used Hospital Discharge Records and number of residents in Italy to calculate number and rate of hospitalization for Chagas disease, dengue, filariasis, leishmaniasis, schistosomiasis, strongyloidiasis, Taenia solium taeniasis, and cysticercosis by sex, citizenship group, and region in the period 2011-2016.

RESULTS

7195 hospitalizations for NTDs were retrieved, accounting for 7375 diagnoses, 60% in Italians and 40% in foreigners. Male-to-female ratio was 2; the age group more commonly affected was 25-44 years (32.5%). The most common diagnoses were leishmaniasis (34%), schistosomiasis (29%), strongyloidiasis (12%), Chagas disease (8%), and dengue (8%). Average yearly hospitalization rate per 100,000 residents for all NTDs was 2.05, 1.33, and 10.39 in general population, Italians, and foreign citizens, respectively. Hospitalization rates higher than 100 per 100,000 subjects were found in citizens from Sub-Saharan Africa (SSA) and Bolivia.

CONCLUSIONS

NTDs have a not negligible burden in Italy. The most clinically relevant NTDs in Italy are leishmaniasis and schistosomiasis, followed by strongyloidiasis, Chagas disease, and dengue. Cystic echinococcosis, that was not included in the analysis since a similar study on this disease was recently published, should also be listed among the leading NTD in Italy. While schistosomiasis has its highest burden on population coming from highly endemic areas such as SSA, leishmaniasis is especially relevant in Italian-born residents of southern regions. Education at university and post-graduate levels, to increase the awareness of healthcare professionals on these topics, as well as targeted public health interventions (such as screening or presumptive treatment in high-risk groups), are an asset to improve clinical management and control of these diseases.

Autochthonous Human and Canine Strongyloides stercoralis Infection in Europe: Report of a Human Case in An Italian Teen and Systematic Review of the Literature

Autochthonous human and canine strongyloidiasis is reported in Europe but is unclear whether the transmission of infection still occurs. We report a previously unpublished human case in an Italian teen and perform a systematic review of literature on autochthonous human and canine strongyloidiasis in Europe to investigate the current dynamic of transmission. Overall, 109 papers published after 1987 were included and one previously unpublished Italian case was added. Eighty case reports were retrieved and 42 of them (52.5%) had severe strongyloidiasis. Most cases were diagnosed in Spain, Italy and France. The median age was 58, the most represented age group was 61-70 years, 11 patients were under 30, and 7 of them were diagnosed after 2000. Epidemiological studies on human strongyloidiasis showed prevalence ranging from 0.56% to 28%. Overall, agriculture work, mine work and walking barefoot were the most commonly reported risk factors for infection. Canine strongyloidiasis was reported mainly in Italy (68 cases), but a few cases occurred also in Iceland, Finland, England, Germany, France, Switzerland, Russia, Slovakia, Romania and Greece. Autochthonous strongyloidiasis is still reported in Europe and sporadic transmission still occurs. Health care professionals should be aware of this issue to identify infected subjects and avoid adverse outcomes, especially in immunosuppressed patients. Further investigations are needed to clarify the zoonotic transmission of this nematode.

Autochthonous liver cystic hydatid: Past or actual French shepherd's disease?

Autochthonous hydatidosis in France and western Europa are uncommon since the beginning of the 21st century. We report here an authentic indigenous cystic echinococcosis case in a French shepherd. The risk of remerging pathology should not be neglected and measures to interrupt parasite transmission are still relevant.

Schistosomiasis, strongyloidiasis and Chagas disease: the leading imported neglected tropical diseases in Italy

BACKGROUND

In recent years, an increasing number of individuals affected by neglected tropical diseases (NTDs) have been observed in Italy, due to migration, international travels and climate changes. Reliable data on the current NTD epidemiology in Italy and the health system preparedness on this issue are not available.

METHODS

We report the results of a survey on selected NTDs (schistosomiasis, strongyloidiasis, echinococcosis, Chagas disease, leishmaniasis, cysticercosis, filariasis and scabies) in nine Italian sentinel centres, in order to investigate their occurrence throughout the country and identify which ones are a priority for public health interventions, development of protocols for case management, and training activities. To explore the preparedness of the centres, we investigate the availability of specific diagnostic tools and drugs, needed for the management of the most common NTDs. We also reviewed and summarized the available national policies, recommendations and guidelines on NTDs in Italy.

RESULTS

Overall, 4123 NTDs cases were diagnosed in nine Italian centres within a 7-year period (2011-2017). Schistosomiasis and strongyloidiasis were the most common NTDs, accounting for about one-third each of all the diagnosed cases, followed by Chagas disease. The number of cases showed a significant trend to increase over time, mainly due to foreign-born subjects. Serology for Schistosoma spp. and Strongyloides stercoralis was available in seven and five centres, respectively. Agar plate stool culture for S. stercoralis was available in three sites. Ivermectin and praziquantel were always available in six centres. Six national policies, recommendations and guidelines documents were available, but for the most part, they are not fully implemented yet.

CONCLUSIONS

This survey showed how some NTDs, such as schistosomiasis and strongyloidiasis, are becoming more common in Italy, due to multiple components. A list of seven key actions was proposed, in order to improve diagnosis, management and control of NTDs in Italy.

Epidemiology of leprosy in Italy (1920 - 2019): a comprehensive review on existing data

BACKGROUND AND AIMS

Incidence of leprosy in Italy has declined steadily over the last century, but available evidence remains fragmentary. Our review aims to summarize available data on the epidemiology of leprosy cases in Italy.

METHODS

The following keywords were used to explore PubMed and Embase: leprosy, Hansen's disease, (Mycobacterium) leprae, Italy, without any chronological restriction.

RESULTS

We identified a total of 39 reports, including 7 national reports, 11 international reports, 20 case reports. Notified leprosy cases were: 839 between 1925 and 1948; 434 between 1955 and 1979; 76 cases for the decade 1980-1989; 112 between 1990 and 1999; 62 between 2000 and 2009, and a total of 25 cases since 2009. Since 2003, 53% of all cases occurred in illegal residents. Focusing on individual cases, latency between early signs/symptoms and a proper diagnosis ranged between 2 and 20 years in 52.1% of individual cases.

CONCLUSION

Imported cases of leprosy are responsible for most leprosy incidence in Italy, and social stigma, the unfamiliarity of healthcare professionals with such disorders, and difficulties of some high-risk groups to be appropriately assessed hint to a possible under-diagnosis. Professionals should be made more aware of the potential for leprosy incidence among patients from countries where the disease is endemic.

Chagas disease in Italy: the study's contribution of Italian researchers

Chagas disease (CD) is an emerging infection in Italy as the consequence of the huge immigration from Latin American countries observed during the last ten-fifteen years. However, the interest of Italian researchers on CD dates back to the '80-90s of the last century with studies conducted in collaboration with Brazilian and Argentinian colleagues by Italian cardiologists and pathologists. Moreover, the first demonstration of the existence in the pre-Columbian America of Chagas disease in a Peruvian mummy was made by a group of Italian paleopathologists. Seroprevalence studies performed between 2010-2014 in Negrar (Verona), Bergamo, Milan, Florence and Rome shows Trypanosoma cruzi infection ranging from 3.9% to 17.1% with people coming from Bolivia as the most affected. As observed in Latin America about 30% of screened subjects in Italy are affected by cardiac or digestive forms of CD. More than 20% of subjects treated with benznidazole discontinued it permanently due to adverse events.

The diagnosis and treatment of urogenital schistosomiasis in Italy in a retrospective cohort of immigrants from Sub-Saharan Africa

OBJECTIVES

To evaluate ultrasound and praziquantel to, respectively, assess and reduce urogenital schistosomiasis (UGS)-associated morbidity in migrants from Sub-Saharan Africa (SSA).

METHODS

Migrants from SSA with UGS attending three Italian centres for tropical diseases during 2011-2016 were retrospectively enrolled. Data on clinical symptoms, routine laboratory, parasitological tests, and ultrasound reported as per the WHO-Niamey protocol were collected at baseline and at available follow-up visits after treatment with praziquantel 40 mg/kg/day for 3 days.

RESULTS

One hundred and seventy patients with UGS were enrolled and treated with praziquantel. Baseline ultrasonography showed urinary tract abnormalities in 115/169 patients (68%); the mean global Schistosoma haematobium score was 2.29 (SD 2.84, IQR 0-2), the mean urinary bladder intermediate score 1.75 (SD 1.73, IQR 0-2), and the mean upper urinary tract intermediate score 0.54 (SD 2.37, IQR 1-10). Abnormalities were more common among the 111 (65%) who were symptomatic (p < 0.02; OR 2.53; 95% CI 1.19-5.35). Symptoms started in 94/111 (85%) before arriving (median 63 months, IQR 12-119). At follow-up, we observed a significant reduction in the prevalence of UGS-related symptoms, blood, urine, and ultrasound abnormalities.

CONCLUSIONS

Our study results support the use of ultrasound and praziquantel for assessing and reducing UGS-associated morbidity in migrants. Health-seeking behaviour, diagnostic, and treatment delays contribute to the advanced pathology and qualified treatment success. To ensure earlier treatment, based on our findings, clinical experience, and available literature, we propose an algorithm for the diagnosis and clinical management of UGS. Multicentre studies are needed to improve the management of subjects with UGS in non-endemic countries.

Coinfections between Persistent Parasitic Neglected Tropical Diseases and Viral Infections among Prisoners from Sub-Saharan Africa and Latin America

In Swiss prisons, more than 70% of detained people are foreigners and over one-third originate from sub-Saharan Africa or Latin America. These two regions are endemic for various tropical diseases and viral infections, which persist after migration to nonendemic countries. Parasitic infections (schistosomiasis; strongyloidiasis) and cooccurrent viral infections (HIV, hepatitis B (HBV), and hepatitis C (HCV)) are especially of concern for clinical care but have been neglected in empirical research. These diseases often remain silent for years before causing complications, especially if they occur concomitantly. Our research aimed to study the prevalence rates and coinfections of two neglected tropical diseases, namely, Strongyloides stercoralis and Schistosoma sp. and viral infections among sub-Saharan Africans (SSA) and Latin Americans (LA) in Switzerland's largest pretrial prison. We carried out a cross-sectional prevalence study using a standardized questionnaire and serological testing. Among the 201 participants, 85.6% were SSA and 14.4% LA. We found the following prevalence ratios: 3.5% of HIV (4.1% in SSA, 0% in LA), 12.4% of chronic HBV (14.5% in SSA, 0% in LA), 2.0% of viraemic HCV (1.7% in SSA, 3.4% in LA), and 8.0% of strongyloidiasis (8.1% in SSA, 6.9% in LA). The serological prevalence of schistosomiasis among SSA was 20.3% (not endemic in Latin America). Two infections were simultaneously detected in SSA: 4.7% were coinfected with schistosomiasis and chronic HBV. Four other coinfections were detected among SSA: schistosomiasis-HIV, HIV-chronic HBV, HIV-HCV, and schistosomiasis-strongyloidiasis. To conclude, the high prevalence rates of persistent viral and parasitic infections and their potential coinfections among SSA and LA detained migrants highlight the need to implement control strategies and programs that reach people in detention centers in nonendemic countries.

Imported onchocerciasis in migrants and travelers

PURPOSE OF REVIEW

With increasing international travel and mass global population migration, clinicians in nonendemic countries must be familiar with imported neglected tropical diseases including onchocerciasis, which is commonly known as 'river blindness'.

RECENT FINDINGS

Imported onchocerciasis manifests differently in travelers compared with migrants from endemic areas and is likely underdiagnosed in both groups. Recent clinical studies confirm that eosinophilia is not a sensitive marker for Onchocerca volvulus, with one-third of patients having a normal eosinophil count. Novel diagnostics measuring antibodies to multiple recombinant O. volvulus antigens maintain a high sensitivity while improving specificity compared with conventional pan-filarial serologic testing. A 6-week course of doxycycline has macrofilaricidal activity through Wolbachia depletion and may be useful in nonendemic areas in addition to standard serial ivermectin.

SUMMARY

Recent studies characterizing distinct clinical presentations in travelers and migrants may enable clinicians to better recognize imported onchocerciasis. Although novel diagnostics have improved specificity, most remain restricted to tropical disease reference laboratories and to date there is no marker of cure. Prolonged doxycycline treatment may reduce the need for serial ivermectin, though more potent short-course macrofilaricidal drugs are being developed.

Onchodermatitis: Where Are We Now?

Onchocerciasis causes debilitating pruritus and rashes as well as visual impairment and blindness. Prior to control measures, eye disease was particularly prominent in savanna areas of sub-Saharan Africa whilst skin disease was more common across rainforest regions of tropical Africa. Mass drug distribution with ivermectin is changing the global scene of onchocerciasis. There has been successful progressive elimination in Central and Southern American countries and the World Health Organization has set a target for elimination in Africa of 2025. This literature review was conducted to examine progress regarding onchocercal skin disease. PubMed searches were performed using keywords 'onchocerciasis', 'onchodermatitis' and 'onchocercal skin disease' over the past eight years. Articles in English, or with an English abstract, were assessed for relevance, including any pertinent references within the articles. Recent progress in awareness of, understanding and treatment of onchocercal skin disease is reviewed with particular emphasis on publications within the past five years. The global burden of onchodermatitis is progressively reducing and is no longer seen in children in many formerly endemic foci.

Post-transplant liver graft schistosomiasis in a migrant from Sub-Saharan Africa

We report a case of post-transplant liver graft infection with Schistosoma spp in a migrant from sub-Saharan Africa transplanted for HBV-related cirrhosis and with undiagnosed schistosomiasis pre-transplantation. The occurrence of tropical diseases in non-endemic areas warrants screening protocols for organ donors and recipients with a history of exposure in endemic areas.