1
|
Pietrzak D, Łuczak JW, Wiśniewski M. Beyond Tradition: Exploring Cutting-Edge Approaches for Accurate Diagnosis of Human Filariasis. Pathogens 2024; 13:447. [PMID: 38921745 PMCID: PMC11206659 DOI: 10.3390/pathogens13060447] [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: 04/29/2024] [Revised: 05/16/2024] [Accepted: 05/23/2024] [Indexed: 06/27/2024] Open
Abstract
Filariasis is recognised as a global public health threat, particularly in tropical and subtropical regions. It is caused by infection with a nematode parasite of the superfamily Filarioidea, including Wuchereria bancrofti, Brugia malayi, Onchocerca volvulus, and Onchocerca lupi. Three main types of filariasis have been classified: lymphatic filariasis, subcutaneous filariasis, and serous cavity filariasis. The symptoms exhibited by individuals afflicted with filariasis are diverse and contingent upon several variables, including the species of parasite, the host's health and immune response, and the stage of infection. While many classical parasitological techniques are considered indispensable tools for the diagnosis of parasitic infections in humans, alternative methods are being sought due to their limitations. Novel tests based on host-parasite interactions offer a rapid, simple, sensitive, and specific diagnostic tool in comparison to traditional parasitological methods. This article presents methods developed in the 21st century for the diagnosis of filariasis caused by invasion from W. bancrofti, B. malayi, O. volvulus, and O. lupi, as well as techniques that are currently in use. The development of modern diagnostic methods based on molecular biology constitutes a significant advancement in the fight against filariasis.
Collapse
Affiliation(s)
- Damian Pietrzak
- Division of Parasitology and Parasitic Diseases, Department of Preclinical Sciences, Institute of Veterinary Medicine, Warsaw University of Life Sciences—SGGW, 02-786 Warsaw, Poland;
| | - Julia Weronika Łuczak
- Faculty of Animal Breeding, Bioengineering and Conservation, Warsaw University of Life Sciences—SGGW, 02-786 Warsaw, Poland;
| | - Marcin Wiśniewski
- Division of Parasitology and Parasitic Diseases, Department of Preclinical Sciences, Institute of Veterinary Medicine, Warsaw University of Life Sciences—SGGW, 02-786 Warsaw, Poland;
| |
Collapse
|
2
|
Latrofa MS, Louzada-Flores VN, Maia C, Kelly MA, Verocai GG, Cantacessi C, Otranto D. Development of an indirect ELISA for the serodiagnosis of canine infection by Onchocerca lupi. Sci Rep 2024; 14:3348. [PMID: 38336818 PMCID: PMC10858053 DOI: 10.1038/s41598-024-53759-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/05/2024] [Indexed: 02/12/2024] Open
Abstract
Onchocerca lupi is a zoonotic filarioid parasite of dogs and cats with widespread distribution. A specific non-invasive diagnostic assay for the detection of O. lupi infections remains unavailable. This study aimed to assess the accuracy, specificity, and sensitivity of an ELISA test designed using nine peptides from two O. lupi proteins. Sera (n = 54) collected from O. lupi infected dogs from endemic areas (Portugal and USA), alongside sera from dogs positive for Dirofilaria immitis, D. repens, Cercopithifilaria bainae, and Acanthocheilonema reconditum (n = 53) from a non-endemic area for O. lupi, as well as from helminth-free dogs (n = 60), were tested. The checkerboard titration method was applied for the optimization of peptide concentrations and conjugate anti-dog dilutions. Sensitivity, specificity, and optimal cut-off values were calculated using ROC curve analysis. All peptides reacted against sera of O. lupi, with no correlation between optic density (OD) values and microfilariae (mfs) loads. Sensitivity and specificity values ranging from 85.45 to 100%, and 88.89% to 100%, respectively, were recorded for all peptides examined, with 100% specificity and sensitivity observed for peptides 40_3, 40_5, 130_3, 120_3 and 40_1, 130_5, respectively. The maximum cut-off value was observed for peptides 40_5 (0.765) and 40_3 (0.708). Testing of sera from dogs positive for other filarioids resulted in lower OD values (up to 1.565) for peptides 40_3 and 40_5 when compared with O. lupi (up to 2.929). The availability of this assay will be of value in epidemiological studies of canine O. lupi infection in both endemic and non-endemic areas, and in assessing the risk for zoonotic transmission.
Collapse
Affiliation(s)
| | | | - Carla Maia
- Global Health and Tropical Medicine, Associate Laboratory in Translation and Innovation Towards Global Health, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua de Junqueira 100, Lisboa, Portugal
| | - Maureen A Kelly
- Department of Veterinary Pathobiology, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843, USA
| | - Guilherme G Verocai
- Department of Veterinary Pathobiology, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843, USA
| | - Cinzia Cantacessi
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Domenico Otranto
- Department of Veterinary Medicine, University of Bari, Valenzano, 70010, Bari, Italy.
- Department of Veterinary Clinical Sciences, City University of Hong Kong, Kowloon Tong, Kowloon, Hong Kong.
| |
Collapse
|
3
|
Ultrasonography of Parasitic Diseases in Domestic Animals: A Systematic Review. Animals (Basel) 2022; 12:ani12101252. [PMID: 35625097 PMCID: PMC9137995 DOI: 10.3390/ani12101252] [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: 04/24/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/21/2022] Open
Abstract
Simple Summary The aim of this literature review was to summarize the current knowledge on the application of ultrasonography in diagnosis, staging and monitoring of helminthic diseases in domestic animals. We selected and analyzed 122 papers about the application of ultrasonography in parasitic disease in ruminants, equids, swine, and companion animals. Helminths can be recognized in ultrasound images by their morphology, size, and location. In some cases, the parasites are not directly seen by ultrasound, but the lesions caused by them can be easily visualized. Ultrasound imaging is taking on an increasingly important role in veterinary parasitology. Abstract The aim of this review was to summarize the current knowledge on the application of ultrasonography in diagnosis, staging and monitoring of helminthic diseases in domestic animals. Only peer reviewed papers written in English language were included in this systematic review. All papers concerning unicellular parasites, wild animals, non-domestic experimental animals, or ex vivo or in vitro applications of ultrasonography were excluded from the review. A total of 122 papers met the inclusion criteria. Among them 47% concerned nematodes, 37% cestodes, and 16% trematodes with the genus Dirofilaria, Echinococcus, and Fasciola the most represented, respectively. Helminths can be recognized in ultrasound images by their morphology, size, and location. In some cases, the parasite stages are not directly seen by ultrasound, but the lesions caused by them can be easily visualized. Ultrasound imaging is taking on an increasingly important role in the diagnosis, staging, monitoring, and control of parasitic diseases in veterinary medicine. However, it cannot replace the clinical approach and the diagnostic tests commonly used in veterinary parasitology.
Collapse
|
4
|
Sazmand A, Bahiraei Z, Nemati F, Annoscia G, Bezerra-Santos MA, Nayebzadeh H, Salemi AM, Mousavi SM, Sadjjadi SM, Otranto D. Dermal microfilariae of dogs, jackals and cats in different regions of Iran. Parasit Vectors 2022; 15:28. [PMID: 35057824 PMCID: PMC8772098 DOI: 10.1186/s13071-021-05141-2] [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: 10/30/2021] [Accepted: 12/22/2021] [Indexed: 12/11/2022] Open
Abstract
Background Due to the complexity of retrieving skin-dwelling microfilariae, filarioids of dogs presenting dermal microfilariae (e.g. Cercopithifilaria spp., Onchocerca lupi) are relatively unknown compared to Dirofilaria spp. and Acanthocheilonema spp. whose microfilariae circulate in the blood. Although Cercopithifilaria spp. and O. lupi filarioids are distributed worldwide, there is a paucity of information on their occurrence in Iran. The aim of this study was to investigate these filarioids in a large population of dogs from different regions of Iran. Methods From October 2018 to September 2020, skin biopsies were obtained from dogs housed in shelters (n = 557) and privately owned dogs (n = 26) in seven provinces of Iran (Hamedan, Kermanshah, Yazd, Mazandaran, Khuzestan, Lorestan, Esfahan), as well as from three road-killed jackals (Canis aureus) and three cats (Felis catus) in Hamedan province. The skin biopsies were first soaked in saline solution at room temperature overnight, and examined for dermal microfilariae under the microscope. Positive skin specimens and sediments were tested by PCR for a 304-bp region of the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene and amplicons were sequenced. Results Microfilariae of Cercopithifilaria spp. were found in skin biopsies of 32 of the 583 (5.5%) dogs tested, with infection rates of up to 25% in Kermanshah. No microfilariae were recovered from skin biopsy samples collected from dogs in Khorramabad and Ahvaz, nor from the examined jackals and cats. None of the privately owned dogs were found to be infected. Morphologic and morphometric characteristics of the microfilariae were consistent with C. bainae. Eighteen skin samples were positive for the cox1 gene, of which 15 sequences showed a nucleotide identity of 100% and three of 93.4% with the reference sequence of C. bainae available in GenBank (haplotype I; GenBank accession number: JF461457). Conclusions The data from this study broadens current knowledge on the geographical distribution of C. bainae in dogs in Middle Eastern countries. Further studies on different wild canine species in the country (e.g. jackal, fox, wolf) could provide further information on the epidemiology of these filarioids. A particular focus should be put on zoonotic O. lupi given the reports of its presence in human patients from this country. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-021-05141-2.
Collapse
|
5
|
Rojas A, Morales-Calvo F, Salant H, Otranto D, Baneth G. Zoonotic Ocular Onchocercosis by Onchocerca lupi. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2021; 94:331-341. [PMID: 34211352 PMCID: PMC8223538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
The parasitic filarioid Onchocerca lupi causes ocular disease characterized by conjunctivitis and nodular lesions. This nematode was first described in 1967 in a wolf from Georgia, and since then cases of infection from dogs and cats with ocular onchocercosis and sporadically from humans also with subcutaneous and cervical lesions caused by O. lupi have been reported from the Middle East, Europe, and North America. Due to its zoonotic potential, this parasitic infection has gained attention in the past 20 years. Phylogenetic studies have highlighted the recent divergence of O. lupi from other Onchocerca spp. and the importance of domestication in the evolutionary history of this worm. Moreover, the finding of an O. lupi genotype associated with subclinical and mild infection in the Iberian Peninsula, raises important questions about the pathogenicity of this presently enigmatic parasite.
Collapse
Affiliation(s)
- Alicia Rojas
- Laboratory of Helminthology, Centro de Investigación en
Enfermedades Tropicales, Universidad de Costa Rica, San José, Costa Rica,To whom all correspondence should be addressed:
Alicia Rojas, Laboratorio de Helmintología, Facultad de Microbiología,
Universidad de Costa Rica, Sede Rodrigo Facio, Montes de Oca, San José Costa
Rica, 11501-2060; Tel: +(506)2511-8645;
; ORCID iD: https://orcid.org/0000-0003-2007-7198
| | - Fernando Morales-Calvo
- Laboratory of Helminthology, Centro de Investigación en
Enfermedades Tropicales, Universidad de Costa Rica, San José, Costa Rica
| | - Harold Salant
- Koret School of Veterinary Medicine, The Hebrew
University of Jerusalem, Rehovot, Israel
| | - Domenico Otranto
- Parasitology Unit, Department of Veterinary Medicine,
University of Bari, Valenzano, Italy,Faculty of Veterinary Sciences, Bu-Ali Sina University,
Hamedan, Iran
| | - Gad Baneth
- Koret School of Veterinary Medicine, The Hebrew
University of Jerusalem, Rehovot, Israel
| |
Collapse
|
6
|
Otranto D, Colella V, Bezerra-Santos MA, Mendoza-Roldan JA, Cavalera MA, Pereira A, Schaper R, Maia C. Efficacy of a spot-on formulation containing moxidectin 2.5%/imidacloprid 10% for the treatment of Cercopithifilaria spp. and Onchocerca lupi microfilariae in naturally infected dogs from Portugal. Parasit Vectors 2021; 14:199. [PMID: 33849643 PMCID: PMC8042703 DOI: 10.1186/s13071-021-04704-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/28/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Onchocerca lupi and Cercopithifilaria spp. are vector-borne filarioids of dogs, which harbour skin microfilariae (mfs), the former being of zoonotic concern. Proper treatment studies using compounds with microfilaricidal activity have not been performed. Therefore, this study aimed to assess the efficacy of a commercially available spot-on formulation containing moxidectin 2.5%/imidacloprid 10% for the treatment of O. lupi or Cercopithifilaria spp. skin-dwelling mfs in naturally infected dogs. METHODS Privately owned dogs (n = 393) from southern Portugal were sampled via skin biopsies to identify and count mfs in 20 µl of skin sediment. A total of 22 mfs-positive dogs were allocated to treatment group (n = 11; G1) or left untreated as a control (n = 11; G2). As a pilot investigation to test the treatment efficacy, five dogs assigned to G1 were treated four times at monthly intervals with moxidectin 2.5%/imidacloprid 10% spot-on formulation on SDs 0, 28 (± 2), 56 (± 2), and 84 (± 2). Based on the negative results for both O. lupi and/or Cercopithifilaria spp. mfs of dogs in the pilot study from SD28 onwards, the remaining six dogs in G1 were treated at SD0 and assessed only at SD28. RESULTS Of the 393 animals sampled, 78 (19.8%) scored positive for skin-dwelling mfs. At the pilot investigation, a mean number of 19.6 mfs for O. lupi was recorded among five infected dogs whereas no mfs were detected at SD28. At SD0, the mean number of Cercopithifilaria spp. larvae was 12.6 for G1 and 8.7 for G2. The mean number of mfs for G2 was 20.09. CONCLUSIONS Results herein obtained suggest that a single treatment with moxidectin 2.5%/imidacloprid 10% spot-on formulation is efficacious against skin-dwelling mfs in dogs. The microfilaricidal effect of moxidectin could also be useful in reducing the risk of O. lupi infection for humans.
Collapse
Affiliation(s)
- Domenico Otranto
- Department of Veterinary Medicine, University of Bari, Valenzano, 70010, Italy.
- Department of Pathobiology, Faculty of Veterinary Science, Bu-Ali Sina University, Hamedan, Iran.
| | - Vito Colella
- Department of Veterinary Medicine, University of Bari, Valenzano, 70010, Italy
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Australia
| | | | | | | | - André Pereira
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene E Medicina Tropical (IHMT), Universidade NOVA de Lisboa (NOVA), Lisboa, Portugal
| | | | - Carla Maia
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene E Medicina Tropical (IHMT), Universidade NOVA de Lisboa (NOVA), Lisboa, Portugal
| |
Collapse
|
7
|
Laidoudi Y, Marié JL, Tahir D, Watier-Grillot S, Mediannikov O, Davoust B. Detection of Canine Vector-Borne Filariasis and Their Wolbachia Endosymbionts in French Guiana. Microorganisms 2020; 8:microorganisms8050770. [PMID: 32455576 PMCID: PMC7285362 DOI: 10.3390/microorganisms8050770] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/20/2022] Open
Abstract
In French Guiana, canine heartworm disease is well known, but the diversity of filarial parasites of dogs remains largely unknown. A total of 98 canine blood samples from Cayenne and Kourou were assessed by a blood wet mount preparation, heartworm antigen test and molecular exploration of filarioid and Wolbachia DNAs, followed by a multiplex species-specific qPCR's identification and a subsequent sequencing analysis. Thereafter, a phylogeny based on maximum likelihood was carried out to facilitate specific identification. Five dogs were microfilaremic. Heartworm antigens were detected in 15 (15.3%) dogs. Of these, six (6.1%) were considered as occult infections as neither microfilariae nor Dirofilaria immitis DNA were detected. The 11 (11.2%) D. immitis isolates corresponded to a low virulent strain. Six of the D. immitis isolates were positive for Wolbachia endosymbionts of D. immitis belonging to the clade C DNA. Acanthocheilonema reconditum DNA was detected in 3 (3.1%) samples. Of these latter, one was found co-infected with the Brugia sp. genotype and the DNA of the clade D of the Wolbachia endosymbiont of Brugia species. This latter was also detected in two filarioid DNA-free samples. Finally, two samples were positive for Cercopithifilaria bainae genotype, which is distinct from those identified in Europe. The present study highlights the urgent need to implement chemoprophylaxis associated with anti-Wolbachia drugs to control these potential zoonoses.
Collapse
Affiliation(s)
- Younes Laidoudi
- Aix Marseille Univ., IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13385 Marseille, France; (Y.L.); (D.T.); (O.M.)
- IHU Méditerranée Infection, 13385 Marseille, France
| | - Jean-Lou Marié
- Animal Epidemiology Working Group of the Military Health Service, 13014 Marseille, France; (J.-L.M.); (S.W.-G.)
| | - Djamel Tahir
- Aix Marseille Univ., IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13385 Marseille, France; (Y.L.); (D.T.); (O.M.)
- IHU Méditerranée Infection, 13385 Marseille, France
| | - Stéphanie Watier-Grillot
- Animal Epidemiology Working Group of the Military Health Service, 13014 Marseille, France; (J.-L.M.); (S.W.-G.)
- Epidemiology and Public Health Center of the French Armed Forces, 13014 Marseille, France
| | - Oleg Mediannikov
- Aix Marseille Univ., IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13385 Marseille, France; (Y.L.); (D.T.); (O.M.)
- IHU Méditerranée Infection, 13385 Marseille, France
| | - Bernard Davoust
- Aix Marseille Univ., IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13385 Marseille, France; (Y.L.); (D.T.); (O.M.)
- IHU Méditerranée Infection, 13385 Marseille, France
- Animal Epidemiology Working Group of the Military Health Service, 13014 Marseille, France; (J.-L.M.); (S.W.-G.)
- Correspondence: ; Tel.: +33-4-13-73-24-01
| |
Collapse
|
8
|
Dantas-Torres F, Otranto D. Overview on Dirofilaria immitis in the Americas, with notes on other filarial worms infecting dogs. Vet Parasitol 2020; 282:109113. [PMID: 32464570 DOI: 10.1016/j.vetpar.2020.109113] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/09/2020] [Accepted: 04/14/2020] [Indexed: 01/08/2023]
Abstract
Canine dirofilariosis in the Americas is primarily caused by Dirofilaria immitis, a mosquito-borne filarial worm infecting dogs, which may also infect and cause disease in other mammalian hosts, including humans. Morphological and molecular evidence gathered in the past decades suggest that other Dirofilaria spp. may infect dogs in the American continent, though the actual taxonomic identity of them still needs to be elucidated. In addition, filarial worms belonging to distinct genera have also been reported in dogs in this part of the world, including Acanthocheilonema reconditum, Cercopithifilaria bainae, and Onchocerca lupi. Among these, O. lupi is a species of major clinical significance, which has been reported not only in dogs, but also in cats and humans in North America. The present article provides a current overview on canine dirofilariosis in the Americas, with notes on other filarial worms infecting dogs. It also provides some insights into outstanding research questions that should be responded to fill some of the several knowledge gaps related to this group of parasites in this continent.
Collapse
Affiliation(s)
- Filipe Dantas-Torres
- Department of Immunology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, Brazil.
| | - Domenico Otranto
- Department of Veterinary Medicine, University of Bari, Valenzano, Italy; Faculty of Veterinary Sciences, Bu-Ali Sina University, Hamedan, Iran
| |
Collapse
|
9
|
A real-time PCR tool for the surveillance of zoonotic Onchocerca lupi in dogs, cats and potential vectors. PLoS Negl Trop Dis 2018; 12:e0006402. [PMID: 29617361 PMCID: PMC5902036 DOI: 10.1371/journal.pntd.0006402] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/16/2018] [Accepted: 03/21/2018] [Indexed: 02/08/2023] Open
Abstract
The ocular onchocercosis is caused by the zoonotic parasite Onchocerca lupi (Spirurida: Onchocercidae). A major hindrance to scientific progress is the absence of a reliable diagnostic test in affected individuals. Microscopic examination of skin snip sediments and the identification of adults embedded in ocular nodules are seldom performed and labour-intensive. A quantitative real-time PCR (qPCR) assay was herein standardized for the detection of O. lupi DNA and the results compared with microscopic examination and conventional PCR (cPCR). The specificity of qPCR and cPCR was assessed by processing the most common filarial nematodes infecting dogs, skin samples from O. lupi infected (n = 35 dogs) or uninfected animals (n = 21 dogs; n = 152 cats) and specimens of potential insect vector (n = 93 blackflies; n = 59 mosquitoes/midges). The analytical sensitivity of both assays was assessed using 10-fold serial dilutions of DNA from adult specimen and from a pool of microfilariae. The qPCR on skin samples revealed an analytical specificity of 100% and a sensitivity up to 8 x 10-1 fg/2μl O. lupi adult-DNA and up to 3.6 x 10-1 pg/2μl of mfs-DNA (corresponding to 1 x 10-2 mfs/2μl). Only 9.5% O. lupi-infected skin samples were positive for cPCR with a sensitivity of 8 x 10-1 pg/2μl of DNA. Out of 152 blackflies and mosquitoes/midges, eight specimens experimentally infected (n = 1 S. erythrocephalum; n = 1 S. ornatum; n = 6 Simulium sp.) were positive by qPCR. The qPCR assay herein standardized represents an important step forward in the diagnosis of zoonotic onchocercosis caused by O. lupi, especially for the detection and quantification of low number of mfs. This assay provides a fundamental contribution for the establishment of surveillance strategies aiming at assessing the presence of O. lupi in carnivores and in insect species acting as potential intermediate hosts. The O. lupi qPCR assay will enable disease progress monitoring as well as the diagnosis of apparently clinical healthy dogs and cats.
Collapse
|
10
|
Colella V, Lia RP, Di Paola G, Cortes H, Cardoso L, Otranto D. International dog travelling and risk for zoonotic Onchocerca lupi. Transbound Emerg Dis 2018; 65:1107-1109. [PMID: 29476600 DOI: 10.1111/tbed.12842] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Indexed: 12/16/2022]
Abstract
Onchocerca lupi is a recently recognized threat for the health of animals and humans in European, American, African and Middle Eastern countries. We describe a case of imported O. lupi infection in Italy and report the lifespan of this parasite in a non-endemic area, to advocate increased awareness of the veterinary community for this zoonotic parasitosis.
Collapse
Affiliation(s)
- V Colella
- Università degli Studi di Bari, Bari, Italy
| | - R P Lia
- Università degli Studi di Bari, Bari, Italy
| | - G Di Paola
- Università degli Studi di Bari, Bari, Italy
| | - H Cortes
- Universidade de Évora, Évora, Portugal
| | - L Cardoso
- University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - D Otranto
- Università degli Studi di Bari, Bari, Italy
| |
Collapse
|
11
|
Evaluation of oxfendazole in the treatment of zoonotic Onchocerca lupi infection in dogs. PLoS Negl Trop Dis 2018; 12:e0006218. [PMID: 29377880 PMCID: PMC5805361 DOI: 10.1371/journal.pntd.0006218] [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: 10/18/2017] [Revised: 02/08/2018] [Accepted: 01/06/2018] [Indexed: 12/17/2022] Open
Abstract
The genus Onchocerca encompasses parasitic nematodes including Onchocerca volvulus, causative agent of river blindness in humans, and the zoonotic Onchocerca lupi infecting dogs and cats. In dogs, O. lupi adult worms cause ocular lesions of various degrees while humans may bear the brunt of zoonotic onchocercosis with patients requiring neurosurgical intervention because of central nervous system localization of nematodes. Though the zoonotic potential of O. lupi has been well recognized from human cases in Europe, the United States and the Middle East, a proper therapy for curing this parasitic infection in dogs is lacking. To evaluate the efficacy of oxfendazole, 11 out of the 21 client-owned dogs (21/123; 17.1%) positive for skin-dwelling O. lupi microfilariae (mfs), were enrolled in the efficacy study and were treated with oxfendazole (50 mg/kg) per OS once a day for 5 (G2) or 10 (G3) consecutive days or were left untreated (G1). The efficacy of oxfendazole in the reduction of O. lupi mfs was evaluated by microfilarial count and by assessing the percentage of mfs reduction and mean microfilaricidal efficacy, whereas the efficacy in the reduction of ocular lesions was evaluated by ultrasound imaging. All dogs where subjected to follow-ups at 30 (D30), 90 (D90) and 180 (D180) days post-treatment. The percentage of reduction of mfs was 78% for G2 and 12.5% for G3 at D180. The mean microfilaricidal efficacy of oxfendazole in the treatment of canine onchocercosis by O. lupi at D30, D90 and D180 was 41%, 81% and 90%, in G2 and 40%, 65% and 70%, in G3, respectively. Retrobulbar lesions did not reduce from D0 to D180 in control group (dogs in G1), whereas all treated dogs (in G2 and G3) had slightly decreased ocular lesions. Percentage of reduction of ocular lesions by ultrasound examination was 50% and 47.5% in G2 and G3 at D180, respectively. Despite the decrease in ocular lesions in all treated dogs (G2 and G3), oxfendazole was ineffective in reducing ocular lesions and skin-dwelling O. lupi mfs in treated dogs (G2 and G3) in a six-month follow-up period. Here we discuss the need for more reliable diagnostic techniques and efficient treatment protocols to better plan future intervention strategies. The genus Onchocerca (Spirurida, Onchocercidae) includes Onchocerca volvulus, which is estimated to infect at least 37 million people globally, and zoonotic Onchocerca lupi in carnivores. Infection by O. lupi has been reported in dogs and cats from several European countries and recently also in the U.S. and Canada, causing mainly ocular lesions. In humans, O. lupi displays a marked neurotropism with nematodes embedded in nodules localized in the cervical spine of infant, children and adults. Though the reported severity of infection in humans and the high prevalence detected in dogs are now well-recognized, a proper treatment regime for curing this parasitic infection is lacking, being the surgical removal of the parasitic nodule the therapy of choice in canine patients. Hence, there is an unmet medical need for treatment of this zoonotic disease in both humans and animals. In this study we evaluated the efficacy of oxfendazole under two treatment regimes in the reduction of ocular lesions and skin-dwelling microfilariae of O. lupi in naturally infected dogs.
Collapse
|
12
|
Edelmann ML, Jager M, Espinheira F, Ledbetter EC. In vivo confocal microscopy for detection of subconjunctival Onchocerca lupi infection in a dog. Vet Ophthalmol 2017; 21:632-637. [PMID: 29277087 DOI: 10.1111/vop.12547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A seven-year-old male castrated mixed-breed dog was diagnosed with bilateral subconjunctival masses. In vivo confocal microscopy facilitated visualization of Onchocerca lupi adult nematodes and their characteristic cuticular morphology. Long, thin, white nematodes were extracted during excisional biopsy. Histopathologic and parasitologic evaluation confirmed the diagnosis of O. lupi. In addition to surgical debulking of the parasitic granulomas, the dog received systemic doxycycline, prednisone, and ivermectin therapy. In vivo confocal microscopy was repeated one year after initial diagnosis, and no remaining nematodes were visible. To the authors' knowledge, this is the first report of use of in vivo confocal microscopy as a noninvasive diagnostic and monitoring tool for canine onchocerciasis.
Collapse
Affiliation(s)
- Michele L Edelmann
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Mason Jager
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Filipe Espinheira
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Eric C Ledbetter
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| |
Collapse
|
13
|
McLean NJ, Newkirk K, Adema CM. Canine ocular onchocerciasis: a retrospective review of the diagnosis, treatment, and outcome of 16 cases in New Mexico (2011-2015). Vet Ophthalmol 2016; 20:349-356. [PMID: 27624855 DOI: 10.1111/vop.12433] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe the clinical exam findings, treatment and outcomes of 16 dogs diagnosed with ocular onchocerciasis in New Mexico. MATERIALS AND METHODS Records of dogs diagnosed by the primary author were reviewed (2011-2015). Records that were accessible and included a diagnosis of Onchocerca lupi by histopathologic or molecular identification of the nematode were included. RESULTS Sixteen cases were included. 3/16 dogs were treated with year-round heartworm prophylaxis prior to infection. Clinical exam findings included conjunctival hyperemia and/or episcleral injection (16/16), focal subconjunctival mass(es) (14/16), retinal detachment (7/16), corneal edema (4/16), chemosis (3/16), corneal opacity (2/16), exophthalmia (1/16), glaucoma (1/16), strabismus (1/16), blepharospasm (1/16), and vitreal degeneration (1/16). Ocular involvement was unilateral in 7/16 dogs and bilateral in 9/16 dogs. The diagnosis was confirmed via histologic identification of the nematodes and/or PCR. Treatment consisted of medical management or a combination medical and surgical management. Known or suspected recurrence of disease was documented in 10 dogs. CONCLUSIONS Canine ocular onchocerciasis is endemic in New Mexico. Histopathology and molecular identification are useful diagnostic tools. Medical management alone was successful in many cases.
Collapse
Affiliation(s)
- Nancy Johnstone McLean
- Ophthalmology, VCA Veterinary Care Animal Hospital and Referral Center, 9901 Montgomery Boulevard NE, 87111, Albuquerque, NM, USA
| | - Kimberly Newkirk
- Anatomic Pathobiology, Biomedical and Diagnostic Sciences, University of Tennessee, 2407 River Drive, Room A205, 37996-4542, Knoxville, TN, USA
| | - Coenraad M Adema
- Center for Evolutionary and Theoretical Immunology, University of New Mexico, Castetter Hall Biology MSC03 2020, 87112-0001, Albuquerque, NM, USA
| |
Collapse
|
14
|
Campbell B, Cortes H, Annoscia G, Giannelli A, Parisi A, Latrofa MS, Dantas-Torres F, Cardoso L, Otranto D. Paramyosin of canine Onchocerca lupi: usefulness for the diagnosis of a neglected zoonotic disease. Parasit Vectors 2016; 9:493. [PMID: 27604904 PMCID: PMC5013582 DOI: 10.1186/s13071-016-1783-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/30/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Of increasing importance to the medical and veterinary communities is the zoonotic filarioid nematode Onchocerca lupi. Onchocercosis, thus far found in wolves, dogs, cats and humans, is diagnosed via skin snips to detect microfilariae and surgical removal of adults from the eye of the host. These methods are time-consuming, laborious and invasive, highlighting the need for new tools for the diagnosis of O. lupi in susceptible hosts. Symptoms related to the presence of the adults in the eye can range from none apparent to severe, including blindness. No reliable chemotherapeutic protocols are available, as yet, to eliminate the infection. Paramyosin, an invertebrate-specific protein, has been well-studied as an allergen, diagnostic marker and vaccine candidate. The aim of this study, therefore, was to isolate and characterise paramyosin from O. lupi to assess its suitability for the development of a serological diagnostic assay. METHODS The adult and microfilarial stages of O. lupi were isolated from the eyes and skin of a 3-year-old male dog. Total RNA was extracted and reverse transcribed into single stranded cDNA. Reverse-transcription PCR was used to isolate a full-length paramyosin cDNA from adult worms and to investigate the temporal expression patterns of this gene. All amplicons were sequenced using dideoxy chain termination sequencing. Bioinformatics was used to predict the amino acid sequence of the gene, to compare the DNA and protein sequences with those available in public databases and to investigate the phylogenetic relationship of all molecules. Antibody binding sites were predicted using bioinformatics and mapped along with published antigenic epitopes against the O. lupi paramyosin protein. The native protein, and three smaller recombinantly expressed peptides, were subjected to western blot using serum from dogs both positive and negative for O. lupi. RESULTS Paramyosin of O. lupi was herein molecularly characterized, encoded by a transcript of 2,643 bp and producing a protein of 881 amino acids (101.24 kDa). The paramyosin transcript was detected, by reverse transcription PCR, in adults and microfilariae, but not in eggs. Phylogenetic analysis indicates that this molecule clusters with paramyosins from other filarioids to the exclusion of those from other taxa. A total of 621 unique antibody binding epitopes were predicted for this protein and another 28 were conserved in other organisms. This information was used to design three peptides, for recombinant expression, to identify the antibody binding epitope(s) and reduce potential cross-reactivity with serum from dogs infected with other filarioid nematodes. Native paramyosin, purified from microfilariae and adults, was detected by antibodies present in serum from dogs with known O. lupi infections. CONCLUSIONS Data provided herein may assist in the development of a serological diagnostic test, based on antibodies to O. lupi paramyosin, for the diagnosis of this infection, in order to gain more information on the real distribution of this little known filarioid of zoonotic concern.
Collapse
Affiliation(s)
- Bronwyn Campbell
- Dipartimento di Medicina Veterinaria, Universitá degli Studi di Bari, Bari, Italy
| | - Helder Cortes
- Victor Caeiro Laboratory of Parasitology, Instituto de Ciências Agrárias e Ambientais Mediterrânicas, Universidade de Évora, Évora, Portugal
| | - Giada Annoscia
- Dipartimento di Medicina Veterinaria, Universitá degli Studi di Bari, Bari, Italy
| | - Alessio Giannelli
- Dipartimento di Medicina Veterinaria, Universitá degli Studi di Bari, Bari, Italy
| | - Antonio Parisi
- IZS Istituto Zooprofilattico Sperimentale Puglia e Basilicata, Putignano, Italy
| | | | - Filipe Dantas-Torres
- Dipartimento di Medicina Veterinaria, Universitá degli Studi di Bari, Bari, Italy
- Departamento de Imunologia, Centro de Pesquisas Aggeu Magalhães (Fiocruz-PE), Recife, Brazil
| | - Luís Cardoso
- Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences, University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Domenico Otranto
- Dipartimento di Medicina Veterinaria, Universitá degli Studi di Bari, Bari, Italy
| |
Collapse
|
15
|
Aberrant laryngeal location of Onchocerca lupi in a dog. Parasitol Int 2016; 65:218-20. [DOI: 10.1016/j.parint.2015.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/09/2015] [Accepted: 12/23/2015] [Indexed: 11/23/2022]
|
16
|
Miró G, Montoya A, Checa R, Gálvez R, Mínguez JJ, Marino V, Otranto D. First detection of Onchocerca lupi infection in dogs in southern Spain. Parasit Vectors 2016; 9:290. [PMID: 27193758 PMCID: PMC4872350 DOI: 10.1186/s13071-016-1587-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/11/2016] [Indexed: 01/12/2023] Open
Abstract
Background Onchocerca lupi causes ocular pathology of varying severity in dogs from south-western United States, western Europe and northern Asia. This filarioid has also been recognized as a zoonotic agent in Tunisia, Turkey, Iran and the USA, though the information about the biology and epidemiology of this infection is largely unknown. In Europe, O. lupi has been reported in dogs from Germany, Greece, Hungary, Portugal and Romania and in a cat from Portugal. The present study was designed to establish the occurrence of O. lupi in dogs in southwestern Spain. In the present study a total of 104 dogs of different breed, sex, and age living in a shelter in Huelva (SW Spain) were examined. Skin snip samples were collected using a disposable scalpel in the forehead and inter-scapular regions and stored as aliquots in saline solution (0.5 ml) before light microscopy observation of individual sediments (20 μl) and molecular examination. Results Of the 104 dogs examined, 5 (4.8 %) were skin snip-positive for O. lupi: two by microscopy and three by PCR. One of the O. lupi infected dogs showed neurological signs but ocular ultrasonography and/or MRI detected no abnormalities. Conclusions This first report of O. lupi infection in dogs in southern Spain expands the range of geographical distribution of this parasite and sounds an alarm bell for practitioners and physicians working in that area.
Collapse
Affiliation(s)
- Guadalupe Miró
- Department of Animal Health, Faculty of Veterinary Sciences, Universidad Complutense de Madrid, Madrid, Spain.
| | - Ana Montoya
- Department of Animal Health, Faculty of Veterinary Sciences, Universidad Complutense de Madrid, Madrid, Spain
| | - Rocío Checa
- Department of Animal Health, Faculty of Veterinary Sciences, Universidad Complutense de Madrid, Madrid, Spain
| | - Rosa Gálvez
- Department of Animal Health, Faculty of Veterinary Sciences, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Valentina Marino
- Department of Animal Health, Faculty of Veterinary Sciences, Universidad Complutense de Madrid, Madrid, Spain
| | - Domenico Otranto
- Department of Veterinary Medicine, University of Bari, Bari, Italy
| |
Collapse
|
17
|
Otranto D, Giannelli A, Latrofa MS, Dantas-Torres F, Trumble NS, Chavkin M, Kennard G, Eberhard ML, Bowman DD. Canine Infections with Onchocerca lupi Nematodes, United States, 2011-2014. Emerg Infect Dis 2016; 21:868-71. [PMID: 25897859 PMCID: PMC4412234 DOI: 10.3201/eid2105.141812] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Infections with Onchocerca lupi nematodes are diagnosed sporadically in the United States. We report 8 cases of canine onchocercosis in Minnesota, New Mexico, Colorado, and Florida. Identification of 1 cytochrome c oxidase subunit 1 gene haplotype identical to 1 of 5 from Europe suggests recent introduction of this nematode into the United States.
Collapse
|
18
|
Diagnostic Tools for Onchocerciasis Elimination Programs. Trends Parasitol 2015; 31:571-582. [PMID: 26458784 DOI: 10.1016/j.pt.2015.06.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/16/2015] [Accepted: 06/24/2015] [Indexed: 11/24/2022]
Abstract
Onchocerciasis (river blindness) is a major public health problem in sub-Saharan Africa. Major disease-control programs have greatly reduced both disease and infection prevalence by mass distribution of donated ivermectin. Recent studies have shown that local elimination was achieved in some areas following many years of ivermectin. The global health community has recently decided to build on these successes with a new program that aims to eliminate onchocerciasis. Diagnostic tests that were useful for identifying priority areas for disease prevention may not be adequate tools for elimination programs. This paper reviews available and emerging diagnostic tests for onchocerciasis and considers how they might be best employed during different stages of onchocerciasis elimination programs.
Collapse
|
19
|
Otranto D. Diagnostic challenges and the unwritten stories of dog and cat parasites. Vet Parasitol 2015; 212:54-61. [DOI: 10.1016/j.vetpar.2015.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 05/26/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
|
20
|
Grácio AJS, Richter J, Komnenou AT, Grácio MA. Onchocerciasis caused by Onchocerca lupi: an emerging zoonotic infection. Systematic review. Parasitol Res 2015; 114:2401-13. [PMID: 25990062 DOI: 10.1007/s00436-015-4535-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/06/2015] [Indexed: 11/25/2022]
Abstract
Globalization has increased circulation of people, their food, livestock and pets in the world, and changes in the environment, climate and human behaviour have led to the rapid expansion of emerging infections throughout the world. One of the reasons of a new pathogen affecting humans is the passage from an animal to a human being. Onchocerca (O.) lupi, a filarial worm first described in a wolf in 1967, is an emerging pathogen which has been incriminated as the etiological agent for 205 canine, 2 feline and 18 human infections in Europe, Tunisia, Turkey, Iran and the USA. Most frequent findings in animals and humans are monolateral or asymmetrical variably painful subconjunctival swellings and nodules containing immature or mature worms affecting the eye and/or adjacent tissues accompanied by conjunctival hyperemia. Occasionally, subcutaneous nodules and masses affecting the spinal cord have been observed in humans. Diagnosis of O. lupi is achieved by microscopy of excised adult female worms which exhibit a particular cuticular structure and molecular analysis. Treatment consists in worm removal accompanied by antihelminthic, antibiotic and anti-inflammatory therapy.
Collapse
Affiliation(s)
- António J Santos Grácio
- Medical Parasitology Unit/Medical Entomology Group, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | | | | |
Collapse
|
21
|
Otranto D, Giannelli A, Scotty Trumble N, Chavkin M, Kennard G, Latrofa MS, Bowman DD, Dantas-Torres F, Eberhard ML. Clinical case presentation and a review of the literature of canine onchocercosis by Onchocerca lupi in the United States. Parasit Vectors 2015; 8:89. [PMID: 25884672 PMCID: PMC4346121 DOI: 10.1186/s13071-015-0699-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 01/26/2015] [Indexed: 11/18/2022] Open
Abstract
Background Onchocerca lupi, a filarioid of zoonotic concern, infects dogs and cats causing ocular lesions of different degrees, from minor to severe. However, infected animals do not always display overt clinical signs, rendering the diagnosis of the infection obscure to the majority of veterinarians. Canine onchocercosis has been reported in the Old World and the information on its occurrence in the United States, as well as its pathogenesis and clinical management is still meagre. This study reports on the largest case series of O. lupi infection from the United States and reviews previous cases of canine onchocercosis in this country. Methods Information on the clinical history of a series of eight cases of O. lupi infection in dogs diagnosed in Minnesota, New Mexico, Colorado and Florida, from 2011 to 2014, was obtained from clinical records provided the veterinary practitioners. Nematodes were morphologically identified at species level and genetically analyzed. Results All dogs displayed a similar clinical presentation, including subconjunctival and episcleral nodules, which were surgically removed. Each dog was subjected to post-operative therapy. Whitish filaria-like parasites were morphologically and molecularly identified as O. lupi. Conclusions This study confirms that O. lupi is endemic in the United States, indicating that the distribution of the infection is probably wider than previously thought. With effect, further studies are urgently needed in order to improve the diagnosis and to assess the efficacy of therapeutic protocols, targeting the parasite itself and/or its endosymbionts.
Collapse
Affiliation(s)
- Domenico Otranto
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Valenzano, Bari, Italy.
| | - Alessio Giannelli
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Valenzano, Bari, Italy.
| | | | - Matt Chavkin
- VRCC Animal Eye Specialists, Englewood, Colorado, USA.
| | | | - Maria Stefania Latrofa
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Valenzano, Bari, Italy.
| | | | - Filipe Dantas-Torres
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Valenzano, Bari, Italy. .,Departamento de Imunologia, Centro de Pesquisas Aggeu Magalhães (Fiocruz-PE), Recife, Pernambuco, Brazil.
| | - Mark L Eberhard
- Division of Parasitic Diseases and Malaria, Centres for Disease Control and Prevention, Atlanta, Georgia, USA.
| |
Collapse
|