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Santucciu C, Peruzzu A, Fara AM, Cossu A, Kronenberg PA, Deplazes P, Masala G. Immunohistochemistry as a Reliable Tool for the Diagnosis of Cystic Echinococcosis in Patients from Sardinia, Italy-A Confirmatory Study. Diseases 2024; 12:84. [PMID: 38785739 PMCID: PMC11119186 DOI: 10.3390/diseases12050084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Cystic Echinococcosis (CE) is a zoonotic disease caused by the larval stage of the tapeworm Echinococcus granulosus sensu lato (s.l.). This study aims to investigate the use of two monoclonal antibodies (mAbEmG3 and mAbEm2G11) by immunohistochemistry (IHC) to confirm the diagnosis of CE in human patients, in particular in those cases in which other techniques fail to provide a correct or conclusive diagnosis. For this purpose, a survey on 13 patients was performed. These subjects were referred to Sardinian hospitals (Italy) from 2017 to 2022 and were suspected to be affected by CE. Our findings from these 13 patients showed the detection of E. granulosus sensu stricto by IHC in 12 of 13 echinococcal cysts, as one sample was of a non-parasitological origin. The results confirmed that IHC, by means of the mAbEmG3 and mAbEm2G11, is a reliable diagnostic tool that showed a very high performances when tested on strain of E. granulosus s.l. from Sardinia.
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Affiliation(s)
- Cinzia Santucciu
- WOAH and National Reference Laboratory for Echinococcosis, Animal Health, Istituto Zooprofilattico Sperimentale della Sardegna, 07100 Sassari, Italy; (A.P.); (G.M.)
| | - Angela Peruzzu
- WOAH and National Reference Laboratory for Echinococcosis, Animal Health, Istituto Zooprofilattico Sperimentale della Sardegna, 07100 Sassari, Italy; (A.P.); (G.M.)
| | - Antonella Maria Fara
- Department of Biomedical Sciences, Institute of Pathology, University of Sassari, 07100 Sassari, Italy; (A.M.F.); (A.C.)
| | - Antonio Cossu
- Department of Biomedical Sciences, Institute of Pathology, University of Sassari, 07100 Sassari, Italy; (A.M.F.); (A.C.)
| | - Philipp A. Kronenberg
- Institute of Parasitology, Vetsuisse and Medical Faculty, University of Zurich, 8091 Zurich, Switzerland; (P.A.K.); (P.D.)
- Medical Micro- and Molecular Biology, Institute of Chemistry and Biotechnology, Zurich University of Applied Sciences (ZHAW), 8820 Wädenswil, Switzerland
| | - Peter Deplazes
- Institute of Parasitology, Vetsuisse and Medical Faculty, University of Zurich, 8091 Zurich, Switzerland; (P.A.K.); (P.D.)
- Clinics of Hepatology and Gastroenterology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Giovanna Masala
- WOAH and National Reference Laboratory for Echinococcosis, Animal Health, Istituto Zooprofilattico Sperimentale della Sardegna, 07100 Sassari, Italy; (A.P.); (G.M.)
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Xue C, Liu B, Kui Y, Wu W, Zhou X, Xiao N, Han S, Zheng C. Developing a geographical-meteorological indicator system and evaluating prediction models for alveolar echinococcosis in China. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2024:10.1038/s41370-024-00664-z. [PMID: 38654145 DOI: 10.1038/s41370-024-00664-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Geographical and meteorological factors have been reported to influence the prevalence of echinococcosis, but there's a lack of indicator system and model. OBJECTIVE To provide further insight into the impact of geographical and meteorological factors on AE prevalence and establish a theoretical basis for prevention and control. METHODS Principal component and regression analysis were used to screen and establish a three-level indicator system. Relative weights were examined to determine the impact of each indicator, and five mathematical models were compared to identify the best predictive model for AE epidemic levels. RESULTS By analyzing the data downloaded from the China Meteorological Data Service Center and Geospatial Data Cloud, we established the KCBIS, including 50 basic indicators which could be directly obtained online, 15 characteristic indicators which were linear combination of the basic indicators and showed a linear relationship with AE epidemic, and 8 key indicators which were characteristic indicators with a clearer relationships and fewer mixed effects. The relative weight analysis revealed that monthly precipitation, monthly cold days, the difference between negative and positive temperature anomalies, basic air temperature conditions, altitude, the difference between positive and negative atmospheric pressure anomalies, monthy extremely hot days, and monthly fresh breeze days were correlated with the natural logarithm of AE prevalence, with sequential decreases in their relative weights. The multinomial logistic regression model was the best predictor at epidemic levels 1, 3, 5, and 6, whereas the CART model was the best predictor at epidemic levels 2, 4, and 5.
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Affiliation(s)
- Chuizhao Xue
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Key Laboratory on Parasite and Vector Biology of Ministry of Health, WHO Centre for Tropical Diseases, National Center for International Research on Tropical Diseases of Ministry of Science and Technology, Shanghai, China, 207, Ruijin Er Road, Huangpu District, Shanghai, 200025, China
| | - Baixue Liu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Key Laboratory on Parasite and Vector Biology of Ministry of Health, WHO Centre for Tropical Diseases, National Center for International Research on Tropical Diseases of Ministry of Science and Technology, Shanghai, China, 207, Ruijin Er Road, Huangpu District, Shanghai, 200025, China
| | - Yan Kui
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Key Laboratory on Parasite and Vector Biology of Ministry of Health, WHO Centre for Tropical Diseases, National Center for International Research on Tropical Diseases of Ministry of Science and Technology, Shanghai, China, 207, Ruijin Er Road, Huangpu District, Shanghai, 200025, China
| | - Weiping Wu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Key Laboratory on Parasite and Vector Biology of Ministry of Health, WHO Centre for Tropical Diseases, National Center for International Research on Tropical Diseases of Ministry of Science and Technology, Shanghai, China, 207, Ruijin Er Road, Huangpu District, Shanghai, 200025, China
| | - Xiaonong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Key Laboratory on Parasite and Vector Biology of Ministry of Health, WHO Centre for Tropical Diseases, National Center for International Research on Tropical Diseases of Ministry of Science and Technology, Shanghai, China, 207, Ruijin Er Road, Huangpu District, Shanghai, 200025, China
| | - Ning Xiao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Key Laboratory on Parasite and Vector Biology of Ministry of Health, WHO Centre for Tropical Diseases, National Center for International Research on Tropical Diseases of Ministry of Science and Technology, Shanghai, China, 207, Ruijin Er Road, Huangpu District, Shanghai, 200025, China
| | - Shuai Han
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Key Laboratory on Parasite and Vector Biology of Ministry of Health, WHO Centre for Tropical Diseases, National Center for International Research on Tropical Diseases of Ministry of Science and Technology, Shanghai, China, 207, Ruijin Er Road, Huangpu District, Shanghai, 200025, China.
| | - Canjun Zheng
- Chinese Center for Disease Control and Prevention, Beijing, China, 155, Changbai Road, Changping District, Beijing, 102206, China.
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Bonelli P, Serra E, Dei Giudici S, Peruzzu A, Crotti S, Danesi P, Carvelli A, Piseddu T, Masala G. Molecular phylogenetic analysis of Echinococcus granulosus sensu lato infecting sheep in Italy. Acta Trop 2024; 252:107151. [PMID: 38367944 DOI: 10.1016/j.actatropica.2024.107151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/27/2024] [Accepted: 02/15/2024] [Indexed: 02/19/2024]
Abstract
Cystic Echinococcosis (CE), caused by the larval form of Echinococcus granulosus sensu lato, is a neglected zoonosis still threatening public health worldwide. In Italy different epidemiological scenarios were reported depending on the geographical area and associated socio-economic activities. Although in northern Italy the occurrence of E. granulosus is considered sporadic, in the southern regions and, particularly in Sardinia, CE prevalence reaches high levels. We analysed CE cysts collected from infected sheep from various areas of mainland Italy and the Sardinia island, with the main objective to investigate intergenotypic and intragenotypic variations at national level. CE cysts were collected from slaughtered sheep following post mortem inspection at local abattoirs. Total genomic DNA was extracted and amplification and sequencing of the partial mitochondrial genes nad5 and cox1 were performed. A Bayesian phylogenetic tree was estimated on a nad5 dataset (n = 260) composed of E. granulosus samples from this study (n = 126) and all the nad5 haplotypes available in GenBank (n = 134). In addition, haplotype network, diversity and neutrality analysis were performed on nad5 and cox1 sequences of Italian origin obtained in this study. E. granulosus sensu stricto (s.s.) was found to be the only Echinococcus species infecting sheep in Italy, mainly represented by G1 genotype (76 %) and, to a lower extent, by G3 genotype (24 %). Phylogenetic analyses revealed 40 nad5 and 33 cox 1 haplotypes, and the presence of two founder haplotypes, belonging to G1 and G3 genotype, showing 100 % similarity with DNA sequences from different geographic regions. The lack of geographical segregation, high haplotype and low nucleotide diversity coupled with significant negative values of Tajima's D and Fu's Fs observed in this study indicated high genetic variation and demographic expansion of E. granulosus s.s. in Italy.
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Affiliation(s)
- Piero Bonelli
- Istituto Zooprofilattico Sperimentale della Sardegna, WOAH Reference Laboratory for Echinococcosis, National Reference Laboratory of Echinococcosis (CeNRE), Via Vienna 2, Sassari, 07100, Italy.
| | - Elisa Serra
- Istituto Zooprofilattico Sperimentale della Sardegna, WOAH Reference Laboratory for Echinococcosis, National Reference Laboratory of Echinococcosis (CeNRE), Via Vienna 2, Sassari, 07100, Italy
| | - Silvia Dei Giudici
- Istituto Zooprofilattico Sperimentale della Sardegna, Diagnostica virologica, Sassari, 07100, Italy
| | - Angela Peruzzu
- Istituto Zooprofilattico Sperimentale della Sardegna, WOAH Reference Laboratory for Echinococcosis, National Reference Laboratory of Echinococcosis (CeNRE), Via Vienna 2, Sassari, 07100, Italy
| | - Silvia Crotti
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, 06126, Italy
| | - Patrizia Danesi
- Istituto Zooprofilattico Sperimentale della Venezie, Legnaro, 35020, Italy
| | - Andrea Carvelli
- Istituto Zooprofilattico Sperimentale del Lazio della Toscana, Roma, 00178, Italy
| | - Toni Piseddu
- Istituto Zooprofilattico Sperimentale della Sardegna, WOAH Reference Laboratory for Echinococcosis, National Reference Laboratory of Echinococcosis (CeNRE), Via Vienna 2, Sassari, 07100, Italy
| | - Giovanna Masala
- Istituto Zooprofilattico Sperimentale della Sardegna, WOAH Reference Laboratory for Echinococcosis, National Reference Laboratory of Echinococcosis (CeNRE), Via Vienna 2, Sassari, 07100, Italy
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Drocchi G, Santucciu C, Mastrandrea S, Sanguedolce F, Madonia M. Diagnosis and treatment of unusual multiorgan Echinococcus hydatid cysts. Curr Urol 2024; 18:75-77. [PMID: 38505159 PMCID: PMC10946642 DOI: 10.1097/cu9.0000000000000130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022] Open
Abstract
Background Echinococcosis is a zoonotic disease caused by Echinococcus granulosus. Usually, the liver is the most affected organ, accounting for approximately 70% to 85% of cases. The lungs represent 20% of the cases. Fewer than 10% are found in other sites, including the bone, brain, spleen, and kidneys. Case presentation A young man was referred to a local hospital for dull pain in the right flank, fever, and mild cough. Computed tomography showed 2 large cysts: the first involved the left lung and measured 130 × 90.5 × 120 mm, whereas the second cyst was located in the right kidney and measured 130 × 100 × 120 mm. Surgery was performed to remove both lesions in 2 separate surgical sessions. Conclusions Echinococcosis is a compulsorily notifiable disease. Collaboration between medical doctors from different specializations is necessary. A multidisciplinary approach is important for the correct therapeutic management of the disease. Furthermore, the high possibility of recurrence makes the long-term follow-up mandatory.
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Affiliation(s)
- Giovanni Drocchi
- Department of Medical, Surgical and Experimental Sciences, Università degli Studi di Sassari, Sassari, Italy
| | - Cinzia Santucciu
- OIE and National Reference Laboratory for Echinococcosis (CeNRE), Istituto Zooprofilattico Sperimentale della Sardegna, Sassari, Italy
| | - Scilla Mastrandrea
- Department of Infectious disease, Sassari University Hospital, Sassari, Italy
| | - Francesco Sanguedolce
- Department of Medical, Surgical and Experimental Sciences, Università degli Studi di Sassari, Sassari, Italy
| | - Massimo Madonia
- Department of Medical, Surgical and Experimental Sciences, Università degli Studi di Sassari, Sassari, Italy
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Paduraru AA, Lupu MA, Sima L, Cozma GV, Olariu SD, Chiriac SD, Totolici BD, Pirvu CA, Lazar F, Nesiu A, Mihu AG, Cumpanas AA, Cretu OM, Olariu TR. Cystic Echinococcosis in Hospitalized Adult Patients from Western Romania: 2007-2022. Microorganisms 2023; 11:2388. [PMID: 37894047 PMCID: PMC10609572 DOI: 10.3390/microorganisms11102388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 10/29/2023] Open
Abstract
Cystic echinococcosis (CE) is a neglected parasitic disease caused by the tapeworm Echinococcus granulosus. The aim of this study was to assess the epidemiological features of human cystic echinococcosis in patients from Western Romania. We retrospectively investigated the medical records of patients hospitalized with CE between 1 January 2007 and 1 September 2022. A total of 366 patients (range 18-90 years) were recorded. The number of hospitalized individuals was higher in patients aged 50-59 years (83/366, 22.7%), in females (194/366, 53%), and in residents of rural areas (225/366, 61.5%). The liver was the most common localization of the cysts (302/366, 82.5%). Ninety-eight patients (26.8%) presented complications, including biliary fistula, allergies, and infection of the cyst. Patients with complications had a longer mean hospital stay (15.7 ± 8.3 days) compared to patients without complications (11.5 ± 7.3 days) (p < 0.001). The results of this study revealed that patients diagnosed with CE required hospitalization and extended medical care, indicating that this zoonotic disease remains a significant public health problem in Western Romania. Public health authorities should enhance CE surveillance by implementing control programs and mandatory notification of new cases.
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Affiliation(s)
- Ana Alexandra Paduraru
- Discipline of Parasitology, Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania (M.A.L.); (A.G.M.); (T.R.O.)
- Center for Diagnosis and Study of Parasitic Diseases, Department of Infectious Disease, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Patogen Preventia, 300124 Timisoara, Romania
- Clinical Laboratory, Municipal Clinical Emergency Hospital, 300254 Timisoara, Romania
| | - Maria Alina Lupu
- Discipline of Parasitology, Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania (M.A.L.); (A.G.M.); (T.R.O.)
- Center for Diagnosis and Study of Parasitic Diseases, Department of Infectious Disease, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Patogen Preventia, 300124 Timisoara, Romania
- Clinical Laboratory, Institute of Cardiovascular Diseases, 300310 Timisoara, Romania
| | - Laurentiu Sima
- Discipline of Surgical Semiology I and Thoracic Surgery, Department of Surgery I, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania (G.V.C.)
- General Surgery Clinic, Municipal Clinical Emergency Hospital, 300254 Timisoara, Romania
| | - Gabriel Veniamin Cozma
- Discipline of Surgical Semiology I and Thoracic Surgery, Department of Surgery I, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania (G.V.C.)
- Thoracic Surgery Clinic, Municipal Clinical Emergency Hospital, 300254 Timisoara, Romania
| | - Sorin Dan Olariu
- General Surgery Clinic, County Clinical Emergency Hospital, 300254 Timisoara, Romania; (S.D.O.)
- Discipline of Surgery I, Department of Surgery II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Sorin Dan Chiriac
- Discipline of Surgery III, Department of Surgery II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Bogdan Dan Totolici
- Department of General Surgery, Vasile Goldis Western University of Medicine and Pharmacy, 310025 Arad, Romania
| | - Catalin Alexandru Pirvu
- General Surgery Clinic, County Clinical Emergency Hospital, 300254 Timisoara, Romania; (S.D.O.)
- Discipline of Surgical Emergencies, Department of Surgery II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Fulger Lazar
- General Surgery Clinic, County Clinical Emergency Hospital, 300254 Timisoara, Romania; (S.D.O.)
- Discipline of Surgery II, Department of Surgery II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Alexandru Nesiu
- Department of Biology and Life Sciences, Vasile Goldis Western University of Medicine and Pharmacy, 310025 Arad, Romania;
- Department of Urology, Arad County Emergency Clinical Hospital, 310037 Arad, Romania
| | - Alin Gabriel Mihu
- Discipline of Parasitology, Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania (M.A.L.); (A.G.M.); (T.R.O.)
- Center for Diagnosis and Study of Parasitic Diseases, Department of Infectious Disease, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Biology and Life Sciences, Vasile Goldis Western University of Medicine and Pharmacy, 310025 Arad, Romania;
| | - Alin Adrian Cumpanas
- Discipline of Urology, Department XV, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Octavian Marius Cretu
- Discipline of Surgical Semiology I and Thoracic Surgery, Department of Surgery I, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania (G.V.C.)
- General Surgery Clinic, Municipal Clinical Emergency Hospital, 300254 Timisoara, Romania
| | - Tudor Rares Olariu
- Discipline of Parasitology, Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania (M.A.L.); (A.G.M.); (T.R.O.)
- Center for Diagnosis and Study of Parasitic Diseases, Department of Infectious Disease, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Patogen Preventia, 300124 Timisoara, Romania
- Clinical Laboratory, Municipal Clinical Emergency Hospital, 300254 Timisoara, Romania
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Maggioni G, Bonis A, Schiavon M, Giraudo C, Lunardi F, Pezzuto F, Calabrese F. An unexpected guest: Pulmonary echinococcosis diagnosed by intraoperative frozen section examination. A case report and literature review. Pathol Res Pract 2023; 248:154615. [PMID: 37343377 DOI: 10.1016/j.prp.2023.154615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 06/23/2023]
Abstract
Echinococcosis is caused by tapeworms belonging to the Echinococcus genus. The most common site of infection is the liver although it may involve almost any organ. Symptoms of pulmonary echinococcosis vary depending on the location and structure of the cyst. While uncomplicated cysts usually appear at imaging as well-defined homogeneous lesions with fluid content and smooth walls of variable thickness, complicated lesions may have a more heterogeneous content with higher density making more difficult the distinction from malignancies or other infections. Hereby we describe the case of a 61-year-old Northern African male admitted to our tertiary center for left upper chest pain who then underwent a chest computed tomography (CT) scan which demonstrated a large hypodense lesion, with smooth and thick walls, in the upper left lobe. The following magnetic resonance confirmed the homogeneous fluid content, and the 18 F- fluorodeoxyglucose-positron emission tomography/CT demonstrated a mild uptake of the walls. According to these findings, the main differential diagnoses at imaging included bronchogenic cyst, synovial sarcoma, and pulmonary hematoma although the patient denied any recent trauma. Given the large size and clinical symptoms he underwent surgery. Intra-operative frozen section, supported by imprint cytology, excluded the presence of malignancy while suggested an echinococcal laminar exocyst. The final pathological examination confirmed the diagnosis of echinococcosis (i.e., Echinococcus Granulosus protoscolex). After surgery he was treated with albendazole and at the six-month follow-up he was in good clinical conditions. Our case highlights the importance of considering rare infections, particularly in individuals from endemic areas. Frozen tissue analyses can be a diagnostic challenge and often require ancillary tools such as imprint cytology and serial sections for more sensitive and accurate diagnosis.
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Affiliation(s)
- Giuseppe Maggioni
- Anatomic Pathology Unit, Department of Medicine, University of Padua, 35121 Padua, Italy
| | - Alessandro Bonis
- Thoracic Surgery Unit, Department of Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35121 Padua, Italy
| | - Marco Schiavon
- Thoracic Surgery Unit, Department of Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35121 Padua, Italy
| | - Chiara Giraudo
- Radiology Unit, Department of Medicine, University of Padua, 35121 Padua, Italy
| | - Francesca Lunardi
- Anatomic Pathology Unit, Department of Medicine, University of Padua, 35121 Padua, Italy
| | - Federica Pezzuto
- Anatomic Pathology Unit, Department of Medicine, University of Padua, 35121 Padua, Italy
| | - Fiorella Calabrese
- Anatomic Pathology Unit, Department of Medicine, University of Padua, 35121 Padua, Italy.
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Santucciu C, Bonelli P, Peruzzu A, Fancellu A, Farà A, Mastrandrea S, Drocchi G, Cossu A, Profili S, Porcu A, Masala G. Genetic Characterization of Echinococcus granulosus sensu stricto Isolated from Human Cysts from Sardinia, Italy. Diseases 2023; 11:91. [PMID: 37489443 PMCID: PMC10366878 DOI: 10.3390/diseases11030091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/26/2023] Open
Abstract
This study involved 20 patients affected by cystic echinococcosis (CE) who were referred to different hospitals of Sardinia (Italy) from 2017 to 2022. By means of a multidisciplinary approach, diagnosis was confirmed for CE in 18 patients and for different aetiologies in two subjects. Moreover, serology was positive for 15 subjects. Since multiple CE cysts were found in five patients, a total of 27 lesions were collected; however, only one for each patient was investigated for genetic characterization of E. granulosus s.s. DNA isolates. Our results included 15 fertile cysts that underwent DNA extraction and amplification by three different PCRs targeting nuclear (calreticulin) and mitochondrial genes (cox1 and nad5). DNA was sequenced, and by neighbour-joining phylogenetic trees we determined 10 G1 and five G3 genotypes previously reported in Sardinia. These sequences were used to construct a network, along with those circulating in Mediterranean areas. The haplotype network calculated on cox1 evidenced seven different haplotypes of the 15 isolates, with SAR2 the most represented, carried by seven cysts, and SAR17 never described in the Mediterranean area. Meanwhile, the nad5 sequences showed the most common haplotype as nd5SAR7, as well as two new haplotypes not previously described, nd5SAR13, isolated from a Sardinian patient, and nd5SAR14, isolated from a Romanian patient.
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Affiliation(s)
- Cinzia Santucciu
- WOAH and NRL for Echinococcosis, Animal Health, IZS della Sardegna, 07100 Sassari, Italy
| | - Piero Bonelli
- WOAH and NRL for Echinococcosis, Animal Health, IZS della Sardegna, 07100 Sassari, Italy
| | - Angela Peruzzu
- WOAH and NRL for Echinococcosis, Animal Health, IZS della Sardegna, 07100 Sassari, Italy
| | - Alessandro Fancellu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Antonella Farà
- Department of Biomedical Sciences, Institute of Pathology, University of Sassari, 07100 Sassari, Italy
| | - Scilla Mastrandrea
- Unità Operativa Complessa di Malattie Infettive, Azienda Ospedaliero-Universitaria, 07100 Sassari, Italy
| | - Giovanni Drocchi
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16132 Genova, Italy
| | - Antonio Cossu
- Department of Biomedical Sciences, Institute of Pathology, University of Sassari, 07100 Sassari, Italy
| | - Stefano Profili
- Unità Operativa Complessa di Radiologia, Azienda Ospedaliero-Universitaria, 07100 Sassari, Italy
| | - Alberto Porcu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Giovanna Masala
- WOAH and NRL for Echinococcosis, Animal Health, IZS della Sardegna, 07100 Sassari, Italy
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8
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Santucciu C, Ferrari PA, Grimaldi G, Murenu A, Nemolato S, Bonelli P, Masala G, Porcu GS, Cherchi R. Environmental Influence on the Occurrence of Multi-Organ Cystic Echinococcosis Infection in a Patient from Sardinia, Italy. Diseases 2023; 11:90. [PMID: 37489442 PMCID: PMC10366914 DOI: 10.3390/diseases11030090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/26/2023] Open
Abstract
An uncommon clinical case of an adult woman who was referred to the hospital with severe symptoms attributable to cystic echinococcosis (CE) is described in this report. According to a questionnaire, the subject was exposed to a high risk of infection since she was employed on a farm about 20 years before diagnosis. She lived close to several animal species and handled vegetables in inadequate hygienic conditions. Medical and laboratory investigations confirmed the presence of massive echinococcal cystic lesions in each lung and in the liver. Given the peculiarity of the case, pharmacological and surgical treatments were the only conceivable option. The association of pharmacological treatment, surgery, and interventional radiology procedure represented a reliable and effective way to handle a complex case of human hydatidosis. A multi-disciplinary approach was mandatory, resulting in a clear and conclusive diagnosis of CE caused by the zoonotic parasite E. granulosus sensu stricto of the G1 genotype.
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Affiliation(s)
- Cinzia Santucciu
- WOAH and NRL for Echinococcosis, Animal Health, IZS della Sardegna, 07100 Sassari, Italy
| | - Paolo Albino Ferrari
- Division of Thoracic Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione "G. Brotzu", 09121 Cagliari, Italy
| | - Giulia Grimaldi
- Division of Thoracic Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione "G. Brotzu", 09121 Cagliari, Italy
| | - Alessandro Murenu
- Division of Thoracic Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione "G. Brotzu", 09121 Cagliari, Italy
| | - Sonia Nemolato
- Department of Pathology, Azienda di Rilievo Nazionale ed Alta Specializzazione "G. Brotzu", 09121 Cagliari, Italy
| | - Piero Bonelli
- WOAH and NRL for Echinococcosis, Animal Health, IZS della Sardegna, 07100 Sassari, Italy
| | - Giovanna Masala
- WOAH and NRL for Echinococcosis, Animal Health, IZS della Sardegna, 07100 Sassari, Italy
| | - Giuseppe Salvatore Porcu
- Department of Pathology, Azienda di Rilievo Nazionale ed Alta Specializzazione "G. Brotzu", 09121 Cagliari, Italy
| | - Roberto Cherchi
- Division of Thoracic Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione "G. Brotzu", 09121 Cagliari, Italy
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9
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Zhang J, Li Y, Chen X, Wang J. Robot-assisted pericystectomy using Da Vinci Xi surgical system with indocyanine green fluorescence imaging for hepatic cystic echinococcosis. Asian J Surg 2023; 46:417-423. [PMID: 35662484 DOI: 10.1016/j.asjsur.2022.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/09/2022] [Accepted: 05/13/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECT The clinical efficacy of robot-assisted laparoscopic pericystectomy using the Da Vinci Xi surgical system plus indocyanine green(ICG) fluorescence imaging and the conventional laparotomy for en bloc pericystectomy was compared. METHODS The clinical data of 7 patients treated by robot-assisted laparoscopic pericystectomy using the Da Vinci Xi surgical system plus ICG fluorescence imaging at our hospital between October 2019 and July 2021 and 15 patients treated by conventional laparotomy for en bloc pericystectomy were retrospectively analyzed. RESULT Compared with the conventional laparotomy group, the intraoperative blood loss was reduced using the Da Vinci surgical system [(225.43 ± 44.75)ml: (521.33 ± 246.34) ml, P = 0.015]. The indwelling time of the urinary catheter was also shorter [2.86 ± 0.75)d: (3.87 ± 0.81)d, P = 0.012]. However, the total expense was increased significantly [(49.9 ± 3.7) thousand RMB: (28.7 ± 5.0) thousand RMB, P < 0.001]. The two groups of patients were not significantly different in operation time, time to flatulence after surgery, time to eat a liquid diet after surgery, length of hospital stay after surgery, time to drainage tube removal, and the incidence of postoperative complications (P = 0.899). Both two groups were followed up for 3-12 months after surgery. The patients were generally good without recurrence or intra-abdominal implantation. CONCLUSION The Da Vinci Xi surgical system could be feasibly and safely applied to the robot-assisted laparoscopic pericystectomy plus ICG fluorescence imaging for Hepatic cystic echinococcosis(HCE). This procedure could effectively remove the hepatic hydatid cysts under the ICG fluorescence imaging with a higher resection rate, causing less trauma and fewer complications.
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Affiliation(s)
- Jie Zhang
- Department of Hepatobiliary Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, NO.91 Tianchi Road, Urumqi, 830011, China
| | - Yupeng Li
- Department of Hepatobiliary Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, NO.91 Tianchi Road, Urumqi, 830011, China
| | - Xiong Chen
- Department of Hepatobiliary Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, NO.91 Tianchi Road, Urumqi, 830011, China
| | - Jinguo Wang
- Department of Hepatobiliary Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, NO.91 Tianchi Road, Urumqi, 830011, China.
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10
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Entezami M, Nocerino M, Widdicombe J, Bosco A, Cringoli G, Casulli A, Iacono GL, Rinaldi L, Prada JM. The spatial distribution of cystic echinococcosis in Italian ruminant farms from routine surveillance data. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.1034572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
IntroductionCystic echinococcosis (CE) is a zoonotic parasite caused by the cestode Echinococcus granulosus sensu lato (s.l.) which predominantly affects livestock. The disease is endemic in central-southern and insular Italy, with CE particularly infecting sheep, goats, cattle, and water buffalo. The spatial distribution of CE in endemic regions is not widely understood, with surveillance efforts varying across the region.MethodsIn this study, we investigated the spatial distribution of CE in livestock using samples from farms across different livestock species using a Stochastic Partial Differential Equations (SPDE) model. Samples were collected during a survey conducted in the area of central-southern and insular Italy between the years 2019 – 2021.ResultsA total of 3141 animal samples (126 goats, 601 sheep and 2414 cattle and water buffalo) were inspected for Echinococcus s.l. cysts through routine surveillance in abattoirs by postmortem visual examination, palpation and incision of target organs. The geographic location of the farm of origin (a total of 2,878) for each sample was recorded. CE prevalence of 46.0% (1,323/2,878) was estimated at the farm level with 78.3% (462/590) of farms with sheep, 28.6% (36/126) of farms with goats, 36.5% (747/2,049) of farms with cattle, and 23.5% (102/434) of farms with water buffalo infected.DiscussionThe spatial model evaluated the probability of infection in farms across the sampled regions, with the distribution of CE showing high clustering of infected cattle farms in Sardinia and Sicily regions, and sheep farms in Salerno province (Campania region). The output of this study can be used to identify CE hot-spots and to improve surveillance and control programs in endemic areas of Italy.
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11
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Comparison and evaluation of analytic and diagnostic performances of four commercial kits for the detection of antibodies against Echinococcus granulosus and multilocularis in human sera. Comp Immunol Microbiol Infect Dis 2022; 86:101816. [PMID: 35472655 DOI: 10.1016/j.cimid.2022.101816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 02/08/2023]
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12
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Serra E, Masu G, Chisu V, Cappai S, Masala G, Loi F, Piseddu T. Environmental Contamination by Echinococcus spp. Eggs as a Risk for Human Health in Educational Farms of Sardinia, Italy. Vet Sci 2022; 9:vetsci9030143. [PMID: 35324871 PMCID: PMC8953574 DOI: 10.3390/vetsci9030143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 02/05/2023] Open
Abstract
Cystic Echinococcosis (CE) is a severe zoonosis caused by the larval stage of the tapeworm Echinococcus granulosus. These parasites are naturally transmitted between canid definitive hosts that harbour the adult stage in the intestine, and mainly ungulate intermediate hosts, with larval cysts developing in their internal organs. The close coexistence between dog and sheep with incorrect hygiene management are the most important factors for the persistence of this parasitic pathology. The Educational Farms (EF) are farms and agritourisms suitably equipped to carry out training activities for people interested in farm practices and agricultural processing, in particular student groups. Public attendance of farms represents a new potential risk factor for the zoonoses transmission. Consumption of contaminated food and water in combination with contact or playing with domestic dogs (Canis familiaris) are possible routes of zoonoses human infection. In fact, Echinococcus spp. eggs may persist in the environment up to several months at low temperatures and moist conditions, having the chance of contaminating different matrices and surfaces. The aim of this investigation was to study environmental contamination by parasitic elements as a risk for zoonoses, such as Echinococcus spp. A total of 116 samples (35 of water, 33 of soil, 23 of vegetables, 25 of dog faeces) were collected in 30 EF in Sardinia. Samples were subjected to biomolecular investigation for the research of specific gene sequences of Echinococcus granulosus, Echinococcus multilocularis and Taenia spp. The study allowed to identify eight positive EF due to the presence of Echinococcusgranulosus in eight dog faeces samples and one positive EF due to the presence of Taenia spp. in a water sample. The work has allowed to develop and harmonise the diagnostic methods and operating protocols essential for controlling the spread of the CE to create “One Health” intervention plans in high endemic areas through the implementation of SOP (standard operating procedures) for monitoring the pathology in animals, humans and environment.
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Affiliation(s)
- Elisa Serra
- OIE-National Reference Laboratory of Echinococcosis, Istituto Zooprofilattico Sperimentale della Sardegna, Via Vienna, 07100 Sassari, Italy; (E.S.); (G.M.); (G.M.); (T.P.)
| | - Gabriella Masu
- OIE-National Reference Laboratory of Echinococcosis, Istituto Zooprofilattico Sperimentale della Sardegna, Via Vienna, 07100 Sassari, Italy; (E.S.); (G.M.); (G.M.); (T.P.)
| | - Valentina Chisu
- OIE-National Reference Laboratory of Echinococcosis, Istituto Zooprofilattico Sperimentale della Sardegna, Via Vienna, 07100 Sassari, Italy; (E.S.); (G.M.); (G.M.); (T.P.)
- Correspondence: (V.C.); (F.L.)
| | - Stefano Cappai
- Osservatorio Epidemiologico Veterinario Regionale della Sardegna, Istituto Zooprofilattico Sperimentale della Sardegna, Via XX Settembre, 09125 Cagliari, Italy;
| | - Giovanna Masala
- OIE-National Reference Laboratory of Echinococcosis, Istituto Zooprofilattico Sperimentale della Sardegna, Via Vienna, 07100 Sassari, Italy; (E.S.); (G.M.); (G.M.); (T.P.)
| | - Federica Loi
- Osservatorio Epidemiologico Veterinario Regionale della Sardegna, Istituto Zooprofilattico Sperimentale della Sardegna, Via XX Settembre, 09125 Cagliari, Italy;
- Correspondence: (V.C.); (F.L.)
| | - Toni Piseddu
- OIE-National Reference Laboratory of Echinococcosis, Istituto Zooprofilattico Sperimentale della Sardegna, Via Vienna, 07100 Sassari, Italy; (E.S.); (G.M.); (G.M.); (T.P.)
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13
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Khan H, Casulli A, Harandi MF, Afzal MS, Saqib MAN, Ahmed H. A Retrospective Cohort Study on Human Cystic Echinococcosis in Khyber Pakhtunkhwa Province (Pakistan) Based on 16 Years of Hospital Discharge Records. Pathogens 2022; 11:pathogens11020194. [PMID: 35215137 PMCID: PMC8876560 DOI: 10.3390/pathogens11020194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022] Open
Abstract
Human cystic echinococcosis (CE) is a worldwide-distributed parasitic zoonotic disease, which represents a threat for both human and animals. The current study aimed at estimating the prevalence of human CE in Khyber Pakhtunkhwa (KPK) province of Pakistan. Clinical records from four major hospitals in this region were reviewed for CE human cases during the period of 2006–2021. Out of 251 (0.00071%) CE patients identified during the considered period, 142 (56.6%) were females, and 109 (43.4%) were males. The highest number of CE cases was recorded in the 21–30 (27.9%) age group, followed by 31–40 (23.1%) and 41–50 (16.3%). Most of the CE patients in KPK province were members of the Afghani ethnic group (17.1%); secondarily, they were Pakistani (6.4%), while for 76.5% ethnicity data were not available. The liver (41%) and the lungs (4.8%) were the most infected organs identified among CE patients in KPK province. The present study identified CE as a significant public health problem in KPK province, and the current findings demonstrated a constant endemicity of CE during the last 15 years. Further filed studies on the active search of CE carriers by means of ultrasound population-based surveys are needed to fill knowledge gaps on clinical and molecular epidemiology of human CE in Pakistan.
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Affiliation(s)
- Huma Khan
- Department of Biosciences, COMSATS University Islamabad (CUI), Islamabad 4550, Pakistan;
| | - Adriano Casulli
- WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
- European Union Reference Laboratory for Parasites, Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
- Correspondence: (A.C.); (H.A.)
| | - Majid Fasihi Harandi
- Research Center for Hydatid Disease in Iran, Department of Medical Parasitology, Kerman University of Medical Sciences, Kerman 761, Iran;
| | - Muhammad Sohail Afzal
- Department of Life Sciences, School of Science, University of Management and Technology (UMT), Lahore 54782, Pakistan;
| | - Muhammad Arif Nadeem Saqib
- Department of Medical Laboratory Technology, National Skills University Islamabad, Islamabad 4550, Pakistan;
| | - Haroon Ahmed
- Department of Biosciences, COMSATS University Islamabad (CUI), Islamabad 4550, Pakistan;
- Correspondence: (A.C.); (H.A.)
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14
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Cassini R, Canali M, Tamarozzi F, Angheben A, Capelli G, Gobbi F, Legnardi M, Brichese M, Napoletano G, Cestaro F, Casulli A, Drigo M, Aragrande M. A One-Health evaluation of the burden of cystic echinococcosis and its prevention costs: Case study from a hypo-endemic area in Italy. One Health 2021; 13:100320. [PMID: 34504939 PMCID: PMC8413884 DOI: 10.1016/j.onehlt.2021.100320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 11/25/2022] Open
Abstract
An integrated model, based on a One Health approach, was implemented to estimate the epidemiological and economic outcomes of cystic echinococcosis (CE) in Veneto region, an hypo-endemic area of Northern Italy, and the costs for its prevention. Data and information needed to populate the model were retrieved from published literature, official statistics, expert opinions, or actively searched through data mining (i.e., Hospital and slaughterhouse data), when fundamental data were not available. Human-health and animal-health costs, both public and private, were considered. The overall impact of CE in the study area was estimated in an yearly cost of about 0.5 million €, due to an average of 19.5 human hospitalized cases and about 200 infected animals among cattle and sheep, per year. The human:animal costs ratio was about 8:1. Most of the infected animals were autochthonous, while the identification of an autochthonous source of the infection for the human cases was extremely difficult, and unlikely in most cases. No specific action resulted to be in place for human surveillance, while veterinary surveillance accounted for a yearly cost of about 22,000 €. Sheepherders were found to pay privately an overall amount of around 2000 € for the preventive treatment of their dogs every year, but the applied protocol proved to be sub-optimal. The source of most of the human cases was likely external to the study area, and their economic impact accounts for a cost that is far exceeding that of surveillance and preventive actions in place in the veterinary sector. Although autochthonous human cases appeared to be very rare, the strengthening of preventive actions and surveillance systems can reduce the risk of their increment. The study integrated epidemiology and economic aspects in a One Health perspective. The research estimates in detail the overall impact of CE in a hypo-endemic region in Italy. The study provided data for evidence-based actions to control CE in the study area. The investigated case study represents a reproducible model for zoonotic diseases evaluation.
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Affiliation(s)
- Rudi Cassini
- Dept. Animal Medicine, Production and Health, University of Padova, Viale dell'Università, 16, 35020 Legnaro, PD, Italy
| | - Massimo Canali
- Dept. of Agricultural and Food Sciences, University of Bologna, Viale Giuseppe Fanin, 50, 40127 Bologna, Italy
| | - Francesca Tamarozzi
- Dept. of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro-Cuore Don Calabria Hospital, Via Don A Sempreboni, 5, 37024 Negrar di Valpolicella, VR, Italy
| | - Andrea Angheben
- Dept. of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro-Cuore Don Calabria Hospital, Via Don A Sempreboni, 5, 37024 Negrar di Valpolicella, VR, Italy
| | - Gioia Capelli
- Istituto Zooprofilattico Sperimentale delle Venezie, Viale dell'Università, 10, 35020 Legnaro, PD, Italy
| | - Federico Gobbi
- Dept. of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro-Cuore Don Calabria Hospital, Via Don A Sempreboni, 5, 37024 Negrar di Valpolicella, VR, Italy
| | - Matteo Legnardi
- Dept. Animal Medicine, Production and Health, University of Padova, Viale dell'Università, 16, 35020 Legnaro, PD, Italy
| | - Michele Brichese
- Veneto Region, Prevention and Public Health, Dorsoduro 3493, 30123 Venezia, Italy
| | | | - Fabrizio Cestaro
- Azienda ULSS 9 Scaligera (Local Health Unit), Prevention Department, Via Valverde 42, 37122 Verona, Italy
| | - Adriano Casulli
- WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Roma, Italy.,European Union Reference Laboratory for Parasites, Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Roma, Italy
| | - Michele Drigo
- Dept. Animal Medicine, Production and Health, University of Padova, Viale dell'Università, 16, 35020 Legnaro, PD, Italy
| | - Maurizio Aragrande
- Dept. of Agricultural and Food Sciences, University of Bologna, Viale Giuseppe Fanin, 50, 40127 Bologna, Italy
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15
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Mustapayeva A, Luca D'Alessandro G, Doszhanova G, Colpani A, Sadybekov N, Baimakhanov Z, Assanov E, Salybekov S, Kaniyev S, Serikuly E, Tagabayeva L, Budke CM, Vola A, Mariconti M, De Silvestri A, Yalisheva S, Sadykova A, Zholdybay Z, Katarbayev A, Zhakenova Z, Brunetti E, Juszkiewicz K, Duisenova A, Manciulli T. Ultrasound-based evaluation of the prevalence of abdominal cystic echinococcosis in the Turkestan region of Kazakhstan. Trans R Soc Trop Med Hyg 2021; 116:222-226. [PMID: 34499709 DOI: 10.1093/trstmh/trab105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/31/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Human cystic echinococcosis (CE) is a zoonotic disease caused by Echinococcus granulosus sensu lato. CE is known to be endemic in some parts of Central Asia. We present findings from an ultrasound-based survey to estimate the prevalence of CE in the Turkestan oblast of Kazakhstan. METHODS In October 2019, six villages were chosen based on records from a national surveillance dataset. Inhabitants aged 5-90 y were invited to undergo a free abdominal ultrasound to screen for CE cysts. All identified cysts were staged according to the WHO-endorsed classification for CE cysts. RESULTS A total of 2252 individuals underwent ultrasound screening. Twenty-two (0.98%) individuals had CE, with a combined total of 33 cysts: 25 (75.7%) inactive (14 CE4, 11 CE5) and 8 (24.3%) active/transitional (2 CE1, 1 CE2, 3 CE3a, 2 CE3b). One patient had a postsurgical cavity. Sixty-eight patients (3.0%) reported CE prior to surgical treatment. In 25 (36.8%) previously diagnosed patients, albendazole prophylaxis was not used. CONCLUSIONS CE is endemic in the study region, with ongoing transmission. The number of surgically treated CE patients suggests an underestimation of the disease burden by the current surveillance system. Further studies on local CE epidemiology and the implementation of expert treatment recommendations are needed.
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Affiliation(s)
- Aigerim Mustapayeva
- Asfendyiarov National Kazakh Medical University, 94 Tole Bi Street, 050012 Almaty, Kazakhstan
| | - Gian Luca D'Alessandro
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Brambilla 54, 27100 Pavia, Italy
| | - Gaukhar Doszhanova
- Asfendyiarov National Kazakh Medical University, 94 Tole Bi Street, 050012 Almaty, Kazakhstan
| | - Agnese Colpani
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Brambilla 54, 27100 Pavia, Italy
| | - Nurbol Sadybekov
- Kazakh Institute of Oncology and Radiolology, 91 Abai ave., 050022 Almaty. Kazakhstan
| | - Zhasulan Baimakhanov
- Syzganov National Institute of Surgery, 62 Zheltoksan str., 050004 Almaty, Kazakhstan
| | - Ernar Assanov
- Syzganov National Institute of Surgery, 62 Zheltoksan str., 050004 Almaty, Kazakhstan
| | - Samat Salybekov
- Syzganov National Institute of Surgery, 62 Zheltoksan str., 050004 Almaty, Kazakhstan
| | - Shokan Kaniyev
- Syzganov National Institute of Surgery, 62 Zheltoksan str., 050004 Almaty, Kazakhstan
| | - Erbol Serikuly
- Syzganov National Institute of Surgery, 62 Zheltoksan str., 050004 Almaty, Kazakhstan
| | - Lyazzat Tagabayeva
- Kazakh Institute of Oncology and Radiolology, 91 Abai ave., 050022 Almaty. Kazakhstan
| | | | - Ambra Vola
- Unit of Microbiology and Virology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Mara Mariconti
- Unit of Microbiology and Virology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Annalisa De Silvestri
- Unit of Biostatistics, IRCCS San Matteo Hospital Foundation, Piazzale Gogli 2, 27100 Pavia, Italy
| | - Sofyia Yalisheva
- Department of Genetics and Molecular Biology, Al Farabi Kazakh National University, 71 al-Farabi Ave., 050040 Almaty, Kazakhstan
| | - Ainur Sadykova
- Asfendyiarov National Kazakh Medical University, 94 Tole Bi Street, 050012 Almaty, Kazakhstan
| | - Zhamilya Zholdybay
- Asfendyiarov National Kazakh Medical University, 94 Tole Bi Street, 050012 Almaty, Kazakhstan.,Kazakh Institute of Oncology and Radiolology, 91 Abai ave., 050022 Almaty. Kazakhstan
| | - Adil Katarbayev
- Asfendyiarov National Kazakh Medical University, 94 Tole Bi Street, 050012 Almaty, Kazakhstan
| | - Zhanar Zhakenova
- Asfendyiarov National Kazakh Medical University, 94 Tole Bi Street, 050012 Almaty, Kazakhstan
| | - Enrico Brunetti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Brambilla 54, 27100 Pavia, Italy.,Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Piazzale Gogli 2, 27100 Pavia, Italy
| | - Konrad Juszkiewicz
- Asfendyiarov National Kazakh Medical University, 94 Tole Bi Street, 050012 Almaty, Kazakhstan.,KIT Royal Tropical Institute, Amsterdam, Netherlands
| | - Amangul Duisenova
- Asfendyiarov National Kazakh Medical University, 94 Tole Bi Street, 050012 Almaty, Kazakhstan
| | - Tommaso Manciulli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Brambilla 54, 27100 Pavia, Italy
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16
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First Report of Echinococcus ortleppi in Free-Living Wild Boar ( Sus scrofa) from Portugal. Microorganisms 2021; 9:microorganisms9061256. [PMID: 34207738 PMCID: PMC8228001 DOI: 10.3390/microorganisms9061256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/02/2021] [Accepted: 06/06/2021] [Indexed: 11/17/2022] Open
Abstract
Cystic echinococcosis (CE) is a zoonosis that is prevalent worldwide. It is considered endemic in Portugal but few studies have been performed on Echinococcus granulosus sensu lato and their hosts. In this study, CE cysts are reported for the first time in a free-living wild boar (Sus scrofa) in Portugal. The presence of the metacestodes in the liver of the wild boar was identified by morphological features, microscopic examination and molecular analysis. The sequencing of part of the DNA nuclear ribosomal internal transcribed spacer-1 (ITS-1) region revealed a G5 genotype that presently corresponds to Echinococcus ortleppi. This is the first report of E. ortleppi in Portugal and to the best of the authors’ knowledge, in Europe. These results suggest that wild boar may be a host of CE, namely, crossing the livestock–wildlife interface, which has important public health implications. Wildlife reservoirs must be taken into account as CE hosts and surveillance of game as well as health education for hunters should be implemented using a One Health approach, with implementation of feasible and tailor-made control strategies, namely, proper elimination of byproducts in the field.
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17
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van der Giessen J, Deksne G, Gómez-Morales MA, Troell K, Gomes J, Sotiraki S, Rozycki M, Kucsera I, Djurković-Djaković O, Robertson LJ. Surveillance of foodborne parasitic diseases in Europe in a One Health approach. Parasite Epidemiol Control 2021; 13:e00205. [PMID: 33665388 PMCID: PMC7900597 DOI: 10.1016/j.parepi.2021.e00205] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/10/2020] [Accepted: 01/26/2021] [Indexed: 12/13/2022] Open
Abstract
In 2012, WHO/FAO ranked 24 foodborne parasites (FBP) using multicriteria decision analysis (MCDA) to provide risk assessors with a basis for prioritising control of highly ranked FBP on the global level. One conclusion was that ranking may differ substantially per region. In Europe, the same methodology was used to rank FBP of relevance for Europe. Of the 24 FBP, the top-five prioritised FBP were identified for Europe as Echinococcus multilocularis, Toxoplasma gondii, Trichinella spiralis, E. granulosus, and Cryptosporidium spp., all of which are zoonotic. The objective of the present study was to provide an overview of surveillance and reporting systems in Europe for these top five prioritised FBP in the human and animal populations, to identify gaps, and give recommendations for improvement. Information on the surveillance systems was collected from 35 European countries and analysed according to the five different regions. For most FBP, human surveillance is passive in most countries and regions in Europe and notification differs between countries and regions. Adequate surveillance programmes for these FBP are lacking, except for T. spiralis, which is notifiable in 34 countries with active surveillance in susceptible animals under EU directive. Although human and animal surveillance data are available for the five prioritised FBP, we identified a lack of consistency in surveillance and reporting requirements between national experts and European bodies. Recommendations for improved surveillance systems are discussed.
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Affiliation(s)
- Joke van der Giessen
- National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, P.O. Box 1, Bilthoven 3720 BA, Netherlands
| | - Gunita Deksne
- Institute of Food Safety, Animal Health and Environment "BIOR", Lejupes Str. 3, Riga LV-1076, Latvia.,Faculty of Biology, University of Latvia, Jelgavas Str. 1, Riga LV-1004, Latvia
| | - Maria Angeles Gómez-Morales
- European Union Reference Laboratory for Parasites, Istituto Superiore di Sanità, Viale Regina Elena, 299, Rome 00161, Italy
| | - Karin Troell
- National Veterinary Institute, Ulls väg 2B, Uppsala SE-751 89, Sweden
| | - Jacinto Gomes
- National Institute for Agrarian and Veterinary Research, Av. da República, Quinta do Marquês, Oeiras 2780-157, Portugal
| | - Smaragda Sotiraki
- Veterinary Research Institute, Hellenic Agricultural Organisation-Demeter, Thermi, Thessaloniki 57001, Greece
| | - Miroslaw Rozycki
- National Veterinary Research Institute, Aleja Partyzantów 57, Puławy 24-100, Poland
| | - István Kucsera
- National Public Health Center, Albert Flórián út 2-6, Budapest 1097, Hungary
| | - Olgica Djurković-Djaković
- Centre of Excellence for Food- and Vector-borne Zoonoses, Institute for Medical Research, University of Belgrade, Dr. Subotića 4, Belgrade 11129, Serbia
| | - Lucy J Robertson
- Department of Paraclinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Adamstuen Campus, Ullevålsveien 72, Oslo 0454, Norway
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Ma T, Jiang D, Quzhen G, Xue C, Han S, Wu W, Zheng C, Ding F. Factors influencing the spatial distribution of cystic echinococcosis in Tibet, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 754:142229. [PMID: 33254864 DOI: 10.1016/j.scitotenv.2020.142229] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 06/12/2023]
Abstract
Cystic echinococcosis (CE), which is caused by Echinococcus granulosus, is a worldwide helminthozoonosis that is highly endemic in the Tibet Autonomous Region of China and has important public health and economic impacts. However, the spatial epidemiological characteristics of CE in Tibet are still unclear. Based on recorded human CE cases and the use of a geographic information system, the spatial distribution patterns of CE prevalence at three different scales were analyzed. In addition, a spatial agglomeration map of CE prevalence was generated based on cold/hot spot analysis. By combining maps of environmental and biological covariates with information about known human CE cases, the links between CE prevalence and relevant covariates were explored, revealing that the annual average precipitation, elevation, water accessibility and animal population (dog and yak) were associated with the prevalence of CE at the significance level of P < 0.05. Our results provide a novel insight and better understanding of the current situation of and the factors influencing CE in Tibet, which can help public health authorities develop disease prevention and control strategies.
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Affiliation(s)
- Tian Ma
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China; College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Dong Jiang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China; College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China; Key Laboratory of Carrying Capacity Assessment for Resource and Environment, Ministry of Natural Resources of the People's Republic of China, Beijing 100101, China
| | - Gongsang Quzhen
- Tibet Autonomous Region Center for Diseases Control and Prevention, Lhasa 850000, Tibet Autonomous Region, China
| | - Chuizhao Xue
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Key Laboratory of Parasite and Vector Biology, MOH, Shanghai 200025, China
| | - Shuai Han
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Key Laboratory of Parasite and Vector Biology, MOH, Shanghai 200025, China
| | - Weiping Wu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Key Laboratory of Parasite and Vector Biology, MOH, Shanghai 200025, China
| | - Canjun Zheng
- Chinese Center for Disease Control and Prevention (China CDC), Beijing 102206, China.
| | - Fangyu Ding
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China; College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China.
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19
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Giant hydatid lung cyst in non-endemic area. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2020.101720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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20
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Manciulli T, Serraino R, D'Alessandro GL, Cattaneo L, Mariconti M, Vola A, Taccari F, Narra R, De Vito G, Trecarichi EM, Mazzitelli M, Matera G, Casulli A, Marascio N, Brunetti E, Tamarozzi F, Torti C. Evidence of Low Prevalence of Cystic Echinococcosis in the Catanzaro Province, Calabria Region, Italy. Am J Trop Med Hyg 2020; 103:1951-1954. [PMID: 32975181 DOI: 10.4269/ajtmh.20-0119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Tommaso Manciulli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,PhD School of Experimental Medicine, University of Pavia, Pavia, Italy.,Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Riccardo Serraino
- Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, "Magna Graecia" University, Catanzaro, Italy
| | - Gian Luca D'Alessandro
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Letizia Cattaneo
- Unit of Infectious Diseases, University of Naples-Federico II, Napoli, Italy
| | - Mara Mariconti
- Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Ambra Vola
- Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Francesco Taccari
- Institute of Clinical Infectious Disease, Catholic University of the Sacred Heart, Rome, Italy
| | - Roberta Narra
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giuseppe De Vito
- Public Health Agency of the Catanzaro Province, Catanzaro, Italy
| | - Enrico Maria Trecarichi
- Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, "Magna Graecia" University, Catanzaro, Italy
| | - Maria Mazzitelli
- Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, "Magna Graecia" University, Catanzaro, Italy
| | - Giovanni Matera
- Department of Health Sciences, Unit of Clinical Microbiology, 'Magna Graecia' University, Catanzaro, Italy
| | - Adriano Casulli
- Department of Infectious Diseases, European Reference Laboratory for Parasites, Foodborne and Neglected Parasitic Diseases Unit, Istituto Superiore di Sanità, Rome, Italy.,Department of Infectious Diseases, WHO Collaborating Centre for Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Foodborne and Neglected Parasitic Diseases Unit, Istituto Superiore di Sanità, Rome, Italy
| | - Nadia Marascio
- Department of Health Sciences, Unit of Clinical Microbiology, 'Magna Graecia' University, Catanzaro, Italy
| | - Enrico Brunetti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Francesca Tamarozzi
- Department of Infectious Diseases, WHO Collaborating Centre for Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Foodborne and Neglected Parasitic Diseases Unit, Istituto Superiore di Sanità, Rome, Italy
| | - Carlo Torti
- Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, "Magna Graecia" University, Catanzaro, Italy
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21
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Santucciu C, Bonelli P, Peruzzu A, Fancellu A, Marras V, Carta A, Mastrandrea S, Bagella G, Piseddu T, Profili S, Porcu A, Masala G. Cystic Echinococcosis: Clinical, Immunological, and Biomolecular Evaluation of Patients from Sardinia (Italy). Pathogens 2020; 9:E907. [PMID: 33143032 PMCID: PMC7693143 DOI: 10.3390/pathogens9110907] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 02/07/2023] Open
Abstract
Cystic echinococcosis (CE), a zoonotic disease caused by the larval stage of the tapeworm Echinococcus granulosus sensu lato (s.l.), is a worldwide public health problem. Echinococcus granulosus sensu stricto (s.s.), associated with G1 and G3 genotypes, is endemic with high prevalence in the Mediterranean basin. The parasite's life cycle comprises definitive hosts (canids) and intermediate hosts (ruminants) and can occasionally involve humans. The main aim of this research was to confirm the diagnosis of 13 patients suspected of CE who presented different complications and needed the surgical removal of the cysts. We also wanted to understand and clarify more the diagnosis of echinococcosis in humans. For this purpose, the patients first underwent cyst evaluation by ultrasound (US), immunological analysis, and then total pericystectomy, followed by parasitological, histopathological, and molecular biology examinations of the cysts. US stadiated one CE1, one CE2, eight CE3b, one CE4, and two CE5; immunology evidenced nine positives; histopathology confirmed 11 CE cysts, of which 8 fertile presenting protoscoleces were identified as E. granulosus s.s. by molecular biology, genotyped as three G1 and four G3 by neighbor-joining (NJ) phylogenetic tree. In conclusion, the results showed that 11 patients were affected by E. granulosus s.s. G1 orG3, and 2 cystic neoformations were of non-parasitic origin.
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Affiliation(s)
- Cinzia Santucciu
- OIE Reference Laboratory for Echinococcosis, National Reference Center for Echinococcosis (CeNRE), IZS della Sardegna, 07100 Sassari, Italy; (P.B.); (A.P.); (S.M.); (T.P.); (G.M.)
| | - Piero Bonelli
- OIE Reference Laboratory for Echinococcosis, National Reference Center for Echinococcosis (CeNRE), IZS della Sardegna, 07100 Sassari, Italy; (P.B.); (A.P.); (S.M.); (T.P.); (G.M.)
| | - Angela Peruzzu
- OIE Reference Laboratory for Echinococcosis, National Reference Center for Echinococcosis (CeNRE), IZS della Sardegna, 07100 Sassari, Italy; (P.B.); (A.P.); (S.M.); (T.P.); (G.M.)
| | - Alessandro Fancellu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.F.); (A.P.)
| | - Vincenzo Marras
- Department of Biomedical Sciences, Institute of Pathology, University of Sassari, 07100 Sassari, Italy;
| | - Antonello Carta
- U.O.C. di Radiologia, A.O.U., 07100 Sassari, Italy; (A.C.); (S.P.)
| | - Scilla Mastrandrea
- OIE Reference Laboratory for Echinococcosis, National Reference Center for Echinococcosis (CeNRE), IZS della Sardegna, 07100 Sassari, Italy; (P.B.); (A.P.); (S.M.); (T.P.); (G.M.)
- U.O.C. di Malattie Infettive, A.O.U., 07100 Sassari, Italy
| | - Giorgio Bagella
- Radiology Unit, University Hospital of Sassari, 07100 Sassari, Italy;
| | - Toni Piseddu
- OIE Reference Laboratory for Echinococcosis, National Reference Center for Echinococcosis (CeNRE), IZS della Sardegna, 07100 Sassari, Italy; (P.B.); (A.P.); (S.M.); (T.P.); (G.M.)
| | - Stefano Profili
- U.O.C. di Radiologia, A.O.U., 07100 Sassari, Italy; (A.C.); (S.P.)
| | - Alberto Porcu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.F.); (A.P.)
| | - Giovanna Masala
- OIE Reference Laboratory for Echinococcosis, National Reference Center for Echinococcosis (CeNRE), IZS della Sardegna, 07100 Sassari, Italy; (P.B.); (A.P.); (S.M.); (T.P.); (G.M.)
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22
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Tamarozzi F, Legnardi M, Fittipaldo A, Drigo M, Cassini R. Epidemiological distribution of Echinococcus granulosus s.l. infection in human and domestic animal hosts in European Mediterranean and Balkan countries: A systematic review. PLoS Negl Trop Dis 2020; 14:e0008519. [PMID: 32776936 PMCID: PMC7440662 DOI: 10.1371/journal.pntd.0008519] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/20/2020] [Accepted: 06/25/2020] [Indexed: 12/22/2022] Open
Abstract
Cystic echinococcosis (CE) is a neglected zoonosis caused by infection with the cestode Echinococcus granulosus sensu lato. We carried out a systematic literature review on E. granulosus s.l. human and animal (cattle, sheep, dog) infection in European Mediterranean and Balkan countries in 2000–2019, to provide a picture of its recent epidemiology in this endemic area. MEDLINE, EMBASE, Scopus, Google Scholar and Open Grey databases were searched. Included cases were: i) for humans, data from hospital records and imaging studies; ii) for dogs, data from necropsy and coprological studies; iii) for ruminants, cases based on slaughter inspection. The NUTS (Nomenclature of Territorial Units for Statistics) classification was used to categorize extracted data in epidemiological units, defined as data referred to one NUTS2 (basic region) in one year time. Data were then aggregated to NUTS1 level (major regions), calculating the average incidence value of included epidemiological units. For prevalence studies covering different epidemiological units, the pooled prevalence was estimated. Data were extracted from 79 publications, 25 on human infection (covering 437 epidemiological units), and 54 on animal infection (52 epidemiological units for cattle, 35 for sheep and 25 for dogs). At NUTS1 level, average annual incidence rates of human CE ranged from 0.10–7.74/100,000; pooled prevalence values ranged from 0.003–64.09% in cattle, 0.004–68.73% in sheep, and 0–31.86% in dogs. Southern and insular Italy, central Spain, Romania and Bulgaria reported the highest values. Bovine data showed a more similar pattern to human data compared to sheep and dogs. Limitation of evidence included the paucity of human prevalence studies, data heterogeneity, and the patchy geographical coverage, with lack of data especially for the Balkans. Our results confirm Italy, Spain, and Eastern Europe being the most affected areas, but data are extremely heterogeneous, geographical coverage very patchy, and human prevalence studies extremely scant. Results also highlight the notorious problem of underreporting of E. granulosus s.l. infection in both humans and animals. Cystic echinococcosis (CE) is a neglected zoonosis caused by infection with the parasite Echinococcus granulosus sensu lato, naturally transmitted between canids and livestock; CE in humans can be a serious condition. In endemic areas, CE is responsible for significant health and economic losses, but its real burden is difficult to estimate. E. granulosus s.l. is especially present in areas where livestock breeding is practiced, including European Mediterranean and Balkan countries. We carried out a systematic literature review on the epidemiology of E. granulosus s.l. human and animal infection in this area in 2000–2019. Data were extracted from 79 publications, and referred to Nomenclature of Territorial Units for Statistics (NUTS) levels per year. Average annual incidence rates of human CE ranged from 0.10–7.74/100,000; pooled prevalences ranged from 0.003–64.09% in cattle, 0.004–68.73% in sheep, and 0–31.86% in dogs. Bovine data showed a more similar pattern to human data compared to sheep and dogs. Our results confirm that Italy, Spain, and Eastern Europe are the most affected areas, but data are extremely heterogeneous, geographical coverage very patchy, and human prevalence studies extremely scant. Results also highlight the well-known problem of underreporting of E. granulosus s.l. infection in both humans and animals.
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Affiliation(s)
- Francesca Tamarozzi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar (Verona), Italy
| | - Matteo Legnardi
- Department of Animal Medicine, Production and Health, University of Padova, Legnaro (Padova), Italy
| | - Andrea Fittipaldo
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar (Verona), Italy
| | - Michele Drigo
- Department of Animal Medicine, Production and Health, University of Padova, Legnaro (Padova), Italy
| | - Rudi Cassini
- Department of Animal Medicine, Production and Health, University of Padova, Legnaro (Padova), Italy
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Abstract
Cystic echinococcosis (CE) is caused by the larval form of Echinococcus granulosus that can cause serious health and economic problems in the endemic foci. CE is globally distributed in various climatic conditions from circumpolar to tropical latitudes. Iran is an important endemic area with a spectrum of weather conditions. The aim of this study was to determine the effects of geo-climatic factors on the distribution of livestock CE in south-western Iran (SWI) in 2016 to 2018. Data of livestock CE were retrieved from veterinary organizations of four provinces of SWI. The geo-climatic factors, including mean annual temperature (MAT), minimum MAT (MinMAT), maximum MAT (MaxMAT), mean annual rainfall (MAR), elevation, mean annual evaporation (MAE), sunny hours, wind speed, mean annual humidity (MAH), slope, frost days and land cover, were analysed using geographical information systems (GIS) approaches. The statistical analysis showed that MAR, frost days, elevation, slope and semi-condensed forest land cover were positively and MAE, MAT, MaxMAT, MinMAT and salt and salinity land cover were negatively correlated with CE occurrence. MAE was shown to be a predictive factor in the stepwise linear logistic regression model. In short, the current GIS-based study found that areas with lower evaporation were the main CE risk zones, though those with lower temperature and higher rainfall, altitude and slope, especially where covered with or in close proximity of semi-condensed forest, should be prioritized for consideration by health professionals and veterinarians for conducting control programmes in SWI.
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Microsatellite Investigations of Multiple Echinococcus Granulosus Sensu Stricto Cysts in Single Hosts Reveal Different Patterns of Infection Events between Livestock and Humans. Pathogens 2020; 9:pathogens9060444. [PMID: 32516904 PMCID: PMC7350307 DOI: 10.3390/pathogens9060444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 01/23/2023] Open
Abstract
Cystic echinococcosis (CE) caused by the cestode Echinococcus granulosus sensu lato (s.l.) is a worldwide zoonosis and E. granulosus sensu stricto (s.s.) is the most common species associated with animal and human diseases. The objective of this study was to obtain a better understanding of CE infection in livestock and humans from very low and high endemic areas—France and Tunisia—by studying the genetic diversity of E. granulosus s.s. at the intra-individual host level. This genetic diversity was studied using EgSca6 and EgSca11 microsatellite profiles in 93 sheep from France and Tunisia, and in 12 cattle and 31 children from Tunisia only, all presenting multiple CE cysts (2 to 10 cysts). Overall, 96% of sheep, 92% of cattle, and 48% of children had at least two cysts with different microsatellite profiles. Inversely, 35% of sheep, 17% of cattle, and 65% of children had at least two cysts with the same microsatellite profile. The genotyping results for the CE samples highlight high and similar genetic diversity in France and Tunisia, suggesting that the probability of being successively infected by CE of the same microsatellite profile was rare in both countries. Therefore, our results suggest that in rare cases, several eggs of the same microsatellite profile, from two to seven in our data, can be ingested simultaneously in a single infection event and develop into several cysts in livestock and children. They also indicate that multiple infection events are frequent in livestock, even in a low endemic country such as France, and are less frequent but not negligible in children in a high endemic country such as Tunisia. Moreover, this is the first time that genetic evidence of secondary CE has been found. Further studies are needed to better assess the pattern of infection events in livestock and humans, especially by studying the genetic diversity of adult worms in definitive hosts.
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Canali M, Aragrande M, Angheben A, Capelli G, Drigo M, Gobbi F, Tamarozzi F, Cassini R. Epidemiologic-economic models and the One Health paradigm: echinococcosis and leishmaniasis, case studies in Veneto region, Northeastern Italy. One Health 2020; 9:100115. [PMID: 32021898 PMCID: PMC6995255 DOI: 10.1016/j.onehlt.2019.100115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 01/18/2023] Open
Abstract
Epidemiology and health economics have systemic interdependencies. The identification of the economic outcomes of any disease is operated by overlapping its epidemiology with the economic functions of the impacted entities. This communication presents two epidemiologic-economic models designed to evaluate the economic burden of cystic echinococcosis and leishmaniasis in Veneto (Northeastern Italy). Following a One Health approach, the research integrates expertise from different disciplines and institutions and fulfilled its first stage by defining the relevant cost categories and the data collection strategy for the two diseases in the study area. The two models identify the relevant epidemiological factors and the economic outcomes of infections in both animals and humans. The results, visualized in flow charts indicating the types of costs associated with these zoonoses, will guide data collection and the epidemiologic and economic assessment in the next research stages. This experience shows that One Health methods, although still innovative or unusual in many scientific and professional contexts, can be applied by using relatively limited resources and already available professional skills.
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Affiliation(s)
- Massimo Canali
- Department of Agricultural and Food Sciences, University of Bologna, Bologna, Italy
| | - Maurizio Aragrande
- Department of Agricultural and Food Sciences, University of Bologna, Bologna, Italy
| | - Andrea Angheben
- Infectious and Tropical Diseases, IRCCS Hospital Sacro Cuore – Don Calabria, Negrar, Verona, Italy
| | - Gioia Capelli
- National reference centre/OIE collaborating centre for diseases at the animal-human interface, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro (PD), Italy
| | - Michele Drigo
- Department of Animal Medicine, Production and Health, University of Padova, Padova, Italy
| | - Federico Gobbi
- Infectious and Tropical Diseases, IRCCS Hospital Sacro Cuore – Don Calabria, Negrar, Verona, Italy
| | - Francesca Tamarozzi
- WHO Collaborating Centre for Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Rudi Cassini
- Department of Animal Medicine, Production and Health, University of Padova, Padova, Italy
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Pavia G, De Gori F, Ciambrone L, De Gori N, Musarella R, Casalinuovo F. Dispersal and molecular characterisation of the Echinococcus granulosus (Batsch, 1786) complex isolated from various intermediate hosts in the Calabria region, southern Italy. Folia Parasitol (Praha) 2020; 67. [PMID: 32458816 DOI: 10.14411/fp.2020.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/05/2020] [Indexed: 11/19/2022]
Abstract
Cystic echinococcosis (CE) is a zoonotic disease caused by the tapeworms of the Echinococcus granulosus sensu lato complex, which have worldwide distribution. No data on the circulation of genotypes of the E. granulosus complex in intermediate hosts in endemic areas in Calabria are available. The aims of our study were to evaluate the dispersal of genotypes of the E. granulosus complex in Calabria and to characterise parasite isolates by Sanger sequencing and phylogenetic analysis. We collected 71 animal samples from pigs, wild boars, sheep, cattle and goats. The first PCR screening analysis targeted three partial genomic regions: the cytochrome c oxidase subunit 1 (cox1), calreticulin protein (cal) and NADH dehydrogenase subunit 1 (nad1); this identified 28 parasitic cysts. Bidirectional sequencing of cox1 amplicons and phylogenetic analysis allowed us to characterise all isolates. Molecular analyses of 28 newly generated cox1 sequences revealed that most wild boars (n = 16) and three pigs were parasitised by the larval stage of Taenia hydatidena Pallas, 1766, called cysticercus tenuicollis. Two isolates from wild boars were identified as Echinococcus canadensis Webster and Cameron, 1961 (G7), while five sheep and two goats were infected with E. granulosus G1 (sheep strain) and G1 microvariant (previously reported as G2 genotype or Tasmanian sheep strain), respectively. These molecular findings should prompt further and more extensive studies, to elucidate regional transmission patterns and to guide control programs.
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Affiliation(s)
- Grazia Pavia
- Istituto Zooprofilattico Sperimentale del Mezzogiorno, Section of Catanzaro, Italy
| | - Federica De Gori
- Istituto Zooprofilattico Sperimentale del Mezzogiorno, Section of Catanzaro, Italy
| | - Lucia Ciambrone
- Istituto Zooprofilattico Sperimentale del Mezzogiorno, Section of Catanzaro, Italy
| | | | - Rosanna Musarella
- Istituto Zooprofilattico Sperimentale del Mezzogiorno, Section of Catanzaro, Italy
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Rossi P, Tamarozzi F, Galati F, Akhan O, Cretu CM, Vutova K, Siles-Lucas M, Brunetti E, Casulli A. The European Register of Cystic Echinococcosis, ERCE: state-of-the-art five years after its launch. Parasit Vectors 2020; 13:236. [PMID: 32381109 PMCID: PMC7206799 DOI: 10.1186/s13071-020-04101-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The real burden of human cystic echinococcosis (CE) remains elusive, due to the peculiar characteristics of the disease and the heterogeneous and incomplete data recording of clinical cases. Furthermore, official notification systems do not collect pivotal clinical information, which would allow the comparison of different treatment outcomes, and thus circumvent the difficulty of implementing clinical trials for CE. The Italian Register of CE (RIEC) was launched in 2012 and expanded in 2014 into the European Register of CE (ERCE). The primary aim of the ERCE was to highlight the magnitude of CE underreporting, through the recording of cases that were not captured by official records. We present an overview of data collated in the ERCE and discuss its future, five years after its inception. METHODS The ERCE database was explored on March 31st 2019; data concerning participating centres and registered cases were descriptively analysed. RESULTS Forty-four centres from 15 countries (7 non-European) were affiliated to the ERCE. Thirty-four centres (77%) registered at least one patient; of these, 18 (53%) recorded at least one visit within the past 18 months. A total of 2097 patients were registered, 19.9% of whom were immigrants. Cyst characteristics were reported for at least one cyst at least in one visit in 1643 (78.3%) patients, and cyst staging was used by 27 centres. In total, 3386 cysts were recorded at first registration; mostly located in the liver (75.5%). Data concerning clinical management could be analysed for 920 "cyst stage-location-management" observations, showing great heterogeneity in the implementation of the stage-specific management approach recommended by the WHO. CONCLUSIONS The ERCE achieved its goal in showing that CE is a relevant but neglected public health problem in Europe and beyond, since a proportion of patients reaching medical attention are not captured by official notification systems. The ERCE may provide a valuable starting platform to complement hospital-derived data, to obtain a better picture of the epidemiology of clinical CE, and to collect clinical data for the issue of evidence-based recommendations. The ERCE will be expanded into the International Register of CE (IRCE) and restructured aiming to overcome its current criticalities and fulfil these aims.
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Affiliation(s)
- Patrizia Rossi
- European Reference Laboratory for Parasites, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
- WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Francesca Tamarozzi
- European Reference Laboratory for Parasites, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
- WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Fabio Galati
- DG-INF - Information Technology Service, Istituto Superiore di Sanità, Rome, Italy
| | - Okan Akhan
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Carmen Michaela Cretu
- C. Davila University of Medicine and Pharmacy, Colentina Clinical Hospital, Bucharest, Romania
| | - Kamenna Vutova
- Specialised Hospital of Infectious and Parasitic Diseases “Prof. Ivan Kirov”, Department of Infectious, Parasitic and Tropical Diseases, Medical University, Sofia, Bulgaria
| | - Mar Siles-Lucas
- Instituto de Recursos Naturales y Agrobiología de Salamanca, CSIC, Salamanca, Spain
| | - Enrico Brunetti
- Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
- Division of Tropical and Infectious Diseases, San Matteo Hospital Foundation, Pavia, Italy
| | - Adriano Casulli
- European Reference Laboratory for Parasites, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
- WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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Khan A, Ahmed H, Naz K, Gul S, Ishaque SM, Zaidi SSA, Afzal MS, Ali MS, Bokari SA, Budke CM. Surgically confirmed cases of cystic echinococcosis from Baluchistan Province, Pakistan for the years 2011-2018. Acta Trop 2020; 205:105354. [PMID: 31982433 DOI: 10.1016/j.actatropica.2020.105354] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 01/19/2020] [Accepted: 01/22/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Cystic echinococcosis (CE) is a parasitic zoonotic disease caused by the larval stage of Echinococcus granulosus tapeworms. It has a worldwide geographic distribution and can threaten the livestock industry and human health in endemic areas, including Pakistan. CE prevalence is high in Pakistan due to lack of local knowledge about disease transmission and a lack of control measures. The Pakistan province of Baluchistan shares a border with Iran and Afghanistan and is largely agricultural. However, little is known about E. granulosus transmission in this region. METHODS Information on surgically confirmed cases of CE in Baluchistan Province was obtained through evaluation of paraffin fixed cyst samples and patient records obtained from three local hospitals for the years 2011-2018. RESULTS A total of 22 paraffin fixed samples were collected during the study period. The majority of cysts were obtained from the liver (9/22; 40.9%), with anatomical location not available for two of the cysts. Demographic information was available for 18 cases. Females made up 61.1% (11/18) of the cases. The largest numbers of cases were found in the 31-40 years age group (5/18; 22.7%). DISCUSSION This study shows that Echinococcus spp. parasites are circulating in the study area. In order to control the disease, a comprehensive regional surveillance and control program is needed.
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Affiliation(s)
- Aisha Khan
- Department of Biosciences, COMSATS University Islamabad (CUI), Islamabad, Pakistan
| | - Haroon Ahmed
- Department of Biosciences, COMSATS University Islamabad (CUI), Islamabad, Pakistan.
| | - Kashf Naz
- Department of Biosciences, COMSATS University Islamabad (CUI), Islamabad, Pakistan
| | - Shaista Gul
- Department of Histopathology, Bolan Medical University of Health Sciences, Quetta, Balochistan, Pakistan
| | - Syed Muhammad Ishaque
- Department of Pathology, Bolan University of Medical & Health Sciences, Quetta, Balochistan, Pakistan
| | | | - Muhammad Sohail Afzal
- Department of Lifesciences, University of Management & Technology (UMT), Lahore, Pakistan
| | - Muhammad Shahzad Ali
- Department of Wildlife & Ecology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - Saleem Ahmed Bokari
- Department of Biosciences, COMSATS University Islamabad (CUI), Islamabad, Pakistan
| | - Christine M Budke
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine & Biomedical Sciences, Texas A & M University, College Station, TX, United States
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Bonelli P, Dei Giudici S, Peruzzu A, Piseddu T, Santucciu C, Masu G, Mastrandrea S, Delogu ML, Masala G. Genetic diversity of Echinococcus granulosus sensu stricto in Sardinia (Italy). Parasitol Int 2020; 77:102120. [PMID: 32259586 DOI: 10.1016/j.parint.2020.102120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 11/28/2022]
Abstract
Cystic echinococcosis (CE) is a severe parasitic zoonosis caused by the metacestode of the tapeworm Echinococcus granulosus sensu lato (s.l.). The disease has a global distribution representing a significant public health concern. Based on mitochondrial DNA analysis E. granulosus s.l. has been subdivided into five species: E. granulosus sensu stricto (s.s.) (G1, G3 genotype), E. equinus (G4 genotype), E. ortleppi (G5 genotype), E. canadensis (G6-G8, G10 genotype) and E. felidis. E. granulosus s.s., and in particular G1, is the most widespread genotype and the major responsible of human CE cases worldwide. In Italy G1 genotype is higly represented with larger percentages in some hyperendemic areas such as Sardinia. Molecular studies represent a valuable tool to improve our understanding of the E. granulosus epidemiology and CE control strategies. In the present study we investigated genetic variability of E. granulosus s.s. in Sardinia. To this purpose 83 hydatid cysts were collected from different animal species including humans and the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene was partially sequenced (720 bp). Nucleotide sequences from Mediterranean basin were also analyzed for comparison. The phylogenetic network revealed 30 haplotypes grouped around a predominant isolate that had been already reported from other world regions. Haplotype diversity (0.8495 ± 0.0336) and nucleotide diversity (0.003305 ± 0.002014) were similar in Sardinia respect to other Mediterranean countries. Neutrality indices obtained by Tajima's D and Fu's Fs test were significantly negative (p ≤ .01) suggesting expansion of Sardinian population. Low Fixation indices (Fst), ranging from negative values (Algeria, Greece, Spain, other part of Italy) to 0.089 (Albania, France), indicated absence of genetic differentiation, and gene flow between Sardinia and other Mediterranean countries.
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Affiliation(s)
- Piero Bonelli
- OIE Reference Laboratory for Echinococcosis, National Reference Laboratory for Cystic Echinococcosis (CeNRE), Istituto Zooprofilattico della Sardegna (IZS), Via Vienna 2, 07100 Sassari, Italy.
| | - Silvia Dei Giudici
- Laboratory of Diagnostic Virology, Istituto Zooprofilattico della Sardegna (IZS), Via Vienna 2, 07100 Sassari, Italy
| | - Angela Peruzzu
- OIE Reference Laboratory for Echinococcosis, National Reference Laboratory for Cystic Echinococcosis (CeNRE), Istituto Zooprofilattico della Sardegna (IZS), Via Vienna 2, 07100 Sassari, Italy
| | - Toni Piseddu
- OIE Reference Laboratory for Echinococcosis, National Reference Laboratory for Cystic Echinococcosis (CeNRE), Istituto Zooprofilattico della Sardegna (IZS), Via Vienna 2, 07100 Sassari, Italy
| | - Cinzia Santucciu
- OIE Reference Laboratory for Echinococcosis, National Reference Laboratory for Cystic Echinococcosis (CeNRE), Istituto Zooprofilattico della Sardegna (IZS), Via Vienna 2, 07100 Sassari, Italy
| | - Gabriella Masu
- OIE Reference Laboratory for Echinococcosis, National Reference Laboratory for Cystic Echinococcosis (CeNRE), Istituto Zooprofilattico della Sardegna (IZS), Via Vienna 2, 07100 Sassari, Italy
| | - Scilla Mastrandrea
- OIE Reference Laboratory for Echinococcosis, National Reference Laboratory for Cystic Echinococcosis (CeNRE), Istituto Zooprofilattico della Sardegna (IZS), Via Vienna 2, 07100 Sassari, Italy
| | | | - Giovanna Masala
- OIE Reference Laboratory for Echinococcosis, National Reference Laboratory for Cystic Echinococcosis (CeNRE), Istituto Zooprofilattico della Sardegna (IZS), Via Vienna 2, 07100 Sassari, Italy
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Abstract
This report of the European Food Safety Authority and the European Centre for Disease Prevention and Control presents the results of zoonoses monitoring activities carried out in 2018 in 36 European countries (28 Member States (MS) and 8 non‐MS). The first and second most commonly reported zoonoses in humans were campylobacteriosis and salmonellosis, respectively. The European Union (EU) trend for confirmed human cases of these two diseases was stable during 2014–2018. The proportion of human salmonellosis cases due to Salmonella Enteritidis was at the same level in 2018 as in 2017. Of the 27 reporting MS, 16 met all Salmonella reduction targets for poultry, whereas 11 MS failed meeting at least one. The EU flock prevalence of target Salmonella serovars in breeding hens, laying hens, broilers and fattening turkeys decreased during recent years but stalled in breeding turkeys. Salmonella results from Competent Authorities for pig carcasses and for poultry tested through National Control Programmes were more frequently positive compared with food business operators. Shiga toxin‐producing Escherichia coli (STEC) infections in humans were the third most commonly reported zoonosis in the EU and increased from 2014 to 2018. Yersiniosis was the fourth most frequently reported zoonosis in humans in 2018 with a stable trend in 2014–2018. The number of reported confirmed listeriosis cases further increased in 2018, despite Listeria rarely exceeding the EU food safety limit tested in ready‐to‐eat food. In total, 5,146 food‐ and waterborne outbreaks were reported. Salmonella was the most commonly detected agent with S. Enteritidis causing one in five outbreaks. Salmonella in eggs and egg products was the highest risk agent/food pair. A large increase of human West Nile virus infections was reported in 2018. The report further updates on bovine tuberculosis, Brucella, Trichinella, Echinococcus, Toxoplasma, rabies, Coxiella burnetii (Q fever) and tularaemia.
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Retrospective Study of Cystic Echinococcosis (CE) Based on Hospital Record from Five Major Metropolitan Cities of Pakistan. Acta Parasitol 2019; 64:866-872. [PMID: 31463885 DOI: 10.2478/s11686-019-00109-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 08/10/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Human cystic echinococcosis (CE) is an important zoonotic parasitic disease. It is one of the NTDs having strong roots in Pakistan. There are limited studies on the prevalence of CE in Pakistan. METHOD A retrospective study was conducted to determine the geographical distribution of human CE in Punjab (Lahore, Multan, and Faisalabad) and Sindh (Karachi and Hyderabad) provinces of Pakistan. Clinical records of infected patients from nine major hospitals were retrieved from 2008 to 2018. RESULTS A total of 188 surgically confirmed cases were included from selected hospitals during the study period, which showed the annual frequency of 18.8 cases/year. The number of reported cases was higher in Sindh province (67.55%) compared to Punjab (32.45%). Total number of CE cases/city was higher in Karachi (47.34%) compared to Hyderabad city (20.21%), while in Punjab province, this frequency was higher in Lahore (25%) followed by Multan (5.32%) and Faisalabad (2.13%). Out of total 188 patients, 73 (38.83%) were males and 115 (61.7%) were females. In surveyed hospitals, high burden of infection was reported in young adults (21-30 years; 29.79%) followed by 21.81% and 17.02% in 31-40 and 41-50 age groups, respectively. Data retrieved from the hospital record of diagnosed cases of CE showed liver (36.17%, n = 68) as the most affected organ followed by lungs (26.06%, n = 49). In this survey, some unusual sites of cyst formation were also observed. CONCLUSION Current study is a step forward towards filling the gap of knowledge for prevalence and regional distribution of hydatidosis in Pakistan reporting the CE cases in humans for the first time in Multan and Faisalabad.
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Sgroi G, Varcasia A, Dessi G, D'Alessio N, Tamponi C, Saarma U, Laurimäe T, Kinkar L, Santoro M, Caputo V, Sarnelli P, Fusco G, Varuzza P, Fioretti A, Scala A, Veneziano V. Cystic echinococcosis in wild boars ( Sus scrofa) from southern Italy: Epidemiological survey and molecular characterization. Int J Parasitol Parasites Wildl 2019; 9:305-311. [PMID: 31338291 PMCID: PMC6626981 DOI: 10.1016/j.ijppaw.2019.04.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 11/20/2022]
Abstract
Cystic Echinococcosis (CE) caused by Echinococcus granulosus sensu lato (s.l.) is one of the most important parasitic zoonotic diseases in the world and it represents an important public health and socio-economic concern. In the Mediterranean basin, CE is widespread and it is endemic in Italy, with major prevalence in southern areas. Several studies have investigated CE in domestic pigs, however, such data in wild boars are scant. In the last decades the wild boar population in Italy has increased and this ungulate could play an important role in the spreading of CE in the wild. Here we report on the prevalence and fertility rate of hydatid cysts in wild boars that were shot during two hunting seasons (2016-2017) in the Campania region of southern Italy. For each animal, a detailed inspection of the carcass and organs (lungs, liver and spleen) was performed and when cysts were found, their number, morphology and fertility were determined by visual and microscopic examination. Cysts were classified morphologically as fertile, sterile, caseous and calcified. Protoscoleces and germinal layers were collected from individual cysts and DNA was extracted to identify different strains/genotypes of E. granulosus s.l. Out of a total of 2108 wild boars 93 (4.4%) were found positive for CE. Infected animals were 45 males and 48 females, aged between 1 and 8 years. The average number of cysts per wild boar was 1.3 (min 1 - max 13). The total number of cysts collected was 123, of which 118 (95.9%) in the liver, 4 (3.3%) in the lungs and 1 (0.8%) in the spleen. Of all analyzed cysts, 70 (56.9%) were fertile and 53 (43.1%) sterile/acephalous. The presence of fertile cysts in 19.4% of CE-positive animals is noteworthy. Overall, molecular diagnosis showed 19 wild boars infected with the pig strain (G7).
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Affiliation(s)
- Giovanni Sgroi
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
| | - Antonio Varcasia
- Department of Veterinary Medicine, University of Sassari, Sassari, Italy
- Inter-University Centre for Research in Parasitology, Naples, Italy
| | - Giorgia Dessi
- Department of Veterinary Medicine, University of Sassari, Sassari, Italy
| | - Nicola D'Alessio
- Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Italy
| | - Claudia Tamponi
- Department of Veterinary Medicine, University of Sassari, Sassari, Italy
| | - Urmas Saarma
- Department of Zoology, Institute of Ecology and Earth Sciences, University of Tartu, Tartu, Estonia
| | - Teivi Laurimäe
- Department of Zoology, Institute of Ecology and Earth Sciences, University of Tartu, Tartu, Estonia
| | - Liina Kinkar
- Department of Zoology, Institute of Ecology and Earth Sciences, University of Tartu, Tartu, Estonia
| | - Mario Santoro
- Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Italy
| | - Vincenzo Caputo
- Regional Reference Center of Urban Veterinary Hygiene (CRIUV),Naples, Italy
| | - Paolo Sarnelli
- UOD Prevenzione e Sanità Pubblica Veterinaria Regione Campania, Naples, Italy
| | - Giovanna Fusco
- Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Italy
| | - Paolo Varuzza
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
| | - Alessandro Fioretti
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
| | - Antonio Scala
- Department of Veterinary Medicine, University of Sassari, Sassari, Italy
- Inter-University Centre for Research in Parasitology, Naples, Italy
| | - Vincenzo Veneziano
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, Naples, Italy
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Pozio E, Ludovisi A, Pezzotti P, Bruschi F, Gómez-Morales MÁ. Retrospective analysis of hospital discharge records for cases of trichinellosis does not allow evaluation of disease burden in Italy. Parasite 2019; 26:42. [PMID: 31309926 PMCID: PMC6632111 DOI: 10.1051/parasite/2019043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/27/2019] [Indexed: 12/16/2022] Open
Abstract
Human trichinellosis is a disease caused by nematode worms of the genus Trichinella. In Italy, as well as in most other European countries, notification of Trichinella infections in humans is mandatory; however, no information is available on the number of cases occurring annually. The aim of the present study was to retrospectively evaluate the burden of trichinellosis in Italy from 2005 to 2016. Hospital discharge records (HDRs) showing the code for trichinellosis (124) were registered and screened. Results were then compared with yearly reports issued by the Italian National Reference Laboratory for Trichinella (NRLT), with reports from the European Centre for Disease Prevention and Control (ECDC), and with literature data. A total of 102 HDRs revealed that the 124 code was erroneously reported in 72 (70.6%) records. Out of the 30 (29.4%) records with a correct diagnosis of trichinellosis, nine cases were reported by HDRs only, 21 cases were documented by both HDRs and the NRLT, whereas the NRLT documented 100 additional cases. In the studied period, the average yearly incidence was 0.01 cases per 100,000 inhabitants. This study highlights the limitations of using HDRs to obtain a clear picture of the prevalence and incidence of trichinellosis in Italy. These findings demonstrate the need to intensify the surveillance system for trichinellosis through the development of an Italian registry. This would allow the identification of patients with severe infections and pauci-symptomatic patients, and would avoid the need for clinical analyses and unnecessary treatments, reducing the resulting economic burden on the Italian National Health Service.
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Affiliation(s)
- Edoardo Pozio
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Department of Infectious Diseases, Istituto Superiore di Sanità viale Regina Elena 299 00161 Rome Italy
| | - Alessandra Ludovisi
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Department of Infectious Diseases, Istituto Superiore di Sanità viale Regina Elena 299 00161 Rome Italy
| | - Patrizio Pezzotti
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Department of Infectious Diseases, Istituto Superiore di Sanità viale Regina Elena 299 00161 Rome Italy
| | - Fabrizio Bruschi
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Department of Translational Research, N.T.M.S. Università di Pisa via Roma 55 56126 Pisa Italy
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Loi F, Laddomada A, Coccollone A, Marrocu E, Piseddu T, Masala G, Bandino E, Cappai S, Rolesu S. Socio-economic factors as indicators for various animal diseases in Sardinia. PLoS One 2019; 14:e0217367. [PMID: 31158242 PMCID: PMC6546212 DOI: 10.1371/journal.pone.0217367] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/10/2019] [Indexed: 11/19/2022] Open
Abstract
The need to consider the role of social factors in the efficacy of farm management and, consequently, in the onset and persistence of diseases typical to animal farms is increasingly being realized increasingly worldwide. Many risk analysis studies have been conducted to assess the role of various factors in the development of animal diseases; however, very few have accounted for the role of social factors. The aim of this work was to bridge this gap, with the main hypothesis that different socio-economic factors could be valid indicators for the occurrence of different animal diseases. A socio-economic analysis was performed using demographic characteristics of the farmers and data from 44 social indicators released by the Italian Statistician National Institute of Statistics (ISTAT) database. African swine fever (ASF) in wild boars (WB) and domestic pigs and other endemic animal diseases and zoonoses in Sardinia were considered, such as cistic echinococcosis (CE), contagious agalactia (CA), trichinellosis, West Nile disease (WND), and bluetongue (BT). Seven different negative binomial regression models were fitted using the number of cases between 2011-2017. Three indicators-cultural demand, employment rate, and legality-showed a statistically significant association with risk for all the diseases considered, but with varying effects. Some indicators, such as the age and sex of the farmer, material deprivation index, number of farms and animals, micro-criminality index, and rate of reported thefts were common to ASF, CA, trichinellosis, and CE cases. Others such as the forest surface and the energy produced from renewable sources were common to BT, WND, and ASF in WB. Tourism in seasons other than summer was a valid predictor of ASF and trichinellosis, while out-of-region hospital use had a statistically significant role in CE risk identification. These results may help understand the social context in which these diseases may occur and thus guide the design and implementation of additional risk management measures that go beyond well-known veterinary measures.
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Affiliation(s)
- Federica Loi
- OEVR—Osservatorio Epidemiologico Veterinario Regionale della Sardegna, Cagliari, Italy
- * E-mail:
| | - Alberto Laddomada
- Istituto Zooprofilattico Sperimentale della Sardegna “G. Pegreffi”, Sassari, Italy
| | - Annamaria Coccollone
- OEVR—Osservatorio Epidemiologico Veterinario Regionale della Sardegna, Cagliari, Italy
| | - Elena Marrocu
- OEVR—Osservatorio Epidemiologico Veterinario Regionale della Sardegna, Cagliari, Italy
| | - Toni Piseddu
- CeNRE—Centro Nazionale di Referenza per l’Echinococcosi/Idatidosi, Sassari, Italy
| | - Giovanna Masala
- CeNRE—Centro Nazionale di Referenza per l’Echinococcosi/Idatidosi, Sassari, Italy
| | - Ennio Bandino
- Istituto Zooprofilattico Sperimentale della Sardegna “G. Pegreffi”, Sassari, Italy
| | - Stefano Cappai
- OEVR—Osservatorio Epidemiologico Veterinario Regionale della Sardegna, Cagliari, Italy
| | - Sandro Rolesu
- OEVR—Osservatorio Epidemiologico Veterinario Regionale della Sardegna, Cagliari, Italy
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Laivacuma S, Deksne G, Jokelainen P, Ivanovs A, Zaharova L, Zeltiņa I, Vīksna L, Krūmiņa A. Risk Factors for Human Cystic Echinococcosis in Latvia. Vector Borne Zoonotic Dis 2019; 19:430-433. [DOI: 10.1089/vbz.2018.2354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Sniedze Laivacuma
- Department of Infectology and Dermatology, Riga Stradiņš University, Riga, Latvia
| | - Gunita Deksne
- Institute of Food Safety, Animal Health and Environment “BIOR,” Riga, Latvia
- Faculty of Biology, University of Latvia, Riga, Latvia
| | | | - Andrejs Ivanovs
- Department of Infectology and Dermatology, Riga Stradiņš University, Riga, Latvia
| | - Larisa Zaharova
- Department of Infectology and Dermatology, Riga Stradiņš University, Riga, Latvia
| | | | - Ludmila Vīksna
- Department of Infectology and Dermatology, Riga Stradiņš University, Riga, Latvia
| | - Angelika Krūmiņa
- Department of Infectology and Dermatology, Riga Stradiņš University, Riga, Latvia
- Institute of Food Safety, Animal Health and Environment “BIOR,” Riga, Latvia
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36
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Loi F, Berchialla P, Masu G, Masala G, Scaramozzino P, Carvelli A, Caligiuri V, Santi A, Bona MC, Maresca C, Zanoni MG, Capelli G, Iannetti S, Coccollone A, Cappai S, Rolesu S, Piseddu T. Prevalence estimation of Italian ovine cystic echinococcosis in slaughterhouses: A retrospective Bayesian data analysis, 2010-2015. PLoS One 2019; 14:e0214224. [PMID: 30934010 PMCID: PMC6443144 DOI: 10.1371/journal.pone.0214224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 03/10/2019] [Indexed: 11/18/2022] Open
Abstract
Cystic echinococcosis (CE) is a complex zoonosis with domestic and sylvatic life-cycles, involving different intermediate and definitive host species. Many previous studies have highlighted the lack of a surveillance system for CE, its persistence in Italy, and endemicity in several Italian regions. Because of the absence of a uniform surveillance program for both humans and animals, disease occurrence is widely underestimated. This study aimed to estimate the prevalence of ovine CE in Italy. Survey data on the prevalence of Echinococcus granulosus complex infections in Italian sheep farms from 2010 to 2015 were obtained in collaboration with Regional Veterinary Epidemiology Observatories (OEVRs). Bayesian analysis was performed to estimate the true CE farm prevalence. The prior true CE prevalence was estimated using data from Sardinia. Second, Bayesian modelling of the observed prevalence in different regions and the true prevalence estimation from the first step were used to ultimately estimate the prevalence of ovine CE in Italy. We obtained survey data from 10 OEVRs, covering 14 Italian regions. We observed that the risk of CE infection decreased over the years, and it was strictly correlated with the density of susceptible species. Using Sardinia as prior distribution, where the disease farm prevalence was approximately 19% (95% CI, 18.82-20.02), we estimated that the highest endemic CE farm prevalence was in Basilicata with a value of 12% (95% BCI: 7.49-18.9%) and in Piemonte 7.64%(95% BCI: 4.12-13.04%). Our results provide spatially relevant data crucial for guiding CE control in Italy. Precise information on disease occurrence location would aid in the identification of priority areas for disease control implementation by the authorities. The current underestimation of CE occurrence should urge the Italian and European governments to become aware of the public health importance of CE and implement targeted interventions for high-risk areas.
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Affiliation(s)
- Federica Loi
- Osservatorio Epidemiologico Veterinario Regionale, Cagliari, Italy
| | - Paola Berchialla
- Dipartimento di Scienze Cliniche e Biologiche, Università degli studi di Torino, Torino, Italy
| | - Gabriella Masu
- Istituto Zooprofilattico Sperimentale della Sardegna “G. Pegreffi”, Sassari, Italy
| | - Giovanna Masala
- Istituto Zooprofilattico Sperimentale della Sardegna “G. Pegreffi”, Sassari, Italy
| | - Paola Scaramozzino
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana, Roma, Italy
| | - Andrea Carvelli
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana, Roma, Italy
| | - Vincenzo Caligiuri
- Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici – Napoli, Italy
| | - Annalisa Santi
- Istituto Zooprofilattico Sperimentale della Lombardia Emilia Romagna "B. Ubertini", Brescia, Italy
| | - Maria Cristina Bona
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d’Aosta, Torino, Italy
| | - Carmen Maresca
- Istituto Zooprofilattico Sperimentale dell’Umbria e delle Marche, Perugia, Italy
| | - Maria Grazia Zanoni
- Istituto Zooprofilattico Sperimentale della Lombardia Emilia Romagna "B. Ubertini", Brescia, Italy
| | - Gioia Capelli
- Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro - Padova, Italy
| | - Simona Iannetti
- Istituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise “G. Caporale”, Teramo, Italy
| | | | - Stefano Cappai
- Osservatorio Epidemiologico Veterinario Regionale, Cagliari, Italy
| | - Sandro Rolesu
- Osservatorio Epidemiologico Veterinario Regionale, Cagliari, Italy
| | - Toni Piseddu
- Istituto Zooprofilattico Sperimentale della Sardegna “G. Pegreffi”, Sassari, Italy
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Abstract
Among parasitic hepatic cystic lesions, the most common disease is represented by cystic echinococcosis (CE), especially in high endemic countries. European epidemiology of CE in children is difficult to assess because of under-reporting but is increasing, because of high immigration flows from endemic countries and an increased awareness. Hydatidosis can be localized in every part of the body. The liver and lungs are the most common localizations in both children and adults. Multiorgan involvement is rarely reported in children. Different tests are available. Usually the sensitivity of serological screening tests is variable, ranging between 60% and 90%. The immunoblot assay is used as a confirmatory test because of its higher sensitivity and specificity. Radiological tests are the criterion standard for diagnosis of CE, with an ultrasound accuracy of approximately 90%. In case of inactive and uncomplicated cysts the watch-and-wait approach is recommended. Albendazole, currently used for 3 to 6 months consecutively represents the most commonly used drug in children even if there is limited experience in treating children younger than 6 years of age. Percutaneous treatment with the puncture, aspiration, injection, and reaspiration technique is a minimally invasive procedure. Surgery is indicated based on cyst characteristics in case of big cysts with multiple daughter cysts, single superficial cysts at risk of spontaneous or traumatic rupture, cysts related with the biliary tract in which the percutaneous treatment is contraindicated, and cysts compressing related structures.
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Coluzzi F, Meniconi RL, Caruso D, Rivosecchi F, Petrone L, Goletti D, Ettorre GM. Severe chest allodynia as an unusual first presentation of hydatid disease: a case report. BMC Infect Dis 2019; 19:37. [PMID: 30626351 PMCID: PMC6327474 DOI: 10.1186/s12879-019-3670-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/02/2019] [Indexed: 11/10/2022] Open
Abstract
Background Cystic echinococcosis (CE) is a worldwide zoonosis and the liver is the most commonly affected organ. Clinical manifestations range from completely asymptomatic cysts to a potential lethal cyst rupture and anaphylaxis. Case presentation Severe chest allodynia was an unusual clinical presentation of hepatic cyst rupture in the retroperitoneal space, without any other specific symptoms. CE diagnosis was confirmed by computed tomography scan and magnetic resonance. The patient underwent hepatectomy with complete resolution of the neuropathic pain. Conclusions Retroperitoneal hydatid cyst rupture is a rare event and its clinical manifestation may mimic other chest neuropathies.
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Affiliation(s)
- Flaminia Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Roberto Luca Meniconi
- Division of General Surgery and Liver Transplantation, POIT Department, San Camillo Hospital - "Lazzaro Spallanzani" National Institute for Infectious Diseases (INMI)-IRCCS, Rome, Italy.
| | - Damiano Caruso
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Flaminia Rivosecchi
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Linda Petrone
- Department of Epidemiology and Preclinical Research, Translational Research Unit, "Lazzaro Spallanzani" National Institute for Infectious Diseases (INMI)- IRCCS, Rome, Italy
| | - Delia Goletti
- Department of Epidemiology and Preclinical Research, Translational Research Unit, "Lazzaro Spallanzani" National Institute for Infectious Diseases (INMI)- IRCCS, Rome, Italy
| | - Giuseppe Maria Ettorre
- Division of General Surgery and Liver Transplantation, POIT Department, San Camillo Hospital - "Lazzaro Spallanzani" National Institute for Infectious Diseases (INMI)-IRCCS, Rome, Italy
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The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2017. EFSA J 2018; 16:e05500. [PMID: 32625785 PMCID: PMC7009540 DOI: 10.2903/j.efsa.2018.5500] [Citation(s) in RCA: 507] [Impact Index Per Article: 84.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
This report of the European Food Safety Authority and the European Centre for Disease Prevention and Control presents the results of zoonoses monitoring activities carried out in 2017 in 37 European countries (28 Member States (MS) and nine non-MS). Campylobacteriosis was the commonest reported zoonosis and its EU trend for confirmed human cases increasing since 2008 stabilised during 2013-2017. The decreasing EU trend for confirmed human salmonellosis cases since 2008 ended during 2013-2017, and the proportion of human Salmonella Enteritidis cases increased, mostly due to one MS starting to report serotype data. Sixteen MS met all Salmonella reduction targets for poultry, whereas 12 MS failed meeting at least one. The EU flock prevalence of target Salmonella serovars in breeding hens, laying hens, broilers and fattening turkeys decreased or remained stable compared to 2016, and slightly increased in breeding turkeys. Salmonella results on pig carcases and target Salmonella serovar results for poultry from competent authorities tended to be generally higher compared to those from food business operators. The notification rate of human listeriosis further increased in 2017, despite Listeria seldom exceeding the EU food safety limit in ready-to-eat food. The decreasing EU trend for confirmed yersiniosis cases since 2008 stabilised during 2013-2017. The number of confirmed shiga toxin-producing Escherichia coli (STEC) infections in humans was stable. A total of 5,079 food-borne (including waterborne) outbreaks were reported. Salmonella was the commonest detected agent with S. Enteritidis causing one out of seven outbreaks, followed by other bacteria, bacterial toxins and viruses. The agent was unknown in 37.6% of all outbreaks. Salmonella in eggs and Salmonella in meat and meat products were the highest risk agent/food pairs. The report further summarises trends and sources for bovine tuberculosis, Brucella, Trichinella, Echinococcus, Toxoplasma, rabies, Coxiella burnetii (Q fever), West Nile virus and tularaemia.
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40
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Bonelli P, Masu G, Dei Giudici S, Pintus D, Peruzzu A, Piseddu T, Santucciu C, Cossu A, Demurtas N, Masala G. Cystic echinococcosis in a domestic cat (Felis catus) in Italy. ACTA ACUST UNITED AC 2018; 25:25. [PMID: 29727269 PMCID: PMC5935470 DOI: 10.1051/parasite/2018027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/16/2018] [Indexed: 11/26/2022]
Abstract
Echinococcus granulosus sensu lato is a zoonotic agent with a life cycle consisting of definitive hosts (dogs and wild carnivores), and intermediate hosts (usually ungulates). Other animals and humans may accidentally ingest eggs and contract cystic echinococcosis, acting as aberrant hosts. A 3-year-old neutered female cat was brought to a veterinary practice in Sassari (Italy) with abdominal distension. Ultrasound showed multiple intraperitoneal vesicles, which on laparotomy were found to be metacestodes of E. granulosus. Videos of the extraction of cysts are provided. Phylogenetic analysis based on a fragment of the cytochrome oxidase subunit 1 (cox1) mitochondrial gene identified the isolate as E. granulosussensu stricto genotype G1, the most common genotype circulating in Europe and the Mediterranean basin. This is the first case report of cystic echinococcosis in domestic cats from Italy.
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Affiliation(s)
- Piero Bonelli
- OIE Reference Laboratory for Echinococcosis, National Reference Laboratory for Cystic Echinococcosis (CeNRE), Istituto Zooprofilattico Sperimentale (IZS) of Sardinia, Via Vienna 2, 07100 Sassari, Italy
| | - Gabriella Masu
- OIE Reference Laboratory for Echinococcosis, National Reference Laboratory for Cystic Echinococcosis (CeNRE), Istituto Zooprofilattico Sperimentale (IZS) of Sardinia, Via Vienna 2, 07100 Sassari, Italy
| | - Silvia Dei Giudici
- Exotic diseases Laboratory, Istituto Zooprofilattico Sperimentale (IZS) of Sardinia, Via Vienna 2, 07100 Sassari, Italy
| | - Davide Pintus
- Anatomical Pathology, Histopathology, Animal Genetics Laboratory, Istituto Zooprofilattico Sperimentale della Sardegna, Via Vienna 2, 07100 Sassari, Italy
| | - Angela Peruzzu
- OIE Reference Laboratory for Echinococcosis, National Reference Laboratory for Cystic Echinococcosis (CeNRE), Istituto Zooprofilattico Sperimentale (IZS) of Sardinia, Via Vienna 2, 07100 Sassari, Italy
| | - Toni Piseddu
- OIE Reference Laboratory for Echinococcosis, National Reference Laboratory for Cystic Echinococcosis (CeNRE), Istituto Zooprofilattico Sperimentale (IZS) of Sardinia, Via Vienna 2, 07100 Sassari, Italy
| | - Cinzia Santucciu
- OIE Reference Laboratory for Echinococcosis, National Reference Laboratory for Cystic Echinococcosis (CeNRE), Istituto Zooprofilattico Sperimentale (IZS) of Sardinia, Via Vienna 2, 07100 Sassari, Italy
| | - Assunta Cossu
- Ambulatorio Dr.ssa Cossu, Via D. Millelire 33/c, 07100 Sassari, Italy
| | - Nicola Demurtas
- Freelance Veterinary Practitioner, Via Torres 36, 07100 Sassari, Italy
| | - Giovanna Masala
- OIE Reference Laboratory for Echinococcosis, National Reference Laboratory for Cystic Echinococcosis (CeNRE), Istituto Zooprofilattico Sperimentale (IZS) of Sardinia, Via Vienna 2, 07100 Sassari, Italy
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41
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Mourglia-Ettlin G, Miles S, Hernández A, Dematteis S. Ageing impairs parasite-specific antibody responses in cystic echinococcosis. Parasite Immunol 2017; 40. [DOI: 10.1111/pim.12505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/15/2017] [Indexed: 01/06/2023]
Affiliation(s)
- G. Mourglia-Ettlin
- Área Inmunología; Facultad de Química/Facultad de Ciencias; DEPBIO/IQB; Universidad de la República; Montevideo Uruguay
| | - S. Miles
- Área Inmunología; Facultad de Química/Facultad de Ciencias; DEPBIO/IQB; Universidad de la República; Montevideo Uruguay
| | - A. Hernández
- Área Inmunología; Facultad de Química/Facultad de Ciencias; DEPBIO/IQB; Universidad de la República; Montevideo Uruguay
| | - S. Dematteis
- Área Inmunología; Facultad de Química/Facultad de Ciencias; DEPBIO/IQB; Universidad de la República; Montevideo Uruguay
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42
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The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2016. EFSA J 2017; 15:e05077. [PMID: 32625371 PMCID: PMC7009962 DOI: 10.2903/j.efsa.2017.5077] [Citation(s) in RCA: 268] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This report of the European Food Safety Authority and the European Centre for Disease Prevention and Control presents the results of the zoonoses monitoring activities carried out in 2016 in 37 European countries (28 Member States (MS) and nine non-MS). Campylobacteriosis was the most commonly reported zoonosis and the increasing European Union (EU) trend for confirmed human cases since 2008 stabilised during 2012-2016. In food, the occurrence of Campylobacter remained high in broiler meat. The decreasing EU trend for confirmed human salmonellosis cases since 2008 ended during 2012-2016, and the proportion of human Salmonella Enteritidis cases increased. Most MS met their Salmonella reduction targets for poultry, except five MS for laying hens. At primary production level, the EU-level flock prevalence of target Salmonella serovars in breeding hens, broilers, breeding and fattening turkeys decreased or stabilised compared with previous years but the EU prevalence of S. Enteritidis in laying hens significantly increased. In foodstuffs, the EU-level Salmonella non-compliance for minced meat and meat preparations from poultry was low. The number of human listeriosis confirmed cases further increased in 2016, despite the fact that Listeria seldom exceeds the EU food safety limit in ready-to-eat foods. The decreasing EU trend for confirmed yersiniosis cases since 2008 stabilised during 2012-2016, and also the number of confirmed Shiga toxin-producing Escherichia coli (STEC) infections in humans was stable. In total, 4,786 food-borne outbreaks, including waterborne outbreaks, were reported. Salmonella was the most commonly detected causative agent - with one out of six outbreaks due to S. Enteritidis - followed by other bacteria, bacterial toxins and viruses. Salmonella in eggs continued to represent the highest risk agent/food combination. The report further summarises trends and sources for bovine tuberculosis, brucellosis, trichinellosis, echinococcosis, toxoplasmosis, rabies, Q fever, West Nile fever and tularaemia.
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43
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44
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Khachatryan AS. Analysis of Lethality in Echinococcal Disease. THE KOREAN JOURNAL OF PARASITOLOGY 2017; 55:549-553. [PMID: 29103270 PMCID: PMC5678460 DOI: 10.3347/kjp.2017.55.5.549] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/03/2017] [Accepted: 09/10/2017] [Indexed: 11/23/2022]
Abstract
The information on mortality from echinococcosis is important not only for a better understanding of the severity of the disease, but also for evaluating the effectiveness of public health interventions. The aim of this research was to study the causes of mortality from echinococcosis. We have collected and analyzed the materials of 1,470 patients in 10 age - groups in the Republic of Armenia (from 2000 to 2016). To find out the causes of mortality from echinococcosis, we have analyzed the medical histories and protocols of postmortem examinations of 19 deaths from echinococcosis and 17 deaths due to other indirect causes not associated with the parasite. The average annual death rate from echinococcosis is 0.007 per 10,000 population, and the mortality is 1.29 (per 100 patients). The highest mortality occurs in people aged 70-79. Mortality from echinococcosis is also recorded among the unoperated children. The rupture of the parasitic cyst and hepatic insufficiency are major among the direct causes of mortality. Sometimes the hydatid cysts unrecognized during the life were first diagnosed at autopsy. Insufficient qualification of doctors in the field of helminthology, as well as the latent course of the disease or manifestation of minor symptoms in echinococcosis over a long period often led to medical errors. Further decline in mortality can be achieved by early diagnosis, timely hospitalization and treatment before the development of severe complications worsening the prognosis and outcomes of surgical intervention.
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Affiliation(s)
- Anna S Khachatryan
- Department of Pathological Anatomy and Clinical Morphology, Yerevan State Medical University after M. Heratsi, Yerevan 0025, Republic of Armenia
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45
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Piseddu T, Brundu D, Stegel G, Loi F, Rolesu S, Masu G, Ledda S, Masala G. The disease burden of human cystic echinococcosis based on HDRs from 2001 to 2014 in Italy. PLoS Negl Trop Dis 2017; 11:e0005771. [PMID: 28746395 PMCID: PMC5546721 DOI: 10.1371/journal.pntd.0005771] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 08/07/2017] [Accepted: 07/03/2017] [Indexed: 02/07/2023] Open
Abstract
Background Cystic echinococcosis (CE) is an important neglected zoonotic parasitic infection belonging to the subgroup of seven Neglected Zoonotic Disease (NZDs) included in the World Health Organization’s official list of 18 Neglected Tropical Diseases (NTDs). CE causes serious global human health concerns and leads to significant economic losses arising from the costs of medical treatment, morbidity, life impairments and fatality rates in human cases. Moreover, CE is endemic in several Italian Regions. The aim of this study is to perform a detailed analysis of the economic burden of hospitalization and treatment costs and to estimate the Disability Adjusted Life Years (DALYs) of CE in Italy. Methods and findings In the period from 2001 to 2014, the direct costs of 21,050 Hospital Discharge Records (HDRs) belonging to 12,619 patients with at least one CE-related diagnosis codes were analyzed in order to quantify the economic burden of CE. CE cases average per annum are 901 (min—max = 480–1,583). Direct costs include expenses for hospitalizations, medical and surgical treatment incurred by public and private hospitals and were computed on an individual basis according to Italian Health Ministry legislation. Moreover, we estimated the DALYs for each patient. The Italian financial burden of CE is around € 53 million; the national average economic burden per annum is around € 4 million; the DALYs of the population from 2001 to 2014 are 223.35 annually and 5.26 DALYs per 105 inhabitants. Conclusion In Italy, human CE is responsible for significant economic losses in the public health sector. In humans, costs associated with CE have been shown to have a great impact on affected individuals, their families and the community as a whole. This study could be used as a tool to prioritize and make decisions with regard to a surveillance system for this largely preventable yet neglected disease. It demonstrates the need of implementing a CE control program aimed at preventing the considerable economic and social losses it causes in high incidence areas. CE is a neglected tropical disease that remains a considerable health problem in endemic regions and which leads to substantial economic losses for agriculture sectors and public health systems. The parasitic cycle requires a definitive host (canidae) and an intermediate host (livestock species), while humans are only occasionally hosts. CE is more prevalent in areas where extensive or semi-extensive farming of livestock (mostly sheep) is common. The study of prevalence and health expenditure at the national macro-regional and regional level is a prerequisite for creating awareness of the importance of this disease. The Italian Ministry of Health provides remuneration to its regions’ hospitals for treatment of illnesses. In this study 21,050 hospital discharge records with CE diagnosis from 2001 to 2014 related to 12,619 patients were analyzed. The median of CE hospitalizations per annum was 848. The direct costs of HDRs for echinococcosis were estimated to be € 53,175,934.34. The assessment of economic remuneration by Italian Regions grouped by Nomenclature of Territorial Units 1 (NUTS1) shows that Southern Italy and its major islands spent €13,523,999 and €15,171,739 respectively. The national annual average direct cost for 105 inhabitants was € 6,398. The study of the National DALYs, a measure of social burden of disease, shows that 41% was correlated to Island patients DALYs per annum are 223.4. An analysis of direct costs and an estimate of DALYs are key factors for establishing how to prioritize control measures for CE, which is essentially a preventable disease.
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Affiliation(s)
- Toni Piseddu
- National Reference Laboratory of Cystic Echinococcosis, Istituto zooprofilattico sperimentale della Sardegna, Sassari, Italy
- * E-mail:
| | - Diego Brundu
- Territorial Department of Nuoro, Istituto zooprofilattico sperimentale della Sardegna, Sassari, Italy
| | - Giovanni Stegel
- Department of Political Science, Communication Sciences and Information Engineering, University of Sassari, Sassari, Italy
| | - Federica Loi
- Epidemiological Veterinary Regional Observatory, Istituto zooprofilattico sperimentale della Sardegna, Sassari, Italy
| | - Sandro Rolesu
- Epidemiological Veterinary Regional Observatory, Istituto zooprofilattico sperimentale della Sardegna, Sassari, Italy
| | - Gabriella Masu
- National Reference Laboratory of Cystic Echinococcosis, Istituto zooprofilattico sperimentale della Sardegna, Sassari, Italy
| | - Salvatore Ledda
- National Reference Laboratory of Cystic Echinococcosis, Istituto zooprofilattico sperimentale della Sardegna, Sassari, Italy
| | - Giovanna Masala
- National Reference Laboratory of Cystic Echinococcosis, Istituto zooprofilattico sperimentale della Sardegna, Sassari, Italy
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46
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Detection of Echinococcus granulosus G3 in a Wild Boar ( Sus scrofa ) in Central Italy using PCR and Sequencing. J Wildl Dis 2017; 53:399-401. [PMID: 28118555 DOI: 10.7589/2015-12-344] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report cystic echinococcosis in a free-living wild boar ( Sus scrofa ) in Europe. Parasites were identified by histopathology and molecular techniques, revealing Echinococcus granulosus of the G3 genotype.
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47
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Deplazes P, Rinaldi L, Alvarez Rojas CA, Torgerson PR, Harandi MF, Romig T, Antolova D, Schurer JM, Lahmar S, Cringoli G, Magambo J, Thompson RCA, Jenkins EJ. Global Distribution of Alveolar and Cystic Echinococcosis. ADVANCES IN PARASITOLOGY 2017; 95:315-493. [PMID: 28131365 DOI: 10.1016/bs.apar.2016.11.001] [Citation(s) in RCA: 558] [Impact Index Per Article: 79.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Alveolar echinococcosis (AE) and cystic echinococcosis (CE) are severe helminthic zoonoses. Echinococcus multilocularis (causative agent of AE) is widely distributed in the northern hemisphere where it is typically maintained in a wild animal cycle including canids as definitive hosts and rodents as intermediate hosts. The species Echinococcus granulosus, Echinococcus ortleppi, Echinococcus canadensis and Echinococcus intermedius are the causative agents of CE with a worldwide distribution and a highly variable human disease burden in the different endemic areas depending upon human behavioural risk factors, the diversity and ecology of animal host assemblages and the genetic diversity within Echinococcus species which differ in their zoonotic potential and pathogenicity. Both AE and CE are regarded as neglected zoonoses, with a higher overall burden of disease for CE due to its global distribution and high regional prevalence, but a higher pathogenicity and case fatality rate for AE, especially in Asia. Over the past two decades, numerous studies have addressed the epidemiology and distribution of these Echinococcus species worldwide, resulting in better-defined boundaries of the endemic areas. This chapter presents the global distribution of Echinococcus species and human AE and CE in maps and summarizes the global data on host assemblages, transmission, prevalence in animal definitive hosts, incidence in people and molecular epidemiology.
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Affiliation(s)
- P Deplazes
- University of Zürich, Zurich, Switzerland
| | - L Rinaldi
- University of Naples Federico II, Napoli, Italy
| | | | | | - M F Harandi
- Research centre of Hydatid Disease in Iran, Kerman University of Medical Sciences, Kerman, Iran
| | - T Romig
- University of Hohenheim, Stuttgart, Germany
| | - D Antolova
- Institute of Parasitology SAS, Kosice, Slovak Republic
| | - J M Schurer
- University of Saskatchewan, Saskatoon, SK, Canada; University of Washington, Seattle, WA, United States
| | - S Lahmar
- National School of Veterinary Medicine, Sidi Thabet, Tunisia
| | - G Cringoli
- University of Naples Federico II, Napoli, Italy
| | - J Magambo
- Meru University of Science and Technology, Meru, Kenya
| | | | - E J Jenkins
- University of Saskatchewan, Saskatoon, SK, Canada
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48
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Abstract
Human cystic echinococcosis (CE) has been eliminated or significantly reduced as a public health problem in several previously highly endemic regions. This has been achieved by the long-term application of prevention and control measures primarily targeted to deworming dogs, health education, meat inspection, and effective surveillance in livestock and human populations. Human CE, however, remains a serious neglected zoonotic disease in many resource-poor pastoral regions. The incidence of human alveolar echinococcosis (AE) has increased in continental Europe and is a major public health problem in parts of Eurasia. Better understanding of wildlife ecology for fox and small mammal hosts has enabled targeted anthelmintic baiting of fox populations and development of spatially explicit models to predict population dynamics for key intermediate host species and human AE risk in endemic landscapes. Challenges that remain for echinococcosis control include effective intervention in resource-poor communities, better availability of surveillance tools, optimal application of livestock vaccination, and management and ecology of dog and wildlife host populations.
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49
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The European Union summary report on trends and sources of zoonoses, zoonotic agents and food‐borne outbreaks in 2015. EFSA J 2016. [DOI: 10.2903/j.efsa.2016.4634] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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50
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van Cauteren D, Millon L, de Valk H, Grenouillet F. Retrospective study of human cystic echinococcosis over the past decade in France, using a nationwide hospital medical information database. Parasitol Res 2016; 115:4261-4265. [PMID: 27473835 DOI: 10.1007/s00436-016-5204-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/13/2016] [Indexed: 11/24/2022]
Abstract
No specific surveillance system of cystic echinococcosis infections in humans exists in France. The incidence and trends over time have not been documented since the last decade of the twentieth century. We performed the current analysis to assess human cystic echinococcosis epidemiology over a 10-year period in France (including the island of Corsica but excluding the overseas territories) using a nationwide hospital medical information database. A total number of 2629 patients were identified in this database between 2005 and 2014. The average annual incidence rate was 0.42 hospitalized cases/100,000 inhabitants. It was highest in the Island of Corsica (1.76 cases/100,000) and in the region Provence-Alpes-Côte d'Azur (0.85 cases/100,000). This retrospective analysis of hospital records provides a population-based estimate of cystic echinococcosis incidence and trends over a 10-year period at a national level. It indicates a significant decrease of the incidence between 2005 and 2014 at the national level and in the area that reported the highest incidence. It stresses the fact that in France, cystic echinococcosis is not re-emerging and that the incidence remains low in comparison with similar studies in other Mediterranean countries.
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Affiliation(s)
| | - Laurence Millon
- French National Reference Centre for Alveolar Echinococcosis, University of Franche-Comté and University Hospital, Besançon, France
| | | | - Frederic Grenouillet
- French National Reference Centre for Alveolar Echinococcosis, University of Franche-Comté and University Hospital, Besançon, France
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