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Dirofilarial nodule as a differential diagnosis for subcutaneous lumps in children. Pediatr Surg Int 2022; 39:55. [PMID: 36542175 DOI: 10.1007/s00383-022-05348-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Subcutaneous nodules in children are commonly caused by pilomatrixoma, dermoid cysts, soft tissue tumors, etc. Parasitic infections are reported to cause subcutaneous nodules and are infrequently described, mostly in the adult literature. We aim to describe the clinicopathological features of subcutaneous lumps caused by dirofilarial infestation in children in an endemic country. METHODS A retrospective analysis was performed of all patients presenting with the above condition to Lady Ridgeway Hospital from 2018 to 2022 and their relevant details were captured in a proforma. RESULTS There were 55 patients with a male to female ratio of 2:1. The mean age at presentation was 50 months (7-156 months). The mean duration was 97 days (1-820 days). The common sites involved were scrotum (30.9%), back (14.5%), abdominal wall (102.7%) and face (10.9%). The majority had a painless nodule (70.9%), while ten (18.2%) had features of acute inflammation. Thirty (55.5%) had preoperative ultrasonography which showed features of parasitic nodules in 26 (47.3%). Parasite was demonstrated in histopathological analysis only in 30 patients (54.5%). CONCLUSION Dirofilarial nodule should be considered in the differential diagnosis of subcutaneous lumps in children, especially in the endemic areas.
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Human Pulmonary Dirofilariasis Due to Dirofilaria immitis: The First Italian Case Confirmed by Polymerase Chain Reaction Analysis, with a Systematic Literature Review. Life (Basel) 2022; 12:life12101584. [PMID: 36295019 PMCID: PMC9605330 DOI: 10.3390/life12101584] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/08/2022] [Accepted: 10/09/2022] [Indexed: 11/16/2022] Open
Abstract
Dirofilariasis is a zoonosis caused by nematodes of the genus Dirofilaria.Dirofilaria immitis is cosmopolitan as regards its distribution in animals, being responsible for human pulmonary dirofilariasis in the New World. However, human infections by Dirofilaria immitis are exceptional in Europe, and the previously reported Italian cases of pulmonary dirofilariasis were due to Dirofilaria repens. We performed a systematic literature review of the Italian cases of human dirofilariasis due to Dirofilariaimmitis according to the PRISMA guidelines. We also report the first autochthonous case of human pulmonary dirofilariasis due to Dirofilariaimmitis, confirmed by polymerase chain reaction analysis. The patient was a 60-year-old man who lived in the Po river valley and had never traveled abroad; on histological examination, the 2-cm nodule found in his right upper lung was an infarct due to a parasitic thrombotic lesion. Only one other autochthonous (but conjunctival) case due to Dirofilariaimmitis (molecularly confirmed) was previously found in the same geographic area. Climatic changes, the increasing movements of animal reservoirs and vectors, and new competent carriers have expanded the geographic distribution of the Dirofilaria species, increasing the risk of human infections. Our report demonstrates that at least some pulmonary Italian cases of human dirofilariasis are due to Dirofilaria immitis, as in the New World.
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Djaković I, Leniček T, Beck R, Kraljević Z, Kuna K, Butorac D. Subcutaneous Dirofilariasis in Female Pubic Region - Case Report. Open Access Maced J Med Sci 2019; 7:392-395. [PMID: 30834008 PMCID: PMC6390160 DOI: 10.3889/oamjms.2019.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND: Number of reported cases of human dirofilariasis in the last couple of decades has been increasing. Dogs are the main reservoir hosts, while various mosquito species represent/serve as vectors. Human infections are caused by two different parasites: Dirofilaria immitis and Dirofilaria repens. Dirofilaria repens is currently considered to be one of the most rapidly-spreading human and animal parasite species in Europe. Clinical features are characterised by subcutaneous or ocular lesions which can persist for months without any symptoms. The disease is considered to be endemic in Mediterranean countries, central Asia, Israel, and Sri Lanka with increased incidence in Central and East Europe. Apart from the local population, tourists are also susceptible to this disease. Export of domestic animals can transfer parasites between different countries. This disease is rare in Croatia. CASE PRESENTATION: We are presenting a case of a 58-year-old female patient with dirofilariasis of the genital region caused by Dirofilaria repens, confirmed with PCR and sequencing. CONCLUSION: From the clinician point of view, subcutaneous dirofilariasis should be considered as a differential diagnosis in cases of long-lasting subcutaneous swellings.
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Affiliation(s)
- Ivka Djaković
- Sestre Milosrdnice University Hospital Center, Vinogradska 29, Zagreb, Croatia
| | - Tanja Leniček
- Sestre Milosrdnice University Hospital Center, Vinogradska 29, Zagreb, Croatia
| | - Relja Beck
- Department for Bacteriology and Parasitology, Croatian Veterinary Institute, Savska cesta 143, Zagreb, Croatia
| | - Zdenko Kraljević
- Sestre Milosrdnice University Hospital Center, Vinogradska 29, Zagreb, Croatia
| | - Krunoslav Kuna
- Sestre Milosrdnice University Hospital Center, Vinogradska 29, Zagreb, Croatia
| | - Dražan Butorac
- Sestre Milosrdnice University Hospital Center, Vinogradska 29, Zagreb, Croatia
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Capelli G, Genchi C, Baneth G, Bourdeau P, Brianti E, Cardoso L, Danesi P, Fuehrer HP, Giannelli A, Ionică AM, Maia C, Modrý D, Montarsi F, Krücken J, Papadopoulos E, Petrić D, Pfeffer M, Savić S, Otranto D, Poppert S, Silaghi C. Recent advances on Dirofilaria repens in dogs and humans in Europe. Parasit Vectors 2018; 11:663. [PMID: 30567586 PMCID: PMC6299983 DOI: 10.1186/s13071-018-3205-x] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/19/2018] [Indexed: 02/03/2023] Open
Abstract
Dirofilaria repens is a nematode affecting domestic and wild canids, transmitted by several species of mosquitoes. It usually causes a non-pathogenic subcutaneous infection in dogs and is the principal agent of human dirofilariosis in the Old World. In the last decades, D. repens has increased in prevalence in areas where it has already been reported and its distribution range has expanded into new areas of Europe, representing a paradigmatic example of an emergent pathogen. Despite its emergence and zoonotic impact, D. repens has received less attention by scientists compared to Dirofilaria immitis. In this review we report the recent advances of D. repens infection in dogs and humans, and transmission by vectors, and discuss possible factors that influence the spread and increase of this zoonotic parasite in Europe. There is evidence that D. repens has spread faster than D. immitis from the endemic areas of southern Europe to northern Europe. Climate change affecting mosquito vectors and the facilitation of pet travel seem to have contributed to this expansion; however, in the authors' opinion, the major factor is likely the rate of undiagnosed dogs continuing to perpetuate the life-cycle of D. repens. Many infected dogs remain undetected due to the subclinical nature of the disease, the lack of rapid and reliable diagnostic tools and the poor knowledge and still low awareness of D. repens in non-endemic areas. Improved diagnostic tools are warranted to bring D. repens diagnosis to the state of D. immitis diagnosis, as well as improved screening of imported dogs and promotion of preventative measures among veterinarians and dog owners. For vector-borne diseases involving pets, veterinarians play a significant role in prevention and should be more aware of their responsibility in reducing the impact of the zoonotic agents. In addition, they should enhance multisectorial collaboration with medical entomologists and the public health experts, under the concept and the actions of One Health-One Medicine.
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Affiliation(s)
- Gioia Capelli
- Laboratory of Parasitology, National reference centre/OIE collaborating centre for diseases at the animal-human interface, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | - Claudio Genchi
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
| | - Gad Baneth
- Koret School of Veterinary Medicine, The Hebrew University, Rehovot, Israel
| | - Patrick Bourdeau
- Veterinary School of Nantes ONIRIS, University of Nantes, LUNAM, Nantes, France
| | - Emanuele Brianti
- Department of Veterinary Science, Università degli Studi di Messina, Messina, Italy
| | - Luís Cardoso
- Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Patrizia Danesi
- Laboratory of Parasitology, National reference centre/OIE collaborating centre for diseases at the animal-human interface, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | - Hans-Peter Fuehrer
- Institute of Parasitology, University of Veterinary Medicine, Vienna, Austria
| | - Alessio Giannelli
- Department of Veterinary Medicine, University of Bari, Valenzano, Italy
| | - Angela Monica Ionică
- Department of Parasitology and Parasitic Diseases, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Cluj-Napoca, Romania
| | - Carla Maia
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisboa, Portugal
| | - David Modrý
- Department of Pathology and Parasitology, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
- Biology Centre, Institute of Parasitology, Czech Academy of Sciences, České Budějovice, Czech Republic
| | - Fabrizio Montarsi
- Laboratory of Parasitology, National reference centre/OIE collaborating centre for diseases at the animal-human interface, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | - Jürgen Krücken
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Elias Papadopoulos
- Laboratory of Parasitology and Parasitic Diseases, Faculty of Veterinary Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dušan Petrić
- Laboratory for medical and veterinary entomology, Faculty of Agriculture, University of Novi Sad, Novi Sad, Serbia
| | - Martin Pfeffer
- Institute of Animal Hygiene and Veterinary Public Health, Veterinary Faculty, University of Leipzig, Leipzig, Germany
| | - Sara Savić
- Scientific Veterinary Institute “Novi Sad”, Novi Sad, Serbia
| | - Domenico Otranto
- Department of Veterinary Medicine, University of Bari, Valenzano, Italy
| | - Sven Poppert
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University Basel, Basel, Switzerland
| | - Cornelia Silaghi
- National Centre of Vector Entomology, University of Zurich, Zurich, Switzerland
- Institute of Infectology, Friedrich-Loeffler-Institute, Isle of Riems, Greifswald, Germany
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Dóczi I, Bereczki L, Gyetvai T, Fejes I, Skribek Á, Szabó Á, Berkes S, Tiszlavicz L, Bartha N, Bende B, Kis E, Kucsera I. Description of five dirofilariasis cases in South Hungary and review epidemiology of this disease for the country. Wien Klin Wochenschr 2015; 127:696-702. [PMID: 26178869 DOI: 10.1007/s00508-015-0825-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Dirofilariasis is an emerging zoonosis (supported by climate change) in Central Europe. Human infections are usually caused by Dirofilaria repens and Dirofilaria immitis with mediation of mosquito vectors. Aims of this publication were to report our dirofilariasis cases, and to summarize Hungarian epidemiological data by reviewing literature. METHODS AND RESULTS We present five (four ophthalomological, one subcutaneous) cases observed within a 2-year period in Southern Hungary. Ages of infected patients were between 31 and 74 years. First case during pregnancy is also reported. There was no travel history in the anamnesis of patients which could explain acquisition of the infection. Moving, intact worms eliminated by surgical interventions were identified on the basis of morphological features as D. repens. Since the first report of human case, 115 further episodes (in addition to ours) were diagnosed in Hungary. Mean age of the patients was 47 years. Reviewing national reports, the ratio of subcutaneous infections was higher than that of the ocular ones (66 and 45, respectively). Evaluation of the territorial distribution of human episodes revealed that most infections occurred in patients living in the Danube-Tisza interfluvial region and eastern part of the country. However, sporadic cases were also found in western counties during 2014. CONCLUSION Most of the Hungarian dirofilariasis cases were autochthonous infections. Occurrence in the western counties may suggest the spreading of this emerging zoonosis to these areas. Comprehensive monitoring and data analysis are desirable, therefore reporting the epidemiologic data in the case of human infections should be made mandatory.
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Affiliation(s)
- Ilona Dóczi
- Faculty of Medicine, Department of Clinical Microbiology, Albert Szent-Györgyi Clinical Center, University of Szeged, 6 Semmelweis str, 6725, Szeged, Hungary.
| | - László Bereczki
- Faculty of Medicine, Department of Clinical Microbiology, Albert Szent-Györgyi Clinical Center, University of Szeged, 6 Semmelweis str, 6725, Szeged, Hungary
| | - Tamás Gyetvai
- Faculty of Medicine, Department of Ophthalmology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Imre Fejes
- Faculty of Medicine, Department of Ophthalmology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Ákos Skribek
- Faculty of Medicine, Department of Ophthalmology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Áron Szabó
- Faculty of Medicine, Department of Ophthalmology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Szilvia Berkes
- Faculty of Medicine, Department of Ophthalmology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - László Tiszlavicz
- Faculty of Medicine, Department of Pathology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Noémi Bartha
- Faculty of Medicine, Department of Clinical Microbiology, Albert Szent-Györgyi Clinical Center, University of Szeged, 6 Semmelweis str, 6725, Szeged, Hungary
| | - Balázs Bende
- Faculty of Medicine, Department of Dermatology and Allergology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Erika Kis
- Faculty of Medicine, Department of Dermatology and Allergology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
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Sassnau R, Genchi C. Qualitative risk assessment for the endemisation of Dirofilaria repens in the state of Brandenburg (Germany) based on temperature-dependent vector competence. Parasitol Res 2013; 112:2647-52. [PMID: 23609600 DOI: 10.1007/s00436-013-3431-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 04/09/2013] [Indexed: 11/24/2022]
Abstract
Climate change with an increase in average temperature may be responsible for propagation of temperature-dependent vectors and/or vector-associated pathogens in regions that were previously not endemic. The analysis of climate data of Brandenburg state (Germany) had showed that the extrinsic development of Dirofilaria repens, the causative agent of canine subcutaneous dirofilariosis, was possible from the years 2001 to 2012. This finding, associated to the movement of infected dogs and their relocation from endemic European areas to Germany makes possible a rapid endemization of the infection and highlight the risk for human health, being D. repens a frequent cause of zoonotic infections.
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Affiliation(s)
- R Sassnau
- Small Animal Practice, Hasenheide 65, 10967 Berlin, Germany.
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Genchi C, Kramer LH, Rivasi F. Dirofilarial Infections in Europe. Vector Borne Zoonotic Dis 2011; 11:1307-17. [DOI: 10.1089/vbz.2010.0247] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Claudio Genchi
- Department of Animal Pathology, Università degli Studi di Milano, Milano, Italy
| | - Laura H. Kramer
- Department of Animal Health, University of Parma, Parma, Italy
| | - Francesco Rivasi
- Institute of Human Pathology, University of Modena, Modena, Italy
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[Autochthonous filaria in south-west France caused by Dirofilaria repens]. Ann Dermatol Venereol 2011; 138:50-3. [PMID: 21276463 DOI: 10.1016/j.annder.2010.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 08/27/2010] [Accepted: 10/18/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Dirofilariasis is an autochthonous disease caused by Dirofilaria (Nochtiella) repens, a subcutaneous parasite of dogs and other carnivorous animals. Human infection leads to a self-limiting disease that generally presents clinically as a subcutaneous nodule. We describe a case occurring outside the classical endemic Mediterranean region. PATIENTS AND METHODS A 38-year-old woman presented with a scalp nodule present for six months. Surgery revealed a thread-like parasite identified as a female Dirofilaria repens without microfilariae. DISCUSSION This case points to the spread of this disease to temperate areas beyond the regions classically affected.
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