Toxocara pteropodis and visceral Larva migrans

The life cycle of Toxocara pteropodis is only the second in the genus to have been elucidated in detail as a result of its suspected role in an epidemic of human disease. Transmission of this species of nematode is not only faecal but also tronsmommory, and the third-stage larvae demonstrate a remarkable affinity for the host's liver. Experimental infections in primates indicate it is not likely to be a human pathogen, and a reappraisal of the original epidemic has provided an unusual alternative explanation.

Potential role of head lice, Pediculus humanus capitis, as vectors of Rickettsia prowazekii

Since the pioneering work of Charles Nicolle in 1909 [see Gross (1996) Proc Natl Acad Sci USA 93:10539-10540] most medical officers and scientists have assumed that body lice are the sole vectors of Rickettsia prowazekii, the aetiological agent of louse-borne epidemic typhus (LBET). Here we review the evidence for the axiom that head lice are not involved in epidemics of LBET. Laboratory experiments demonstrate the ability of head lice to transmit R. prowazekii, but evidence for this in the field has not been reported. However, the assumption that head lice do not transmit R. prowazekii has meant that head lice have not been examined for R. prowazekii during epidemics of LBET. The strong association between obvious (high) infestations of body lice and LBET has contributed to this perception, but this association does not preclude head lice as vectors of R. prowazekii. Indeed, where the prevalence and intensity of body louse infections may be high (e.g. during epidemics of LBET), the prevalence and intensity of head louse infestations is generally high as well. This review of the epidemiology of head louse and body louse infestations, and of LBET, indicates that head lice are potential vectors of R. prowazekii in the field. Simple observations in the field would reveal whether or not head lice are natural vectors of this major human pathogen.

Neuro-angiostrongylosis in wild Black and Grey-headed flying foxes (Pteropus spp)

OBJECTIVE

To identify nematodes seen in histological sections of brains of flying foxes (fruit bats) and describe the associated clinical disease and pathology.

PROCEDURES

Gross and histological examination of brains from 86 free-living flying foxes with neurological disease was done as part of an ongoing surveillance program for Australian bat lyssavirus. Worms were recovered, or if seen in histological sections, extracted by maceration of half the brain and identified by microscopic examination. Histological archives were also reviewed.

RESULTS

There was histological evidence of angiostrongylosis in 16 of 86 recently submitted flying foxes with neurological disease and in one archival case from 1992. In 10 flying foxes, worms were definitively identified as Angiostrongylus cantonensis fifth-stage larvae. A worm fragment and third stage larvae were identified as Angiostrongylus sp, presumably A cantonensis, in a further three cases. The clinical picture was dominated by paresis, particularly of the hindlimbs, and depression, with flying foxes surviving up to 22 days in the care of wildlife volunteers. Brains containing fifth-stage larvae showed a moderate to severe eosinophilic and granulomatous meningoencephalitis (n = 14), whereas there was virtually no inflammation of the brains of bats which died when infected with only smaller, third-stage larvae (n = 3). There was no histological evidence of pulmonary involvement.

CONCLUSION

This is the first report of the recovery and identification of A cantonensis from free-living Australian wildlife. While angiostrongylosis is a common cause of paresis in flying foxes, the initial clinical course cannot be differentiated from Australian bat lyssavirus infection, and wildlife carers should be urged not to attempt to rehabilitate flying foxes with neurological disease.

The spread of Angiostrongylus cantonensis in Australia

Until the recent establishment of Angiostrongylus cantonensis in North America, Australia was the only developed region endemic for this parasite. Almost 50 years ago the life cycle was elucidated there, in the city of Brisbane, and the first human infections probably occurred in 1959. From the 1970s, increasing numbers of autochthonous infections have been reported along the central east coast of the continent (southeast Queensland and northern New South Wales), involving humans, rats, dogs, horses, flying foxes and marsupials. Ten years ago, the parasite was discovered in Sydney, almost 1,000 km to the south, in dogs. In that city, it has since been diagnosed as a cause of neurological disease in increasing numbers of dogs, flying foxes, marsupials and zoo primates. Presumably, these infections resulted from the ingestion of snails or slugs, and it seems that virtually all species of native and exotic terrestrial molluscs can serve as intermediate hosts. It is not known how the parasite was introduced to this continent, or how it has spread over such an extensive territory, although eventually its range could encompass the entire east coast, and potentially other regions. It is also not known if the almost identical, native species, A. mackerrasae, is able to infect people (or other non-rodent hosts). All worms recovered to date, from one fatal human case, and from many animal infections, have been confirmed as A. cantonensis.

Microsporidiosis in a Gouldian finch (Erythrura [Chloebia] gouldiae)

A 12-day-old nestling Gouldian finch (Erythrura [Chloebia] gouldiae) was presented for investigation of a mortality problem in nestling finches raised by Bengalese finch foster parents. On histological examination, large numbers of spores consistent with a microsporidian organism were present within the small intestinal mucosa. Electron microscopy and molecular studies (sequencing the 5' end of the ssu rRNA gene) further defined the organism as Encephalitozoon hellem. Sequence homology with other eukaryotes was determined using a BLASTN search from the NCBI GenBank database. The finch isolate sequences showed greater than 99% homology with those of previously reported human and avian isolates.

Hemoglobin-degrading, aspartic proteases of blood-feeding parasites: substrate specificity revealed by homology models

Blood-feeding parasites, including schistosomes, hookworms, and malaria parasites, employ aspartic proteases to make initial or early cleavages in ingested host hemoglobin. To better understand the substrate affinity of these aspartic proteases, sequences were aligned with and/or three-dimensional, molecular models were constructed of the cathepsin D-like aspartic proteases of schistosomes and hookworms and of plasmepsins of Plasmodium falciparum and Plasmodium vivax, using the structure of human cathepsin D bound to the inhibitor pepstatin as the template. The catalytic subsites S5 through S4' were determined for the modeled parasite proteases. Subsequently, the crystal structure of mouse renin complexed with the nonapeptidyl inhibitor t-butyl-CO-His-Pro-Phe-His-Leu [CHOHCH(2)]Leu-Tyr-Tyr-Ser- NH(2) (CH-66) was used to build homology models of the hemoglobin-degrading peptidases docked with a series of octapeptide substrates. The modeled octapeptides included representative sites in hemoglobin known to be cleaved by both Schistosoma japonicum cathepsin D and human cathepsin D, as well as sites cleaved by one but not the other of these enzymes. The peptidase-octapeptide substrate models revealed that differences in cleavage sites were generally attributable to the influence of a single amino acid change among the P5 to P4' residues that would either enhance or diminish the enzymatic affinity. The difference in cleavage sites appeared to be more profound than might be expected from sequence differences in the enzymes and hemoglobins. The findings support the notion that selective inhibitors of the hemoglobin-degrading peptidases of blood-feeding parasites at large could be developed as novel anti-parasitic agents.

Immune responses in hookworm infections

Hookworms infect perhaps one-fifth of the entire human population, yet little is known about their interaction with our immune system. The two major species are Necator americanus, which is adapted to tropical conditions, and Ancylostoma duodenale, which predominates in more temperate zones. While having many common features, they also differ in several key aspects of their biology. Host immune responses are triggered by larval invasion of the skin, larval migration through the circulation and lungs, and worm establishment in the intestine, where adult worms feed on blood and mucosa while injecting various molecules that facilitate feeding and modulate host protective responses. Despite repeated exposure, protective immunity does not seem to develop in humans, so that infections occur in all age groups (depending on exposure patterns) and tend to be prolonged. Responses to both larval and adult worms have a characteristic T-helper type 2 profile, with activated mast cells in the gut mucosa, elevated levels of circulating immunoglobulin E, and eosinophilia in the peripheral blood and local tissues, features also characteristic of type I hypersensitivity reactions. The longevity of adult hookworms is determined probably more by parasite genetics than by host immunity. However, many of the proteins released by the parasites seem to have immunomodulatory activity, presumably for self-protection. Advances in molecular biotechnology enable the identification and characterization of increasing numbers of these parasite molecules and should enhance our detailed understanding of the protective and pathogenetic mechanisms in hookworm infections.

Giardia trophozoites in dog hookworm, Ancylostoma caninum: accident or hyperparasitism?

During the course of transmission electron microscopic studies of adult Ancylostoma caninum removed from a dog, several Giardia trophozoites were found in sections of the buccal cavity, oesophagus and intestine of several hookworms. Although the protozoa appeared viable, this unusual finding probably represents accidental uptake by, rather than an established infection of, the hookworm. It is feasible, however, that the trophozoites might have survived and even multiplied in this aberrant site.

Gastrointestinal worm infections. The prevalence and treatment in Australia

BACKGROUND

Intestinal worm (helminth) infections occur in a large proportion of the world's population, often constituting public health problems, and are occasionally encountered by practitioners in urban Australia. Prevalence levels in some remote Australian Aboriginal communities compare with those in developing countries.

OBJECTIVE

To provide general practitioners with a brief outline of the most common human intestinal helminthiases, their usual clinical presentations and how they are diagnosed and managed.

DISCUSSION

The pinworm, Enteroblus vermicularis, occurs in all populations, and is the most common species of nematode encountered in suburbia. Eradication is impossible, but its numbers can be kept low in those children who seem predisposed to heavy, symptomatic infections. The other nematodes are prevalent in some remote Australian Aboriginal communities, and are encountered occasionally in travellers from overseas. These infections are often asymptomatic, they cannot spread directly to other people and so do not pose any public health threat to the general community under suburban living conditions. The tapeworms are encountered even less frequently, except for Hymenolepis, the dwarf tapeworm, which is prevalent in some Aboriginal communities.

Purification of a diagnostic, secreted cysteine protease-like protein from the hookworm Ancylostoma caninum

The enteric infection of humans with the canine hookworm Ancylostoma caninum varies in its clinical presentation, ranging from asymptomatic to eosinophilic gastroenteritis requiring surgical intervention. Infections are not patent, but can be diagnosed immunologically by detecting antibodies to an immunodominant secreted hookworm protein termed Ac68. To characterise Ac68, we purified the native protein from A. caninum excretory/secretory products using size exclusion followed by anion exchange chromatography. The epitopes in the purified protein recognised by human infection sera were shown to be proteins and not carbohydrates. The N-terminal amino acid sequence of the purified Ac68 was determined and six of the 11 residues obtained were shared with a previously characterised cysteine protease of A. caninum, AcCP1.

Persistent head lice following multiple treatments: evidence for insecticide resistance in Pediculus humanus capitis

Viable head lice were found on the scalps of two family members following multiple topical insecticide treatments. The possibility of reinfestation had been reliably excluded. Persistent infestation could be diagnosed only after cutting the hair and combing repeatedly, which allowed visualization of juvenile (nymphal) and adult lice. Insecticide-resistant headlouse infestations are probably much more common than is generally realised and may persist unnoticed, so that more aggressive approaches will be needed to eradicate these ectoparasites from individuals and communities.

Neuro-angiostrongyliasis: unresolved issues

Angiostrongylus cantonensis, the rat lungworm, probably evolved with its hosts, members of the genus Rattus and closely related species, in south-east Asia. Since its first discovery in rats in China and in a case of human infection in Taiwan, the parasite has been found to infect humans and other mammals across a wide and ever-increasing territory, which now encompasses much of south-east Asia, Melanesia, Polynesia and eastern Australia. It has also established a foothold in Africa, India, the Caribbean and south-eastern USA. This dispersal has been a direct result of human activity, and in some cases has been linked with the spread of the African giant land snail, Achatina fulica. However, this snail is not critical to the extension of the parasite's range, as numerous other indigenous molluscan species serve as adequate intermediate hosts; the importance of Achatina to the life cycle may have been over-emphasized. In Australia, the parasite is established along parts of the east coast, and the presence of an indigenous close relative, Angiostrongylus mackerrasae, suggests a long association of the parasite with its local rat hosts, a situation analogous to that of Angiostrongylus malaysiensis in south-east Asia. These three Angiostrongylus species share virtually the same life cycle, but only A. cantonensis has been confirmed to be a human pathogen.

Host specificity in blood feeding parasites: a defining contribution by haemoglobin-degrading enzymes?

A hypothesis is presented that proposes that the compatibility between species-specific variants of haemoglobin-degrading proteases of blood-feeding parasites (e.g. hookworms, schistosomes, malarial parasites, etc.), and their natural substrates, i.e. haemoglobins from diverse species of mammals, has influenced to evolution of the host range of these parasites. Support for the hypothesis was drawn from molecular modelling studies of the three dimensional structure of an aspartic protease, Acasp, from the canine hookworm Ancylostoma caninum, and models of canine and human haemoglobins docked with the active site of Acasp. The molecular modelling suggested that Acasp, from a canine-specific hookworm, would have a higher substrate affinity for canine haemoglobin than for human haemoglobin.

Health aspects of Antarctic tourism

Increasing numbers of seaborne tourists are visiting Antarctica, with most coming from the United States (3503 in 1996-97), Germany (777), and Australia (680; cf. 356 in 1994-95 and 410 in 1995-96). The impression among travel medicine clinicians is that, each year, more prospective travelers seek advice about the health demands of this type of adventure, mostly relating to fitness for travel, exposure to extreme cold, hazards in ice and snow, and other potential health risks. This is a recent phenomenon. While a regular shipping service had been established between the Falklands and the subantarctic islands of South Georgia and the South Shetlands by 1924, the first documented tourists accompanied an Argentine expedition to the South Orkneys in 1933.1 Commercial airline flights over these islands and the Antarctic Peninsula began in 1956, from Chile, and recreational cruises to the Peninsula began in 1958. Tourist numbers subsequently grew slowly, for what was clearly an exclusive and very expensive undertaking, with few ships available for these hazardous voyages. From 1957 to 1993, 37,000 tourists visited by sea, most seeing only the Peninsula.2 The dramatic recent growth in numbers is a consequence of the collapse of the Soviet Union. The small fleet of ice-strengthened research vessels and working icebreakers, which was made redundant by withdrawal of central government support from isolated communities and military activities along the northern coast of Siberia (and from Antarctic research bases), now accounts for the bulk of charter-cruise tourism to Antarctica, at competitive prices. According to the International Association of Antarctica Tour Operators,3 7322 people traveled to Antarctica on commercially organized voyages in the 1996-97 season, and a record 10,000 shipborne visitors were expected for the 1997-98 season (November-March), traveling mainly from South America to the Peninsula on 15 ice-reinforced vessels, each carrying between 36 and 180 passengers. Most tours embark from Ushuaia in southern Argentina, or Punta Arenas in Chile, although occasional cruises leave from Australia, New Zealand, or even South Africa.

Cerebrospinal angiostrongyliasis in five captive tamarins (Sanguinus spp)

Four cotton-top tamarins (Sanguinus oedipus oedipus) and one emperor tamarin (S imperator subgrisescens) housed in a zoo became depressed, anorexic, paraparetic and eventually paralysed. The animals died within 5 days to 18 months of the appearance of clinical signs. Histological examination showed nonsuppurative and eosinophilic meningoencephalitis, and metastrongyle nematode larvae were found within subarachnoid spaces of all animals and within the spinal cord of one. Intact larvae with features consistent with Angiostrongylus cantonensis were recovered from the brain of one animal. This parasite is the classical cause of eosinophilic meningoencephalitis in many parts of the world and the diagnosis can be strongly suspected on clinical grounds. In endemic areas like south-east Queensland, protection of captive animals against infection with A cantonensis is a difficult balance between providing a stimulating, natural setting and eliminating potentially infectious definitive, intermediate and paratenic hosts. This is the first report of cerebrospinal angiostrongyliasis in tamarins and nonhuman primates in Australia.

Acasp, a gene encoding a cathepsin D-like aspartic protease from the hookworm Ancylostoma caninum

Intestinal infection with the zoonotic hookworm Ancylostoma caninum can provoke human eosinophilic enteritis. A cDNA was isolated from A. caninum, using an oligonucleotide primer designed to hybridize to the region encoding the consensus, catalytic site residues D32TGSSNLW of aspartic proteases. This novel cDNA encoded an aspartic protease zymogen of 422 amino acids, exhibiting 47% identity to the lysosomal aspartic protease of Aedes aegypti, 46% identity to the aspartic protease of Schistosoma japonicum, and 48.5% to human cathepsin D. Its deduced structure differed from that of cathepsin D in the loop 2 "flap," which holds the substrate at the active site, and by the presence of a COOH-terminal extension of approximately 30 residues.

Human enteric infection with Ancylostoma caninum: hookworms reappraised in the light of a "new" zoonosis

Recent studies in northeastern Australia indicate that enteric infection with Ancylostoma caninum is a leading cause of human eosinophilic enteritis. Much more frequent accompaniments of this infection are obscure abdominal pain with or without blood eosinophilia, while a large part of the population is probably infected asymptomatically. These conclusions are based on extensive serological investigations in patients and control subjects, as well as 15 cases in which single, adult hookworms were identified in situ in patients. In no case has more than one worm been identified, and none has been fully mature, so the infections have never been patent. Aphthous ulcers of the terminal ileum, caecum and colon have been seen in association with this infection and have also been observed in almost 5% of patients who are colonoscoped in north Queensland. Serodiagnosis has relied on an IgG and IgE ELISA using excretory-secretory antigens from adult A. caninum, but Western blot using these antigens to identify IgG4 antibodies to a protein of molecular weight 68 kDa (Ac68) promises to be more specific and sensitive. However, identical antigens appear to be secreted by the anthropophilic hookworms as well. The clinical, public health and biological significance of these findings are discussed in detail.

Immunoglobulin G subclass antibodies against excretory/secretory antigens of Ancylostoma caninum in human enteric infections

Most patients with proven or suspected enteric infection with the common hookworm of dogs, Ancylostoma caninum, produce immunoglobulin G (IgG) and IgE antibodies to an immunodominant excretory/secretory antigen (Ac68) of the parasite. These antibodies were detected in both enzyme-linked immunosorbent assay (ELISA) and Western blots; the Western blot to detect IgG antibodies to Ac68 was the most specific and sensitive. The subclasses of IgG of the antibody response to the parasite were analyzed using Western blots with anti-IgG subclass-specific monoclonal antibodies as marker systems in an attempt to further improve the specificity of the assay. Eight patients with confirmed enteric infections with A. caninum (positive controls) were tested; six had antibodies in all IgG subclasses against Ac68. Twenty sera from patients with suspected enteric infection with A. caninum (manifested as eosinophilic enteritis or unexplained abdominal pain with peripheral eosinophilia) were tested; 16 had total IgG antibodies to Ac68, while IgG1, IgG2, IgG3, and IgG4 responses were found in 11, 10, 9, and 12 of these sera, respectively. Small numbers of sera from groups of patients infected with other helminths and from healthy blood donors had various combinations of IgG, IgG1, IgG2, and IgG3 antibodies to Ac68, but none of these sera had IgG4 antibodies to Ac68. Sera from all nine patients with human hookworm infection had IgG, IgG1, IgG2, and IgG3 antibodies to Ac68 and eight of the nine were also positive for IgG4 antibodies. These results indicate the Western blot to detect IgG4 antibodies to Ac68 is the most reliable immunodiagnostic test yet described for enteric infection with A. caninum, although this test does not discriminate between infections with human and canine hookworms.

Deaths of Australian travellers overseas

OBJECTIVE

To determine the number and causes of deaths of Australian citizens who died overseas in a 12-month period.

DESIGN

Retrospective survey of deaths reported to the Australian Department of Foreign Affairs and Trade by Australian embassies, high commissions and consulates for the period July 1992 to June 1993. Data on Australians travelling overseas were obtained from the Australian Bureau of Statistics.

RESULTS

During the year 1992-1993, 2,299,500 Australians travelled overseas for less than 12 months (short term travellers), with an estimated mean trip duration of 6.3 weeks. Another 65,450 left for more than 12 months (long term travellers), and 27,910 left permanently (residents). Of the 421 recorded deaths, 289 were in short term travellers, 108 in long term travellers/residents and 24 in members of work parties. The annual crude mortality rate for short term travellers and work party members was estimated at about 0.1%. Men outnumbered women almost 4:1. Death rates increased with age, reflecting underlying medical problems in older travellers, with heart disease being the leading cause (146 deaths, 35%). Fatal trauma predominated in younger people. Accidents, mainly in traffic, accounted for 77 deaths (18%) and infections for 10 (2.4%), including two cases of malaria. Death rates varied between geographical regions, with New Zealand being the safest destination.

CONCLUSIONS

The risk of an Australian dying while travelling overseas is probably little different from that while staying home. The low level of fatal infections may result from preventive measures. Travellers should be aware of the danger of accidents, particularly traffic accidents, while overseas.

Amplification and characterization of cysteine proteinase genes from nematodes

In order to isolate proteinase genes from parasitic nematodes by polymerase chain reaction (PCR) techniques, we employed a pair of consensus oligonucleotide primers designed to anneal to the active site cysteine (primer ncpC) and asparagine (primer ncpN) coding regions of cysteine proteinases. The primers were biased toward the nucleotide and codon usages of cysteine proteinase genes of nematodes and were based on the consensus nucleotide sequences flanking the active site residues of genes from Haemonchus contortus, Caenorhabditis elegans, and Ostertagia ostertagi. We employed 'touchdown' PCR conditions and were able to amplify novel cysteine proteinase gene fragments from the rodent parasite Strongyloides ratti, the human pathogen S. stercoralis, the canine hookworm Ancylostoma caninum, and from C. elegans. These clones are gene homologs of cathepsin B-like (lysosomal associated) proteases and will facilitate screening of both cDNA and genomic DNA libraries.

Characterization and localization of cathepsin B proteinases expressed by adult Ancylostoma caninum hookworms

The hookworm Ancylostoma caninum induces human eosinophilic enteritis (EE), probably via allergic responses to its secretions. Cysteine and metallo-proteinases may be the components of these secretions that elicit hypersensitivity reactions. In order to characterize genes encoding cysteine proteinases (CP) secreted by A. caninum, an adult hookworm cDNA library was constructed and screened with a cloned fragment of a hookworm CP gene. This fragment was obtained using consensus oligonucleotide, CP-gene-specific primers in the polymerase chain reaction. cDNAs encoding two CPs were obtained from the library and sequenced. The first gene, AcCP-1, encoded a cathepsin B-like zymogen CP of 343 amino acids (aa), predicted to be processed in vivo into a mature CP of 255 aa. Closest nucleotide identities were to Haemonchus contortus cysteine protease (61%) and to human cathepsin B (60%). The second gene, AcCP-2, encoded a mature CP of 254 aa, that showed 86% identity to AcCP-1, and 58% and 47% identity to bovine cathepsin B and human cathepsin B, respectively. Rabbit antisera raised against recombinant AcCP-1 reacted with esophageal, amphidial and excretory glands in formalin-fixed, paraffin embedded sections of both male and female adult hookworms, and with an antigen of approx. 40 kDa in Western blot analysis of excretory/secretory products from adult hookworms. Together, these immuno-hybridization results strongly suggest that the CP encoded by the AcCP-1 gene is secreted by hookworms. These are the first reported CP genes from hookworms. Proteinases encoded by these genes may be responsible for the CP activity that we have shown previously to be secreted by adult A. caninum.

Eosinophilic enteritis in northeastern Australia. Pathology, association with Ancylostoma caninum, and implications

While eosinophilic gastroenteritis is considered a rare condition, eosinophilic enteritis without gastric involvement is quite common in northeastern Australia. We present 79 patients with biopsy-proven eosinophilic enteritis, 70 seen since 1987. In 10 patients, eosinophilic enteritis was associated with infection by single, sexually immature, adult hookworms, most positively identified as the common dog hookworm Ancylostoma caninum. An additional 22 patients (of 34 tested) had serological evidence of A. caninum exposure. The essential pathology, i.e., edema and eosinophilic infiltration of the gut wall, ascites, and regional lymphadenopathy, was identical to that seen in eosinophilic gastroenteritis. Additional, more specific features included pathological reactions centered on attached worms, mucosal alterations and ulcers considered to be hookworm bite sites, and submucosal and lymph node granulomas with central eosinophil degranulation and degradation products. Since A. caninum has an almost worldwide distribution, it is probable that A. caninum-induced eosinophilic enteritis occurs outside Australia. We show that the worm is easily overlooked in pathological specimens and that care is required to preserve worms intact for specific parasitological identification. The clinical and pathological features were similar to those seen in another human enteric helminthic zoonosis, anisakiasis. The possibility that there are yet other undiscovered intestinal zoonoses remains.

The changing epidemiology of human hookworm infection in Australia

OBJECTIVE

To document the distribution of human hookworm infection in Australia.

DESIGN

A retrospective study of published data and accessible archival records.

METHODS

The core data were derived from the report of the Australian Hookworm Campaign, annual reports of various State health departments and the Queensland Institute of Medical Research, and unpublished files of the former Queensland Aboriginal Health Programme.

FINDINGS

Today, hookworm infection is endemic only among Aboriginal communities of northern Western Australia and the Northern Territory, where Ancylostoma duodenale may be the sole species. Early this century, infection was also established in Queensland and northern New South Wales, in both Aboriginal and white communities, and Necator americanus predominated. The origin of these parasites is obscure. Sustained control programs seem to have eradicated hookworms from Queensland.

CONCLUSIONS

Improved sanitation, hygiene and chemotherapy have eliminated hookworms from white populations of Australia. Continued anthelminthic campaigns will also clear the parasites from Aboriginal communities, but unless living conditions improve significantly infection will recur.

Immunohistochemical localization of excretory/secretory antigens in adult Ancylostoma caninum using monoclonal antibodies and infected human sera

Human eosinophilic enteritis (EE) may result from hypersensitivity to the excretory/secretory (ES) antigens of adult Ancylostoma caninum. The origin of several antigens were identified by probing adult A. caninum with mouse monoclonal antibodies (MoAbs), sera from mice vaccinated with ES antigens and sera from human EE patients. Six MoAbs (AC/ES 1-6) were produced against ES antigens, two being IgG3 and four IgM. Western blots demonstrated four different antigen specificities: MoAb AC/ES 1 bound strongly to an ES product at about 30 kDa; AC/ES 2 recognized a broad band ranging from 50-200 kDa; AC/ES 3, AC/ES 5 and AC/ES 6 reacted at about 68 kDa, and AC/ES 4 at about 97 kDa. Sections of formalin-fixed, paraffin embedded adult A. caninum were then incubated with these MoAbs and immunostained by the peroxidase-anti-peroxidase (PAP) technique. The target epitope of MoAb AC/ES 1 was found mainly in the oesophageal, amphidial and excretory glands; AC/ES 2 reacted weakly with many structures in the sections; AC/ES 3, AC/ES 5 and AC/ES 6 were specific for excretory glands only, and AC/ES 4 bound to amphidial glands. Sera from immunized mice reacted with all three (especially the excretory) glands and the cuticle. In an indirect assay, worm sections probes with three human EE patient sera demonstrated maximal staining in the amphidial glands. Our findings confirm that ES products of A. caninum include immunogenic glandular secretions which may be involved in the pathogenesis of human EE.

Secretion of cysteine proteinase activity by the zoonotic hookworm Ancylostoma caninum

The zoonotic hookworm, Ancylostoma caninum, probably induces human eosinophilic enteritis by inducing allergic responses to its secretions. This species is already known to secrete metalloproteinases, but in other parasites, cysteine proteinases are involved in pathogenesis. We studied somatic extracts of A. caninum adults and infective larvae and adult excretory/secretory (ES) antigens for cysteine proteinase activity using fluorogenic peptide substrates and by gelatin and fluorogenic substrate polyacrylamide gel electrophoresis. Proteolytic activity was observed against the cathepsins L and B-specific substrate Z-phe-arg-AMC, against the plasmin substrate Boc-val-leu-lys-AMC, and against gelatin. The Z-phe-arg-AMC-hydrolyzing activity in ES antigens and in adult extracts was enhanced up to 15-fold by the reducing agent dithiothreitol (DTT), but was totally blocked by specific inhibitors of cysteine proteinases, including the peptidyl diazomethyl ketone Z-phe-ala-CHN2,E-64, leupeptin, and N-ethylmaleimide. In a similar fashion, gelatinolytic activity in ES antigens detected using substrate gels was enhanced by the addition of reducing agents and inhibited by Z-phe-ala-CHN2 and E-64. The DTT-enhanced, Z-phe-arg-AMC-hydrolyzing activity in ES antigens was active over a wide pH range (pH 5-9). Similar cysteine proteinase activity to that detected in ES antigens was present in extracts of adult and infective larvae of A. caninum. Because the substrate Z-phe-arg-AMC was specifically hydrolyzed, and because this hydrolysis was totally blocked by cysteine proteinase-specific inhibitors, ES antigens and tissue extracts of A. caninum clearly possess cysteine proteinase activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Human enteric infection with canine hookworms

OBJECTIVE

To describe a zoonotic ancylostomiasis (canine), acquired from domestic pets by patients living in developed, urban communities.

DESIGN

An 8-year, retrospective case study.

SETTING

A clinical gastroenterologic practice in Townsville and a university parasitology department in Brisbane, Australia.

PATIENTS

Nine patients, each with enteric hookworm infection diagnosed by finding a single organism in situ; five were treated by us, and the rest were referred to us for parasite identification.

MEASUREMENTS

Clinical and demographic data, complete blood examinations, total serum immunoglobulin E assay, and serologic testing with enzyme-linked immunosorbent assay and Western blot using excretory-secretory antigens of Ancylostoma caninum. Gut biopsy specimens were examined histologically, and hookworms were identified using morphologic criteria.

RESULTS

The infections in three of the patients were diagnosed during the initial 6 years and six in the last 2 years. All owned a dog and described activity potentially exposing them to infection with canine hookworm larvae. Three patients had a laparotomy for acute abdominal pain, and six had colonoscopies (five with pain and one without symptoms). Six of the nine had blood eosinophilia (mean, 0.97 x 10(9)/L), and five of eight had elevated immunoglobulin E levels (mean level, 756 micrograms/L); six of eight had eosinophilic inflammation of the gut. In six patients, the worm was identified as A. caninum, whereas in three, damage to the specimen did not allow specific identification; however, they were unlikely to be human parasite species. Although all parasites were in the adult stage, none were sexually mature. Positive serologic findings in seven of the eight patients tested confirmed presence of antibody to the parasite.

CONCLUSIONS

Human enteric infections with A. caninum are being diagnosed more frequently in northeastern Australia. Although infection may be subclinical, the chief symptom is abdominal pain, sometimes sudden and severe. The pathologic finding is focal or diffuse eosinophilic inflammation caused by a type 1 hypersensitivity response to secreted antigens. Infection by sexually immature worms is scant and nonpatent, indicating poor adaptation to the human host. Serologic testing assists in identification of occult infection. Advanced hygiene and sanitation afford little protection because the parasite reservoir is a large and growing pool of infected domestic pets.

Immunologic incrimination of Ancylostoma caninum as a human enteric pathogen

In northeastern Australia, the incidence of human eosinophilic enteritis (EE) and unexplained abdominal pain with peripheral blood eosinophilia (PE) appear to be exceptionally high. Because adults of the common dog hookworm, Ancylostoma caninum, were found in situ in several cases, we compared specific antibody responses in patients with EE or PE with those of individuals from various control groups. Sera were obtained from three patients with confirmed dog hookworm infection, 25 patients with EE/PE, 42 with other diagnosed gastrointestinal disorders, eight with human hookworm infection, 27 with other diagnosed parasitic infections, and 100 blood donors from the State of Tasmania, where A. caninum does not occur. They were analyzed by enzyme-linked immunosorbent assay (ELISA) and Western blot for IgG and IgE antibodies to excretory-secretory (ES) antigens from adult A. caninum. In the ELISA, sera from 88% of EE/PE patients were positive for IgG and IgE antibodies to ES antigen. All eight patients infected with human hookworm (identified as A. duodenale in three) were also seropositive, while most of those with other parasitic infections, as well the blood donors, those with diagnosed gastrointestinal diseases, and the control subjects, were seronegative. In Western blots, sera from 92% of EE/PE patients demonstrated IgG and IgE antibodies to a component of ES antigen with a molecular weight of approximately 68 kD (Ac68), as did all sera from cases infected with human hookworms. Among the patients with other gastrointestinal disorders and parasitic infections, four of 42 (10%) and three of 27 (11%), respectively, reacted positively.(ABSTRACT TRUNCATED AT 250 WORDS)

Occult enteric infection by Ancylostoma caninum: a previously unrecognized zoonosis

BACKGROUND/AIMS

Human disease caused by the canine hookworm Ancylostoma caninum and a high incidence of eosinophilic enteritis have been reported from northern Queensland, Australia. The aim of this study was to evaluate patients with unexplained abdominal pain and a possible association with cryptic infections by A. caninum.

METHODS

The clinical and demographic features of patients from this region with eosinophilic enteritis (group A1, n = 42), obscure abdominal pain associated with (group A2, n = 105) and without (group A3, n = 84) blood eosinophilia were reviewed and sera were tested against A. caninum excretory-secretory antigens by enzyme-linked immunosorbent assay (ELISA) and Western blot. Four additional patients, two with confirmed A. caninum, had hookworm infection.

RESULTS

The level of dog ownership in these four groups was 79%-100%, higher than in the local population (P < 0.001). The ELISA tested positive in 71% of A1, 67% of A2, and 30% of A3, versus 8% in controls (P < 0.002). All cases tested were positive on Western blot versus 10% of controls (P < 0.0001). The ELISA values increased with chronicity and decreased during convalescence.

CONCLUSIONS

We conclude occult human A. caninum infections are common and are characterized by eosinophilic enteritis and obscure abdominal pain with or without blood eosinophilia. The diagnosis can be confirmed by serology.

Parasitic origin of a solitary necrotic nodule of the liver

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