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Antolová D, Šnábel V, Jarošová J, Cavallero S, D’Amelio S, Syrota Y, Rosoľanka R, Avdičová M, Miterpáková M. Human alveolar echinococcosis in Slovakia: Epidemiology and genetic diversity of Echinococcus multilocularis, 2000-2023. PLoS Negl Trop Dis 2024; 18:e0011876. [PMID: 38198452 PMCID: PMC10805277 DOI: 10.1371/journal.pntd.0011876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/23/2024] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Human alveolar echinococcosis (AE) is a serious parasitic disease caused by larval stages of Echinococcus multilocularis. Between January 2000 and October 2023, 137 AE cases were confirmed in Slovakia. The average annual incidence increased from 0.031 per 100,000 inhabitants between 2000 and 2011, to an average of 0.187 since 2012, i.e. about six times. Among patients, 45.3% were men and 54.7% were women; the mean age at the time of diagnosis was 52.8 years. Most cases were diagnosed in the age groups 51-60 years and 61-70 years (33 cases each), and eight patients fell into the age category ≤ 20 years. To better recognize the gene diversity in clinical samples, metacestodes from 21 patients collected between 2013 and 2021 were subjected to DNA sequencing of four mitochondrial genes. Using concatenated sequences of cob (603 bp), nad2 (882 bp) and cox1 (789 bp) gene fragments, 14 isolates (66.7%) were assigned to the European E5 profile of E. multilocularis, two isolates (9.5%) to the E5a subtype, four isolates (19%) to the E4 profile, and one isolate (4.8%) to haplogroup E1/E2. The E5-type profiles and E4 profiles were distributed throughout the country, whereas the E1/E2 profile was found in the patient from western Slovakia. According to the data obtained and GenBank sequences, the E5-type dispersal is so far limited to central-eastern Europe and the variant seems to be indigenous to that region. The admixture with the haplotypes E4 and E1/E2 could have taken place from a historical endemic focus during the fox expansion in the last decades. By employing the nad1 fragment, a typical European haplotype was observed in all 21 resolved Slovak samples. The acceleration in the AE incidence in the last decade suggests the emergence of the disease and the need for further research on human and animal isolates.
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Affiliation(s)
- Daniela Antolová
- Institute of Parasitology of the Slovak Academy of Sciences, Košice, Slovakia
| | - Viliam Šnábel
- Institute of Parasitology of the Slovak Academy of Sciences, Košice, Slovakia
| | - Júlia Jarošová
- Institute of Parasitology of the Slovak Academy of Sciences, Košice, Slovakia
| | - Serena Cavallero
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Stefano D’Amelio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Yaroslav Syrota
- Institute of Parasitology of the Slovak Academy of Sciences, Košice, Slovakia
- I. I. Schmalhausen Institute of Zoology of National Academy of Sciences of Ukraine, Ukraine, Kyiv, Ukraine
| | - Róbert Rosoľanka
- Clinic of Infectology and Travel Medicine, Jessenius Faculty of Medicine and University Hospital in Martin, Comenius University Bratislava, Martin, Slovakia
| | - Mária Avdičová
- Regional Authority of Public Health Banská Bystrica, Banská Bystrica, Slovakia
| | - Martina Miterpáková
- Institute of Parasitology of the Slovak Academy of Sciences, Košice, Slovakia
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Delling C, Helm C, Heinze P, Friedman M, Böttcher D. First report of infection with metacestode stages of Echinococcus multilocularis in a kulan ( Equus hemionus kulan) from Slovakia. Int J Parasitol Parasites Wildl 2023; 22:80-83. [PMID: 37736617 PMCID: PMC10509565 DOI: 10.1016/j.ijppaw.2023.09.003] [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: 07/25/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
While the principle definitive host of the zoonotic cestode Echinococcus multilocularis in Europe is the red fox, several rodent species act as main intermediate hosts. Among others, e.g., humans, dogs, and pigs, also horses have been described to act as aberrant hosts in highly endemic regions. Here, a case of an E. multilocularis infection in a kulan (Equus hemionus kulan) is described. The five years old kulan from a zoo in Slovakia was transported to an animal park in Germany. The animal had to be euthanized within a few weeks after the import due to its poor general state of health. The pathological examination revealed a nodular mass in the liver as an incidental finding. By histological examination of the mass, a pyogranulomatous and necrotizing inflammation and intralesional fragments of amorphous eosinophil layers were detected. The suspected diagnosis of E. multilocularis infection was confirmed by PCR addressing parts of the genes 12S rRNA and the NADH dehydrogenase subunit 2, showing very high identities with isolates from France, Slovakia and the USA.
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Affiliation(s)
- Cora Delling
- Institute of Parasitology, Faculty of Veterinary Medicine, Leipzig University, An den Tierkliniken 35, 04103, Leipzig, Germany
| | - Christiane Helm
- Institute of Veterinary Pathology, Faculty of Veterinary Medicine, Leipzig University, An den Tierkliniken 33, 04103, Leipzig, Germany
| | - Peggy Heinze
- Tierpark Chemnitz, Nevoigtstraße 18, 09117, Chemnitz, Germany
| | - Miroslava Friedman
- Zoologická záhrada Košice, Ulica k Zoologickej záhrade 1, 040 01, Košice-Kavečany, Slovakia
| | - Denny Böttcher
- Institute of Veterinary Pathology, Faculty of Veterinary Medicine, Leipzig University, An den Tierkliniken 33, 04103, Leipzig, Germany
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Gligorijevic N, Kaljevic M, Radovanovic N, Jovanovic F, Joksimovic B, Singh S, Dumic I. Adrenal Abscesses: A Systematic Review of the Literature. J Clin Med 2023; 12:4601. [PMID: 37510716 PMCID: PMC10380332 DOI: 10.3390/jcm12144601] [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: 05/21/2023] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Objective: To summarize the existing knowledge about adrenal gland abscesses, including etiology, clinical presentation, common laboratory and imaging findings, management and overall morbidity and mortality. Design: Systematic literature review. Methods: We performed a search in the PubMed database using search terms: 'abscess and adrenal glands', 'adrenalitis', 'infection and adrenal gland', 'adrenal abscess', 'adrenal infection' and 'infectious adrenalitis'. Articles from 2017 to 2022 were included. We found total of 116 articles, and after applying exclusion criteria, data from 73 articles was included in the final statistical analysis. Results: Of 84 patients included in this review, 68 were male (81%), with a mean age of 55 years (range: 29 to 85 years). Weight loss was the most frequent symptom reported in 58.3% patients, followed by fever in 49%. Mean duration of symptoms was 4.5 months. The most common laboratory findings were low cortisol (51.9%), elevated ACTH (43.2%), hyponatremia (88.2%) and anemia (83.3%). Adrenal cultures were positive in 86.4% cases, with Histoplasma capsulatum (37.3%) being the leading causative agent. Blood cultures were positive in 30% of patients. The majority of the adrenal infections occurred through secondary dissemination from other infectious foci and abscesses were more commonly bilateral (70%). A total of 46.4% of patients developed long-term adrenal insufficiency requiring treatment. Abscess drainage was performed in 7 patients (8.3%) and adrenalectomy was performed in 18 (21.4%) patients. The survival rate was 92.9%. Multivariate analysis showed that the only independent risk factor for mortality was thrombocytopenia (p = 0.048). Conclusion: Our review shows that adrenal abscesses are usually caused by fungal pathogens, and among these, Histoplasma capsulatum is the most common. The adrenal glands are usually involved in a bilateral fashion and become infected through dissemination from other primary sources of infection. Long-term adrenal insufficiency develops in 46% of patients, which is more common than what is observed in non-infectious etiology of adrenal gland disorders. Mortality is about 7%, and the presence of thrombocytopenia is associated with worse prognosis. Further prospective studies are needed to better characterize optimal testing and treatment duration in patients with this relatively rare but challenging disorder.
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Affiliation(s)
- Nikola Gligorijevic
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Marija Kaljevic
- Department of Hospital Medicine, Saint Francis Hospital and Medical Center, Hartford, CT 06105, USA
- Division of Internal Medicine, University of Connecticut, Farmington, CT 06030, USA
| | - Natasa Radovanovic
- Department of Endocrinology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Filip Jovanovic
- Department of Internal Medicine, Merit Health Wesley, Hattiesburg, MS 39402, USA
| | - Bojan Joksimovic
- Department of Pathological Physiology, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
| | - Sandra Singh
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Igor Dumic
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
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Stefaniak M, Derda M, Zmora P, Nowak SP. Risk Factors and the Character of Clinical Course of the Echinococcus multilocularis Infection in Patients in Poland. Pathogens 2023; 12:pathogens12020199. [PMID: 36839470 PMCID: PMC9962699 DOI: 10.3390/pathogens12020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Alveolar echinococcosis (AE) is a chronic zoonotic disease caused by the larval form of Echinococcus multilocularis. In humans, it may become a serious chronic infection of the liver which resembles a slow malignant process leading to death when untreated. The aim of the study was an assessment of the risk factors of the E. multilocularis infections and the description of AE clinical course in the group of 36 patients with confirmed AE, hospitalized at the Department and Clinic of Tropical and Parasitic Diseases, Poznan University of Medical Sciences between 2013 and 2022. Among the study participants, most patients cultivated land, bred livestock, worked in the forest, or were employed in animal shelters. The E. multilocularis infection was diagnosed based on imaging and immunoassay techniques within 6 months in the majority of patients hospitalized in the Department. All patients hospitalized in the Department initiated anti-parasitic therapy at the moment of the diagnosis. Pharmacological treatment combined with surgery was applied in most of the study participants, who were presented with more advanced stages of infection. We conclude the following: 1. For humans in the risk group, regular abdominal imaging examinations and the detection of specific antibodies against E. multilocularis are recommended. 2. Regular screening tests in the hyperendemic areas of AE would increase the early detection of the disease and to improve the clinical prognosis in this extremely life-threatening parasitic disease.
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Affiliation(s)
- Magdalena Stefaniak
- Department of Biology and Medical Parasitology, Institute of Biostructural Basics of Medical Sciences, Poznan University of Medical Sciences, 60-781 Poznan, Poland
| | - Monika Derda
- Department of Biology and Medical Parasitology, Institute of Biostructural Basics of Medical Sciences, Poznan University of Medical Sciences, 60-781 Poznan, Poland
| | - Pawel Zmora
- Department of Molecular Virology, Institute of Bioorganic Chemistry Polish Academy of Sciences, 61-704 Poznan, Poland
| | - Szymon Pawel Nowak
- Department and Clinic of Tropical and Parasitic Diseases, Poznan University of Medical Sciences, 60-355 Poznan, Poland
- Correspondence: ; Tel.: +48-61-869-13-63
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Gubbiotti MA, LiVolsi V, Montone K, Baloch Z. A Cyst-ematic Analysis of the Adrenal Gland: A Compilation of Primary Cystic Lesions From Our Institution and Review of the Literature. Am J Clin Pathol 2022; 157:531-539. [PMID: 34596217 DOI: 10.1093/ajcp/aqab156] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/12/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Although primary adrenal lesions and metastases are most commonly encountered, de novo cysts of the adrenal gland can occasionally occur. METHODS We analyzed the pathology archives at the Hospital of the University of Pennsylvania for diagnoses of cystic lesions of the adrenal gland between 1998 and 2020. Patient demographics and clinical information were extracted, and pathology slides and stains, as appropriate, were analyzed. The literature between 1998 and 2020 was also searched for large case series involving cystic adrenal lesions. RESULTS We found 18 cystic lesions of the adrenal gland in our archives, categorized as pseudocysts (7), endothelial cysts (5), mesothelial cysts (2), mature teratoma (1), cystic adrenal cortical adenoma (1), cystic pheochromocytoma (1), and cystic metastasis (1). The mean age at time of diagnosis was 52.3 years, and the mean size of the cysts was 6.0 cm. There was a slight female predilection, and cysts were more likely to be found on the left side. All lesions were incidental findings. The cystic metastasis was clear cell renal cell carcinoma. Our findings were also compared with those found in the literature published within the same timeframe. CONCLUSIONS Adrenal cysts are rare entities. Our findings are concordant with other large studies and provide additional cases to the existing literature. In addition, our literature search expands the possible differential diagnoses for cystic lesions arising in the adrenal gland.
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Affiliation(s)
| | - Virginia LiVolsi
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kathleen Montone
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Zubair Baloch
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Jarošová J, Antolová D, Lukáč B, Maďari A. A Survey of Intestinal Helminths of Dogs in Slovakia with an Emphasis on Zoonotic Species. Animals (Basel) 2021; 11:ani11103000. [PMID: 34680018 PMCID: PMC8532715 DOI: 10.3390/ani11103000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/08/2021] [Accepted: 10/15/2021] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Dogs are the most popular pet animals worldwide; however, frequent and close contact with people increases the risk of transmission of different zoonotic parasites. As the occurrence of intestinal parasites in the dog population is affected by several factors, understanding the epidemiology of zoonotic parasitic infections is important to minimize the risks for humans. This study presents results about the prevalence of gastrointestinal helminths in seven different groups of dogs (pet, shelter, guard, working, and hunting dogs, as well as dogs from segregated Roma settlements) in Slovakia. Out of 495 faecal samples collected between 2016 and 2021, eggs of intestinal helminths were detected in 134 (27.1%) samples. Altogether, six different species/genera/families, namely, Toxocara canis (14.7%), Toxascaris leonina (1.6%), Trichuris vulpis (6.3%), Capillaria spp. (1.4%), Ancylostoma/Uncinaria spp. (8.3%), and taeniid eggs (4.0%), were recorded. Infection with Echinococcus multilocularis was confirmed in 2.2% of dogs and 0.4% of the animals were infested with Taenia hydatigena. The results showed that the occurrence of intestinal helminths is quite frequent in the majority of analyzed dog groups, with a close correlation between the occurrence of intestinal helminths and availability of veterinary care and anthelmintic therapy. Abstract Dogs are the most popular pets worldwide; however, close contact with people increases the risk of transmission of different zoonotic parasites. This study aims to determine the prevalence of gastrointestinal helminths in dogs in Slovakia. A total of 495 faecal samples collected from pet, shelter, guard, working (police), and hunting dogs, as well as dogs from segregated Roma settlements between 2016 and 2021, were examined using flotation and molecular methods. Eggs of intestinal helminths were detected in 134 (27.1%) samples. Microscopically, six different species/genera/families, namely, Toxocara canis (14.7%), Toxascaris leonina (1.6%), Trichuris vulpis (6.3%), Capillaria spp. (1.4%), Ancylostoma/Uncinaria spp. (8.3%), and taeniid eggs (4.0%), were recorded. Molecular analyses revealed infection with Echinococcus multilocularis in 2.2% of dogs and 0.4% of the animals were infected with Taenia hydatigena. The results showed a correlation between the occurrence of intestinal helminths and the availability of veterinary care, as dogs from Roma settlements and shelter dogs were the most often infected (66.7% and 39.2%, respectively). On the other hand, working animals were in the best health condition, with only 2.5% being positive. The relatively frequent occurrence of zoonotic species points to the constant need for preventive measures and regular deworming of dogs.
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Affiliation(s)
- Júlia Jarošová
- Institute of Parasitology, Slovak Academy of Sciences, Hlinkova 3, 040 01 Košice, Slovakia;
- Correspondence: ; Tel.: +421-55-633-14-11-13
| | - Daniela Antolová
- Institute of Parasitology, Slovak Academy of Sciences, Hlinkova 3, 040 01 Košice, Slovakia;
| | - Branislav Lukáč
- Small Animal Clinic, University of Veterinary Medicine and Pharmacy in Košice, Komenského 73, 041 81 Košice, Slovakia; (B.L.); (A.M.)
| | - Aladár Maďari
- Small Animal Clinic, University of Veterinary Medicine and Pharmacy in Košice, Komenského 73, 041 81 Košice, Slovakia; (B.L.); (A.M.)
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