Fabrizio Bruschi

Opinion on the diagnosis and treatment of human trichinellosis

The clinical diagnosis of trichinellosis is difficult because there are no pathogenic signs or symptoms and in diagnosing the infection epidemiological data are of great importance. Trichinellosis usually begins with a sensation of general discomfort and headache, increasing fever, chills and sometimes diarrhoea and/or abdominal pain. Pyrexia, eyelid or facial oedema and myalgia represent the principal syndrome of the acute stage, which can be complicated by myocarditis, thromboembolic disease and encephalitis. High eosinophilia and increased creatine phosphokinase activity are the most frequently observed laboratory features and the parasitological examination of a muscle biopsy and the detection of specific circulating antibodies will confirm the diagnosis. The medical treatment includes anthelmintics (mebendazole or albendazole) and glucocorticosteroids. Mebendazole is usually administered at a daily dose of 5 mg/kg but higher doses (up to 20 – 25 mg/kg/day) are recommended in some countries. Albendazole is used at 800 mg/day (15 mg/kg/day) administered in two doses. These drugs should be taken for 10 – 15 days. The use of mebendazole or albendazole is contraindicated during pregnancy and not recommended in children aged < 2 years. The most commonly used steroid is prednisolone, which may alleviate the general symptoms of the disease. It is administered at a dose of 30 – 60 mg/day for 10 – 15 days.

Anisakiasis and Gastroallergic Reactions Associated with Anisakis pegreffii Infection, Italy

Human cases of gastric anisakiasis caused by the zoonotic parasite Anisakis pegreffii are increasing in Italy. The disease is caused by ingestion of larval nematodes in lightly cooked or raw seafood. Because symptoms are vague and serodiagnosis is difficult, the disease is often misdiagnosed and cases are understimated.

Enzymatic antioxidant systems in helminth parasites.

Parasitic helminths have a coexistence with mammalian hosts whereby they survive for several years in known hostile conditions of their hosts. Many explanations exist describing how these parasitic helminths are able to survive. In the last years, a lot of studies have focused on both enzymatic and non-enzymatic antioxidant systems now shown to exist in these parasites and which may serve as defence tactics against the host-generated oxygen radicals. The relevance of antioxidant enzymes is confirmed by the fact that some of these molecules represent putative protective anti-parasite vaccines (i.e. in schistosomiasis). This review tries to compile what is known to date of the enzymatic antioxidant systems in selected parasitic helminths.

High genetic polymorphism among Giardia duodenalis isolates from Sahrawi children

Human giardiasis, the gastrointestinal infection caused by two genetically different groups (or assemblages) of Giardia duodenalis, is very common worldwide, and its prevalence is higher in developing countries. However, few surveys in these regions have been performed to include a genetic characterization of the parasite, which is necessary to unravel the complex epidemiology of the infection. In this work, we screened 120 faecal samples collected from Sahrawi children in 2003-2005, and found 41 (34.2%) of them to be positive, using immunofluorescent microscopy, for the presence of G. duodenalis cysts. Molecular characterization of the isolates was performed by RFLP and/or sequence analysis of the triose phosphate isomerase (tpi) and the glutamate dehydrogenase (gdh) genes. The results disclosed an unexpectedly high genetic polymorphism among isolates of both assemblages A and B, and a large percentage of the sequences (50% for the tpi gene, and 90% for the gdh gene) from assemblage B isolates characterized by the presence of overlapping nucleotide peaks at specific positions in the chromatograms, which can be attributed to mixed infections or to allelic sequence heterozygosity of single cysts. Notably, this phenomenon was not observed in sequences from assemblage A isolates. These results suggest that the genetic structure is different in isolates of assemblages A and B.

Neurocysticercosis in Europe: Still a public health concern not only for imported cases.

Neurocysticercosis (NCC), a parasitic disease caused by the larvae of the cestode Taenia solium, is the most frequent parasitic disease of the central nervous system (CNS) in the world and the leading cause of secondary epilepsy in Central and South America, East and South Asia, and sub-Saharan Africa. It is endemic in many low- and middle-income countries of the world. Due to increased travels and immigration, NCC may be diagnosed also in non-endemic areas. In fact, tapeworm carriers from endemic zones can transmit infection to other citizens or arrive already suffering NCC. This phenomenon, occurred first in USA during the last 30 years, has been also observed in Europe, as well as in Australia, Canada, Israel, Japan and Muslim countries of the Arab World. Actually, concerning Europe, although, in some areas only few cases have been described, nevertheless the prevalence of NCC may be considered increasing, especially in Spain and Portugal. We reviewed the literature on the burden of NCC in Europe, by a search of PubMed regarding papers from 1970 to present. We only considered on PubMed published and available papers in English, French, Italian, and Spanish, the languages understood by the authors. One hundred seventy six cases of NCC have been reported in seventeen European countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Netherlands, Sweden, United Kingdom, and Croatia, Norway, Switzerland). A particular epidemic situation is present in Spain and Portugal. In fact, we collected data that show, in Spain, an increasing incidence both in immigrated patients and in those which were born in certain Spanish geographical areas and, in Portugal, prevalence similar to that observed in endemic areas. Globally, it is clear that as a result of increased migrations and travels from endemic regions, NCC is becoming an emerging public health problem in high-income countries, particularly affecting communities where hygiene conditions are poor and sub-sequentially the parasite can spread from human to human through eggs even in absence of a travel to the tropics. NCC is a preventable disease, it derives that its important to acquire a great consciousness of the epidemiology and to implement accurate surveillance systems.

Immunosuppression of TH2 responses in Trichinella spiralis infection by Helicobacter pylori neutrophil-activating protein

BACKGROUND The Helicobacter pylori neutrophil-activating protein (HP-NAP) is able to induce IL-12 expression by cells of innate immunity and to shift to T(H)1 human allergen-specific T(H)2 cells in vitro. OBJECTIVE We performed an in vivo investigation of the ability of HP-NAP to downmodulate the T(H)2 response induced in mice by Trichinella spiralis infection. METHODS Groups of T spiralis-infected BALB/c mice received intraperitoneal PBS/rat IgG2b (control animals) or 10 microg of HP-NAP with or without anti-Toll-like receptor 2 antibody on days 10 and 28 after infection. Blood eosinophils, total and T spiralis-specific IgE levels, and cytokine levels were measured in the plasma up to day 42, when splenocytes were cultured for cytokine production. RESULTS Although control animals showed significant eosinophilia and increase of total and T spiralis-specific IgE, IL-4, and IL-5 levels from days 10 to 14, HP-NAP-treated animals showed less eosinophilia and total and excretory/secretory antigens of T spiralis-specific IgE in the blood. HP-NAP-treated animals also had higher IL-12 and IFN-gamma plasma levels and lower IL-4 and IL-5 levels. The addition of anti-Toll-like receptor 2 antibody abrogated the anti-T(H)2/pro-T(H)1 activity of HP-NAP. CONCLUSION This study provides evidence that HP-NAP enhances endogenous IL-12 and IFN-gamma response and exerts a powerful anti-T(H)2 activity in vivo, targeting both IL-5-induced eosinophilia and IL-4-mediated hyper-IgE responses induced by parasitic infection.

Serum levels of proinflammatory cytokines interleukin-1β, interleukin-6, and tumor necrosis factor α in mixed cryoglobulinemia.

OBJECTIVE No single previous study has evaluated serum levels of the proinflammatory cytokines interleukin-1beta (IL-1beta), IL-6, and tumor necrosis factor alpha (TNFalpha) in patients with hepatitis C virus-associated mixed cryoglobulinemia (HCV-MC). This study was undertaken to evaluate serum levels of these cytokines in patients with HCV-MC. METHODS Serum IL-1beta, IL-6, and TNFalpha were assayed in 43 patients with HCV-MC, in 43 sex- and age-matched patients with chronic HCV without cryoglobulinemia, and in 43 sex- and age-matched controls. RESULTS HCV-MC patients showed significantly higher mean IL-1beta, IL-6, and TNFalpha levels than did the controls (P<0.01) or the HCV patients (P<or=0.04). Serum levels of IL-6 and TNFalpha were significantly higher in HCV patients than in controls (P<0.05). CONCLUSION Our findings demonstrate elevated serum levels of IL-1beta, IL-6, and TNFalpha in patients with HCV-MC. If the importance of IL-1beta and IL-6 in the pathogenesis of MC is confirmed, these results will open the way for the evaluation of new therapies for MC.

Toxoplasmosis and neuropsychiatric diseases: can serological studies establish a clear relationship?

Toxoplasmosis is a widespread infection, with clinical spectrum ranging from a completely asymptomatic infection to multi-organ involvement. After entering the body, the parasite forms tissue cysts and establishes a chronic infection, involving also the central nervous system (CNS). During the last years, a lot of research has focused on the possible link between exposure to T. gondii and development of neuropsychiatric disorders such as schizophrenia and Parkinson’s disease (PD). If a firm association between Toxoplasma infection and neuropsychiatric disorders will be established, this would lead to novel strategies for their prevention and treatment. We will review data from serological and neurodevelopment studies relating infection with T. gondii to such neuropsychiatric diseases.

Eosinophils and Trichinella infection: toxic for the parasite and the host?

Peripheral blood and tissue eosinophilia characterize trichinellosis in humans, and present in addition to the increased total IgE levels that occur in many helminth infections. Both processes are the consequence of T-helper 2 activation. Blood and tissue eosinophilia begins with eosinophilopoiesis in the bone marrow, which is followed by the migration of eosinophils through the circulatory system, the eosinophil infiltration of tissues at the inflammatory foci and, finally, degranulation and cell death. Recently, some aspects of eosinophilia caused by Trichinella spiralis infection have been elucidated; however, the protective role of this population of cells against Trichinella parasites remains controversial. Furthermore, when eosinophils are numerous, they can be toxic for host tissues. This review discusses these issues in both human and rodent infection models.

Molecular identification of Anisakis spp. from fishes collected in the Tyrrhenian Sea (NW Mediterranean).

The accurate identification of anisakid nematodes at any life cycle stage is important both to deepen the knowledge on their taxonomy, ecology, epidemiology and for diagnosis and control, as larval stages cause a clinical disease in humans known as anisakidosis. With the aim to investigate the presence of anisakid larvae, specimens of horse mackerel, Trachurus trachurus (Linnaeus, 1758), silver scabbardfish, Lepidopus caudatus (Euphrasen, 1788), European anchovy, Engraulis encrasicolus (Linnaeus, 1758) and opah fish, Lampris guttatus (Brunnich, 1788), were collected by trawling at depths ranging from 50 to 400 m. A molecular approach based on restriction profiles obtained after digestion of the nuclear ribosomal ITS region was used to identify Anisakis spp. larvae recovered in fish samples. Restriction profiles showed three banding patterns, corresponding to Anisakis pegreffii, Anisakis physeteris and to heterozygote pattern between A. pegreffii and Anisakis simplex s.s. Specimens showing the heterozygote restriction pattern were also analyzed by sequencing of the entire ITS region, to confirm the heterozygote status.