Microorganisms

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16 pages, 1439 KiB

Open AccessArticle

Strongyloidiasis in Children Outside the Tropics: Do We Need to Increase Awareness?

by Elisabetta Venturini, Lara Fusani, Antonia Mantella, Leila Bianchi, Alberto Antonelli, Carlotta Montagnani, Elena Chiappini, Michele Spinicci, Alessandro Bartoloni, Gian Maria Rossolini, Lorenzo Zammarchi and Luisa Galli

Microorganisms 2021, 9(9), 1905; https://doi.org/10.3390/microorganisms9091905 - 8 Sep 2021

Cited by 2 | Viewed by 2364

Abstract

Strongyloidiasis belongs to the group of neglected tropical diseases, due to diagnostic difficulties and the lack of systematic screening. Studies on strongyloidiasis prevalence are often heterogenous and mainly performed in adults in endemic countries. We retrospectively enrolled 2633 children referred to a tertiary [...] Read more.

Strongyloidiasis belongs to the group of neglected tropical diseases, due to diagnostic difficulties and the lack of systematic screening. Studies on strongyloidiasis prevalence are often heterogenous and mainly performed in adults in endemic countries. We retrospectively enrolled 2633 children referred to a tertiary care hospital in Italy between 2009 and 2020 and tested for S. stercoralis infection. Sixty-one (2.3%) had a positive serology and for 55 of them, clinical and epidemiological information were available. Thirteen cases (24%) were diagnosed in Italian children without history residency or travel to foreign countries, while the remaining were internationally adopted or migrant children. Seropositive patients were mostly asymptomatic, and often eosinophilia was the only sign of strongyloidiasis. Sero-reactivity to Toxocara canis was found in 1/3 of patients. Ivermectin was used in 37 (75.5%) treated patients. A significant reduction of eosinophil levels and IgG titer was seen after treatment. Our study confirms that strongyloidiasis is usually asymptomatic in children. However, due to the ability of the parasite to cause a life-long infection together with the risk of a severe form in case of immunosuppression, it is important to identify and treat infected children. Special consideration should be reserved to high-risk groups, such as immigrants and international adoptees, where screening for S. stercoralis is indicated. However, the study highlights that sporadic cases of autochthonous strongyloidiasis in Italy may occur. Therefore, pediatricians should be aware of this condition, which is often under-recognized. Full article

(This article belongs to the Special Issue Neglected Tropical Diseases outside the Tropics)

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22 pages, 21734 KiB

Open AccessArticle

Cutaneous Leishmaniasis in Algeria; Highlight on the Focus of M’Sila

by Razika Benikhlef, Karim Aoun, Abdelkarim Boudrissa, Meriem Ben Abid, Kamel Cherif, Wafa Aissi, Souad Benrekta, Said C. Boubidi, Gerald F. Späth, Aïda Bouratbine, Denis Sereno and Zoubir Harrat

Microorganisms 2021, 9(5), 962; https://doi.org/10.3390/microorganisms9050962 - 29 Apr 2021

Cited by 10 | Viewed by 3518

Abstract

Algeria ranks second after Afghanistan for the incidence of cutaneous leishmaniasis (CL) worldwide. Here, we report a 34-years retrospective analysis of CL in Algeria and focused on the most affected region, the M’Sila province. All 66 cutaneous isolates corresponded to Leishmania (L [...] Read more.

Algeria ranks second after Afghanistan for the incidence of cutaneous leishmaniasis (CL) worldwide. Here, we report a 34-years retrospective analysis of CL in Algeria and focused on the most affected region, the M’Sila province. All 66 cutaneous isolates corresponded to Leishmania (L.) major. Our study of the sandfly and rodent fauna further highlighted the high density of Phlebotomus papatasi and additional phlebotomine species of medical importance, not previously identified in M’Sila. Wild rodents belonging to nine species were trapped in M’Sila, and Psammomys obesus and Meriones shawi were found infected by L. major. In addition, Leishmania infantum was isolated from two visceral leishmaniasis cases, one dog and its proven vectors (P. perniciosus, P. longicuspis, and P. perfiliewi) inventoried during the survey. The high incidence of CL in the M’Sila province is likely a consequence of the increase in minimum temperatures recorded that constitutes suitable conditions for establishing a high endemicity and leads to an explosive rise in leishmaniases cases in this region. A thorough investigation of the underlying risk factors is urgently needed to detect new cases earlier. All these would improve the preparedness to fight the disease. Full article

(This article belongs to the Special Issue Neglected Tropical Diseases outside the Tropics)

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8 pages, 362 KiB

Open AccessCommunication

Prevalence of Strongyloidiasis in a Cohort of Migrants in Italy and Accuracy of a Novel ELISA Assay for S. stercoralis Infection, a Cross-Sectional Study

by Dora Buonfrate, Rosalia Marrone, Ronaldo Silva, Concetta Mirisola, Andrea Ragusa, Manuela Mistretta, Francesca Perandin and Zeno Bisoffi

Microorganisms 2021, 9(2), 401; https://doi.org/10.3390/microorganisms9020401 - 15 Feb 2021

Cited by 9 | Viewed by 1899

Abstract

Strongyloides stercoralis infection is a life-threatening neglected tropical disease. Diagnostic issues have caused an underestimation of its global burden. The choice of appropriate diagnostic tests for the screening of populations at risk of the infection, such as migrants from endemic countries, is of [...] Read more.

Strongyloides stercoralis infection is a life-threatening neglected tropical disease. Diagnostic issues have caused an underestimation of its global burden. The choice of appropriate diagnostic tests for the screening of populations at risk of the infection, such as migrants from endemic countries, is of paramount importance. From November 2017 to July 2018, all migrants presenting to the National Institute for Health Migration and Poverty (INMP) in Rome, Italy were offered screening tests for S. stercoralis infection. The study objective was to estimate the prevalence of strongyloidiasis in the study population and the accuracy of a novel ELISA assay. The following tests were carried out at the IRCCS Sacro Cuore Don Calabria hospital in Negrar, Verona: stool microscopy, real-time PCR for S. stercoralis, in-house immunofluorescence test (IFAT), a commercial ELISA assay (Bordier ELISA), and a novel ELISA assay (Euroimmun ELISA). A latent class analysis (LCA) model set up with test results, clinical variables, and eosinophilia indicated a prevalence around 7.5%, in line with previous findings. The sensitivity and the specificity of Euroimmun ELISA were 90.6% (95% CI 80.5–100) and 87.7% (95CI 84.5–91.0); these results indicate that the novel ELISA assay would be suitable for screening of migrants from endemic countries. Full article

(This article belongs to the Special Issue Neglected Tropical Diseases outside the Tropics)

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12 pages, 1831 KiB

Open AccessArticle

Arbo-Score: A Rapid Score for Early Identification of Patients with Imported Arbovirosis Caused by Dengue, Chikungunya and Zika Virus

by Iacopo Vellere, Filippo Lagi, Michele Spinicci, Antonia Mantella, Elisabetta Mantengoli, Giampaolo Corti, Maria Grazia Colao, Federico Gobbi, Gian Maria Rossolini, Alessandro Bartoloni and Lorenzo Zammarchi

Microorganisms 2020, 8(11), 1731; https://doi.org/10.3390/microorganisms8111731 - 4 Nov 2020

Cited by 4 | Viewed by 2093

Abstract

Background: Chikungunya (CHIKV), Dengue (DENV), and Zika (ZIKV) viruses present significant clinical and epidemiological overlap, making an accurate and rapid diagnosis challenging. Timely activation of preventive vector control measures is crucial to avoid outbreaks in non-endemic settings. Diagnosis is based on combination of [...] Read more.

Background: Chikungunya (CHIKV), Dengue (DENV), and Zika (ZIKV) viruses present significant clinical and epidemiological overlap, making an accurate and rapid diagnosis challenging. Timely activation of preventive vector control measures is crucial to avoid outbreaks in non-endemic settings. Diagnosis is based on combination of serological and molecular assays which could be time consuming and sometimes disappointing. Methods: We report the results of a retrospective case-control study carried out at a tertiary teaching hospital in Italy, including all febrile subjects returning from tropical countries during the period 2014–2019. Controls were travelers with other febrile illnesses who tested negative in laboratory analysis for CHIKV, DENV, ZIKV arbovirosis. A score weighted on the regression coefficients for the independent predictors was generated. Results: Ninety patients were identified: 34 cases (22 DENV, 4 CHIKV, and 8 ZIKV) and 56 controls. According to our results, myalgia, cutaneous rash, absence of respiratory symptoms, leukopenia, and hypertransaminasemia showed the strongest association with arbovirosis. Combining these variables, we generated a scoring model that showed an excellent performance (AUC 0.93). The best cut-off (>=2) presented a sensitivity of 82.35% and specificity of 96.43%. Conclusion: A handy and simple score, based on three clinical data (myalgia, cutaneous rash and absence of respiratory symptoms) and two laboratory results (leukopenia and hypertransaminasemia), provides a useful tool to help diagnose arboviral infections and appropriately activate vector control measures in order to avoid local transmission. Full article

(This article belongs to the Special Issue Neglected Tropical Diseases outside the Tropics)

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12 pages, 1026 KiB

Open AccessCommunication

Performance Evaluation of a Commercial Real-Time PCR Assay and of an In-House Real-Time PCR for Trypanosoma cruzi DNA Detection in a Tropical Medicine Reference Center, Northern Italy

by Silvia Stefania Longoni, Elena Pomari, Alberto Antonelli, Fabio Formenti, Ronaldo Silva, Stefano Tais, Salvatore Scarso, Gian Maria Rossolini, Andrea Angheben and Francesca Perandin

Microorganisms 2020, 8(11), 1692; https://doi.org/10.3390/microorganisms8111692 - 30 Oct 2020

Cited by 7 | Viewed by 1920

Abstract

Chagas disease, a neglected protozoal disease endemic in Latin America, is also currently considered an emerging threat in nonendemic areas because of population movements. The detection of Trypanosoma cruzi DNA is increasingly being considered as important evidence to support Chagas disease diagnoses. However, [...] Read more.

Chagas disease, a neglected protozoal disease endemic in Latin America, is also currently considered an emerging threat in nonendemic areas because of population movements. The detection of Trypanosoma cruzi DNA is increasingly being considered as important evidence to support Chagas disease diagnoses. However, further performance evaluation of molecular assays is useful for a standardization of strategy considering the whole process in routine diagnosis, especially for the different settings such as endemic and nonendemic countries. Seventy-five samples were collected from subjects screened for Chagas disease in Italy. The DNA was isolated from blood using automated extraction. We evaluated the performance of the commercial RealCycler^® CHAG kit (pmPCR) based on satellite DNA (SatDNA) and of an in-house real-time PCR (ihPCR) targeting Sat and kinetoplast (k) DNAs, using the concordance of two serology assays as a reference standard. The sensitivity of kDNA and SatDNA tests by ihPCR and SatDNA by pmPCR were 14.29% (95% confidence interval (CI) 6.38 to 26.22), 7.14% (95% CI 1.98 to 17.29), and 7.14% (95% CI 1.98 to 17.29), respectively. Specificity was 100% for all PCR assays and targets. Overall, our results suggest that the preferred approach for clinical laboratories is to combine the kDNA and SatDNA as targets in order to minimize false-negative results increasing sensitivity. Full article

(This article belongs to the Special Issue Neglected Tropical Diseases outside the Tropics)

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16 pages, 2274 KiB

Open AccessArticle

Leprosy in Refugees and Migrants in Italy and a Literature Review of Cases Reported in Europe between 2009 and 2018

by Anna Beltrame, Gianfranco Barabino, Yiran Wei, Andrea Clapasson, Pierantonio Orza, Francesca Perandin, Chiara Piubelli, Geraldo Badona Monteiro, Silvia Stefania Longoni, Paola Rodari, Silvia Duranti, Ronaldo Silva, Veronica Andrea Fittipaldo and Zeno Bisoffi

Microorganisms 2020, 8(8), 1113; https://doi.org/10.3390/microorganisms8081113 - 24 Jul 2020

Cited by 6 | Viewed by 2674

Abstract

Leprosy is a chronic neglected infectious disease that affects over 200,000 people each year and causes disabilities in more than four million people in Asia, Africa, and Latin America. The disease can appear with a wide spectrum of clinical forms, and therefore the [...] Read more.

Leprosy is a chronic neglected infectious disease that affects over 200,000 people each year and causes disabilities in more than four million people in Asia, Africa, and Latin America. The disease can appear with a wide spectrum of clinical forms, and therefore the clinical suspicion is often difficult. Refugees and migrants from endemic countries affected by leprosy can remain undiagnosed in Europe due to the unpreparedness of clinicians. We retrospectively describe the characteristics of 55 refugees/migrants with a diagnosis of leprosy established in Italy from 2009 to 2018. Continents of origin were Africa (42%), Asia (40%), and South and Central America (18%). The symptoms reported were skin lesions (91%), neuropathy (71%), edema (7%), eye involvement (6%), fever (6%), arthritis (4%), and lymphadenopathy (4%). Seven patients (13%) had irreversible complications. Overall, 35% were relapses and 66% multibacillary leprosy. Furthermore, we conducted a review of 17 case reports or case series and five nationwide reports, published in the same decade, describing 280 migrant patients with leprosy in Europe. In Europe, leprosy is a rare chronic infectious disease, but it has not completely disappeared. Diagnosis and treatment of leprosy in refugees and migrants from endemic countries are a challenge. European guidelines for this neglected disease in this high-risk population would be beneficial. Full article

(This article belongs to the Special Issue Neglected Tropical Diseases outside the Tropics)

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Review

Jump to: Research, Other

12 pages, 1274 KiB

Open AccessReview

Soil-Transmitted Helminths and Anaemia: A Neglected Association Outside the Tropics

by Sara Caldrer, Tamara Ursini, Beatrice Santucci, Leonardo Motta and Andrea Angheben

Microorganisms 2022, 10(5), 1027; https://doi.org/10.3390/microorganisms10051027 - 13 May 2022

Cited by 9 | Viewed by 2534

Abstract

Anaemia is an important cause of morbidity and mortality globally. Among infectious agents responsible for anaemia, helminthic infections are often neglected, particularly in non-endemic countries. However, they should not be neglected in this setting, as international travel and migration are on the rise. [...] Read more.

Anaemia is an important cause of morbidity and mortality globally. Among infectious agents responsible for anaemia, helminthic infections are often neglected, particularly in non-endemic countries. However, they should not be neglected in this setting, as international travel and migration are on the rise. In this narrative review, we aimed to describe soil-transmitted helminths as a cause of or contributing factor to anaemia, focusing on hookworms (Necator americanus and Ancylostoma duodenale), the whipworm (Trichuris trichiura), the roundworm (Ascaris lumbricoides), and the threadworm (Strongyloides stercoralis). A general review on the epidemiology, lifecycle, and clinical spectrum of anaemia is proposed, with a special focus on helminthic infections’ association with anaemia as well as the diagnostic approach, which are both particularly important in non-endemic settings. Full article

(This article belongs to the Special Issue Neglected Tropical Diseases outside the Tropics)

Other

Jump to: Research, Review

8 pages, 2219 KiB

Open AccessCase Report

In Vitro Reduced Susceptibility to Pentavalent Antimonials of a Leishmania infantum Isolate from a Human Cutaneous Leishmaniasis Case in Central Italy

by Aurora Diotallevi, Gloria Buffi, Giovanni Corbelli, Marcello Ceccarelli, Margherita Ortalli, Stefania Varani, Mauro Magnani and Luca Galluzzi

Microorganisms 2021, 9(6), 1147; https://doi.org/10.3390/microorganisms9061147 - 26 May 2021

Cited by 3 | Viewed by 2542

Abstract

Cutaneous leishmaniasis (CL) caused by Leishmania (Leishmania) infantum is endemic in the Mediterranean basin. Here we report an autochthonous case of CL in a patient living in central Italy with an unsatisfactory response to treatment with intralesional Meglumine Antimoniate and in [...] Read more.

Cutaneous leishmaniasis (CL) caused by Leishmania (Leishmania) infantum is endemic in the Mediterranean basin. Here we report an autochthonous case of CL in a patient living in central Italy with an unsatisfactory response to treatment with intralesional Meglumine Antimoniate and in vitro demonstration of reduced susceptibility to SbIII. Parasitological diagnosis was first achieved by histopathology on tissue biopsy and the patient was treated with a local infiltration of Meglumine Antimoniate. Since the clinical response at 12 weeks from the treatment’s onset was deemed unsatisfactory, two further skin biopsies were taken for histopathological examination, DNA extraction and parasite isolation. L. (L.) infantum was identified by molecular typing. The low susceptibility to Meglumine Antimoniate was confirmed in vitro: the promastigotes from the patient strain showed significantly lower susceptibility to SbIII (the active trivalent form of antimonial) compared to the reference strain MHOM/TN/80/IPT1. The patient underwent a new treatment course with intravenous liposomal Amphotericin B, reaching complete healing of the lesion. Additional studies are needed to confirm the epidemiological and clinical relevance of reduced susceptibility to SbIII of human L. (L.) infantum isolate in Italy. Full article

(This article belongs to the Special Issue Neglected Tropical Diseases outside the Tropics)

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