Abeer E Mahmoud

Three new cases of human infection with Dirofilaria repens, one pulmonary and two subcutaneous, in the Egyptian governorate of Assiut

Abstract Human dirofilariasis caused by Dirofilaria repens is a parasitic infection, currently considered to be an emerging zoonosis, that has been observed in many areas of the Old World. Dogs are the main reservoir host. In humans, D. repens can cause inflammatory nodules, most commonly in the subcutaneous tissues or in the subconjunctival space. Lung involvement, which is the most common of the non-cutaneous and non-ocular manifestations, is frequently mis-diagnosed as a primary or metastatic lung tumour. Two new subcutaneous cases and one new pulmonary case, all observed in the Egyptian governorate of Assiut, are described here. This represents the first report of human pulmonary dirofilariasis caused by D. repens on the African continent. All the worms collected from the cases, including a living worm from the left lung of the pulmonary case, were identified morphologically, and the identity of the lung parasite was confirmed by PCR.

Xenomonitoring of Different Filarial Nematodes Using Single and Multiplex PCR in Mosquitoes from Assiut Governorate, Egypt

Wuchereria bancrofti, Dirofilaria immitis, and Dirofilaria repens are filarial nematodes transmitted by mosquitoes belonging to Culex, Aedes, and Anopheles genera. Screening by vector dissection is a tiresome technique. We aimed to screen filarial parasites in their vectors by single and multiplex PCR and evaluate the usefulness of multiplex PCR as a rapid xenomonitoring and simultaneous differentiation tool, in area where 3 filarial parasites are coexisting. Female mosquitoes were collected from 7 localities in Assiut Governorate, were microscopically identified and divided into pools according to their species and collection site. Detection of W. bancrofti, D. immitis, and D. repens using single PCR was reached followed by multiplex PCR. Usefulness of multiplex PCR was evaluated by testing mosquito pools to know which genera and species are used by filarial parasites as a vector. An overall estimated rate of infection (ERI) in mosquitoes was 0.6%; the highest was Culex spp. (0.47%). W. bancrofti, D. immitis, and D. repens could be simultaneously and differentially detected in infected vectors by using multiplex PCR. Out of 100 mosquito pools, 8 were positive for W. bancrofti (ERI of 0.33%) and 3 pools each were positive for D. immitis and D. repens (ERI 0.12%). The technique showed 100% sensitivity and 98% specificity. El-Nikhila, El-Matiaa villages, and Sahel Seleem district in Assiut Governorate, Egypt are still endemic foci for filarial parasites. Multiplex PCR offers a reliable procedure for molecular xenomonitoring of filariasis within their respective vectors in endemic areas. Therefore, it is recommended for evaluation of mosquito infection after lymphatic filariasis eradication programs.

Effect of myrrh and thyme on Trichinella spiralis enteral and parenteral phases with inducible nitric oxide expression in mice.

Trichinellosis is a serious disease with no satisfactory treatment. We aimed to assess the effect of myrrh (Commiphora molmol) and, for the first time, thyme (Thymus vulgaris L.) against enteral and encysted (parenteral) phases of Trichinella spiralis in mice compared with albendazole, and detect their effect on inducible nitric oxide synthase (iNOS) expression. Oral administration of 500 mg/kg of myrrh and thyme led to adult reduction (90.9%, 79.4%), while 1,000 mg/kg led to larvae reduction (79.6%, 71.3%), respectively. Administration of 50 mg/kg of albendazole resulted in adult and larvae reduction (94.2%, 90.9%). Positive immunostaining of inflammatory cells infiltrating intestinal mucosa and submucosa of all treated groups was detected. Myrrh-treated mice showed the highest iNOS expression followed by albendazole, then thyme. On the other hand, both myrrh and thyme-treated groups showed stronger iNOS expression of inflammatory cells infiltrating and surrounding encapsulated T. spiralis larvae than albendazole treated group. In conclusion, myrrh and thyme extracts are highly effective against both phases of T. spiralis and showed strong iNOS expressions, especially myrrh which could be a promising alternative drug. This experiment provides a basis for further exploration of this plant by isolation and retesting the active principles of both extracts against different stages of T. spiralis.

Polymerase chain reaction detection and inducible nitric-oxide synthase expression of Leishmania major in mice inoculated by two different routes.

Introduction: Leishmania major needs a sensitive and specific method for proper diagnosis. This study aims to study the course and histopathology of L. major in certain tissues of experimentally infected BALB/c mice after subcutaneous (sc) and intraperitoneal (ip) inoculation. Materials and Methods: After infecting BALB/c mice using sc and ip inoculation, the histopathology was studied. The kinetoplastic DNA polymerase chain reaction (PCR) for its molecular detection and detect the inducible nitric-oxide synthase (iNOS) pattern during the first 3 months of infection. Result: PCR could detect the presence of L. major in all spleens, lymph nodes, and skin ulcers by both inoculation routes while (33%) and (42%) of livers were positive after sc and ip routes, respectively. Chronic inflammatory cell infiltrates with capsulitis was found in the spleen, lymph nodes, and liver. Granulomas were found in the spleen and liver. There was a statistically significant difference in iNOS expression along the experiment in the spleen and lymph nodes by both routes and in the liver by ip only. Apart from the liver, iNOS could not be detected on the 2 nd week postinfection and was high after 1 month for both routes in all samples; a moderate decrease at 2 months and the highest decrease were detected after 3 months. Conclusions: L. major inoculation by both routes produce visceral disease in mice, and kinetoplastic DNA PCR can detect its presence from the 2 nd week up to the 3 rd month postinfection. The iNOS expression was high at 1 and 2 months and remained throughout the 3 months of the experiment; which plays an important role in the disease course and control.

Socio-demographic, Clinical and Laboratory Predictors for the Diagnosis of Visceral Larva Migrans in Children - Upper Egypt

Visceral larva migrans (VLM) is a worldwide neglected disease, prevalent among children from socio-economically disadvantaged populations in temperate and tropical regions. Infections may go undiagnosed as the required diagnostic tests; serological, molecular and/or imaging examinations are expensive, which may not be affordable or available. We aimed to establish predictors useful in the diagnosis of VLM in children in Upper Egypt. A one year cross-sectional study was conducted at Assiut University Childrens Hospital and eighty-one children aged between 6 months to 13 years old (mean± SD 5.7 ± 3.2 years) were eligible to our inclusion criteria, 55.6% of Original Research Article Galal et al.; IJTDH, 19(2): 1-13, 2016; Article no.IJTDH.28780 2 them were males. Socio-demographic risk factors, clinical, laboratory and imaging tests were collected. ELISA (anti-T. canis IgG) results were positive in 60.5%. By using the bivariate analysis, a significant association was found between seropositive ELISA and younger age less than four years (p-value <0.0001), having underground water at their homes (p= 0.004), previous history of parasitic infection (p= 0.003) and positive liver ultrasonographic findings (p=0.001). In a multivariate logistic regression model with positive and negative ELISA results as a dependent factor, younger age (<4 years), history of parasitic infestation and positive liver ultrasonographic findings were found to be significant predictors, while no significant association with other factors was identified. Thus, clinicians should consider the positive liver ultrasonographic changes with the earlier history of parasitic infection in children under four years as predictors for VLM infection, according to which they should undergo ELISA or other tests to confirm their diagnosis.

Finding Wolbachia in Filarial larvae and Culicidae Mosquitoes in Upper Egypt Governorate

Wolbachia is an obligatory intracellular endosymbiotic bacterium, present in over 20% of all insects altering insect reproductive capabilities and in a wide range of filarial worms which is essential for worm survival and reproduction. In Egypt, no available data were found about Wolbachia searching for it in either mosquitoes or filarial worms. Thus, we aimed to identify the possible concurrent presence of Wolbachia within different mosquitoes and filarial parasites, in Assiut Governorate, Egypt using multiplex PCR. Initially, 6 pools were detected positive for Wolbachia by single PCR. The simultaneous detection of Wolbachia and filarial parasites (Wuchereria bancrofti, Dirofilaria immitis, and Dirofilaria repens) by multiplex PCR was spotted in 5 out of 6 pools, with an overall estimated rate of infection (ERI) of 0.24%. Unexpectedly, the highest ERI (0.53%) was for Anopheles pharoensis with related Wolbachia and W. bancrofti, followed by Aedes (0.42%) and Culex (0.26%). We also observed that Wolbachia altered Culex spp. as a primary vector for W. bancrofti to be replaced by Anopheles sp. Wolbachia within filaria-infected mosquitoes in our locality gives a hope to use bacteria as a new control trend simultaneously targeting the vector and filarial parasites.

Spotlight on the brain hydatid cyst and whether its location is accidental or target

Hydatidosis of the brain is a rare disease. The diagnosis is usually late because of its slow progression and absence of specific symptoms. This review attempted to throw light on some aspects of cerebral hydatidosis because of deficient clinical suspicion of the disease, and imaging investigations are sometimes inadequate and biopsy reports inconclusive. Thus, the literature pertaining to parasitic causes, the incidence, the pathogenesis, the clinical picture, the diagnosis, and the management of the disease were overviewed. Our intention was to alert parasitologists and neurosurgeons concerning this morbid and rare condition, and to emphasize the fact that parasitic infection should be suspected in cystic lesions affecting the brain, especially in endemic areas of the world. Moreover, we aim to discuss or derive an answer to some amazing aspects of the disease. These include its clear abundance in children and in young age, its unusual huge size in their brains, whether the brain is an accidental or a target location, its extreme rarity in domestic animal′s brains, the usual failure of serological and immunological tests used for its diagnosis, the wide range of clinical manifestations and differential diagnoses, and the recent measures used for its treatment and control.