Jernej Logar

Cryptosporidiosis associated with animal contacts

SummaryTransmission ofCryptosporidium sp. within the general public was studied. We were looking for a possible risk of infection associated with animal contacts. Investigation of the animal contacts of affected individuals led to the formulation of the hypothesis that animals are a source of cryptosporidiosis. The research was done in the Region of Ljubljana, an area with 587.000 inhabitants during a period of three years. Stool specimens of 338 persons with acute enteric diseases were positive forCryptosporidium sp. Diagnosis was done with an immunofluorescence test and modified Ziel-Neelsen staining. Processing of statistical data was done with the medical software application EPI INFO 6. According to our questionnaire, direct contact with animals occurred in 49 of the 338 cases of cryptosporidiosis, and was more frequently registered in males (Odds ratio=1.96). Subgenotyping analysis revealed the presence of two subgenotypes ofCryptosporidium parvum bovine (GPB and GPC) in humans.These data indicate that genetic heterogeneity inC parvum bovine genotype exists in a localized area and that farm animals can be a source of infection.

Prevention of Congenital Toxoplasmosis in Slovenia by Serological Screening of Pregnant Women

A programme for the prevention of congenital toxoplasmosis in Slovenia involving the screening of pregnant women for Toxoplasma infection is presented. Of 21,270 pregnant women screened for toxoplasmosis between, 1996 and the end of 1999, 13,987 (66%) were seronegative, 7,151 (34%) seropositive and 132 had primary infection; ≈ 9/1,000 women were at risk of acquiring the primary infection. One hundred live-born infants of primary infected women were available for follow-up. Nine infected but asymptomatic children were born to mothers who were screened and treated in time and two congenitally infected babies were born to mothers in whom infection was detected too late in pregnancy and who therefore received no adequate treatment. It is suggested that the results obtained in this study outweigh the cost of screening for toxoplasmosis in pregnancy. Pregnant women should always be tested at the beginning of pregnancy and, in cases of seronegativity, should be re-tested in the second and third trimesters of the pregnancy. Toxoplasma primary infected pregnant women and neonates should be treated as soon as possible. However, long-term follow-up of children born to primary infected women would be necessary for an accurate evaluation of the effectiveness of the screening because of the possibility of late onset of symptoms.

Serological screening for toxoplasmosis in pregnancy in Slovenia

In the period from 1981 to 1994, serological screening for toxoplasmosis was carried out in 20,953 pregnant women in Slovenia. Seropositivity among pregnant women was found to have decreased from 52% in the 1980s to 37% in the recent period, 1991-94, while during the same period the incidence of suspected primary infections acquired in pregnancy rose from 0.33% to 0.75%. These latest figures ought to promote an informed debate on the possible need for obligatory serological screening of pregnant women in Slovenia for toxoplasmosis.

Incidence of Congenital Toxoplasmosis in the Republic of Slovenia

Over a 12-month period, 3959 pregnant women were systematically tested with the Sabin-Feldman dye test in order to assess the incidence of congenital toxoplasmosis in Slovenia. The results suggest that this is approximately 3/1000 live births. This relatively high incidence of congenital toxoplasmosis in Slovenia may make the costing of preventive screening programmes justifiable.

Serological evidence for human cystic echinococcosis in Slovenia

BackgroundCystic echinococcosis (CE) is caused by the larva of tapeworm Echinococcus granulosus. Dogs and other canids are the primary definitive hosts for this parasite. CE may develop after accidental ingestion of tapeworm eggs, excreted with the feces of these animals. In the intestine, the larvae released from the eggs are nested in the liver, lungs or other organs of livestock as intermediate hosts and humans as aberrant hosts. The aim of this study was to examine serologically whether some of the patients in Slovenia, suspected of CE by imaging findings in the liver or lungs had been infected with the larva of Echinococcus granulosus.MethodsBetween January 1, 2002 and the end of December 2006, 1323 patients suspected of having echinococcosis were screened serologically by indirect haemagglutination assay (IHA). For confirmation and differentiation of Echinococcus spp. infection, the sera of IHA-positive patients were then retested by western blot (WB).ResultsOut of 127 IHA-positive sera, 34 sera were confirmed by WB and considered specific for CE. Of 34 sera of CE-positive patients sera, 32 corresponded to the characteristic imaging findings of a liver cysts and 2 to those of lung cysts. The mean age of CE-positive patients was 58.3 years. No significant differences were found between the CE-positive patients in regard to their sex.ConclusionIn the study, it was found out that CE was mostly spread in the same area of Slovenia as in the past, but its prevalence decreased from 4.8 per 105 inhabitants in the period 1956–1968 to 1.7 per 105 inhabitants in the period 2002–2006. In spite of the decreased prevalence of CE in the last years, it is suggested that clinicians and public health authorities, especially in the eastern parts of Slovenia where the most CE patients come from, should pay greater attention to this disease in the future.

Cutaneous myiasis caused by Cordylobia anthropophaga.

ZusammenfassungDie kutane Myiasis ist eine temporäre Besiedlung der Haut beim Menschen oder beim Vertebraten durch Fliegenlarven von vor allem zwei Spezies. In Zentral- und Südamerika wird die kutane Myiasis meist durch die Larven der Dermatobia hominis verursacht, in Afrika meist von Larven der Cordylobia sp. Wir beschreiben einen Fall von kutaner Myiasis bei einer Familie, die von einer 3-wöchigen Reise aus Ghana zurückgekehrt war. Die Parasiten (ca. 1–2 cm im Durchmesser und 0,5–1 cm hohe tumorähnliche Schwellungen) wurden vom Rücken des 48-jährigen Mannes, von der Nase, der Schulter und einem Handgelenk seiner 47-jährigen Frau sowie vom Rücken der 14-jährigen Tochter entfernt. Die Parasiten wurden als Larven der Cordylobia antropophaga Fliege indentifiziert. Nach Entfernung der ungefähr 8 mm großen Larven heilten die Läsionen innerhalb von 2 Wochen ohne weitere Therapie. Fälle von kutaner Myiasis beim Menschen sind höchstwahrscheinlich häufiger als angenommen, weil viele nicht diagnostiziert bzw. nicht veröffentlicht werden. Da Reisen in tropische und suptropische Gebiete aber immer häufiger werden, sollten Kliniker und Labors bei Furunkel-ähnlichen Läsionen auch an die Möglichkeit einer solchen Cordylobia-Myiasis denken. Dies gilt vor allem für Reisende, die aus dem tropischen Afrika zurückkehren.SummaryCutaneous myiasis is a temporary parasitic infestation of the skin of human and other vertebrates by fly larvae, primarily species of the flies Dermatobia and Cordylobia. In Central and South America cutaneous myiasis is mainly caused by the larvae of Dermatobia hominis; in Africa it is mostly due to the larvae of Cordylobia spp. We describe a case of cutaneous myiasis in a family who returned to Slovenia from a three-week trip to Ghana. The parasites, in tumor-like swellings about 1–2 cm in diameter and 0.5–1 cm high, were removed from the back of the 48-year-old man, the nose, shoulder and wrist of his 47-year-old wife, and the back of their 14-year-old daughter. The parasites were identified as larvae of the fly C. anthropophaga. After removal of the larvae, which were oval-shaped and about 8 mm long, the lesions healed in two weeks without further treatment. Human cases of cutaneous myiasis are most probably underreported because many remain undiagnosed or unpublished. Because of increasing travel to tropical and subtropical areas, clinical and laboratory staff will need to be more alert to the possibility of Cordylobia myiasis in patients with furuncle-like lesions, particularly in individuals who have recently returned from tropical Africa.

Subcutaneous myiasis caused by Dermatobia hominis.

A case of subcutaneous myiasis caused by the larvae of the Dermatobia hominis fly is described, involving the ankle region of a 25-y-old man who had returned from Peru. After removal of 4 larvae from the affected sites, the lesions healed in 2 weeks without further treatment. Because of the increasing number of people travelling to tropical America, physicians in Slovenia will have to consider Dermatobia myiasis in the differential diagnosis of furuncular lesions in patients with a relevant travel history.A case of subcutaneous myiasis caused by the larvae of the Dermatobia hominis fly is described, involving the ankle region of a 25-y-old man who had returned from Peru. After removal of 4 larvae from the affected sites, the lesions healed in 2 weeks without further treatment. Because of the increasing number of people travelling to tropical America, physicians in Slovenia will have to consider Dermatobia myiasis in the differential diagnosis of furuncular lesions in patients with a relevant travel history.

Toxocara antibodies in patients with visceral or ocular disorder in Slovenia

The incidence ofToxocara antibodies was determined in 319 sera from patients suspected of havingToxocara infection. Serological responses were compared with clinical manifestations and age of the patients. A seropositive reaction was found in 24% of the patients. Highly positive results (OD 0.510–1.000 and OD>1.000) by ELISA were obtained significantly more frequently in younger patients than in older ones (p<0.005). The percentage of seropositive patients with visceral disorder was found to decrease with age, whereas the proportion of seropositive patients with ocular disorder increased with age. Serologically confirmedToxocara infection in Slovenia alerted us to the fact that this health issue should be given due attention in the future. Bei 319 Patienten mit Verdacht auf eineToxocara-Infektion wurden Serumantikörper gegenToxocara bestimmt. Bei 24% der Patienten war die Reaktion positiv. Hohe ELISA-Titer (OD 0,510–1000 und Über 1000) fanden sich bei jungen Patienten signifikant häufiger als bei älteren (p<0,005). Bei Patienten mit Organerkrankungen nahm der Anteil seropositiver Fälle mit dem Alter ab, bei Patienten mit Augenstörungen nahmen seropositive Befunde zu. Die Befunde sind alarmierend und weisen darauf hin, daß der Gefährdung der slovenischen Bevölkerung durchToxocara-Infektionen in Zukunft große Aufmerksamkeit geschenkt werden muß.SummaryThe incidence ofToxocara antibodies was determined in 319 sera from patients suspected of havingToxocara infection. Serological responses were compared with clinical manifestations and age of the patients. A seropositive reaction was found in 24% of the patients. Highly positive results (OD 0.510–1.000 and OD>1.000) by ELISA were obtained significantly more frequently in younger patients than in older ones (p<0.005). The percentage of seropositive patients with visceral disorder was found to decrease with age, whereas the proportion of seropositive patients with ocular disorder increased with age. Serologically confirmedToxocara infection in Slovenia alerted us to the fact that this health issue should be given due attention in the future.ZusammenfassungBei 319 Patienten mit Verdacht auf eineToxocara-Infektion wurden Serumantikörper gegenToxocara bestimmt. Bei 24% der Patienten war die Reaktion positiv. Hohe ELISA-Titer (OD 0,510–1000 und Über 1000) fanden sich bei jungen Patienten signifikant häufiger als bei älteren (p<0,005). Bei Patienten mit Organerkrankungen nahm der Anteil seropositiver Fälle mit dem Alter ab, bei Patienten mit Augenstörungen nahmen seropositive Befunde zu. Die Befunde sind alarmierend und weisen darauf hin, daß der Gefährdung der slovenischen Bevölkerung durchToxocara-Infektionen in Zukunft große Aufmerksamkeit geschenkt werden muß.

Evidence of human neurocysticercosis in Slovenia.

To assess the prevalence of Taenia solium cysticercosis in patients with neurological disorders in Slovenia, serum/cerebrospinal fluid (CSF) samples from 348 suspected patients were collected between the beginning of January 2001 and the end of December 2012 and analysed serologically for the presence of anti-T. solium IgG antibodies. Of 20 patients whose samples tested positive or equivocal by enzyme-linked immunosorbent assay (ELISA), samples of 7 patients were confirmed positive by Western blot (WB). The overall seroprevalence rate of T. solium infection in patients with neurological disorders included in the study was 2.0%. Serological results of positive patients corresponded to clinical and/or imaging findings concerning their brain cysts. Based on their personal data, it was ascertained that neurocysticercosis (NCC) positive patients had immigrated or came to Slovenia from the former Yugoslav republics. Since the disease is believed not to be endemic in Slovenia we assume that all of the NCC-positive patients had acquired the infection before immigration to Slovenia or visiting or being visited by their relatives infected with an adult T. solium parasite. The present results represent the first insight into the prevalence of NCC in patients with neurological disorders in Slovenia.