Human pentastomiasis in Sub-Saharan Africa

Ocular Pentastomiasis in Human Hosts

This case report describes the pathogenesis of ocular pentastomiasis in human hosts.

Abdominal Calcifications in a Patient From the Congo Basin with History of Snake Meat Consumption: Radiographic Evidence of Prior Armillifer Infection

We report a case of a 60-year-old asymptomatic male with history of consumption of uncooked snake meat while living in the Congo basin and prior imaging showing multiple abdominal calcifications. Patient had multiple subepithelial colonic lesions identified during screening colonoscopy and microscopic examination of the lesions demonstrated a calcified nodule in the submucosa with overlying normal mucosa. However, no parasite was identified within the calcified nodule. Given the history of consumption of uncooked snake meat and the typical radiographic feature of multiple abdominal calcifications, it is very likely that the patient's radiographic abnormalities are due to prior Armillifer armillatus infection, a parasitic infection acquired from consumption of uncooked snake meat. Patient was asymptomatic at the time of evaluation and was not given anti-parasitic treatment.

Detection of a Larva of Armillifer armillatus in a Potto (Perodicticus potto) from the Republic of the Congo

We determined the complete sequence of the mitochondrial DNA (mtDNA) of a parasite discovered between the subcutaneous tissue and the peritoneum of an African nocturnal non-human primate (NHP). The parasite and host sequences were obtained by a combination of Sanger sequencing and nanopore MinION techniques. Analyses of mtDNA gene arrangements and sequences unambiguously showed that the parasite investigated was the pentastomid Armillifer armillatus, also commonly named the tongue worm. The full-length mitochondrial genome of A. armillatus, measuring 16,706 bp in length, contains 13 protein-coding genes, 2 ribosomal RNA genes, and 22 transfer RNA genes, an arrangement identical to that of previously described pentastomid mitochondrial genomes. We describe here the second full mitochondrial genome of A. armillatus to date. To identify the NHP host, maximum likelihood phylogenetic analyses of a 441-bp fragment on the 12S rDNA gene and of a 1,140-bp fragment of the mitochondrial cytochrome b strongly support clustering with the African lorisid Perodicticus potto, a species that has rarely been reported as an intermediate host of this parasite.

Morphological and molecular description of Armillifer moniliformis larvae isolated from Sri Lankan brown palm civet (Paradoxurus montanus)

We report Armillifer moniliformis species infecting the endemic Sri Lankan brown palm civet (Paradoxurus montanus) from the Knuckles Range Forest Conservation Area, Sri Lanka. Larval stages of A. moniliformis were found during the postmortem of three civet cats found dead. Morphological studies were done by a light microscope and a scanning electron microscope (SEM). Histopathological examination was conducted using tissue samples obtained from the liver. For the molecular analysis, DNA was extracted from the isolated third-stage larvae. The NADH dehydrogenase subunit 5 (ND5) and the second internal transcribed spacer region (ITS-2), a portion of the large subunit nuclear ribosomal DNA (28S), a portion of 18S ribosomal rRNA gene (18S), and cytochrome c oxidase subunit 1 gene (COX1) were amplified using polymerase chain reaction (PCR). Excysted third-stage larvae were observed in the lungs, omentum, the pleural cavity, the abdominal cavity, and the surface of the spleen and the pericardium. Around 88 third-stage larvae were isolated from three civet cats. First-stage larvae in the liver were surrounded by outer fibrous layer over the inner germinal layer and filled with clear fluid. Slight hemorrhage, leukocyte infiltration, and mild hepatocellular degeneration in the liver were observed. The SEM examination indicated the unique oral apparatus comprises the oval-shaped mouth opening in between two pairs of curved, retractile hamuli. The sequences obtained for ND5, ITS-2, 28S, 18S, and COX1 were 301, 382, 325, 414, and 644 bp in length respectively. Morphology, sequence similarity search, sequence alignment, and phylogenetic analysis identified this parasite as A. moniliformis.

Pathological characteristics of Linguatula serrata (aberrant arthropod) infestation in sheep and factors associated with prevalence in Iran

Linguatula serrata is a cosmopolitan zoonotic parasite in which carnivores and herbivores serve as final and intermediate hosts, respectively. The aim of this study was to compare the L. serrata nymphal infection rate and intensity of infection (mean number of nymphs ± standard error) to the appearance and pathological changes of mesenteric lymph nodes (MLNs) infected with L. serrata using sheep slaughtered in Tabriz, Iran. In addition, the effect of age, sex, and season on the prevalence of L. serrata infection was evaluated. For this purpose, over a four-year period, 31,078 MLNs from 3199 sheep were examined, with 4972 (15.99%) MLNs infected representing 518 (16.20%) sheep. Collected MLNs were categorized by color as normal, red or black and by consistency as normal, soft or hard. L. serrata were found in 8.88% of normal-colored MLNs, 14.45% of red (hemorrhagic) MLNs and 44.57% of black-colored MLNs, with the difference being significant for infection and infection intensity (P < 0.0001). In regards to MLN consistency, 7.98% of normal, 31.52% of soft and 5.42% of hard lymph nodes were found to be infected with the infection rate and intensity in soft nodes being significantly different (P < 0.0001). Pathological changes in MLNs infected with L. serrata nymph with normal color and consistency had calcification of the L. serrata nymph, granulomatous inflammation around the nymph and some neutrophils. Granulomatous inflammation around the L. serrata nymph, haemosiderophage, macrophage and lymph node depletion from lymphocytes were observed in MLNs infected with L. serrata nymph with soft consistency. In addition, MLNs infected with L. serrata nymph with hard consistency and black color contained neutrophils in the capsule's wall, caseous necrotic mass and L. serrata surrounded by a thick capsule. In regards to prevalence, age, sex and season (autumn) were significant (P < 0.0001, P < 0.01, respectively). These study results suggest that targeted meat inspection and targeted animal interventions could be used to decrease human exposure to L. serrata and animal infection.

A sensitive serodiagnostic tool for the detection of active infection of zoonotic visceral and nasopharyngeal linguatulosis

Aim:

This study aimed to evaluate the different serological techniques for early diagnosis of acute concurrent infections with linguatulosis in the definitive host (dogs) and an intermediate host (goats). This evaluation compared between the gold standard (GS) test (GS; examination of nasal and fecal samples in dogs and examination of lymph nodes in goats), sandwich enzyme-linked immunosorbent assay (S-ELISA), and indirect ELISA.

Materials and Methods:

Fifty goats and fifty dogs were examined for the presence of Linguatula serrata nymphs and adults, respectively, besides the collection of blood samples from the examined animals for serologic testing.

Results:

In goats; GS, S-ELISA, and indirect ELISA showed positivity in 32 (64%), 28 (56%), and 39 (78%) samples, respectively. In dogs; GS, S-ELISA, and indirect ELISA showed positivity in 25 (50%), 25 (50%), and 30 (60%) samples, respectively. S-ELISA displayed significant higher agreement with the GS test (≥0.83) than indirect ELISA (≤0.67) in both hosts. Infection with linguatulosis showed significant relation with the age of goats and dogs and the sex of goats (p<0.05).

Conclusion:

S-ELISA displayed more sensitivity and specificity for the detection of concurrent infections with linguatulosis in both dogs and goats than indirect ELISA, which could detect the prior infections. Similarly, these assays could be used for diagnosis of concurrent infections with linguatulosis in human, especially the chronic ones.

Armillifer Infections in Humans: A Systematic Review

Armillifer is a genus of obligate parasites belonging to the Pentastomida subclass that was first described as a cause of human disease in 1847. Human infection by Armillifer is rare and not widely known. These parasites are transmitted to humans by handling or eating undercooked meat from infected snakes, which are the definitive hosts, or oral uptake of environmental ova. The aim of this systematic review was to record all available evidence regarding infections by Armillifer in humans. A systematic review of PubMed (through 21 December 2018) for studies providing epidemiological, clinical, microbiological, as well as treatment data and outcomes of Armillifer infections was conducted. A total of 26 studies, containing data of 40 patients, were eventually included in the analysis. The most common sites of infection were the peritoneal cavity, the liver, the lower respiratory and the abdominal tract. The commonest infecting species was A. armillatus and most patients were asymptomatic; however, when symptoms occurred, the commonest was abdominal pain, even though unusual presentations occurred, such as hepatic encephalopathy or neurologic symptoms. Most cases were diagnosed at surgery or by imaging, and most patients were not treated. Mortality was low, but the majority of the cases with ocular infection lead to permanent loss of vision.

A systematic review of zoonotic enteric parasitic diseases among nomadic and pastoral people

Introduction

Zoonotic enteric parasites are ubiquitous and remain a public health threat to humans due to our close relationship with domestic animals and wildlife, inadequate water, sanitation, and hygiene practices and diet. While most communities are now sedentary, nomadic and pastoral populations still exist and experience unique exposure risks for acquiring zoonotic enteric parasites. Through this systematic review we sought to summarize published research regarding pathogens present in nomadic populations and to identify the risk factors for their infection.

Methods

Using systematic review guidelines set forth by PRISMA, research articles were identified, screened and summarized based on exclusion criteria for the documented presence of zoonotic enteric parasites within nomadic or pastoral human populations. A total of 54 articles published between 1956 and 2016 were reviewed to determine the pathogens and exposure risks associated with the global transhumance lifestyle.

Results

The included articles reported more than twenty different zoonotic enteric parasite species and illustrated several risk factors for nomadic and pastoralist populations to acquire infection including; a) animal contact, b) food preparation and diet, and c) household characteristics. The most common parasite studied was Echinococcosis spp. and contact with dogs was recognized as a leading risk factor for zoonotic enteric parasites followed by contact with livestock and/or wildlife, water, sanitation, and hygiene barriers, home slaughter of animals, environmental water exposures, household member age and sex, and consumption of unwashed produce or raw, unprocessed, or undercooked milk or meat.

Conclusion

Nomadic and pastoral communities are at risk of infection with a variety of zoonotic enteric parasites due to their living environment, cultural and dietary traditions, and close relationship to animals. Global health efforts aimed at reducing the transmission of these animal-to-human pathogens must incorporate a One Health approach to support water, sanitation, and hygiene development, provide education on safe food handling and preparation, and improve the health of domestic animals associated with these groups, particularly dogs.

A Case of Pentastomiasis at the Left Maxilla Bone in a Patient with Thyroid Cancer

Pentastomiasis, a zoonotic parasite infection, is typically found in the respiratory tract and viscera of the host, including humans. Here, we report for the first time an extremely rare case of intraosseous pentastomiasis in the human maxilla suffering from medication related osteonecrosis of the jaw (MRONJ). A 55-year-old male had continuously visited the hospital for MRONJ which had primarily developed after bisphosphonate and anti-neoplastic administration for previous bone metastasis of medullary thyroid cancer. Pain, bone exposure, and pus discharge in the right mandible and left maxilla were seen. Osteolysis with maxillary cortical bone perforation at the left buccal vestibule, palate, nasal cavity, and maxillary sinus was observed by radiologic images. A biopsy was done at the left maxilla and through pathological evaluation, a parasite with features of pentastome was revealed within the necrotic bone tissue. Further history taking and laboratory evaluation was done. The parasite was suspected to be infected through maxillary open wounds caused by MRONJ. Awareness of intraosseous pentastomiasis should be emphasized not to be missed behind the MRONJ. Proper evaluation and interpretation for past medical history may lead to correct differential diagnosis and therapeutic intervention for parasite infections.