Assessing an Adaptation of the Universal Parasite Diagnostic Assay for Bloodborne Parasites in a US State Public Health Laboratory.

For complex clinical cases where a parasitic infection is suspected, it can be difficult for clinicians to recommend an appropriate laboratory test. These tests are usually pathogen-specific and require a certain degree of suspicion for the precise etiology. A recently described assay, the universal parasite diagnostic (UPDx) can potentially provide a diagnosis of any parasite present in a specimen. Using primers that amplify DNA from all eukaryotes, UPDx differentiates several parasitic infections in blood by amplicon-based next-generation sequencing (NGS) of the 18S rDNA locus. As the state's public health reference laboratory, the Parasitology Laboratory at the Wadsworth Center (Albany, NY) receives specimens from patients who have potentially encountered a wide variety of parasites. As such, the ability to differentiate several blood parasites using a single assay is of interest. We assessed UPDx for its ability to confirm parasitic infections for 20 specimens that were previously identified by real-time PCR (RT-PCR). This included specimens positive for Babesia microti, Trypanosoma cruzi, Leishmania tropica, various Plasmodium species, and specimens comprising mixed Plasmodium sp. infections. Results obtained using UPDx were largely concordant with the RT-PCR assays. A T. cruzi positive specimen was negative by UPDx and for two mixed Plasmodium sp. infections only one species was detected. The results obtained for other specimens were concordant. We conclude that UPDx shows promise for the detection of blood parasites in diagnostic laboratories. As NGS becomes cheaper, assays like UPDx will become increasingly amenable to use in clinical settings.

PREVALENCE OF PARASITIC INFECTIONS IN CHILDREN OF BOKE, GUINEA.

Helminthic and intestinal protozoan infections and malaria infections are common in children less than 15 yr old in sub-Saharan Africa, but little is known about these infections in Guinea. The aim of this study was to determine the prevalence of parasitic infections in children aged less than 15 yr and the relationship of these infections with anemia. The cross-sectional study was done in Dabbis sub-prefecture in the Boke region of Guinea from 18 to 26 March 2017. A simple random sampling at the household level was performed, and 1 child under the age of 15 was included per eligible household. A total of 392 children were included in the analysis. Clinical and parasitological information were assessed, including anthropometric measures (weight and height), disease symptoms, hemoglobin level, and malaria parasitemia. Helminthic and protozoan intestinal infections were present in 59.7% of the children surveyed. Malaria infection prevalence was 45.5% when assessed by microscopy and 43.6% when assessed by a rapid diagnostic test. Plasmodium falciparum, accounting for 84.2% of malaria infections, was the main malaria species infection. Gastrointestinal parasites were present in 19.1% of children. The main gastrointestinal parasites present included Entamoeba coli (5.4%) and Giardia intestinalis (5.1%). There was no association between the presence of anemia and the parasitic status of the children. Parasitic screening and mass treatment in this age group, as well as household awareness raising, would reduce cases of parasitic infections in rural Guinea.

COVID-19 and Corticosteroids: Unfamiliar but Potentially Fatal Infections That Can Arise following Short-Course Steroid Treatment.

Corticosteroid use is increasing worldwide as recent studies confer survival benefit of corticosteroids in the management of patients with severe COVID-19. Strongyloides and amebic infections are neglected diseases that can progress to catastrophic complications in patients exposed to corticosteroids, even with short treatment courses. To prevent lethal outcomes, clinicians should be aware of the threat these two parasitic infections pose to at-risk patients receiving corticosteroids, especially in the era of COVID-19.

Comparing spatio-temporal distribution of the most common human parasitic infections in Iran over two periods 2007 to 2012 and 2013 to 2018: A systematic quantitative literature review.

This study analyses the spatio-temporal trend of the prevalence of the four most prevalent parasitic diseases in Iran over two periods, 2007 to 2012 and 2013 to 2018, indicating high-risk and low-risk areas. Out of 19 126 articles, we selected 220 articles for data extraction and calculated the pooled prevalence for cutaneous leishmaniasis, human toxoplasmosis, giardiasis and blastocystosis for all 31 provinces in the country. Anselin local Moran's I was used to identify clusters and outliers in the prevalence rates. The mean prevalence of cutaneous leishmaniasis patients was found 35.12 per 100 000 in 2007 to 2012 but fell to 19.12 per 100 000 in the 2013 to 2018 period. The mean prevalence of acute and chronic toxoplasmosis was 2.36% and 32.5%, respectively, in 2007 to 2012, which changed to 2.28% and 31.14% in 2013 to 2018. The total prevalence of giardiasis declined from 9.8% in 2007 to 2012 to 4.8% in 2013 to 2018, while the mean prevalence of blastocystosis declined from 8.9% in 2007 to 2012 to 6.76% in the 2013 to 2018 period. There was only one high-high cluster in 2007 to 2012 and that was due to giardiasis, while there were two in 2013 to 2018, one for blastocystosis and one for chronic toxoplasmosis. The total prevalence of blastocystosis, giardiasis and cutaneous leishmaniasis in Iran has continually declined since 2007. In contrast, the prevalence of toxoplasmosis in pregnant Iranian women has not been changed. Iran's Midwest has more parasitic infections compared to the Mideast, which may be explained by the existence of vast deserts and consequently dry and hot climate in the latter part of the country.

Recent Advances in the Discovery of Novel Antiprotozoal Agents.

Parasitic diseases have serious health, social, and economic impacts, especially in the tropical regions of the world. Diseases caused by protozoan parasites are responsible for considerable mortality and morbidity, affecting more than 500 million people worldwide. Globally, the burden of protozoan diseases is increasing and is been exacerbated because of a lack of effective medication due to the drug resistance and toxicity of current antiprotozoal agents. These limitations have prompted many researchers to search for new drugs against protozoan parasites. In this review, we have compiled the latest information (2012-2017) on the structures and pharmacological activities of newly developed organic compounds against five major protozoan diseases, giardiasis, leishmaniasis, malaria, trichomoniasis, and trypanosomiasis, with the aim of showing recent advances in the discovery of new antiprotozoal drugs.

Parasitic Infections Associated with Unfavourable Outcomes in Transplant Recipients.

Introduction. The immunosuppression used after transplantation (Tx) is associated with an increased risk of opportunistic infections. In Europe, parasitic infections after Tx are much less common than viral, bacterial and fungal ones. However, diseases caused by parasites are very common in tropical countries. In the last years the number of travellers with immunosuppression visiting tropical countries has increased. Methods. We performed a literature review to evaluate a risk of parasitic infections after Tx in Europe. Results. There is a real risk of parasitic infection in patients after Tx travelling to tropical countries. Malaria, leishmaniasis, strongyloidiasis and schistosomiasis are the most dangerous and relatively common. Although the incidence of these tropical infections after Tx has not increased, the course of disease could be fatal. There are also some cosmopolitan parasitic infections dangerous for patients after Tx. The greatest threat in Europe is toxoplasmosis, especially in heart and bone marrow recipients. The most severe manifestations of toxoplasmosis are myocarditis, encephalitis and disseminated disease. Diarrhoea is one of the most common symptoms of parasitic infection. In Europe the most prevalent pathogens causing diarrhoea are Giardia duodenalis and Cryptosporidium. Conclusions. Solid organ and bone marrow transplantations, blood transfusions and immunosuppressive treatment are associated with a small but real risk of parasitic infections in European citizens. In patients with severe parasitic infection, i.e., those with lung or brain involvement or a disseminated disease, the progression is very rapid and the prognosis is bad. Establishing a diagnosis before the patient's death is challenging.

A Comprehensive Review of Hirudiniasis: From Historic Uses of Leeches to Modern Treatments of Their Bites.

Exposure to leeches in the wilderness setting is common. Leeches may attach themselves to exposed skin or pass through one of the body's orifices and attach internally. The condition of leech attachment is known as hirudiniasis, which can result in serious morbidity and, rarely, mortality. A comprehensive review of the literature was performed to detail the prevention of leech attachment, as well as both anecdotal and studied methods of removal. Complications from leech attachments include ongoing bleeding, wound infection, and poor wound healing. Although medicinal leeches are the most well-studied variety, this review examines all aspects of leech attachment, prevention, and management.

[Hospitalizations for ambulatory care-sensitive conditions: validation study at a Hospital Information System (SIH) in the Federal District, Brazil, in 2012]. / Internações por condições sensíveis à atenção primária: estudo de validação do SIH/SUS em hospital do Distrito Federal, Brasil, 2012.

This study analyzes hospitalizations due to ambulatory care-sensitive conditions with a focus on infectious and parasitic diseases (IPDs) and validates the Hospital Information System, Brazilian Unified National Health System (SIH/SUS) for recording hospitalizations due to ambulatory care-sensitive conditions in a hospital in the Federal District, Brazil, in 2012. The study estimates the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the SIH for recording hospitalizations due to ambulatory care-sensitive conditions, with the patient's medical file as the gold standard. There were 1,604 hospitalizations for hospitalizations due to ambulatory care-sensitive conditions (19.6%, 95%CI: 18.7-20.5), and the leading IPDs were renal and urinary tract infection, infection of the skin and subcutaneous tissue, and infectious gastroenteritis. IPDs were the leading cause of hospitalization in the 20 to 29-year age bracket and caused 28 deaths. Sensitivity was 70.1% (95%CI: 60.5-79.7), specificity 88.4% (95%CI: 85.6-91.2), PPV = 51.7% (95%CI: 42.7-60.7), and NPV = 94.3% (95%CI: 92.2-96.4). The findings for admissions due to ACSCs in this hospital were similar to those of other studies, featuring admissions for IPDs. The SIH/SUS database was more specific than sensitive.

Seasonality of nematode larvae in Iguanodectes spilurus (Characidae) an ornamental fish from northeastern Para, Brazil / Sazonalidade de larvas de nematóide em Iguanodectes spilurus (Characidae) um peixe ornamental no nordeste do Pará, Brasil

The current study presents a parasitological survey of larval nematodes from freshwater ornamental fish Iguanodectes spilurus caught in the watercourse of the Caete River, in the northeast region of the State of Para, Brazil. A total of 176 specimens, 1.36±0.75 g weight and 5.53±0.98 cm total length, were analyzed. Nematode larvae were identified as Capillaria sp., Procamallanus sp. and Anisakidae, with prevalence of 70.45% and infection intensity ranging from 1.81 to 4.70 larvae. The highest prevalence 57.38% occurred in the liver, but no seasonality was observed, indicating high infection throughout the year. Seasonality was observed in fish parasitized in the stomach, intestine and caecum, with prevalence and mean intensity of 17.61% and 2.32 parasites, 12.5% and 1.81 parasites, 10.79% and 2.21 parasites, respectively. The highest degree of infection was observed in the rainy season, probably due to increased availability of intermediate hosts or food.

O presente estudo apresenta um levantamento parasitológico de larvas de nematóides de Iguanodectes spilurus capturados no fluxo do Rio Caeté, nordeste do Pará, Brasil. Um total de 176 espécimes com médias de 1,36 ± 0,75 g de peso e 5,53 ± 0,98 cm de comprimento total foram analisados. Foram identificados em 124 peixes os nematóides Capillaria sp., Procamallanus sp. e da família Anisakidae, apresentaram uma prevalência de 70,45% e intensidade de infecção de 1,81 a 4,70 larvas. A maior prevalência foi de 57,38% no fígado, mas não foi observada sazonalidade, indicando alta potência de infecção ao longo do ano. A sazonalidade foi observada em peixes parasitados no intestino, estômago e ceco com prevalência e intensidade média de 17,61% e 2,32 parasitas, 12,5% e 1,81 parasitas, 10,79% e 2,21 parasitas, respectivamente. A maior infecção foi encontrada na estação chuvosa, provavelmente devido ao aumento da disponibilidade de hospedeiros intermediários ou de alimentos.

Epidemiological and clinical picture of parasitic infections in the group of children and adolescents from north-east region of Poland.

The epidemiological and clinical purview of parasite diseases is constantly evolving, mainly due to the changes in human behavior and our environment. The aim of this study was frequency analysis of certain parasite infections, risk factors and clinical symptoms in children and adolescents of north-eastern Poland. 120 children were tested due to the symptoms resembling parasite infection from December 2008 to May 2009. 90 patients (the tested group) aged from 5 months to 18 years were found to be infected with one or more than one of the following parasites: Ascaris lumbricoides, Giardia lamblia, Toxocara spp., Strongyloides stercoralis or Enterobius vermicularis. 30 children with no infections found were the control group. Parasites were found by means of microscope decantation stool tests, RIDA Quick Giardia stool test and ELISA blood test (Toxocara IgG). The patients' parents filled out the survey concerning the probability factors of infection and the ailments that were the cause of parasitical diagnosis. High percentage of either isolated or co-invasive parasite infections was ascertained in the tested group--75%. The prevalence of ascariasis was 55.83%, toxocariasis--16.67%, giardiasis--12.5%, strongyloidiasis--5.83% and of enterobiasis--3.33%. The statistical significance of higher dirty hands-mouth contact frequency and more frequent presence of domestic animals in the tested group than in the control group was ascertained. A highly important correlation between the infection and the occurrence of symptoms from at least 3 various systems was ascertained. The presence of habits involving dirty hands-mouth contact and having domestic animals are significant risk factors of parasite infections. The presence of symptoms from at least 3 systems should compel to parasite infection diagnosis with proper differential diagnosis.

Predicting drugs and proteins in parasite infections with topological indices of complex networks: theoretical backgrounds, applications, and legal issues.

Quantitative Structure-Activity Relationship (QSAR) models have been used in Pharmaceutical design and Medicinal Chemistry for the discovery of anti-parasite drugs. QSAR models predict biological activity using as input different types of structural parameters of molecules. Topological Indices (TIs) are a very interesting class of these parameters. We can derive TIs from graph representations based on only nodes (atoms) and edges (chemical bonds). TIs are not time-consuming in terms of computational resources because they depend only on atom-atom connectivity information. This information expressed in the molecular graphs can be tabulated in the form of adjacency matrices easy to manipulate with computers. Consequently, TIs allow the rapid collection, annotation, retrieval, comparison and mining of molecular structures within large databases. The interest in TIs has exploded because we can use them to describe also macromolecular and macroscopic systems represented by complex networks of interactions (links) between the different parts of a system (nodes) such as: drug-target, protein-protein, metabolic, host-parasite, brain cortex, parasite disease spreading, Internet, or social networks. In this work, we review and comment on the following topics related to the use of TIs in anti-parasite drugs and target discovery. The first topic reviewed was: Topological Indices and QSAR for antiparasitic drugs. This topic included: Theoretical Background, QSAR for anti-malaria drugs, QSAR for anti-Toxoplasma drugs. The second topic was: TOMO-COMD approach to QSAR of antiparasitic drugs. We included in this topic: TOMO-COMD theoretical background and TOMO-COMD models for antihelmintic activity, Trichomonas, anti-malarials, anti-trypanosome compounds. The third section was inserted to discuss Topological Indices in the context of Complex Networks. The last section is devoted to the MARCH-INSIDE approach to QSAR of antiparasitic drugs and targets. This begins with a theoretical background for drugs and parameters for proteins. Next, we reviewed MARCH-INSIDE models for Pharmaceutical Design of antiparasitic drugs including: flukicidal drugs and anti-coccidial drugs. We close MARCH-NSIDE topic with a review of multi-target QSAR of antiparasitic drugs, MARCH-INSIDE assembly of complex networks of antiparasitic drugs. We closed the MARCH-INSIDE section discussing the prediction of proteins in parasites and MARCH-INSIDE web-servers for Protein-Protein interactions in parasites: Plasmod-PPI and Trypano-PPI web-servers. We closed this revision with an important section devoted to review some legal issues related to QSAR models.

Parasite zoonoses and wildlife: emerging issues.

The role of wildlife as important sources, reservoirs and amplifiers of emerging human and domestic livestock pathogens, in addition to well recognized zoonoses of public health significance, has gained considerable attention in recent years. However, there has been little attention given to the transmission and impacts of pathogens of human origin, particularly protozoan, helminth and arthropod parasites, on wildlife. Substantial advances in molecular technologies are greatly improving our ability to follow parasite flow among host species and populations and revealing valuable insights about the interactions between cycles of transmission. Here we present several case studies of parasite emergence, or risk of emergence, in wildlife, as a result of contact with humans or anthropogenic activities. For some of these parasites, there is growing evidence of the serious consequences of infection on wildlife survival, whereas for others, there is a paucity of information about their impact.

Integrative approaches to the study of primate infectious disease: implications for biodiversity conservation and global health.

The close phylogenetic relationship between humans and nonhuman primates, coupled with the exponential expansion of human populations and human activities within primate habitats, has resulted in exceptionally high potential for pathogen exchange. Emerging infectious diseases are a consequence of this process that has the capacity to threaten global health and drive primate population declines. Integration of standardized empirical data collection, state-of-the-art diagnostics, and the comparative approach offers the opportunity to create a baseline for patterns of infection in wild primate populations; to better understand the role of disease in primate ecology, behavior, and evolution; and to examine how anthropogenic effects alter the zoonotic potential of various pathogenic organisms. We review these technologies and approaches, including noninvasive sampling in field conditions, and we identify ways in which integrative research activities are likely to fuel future discoveries in primate disease ecology. In addition to considering applied aspects of disease research in primate health and conservation, we review how these approaches are shedding light on parasite biodiversity and the drivers of disease risk across primate species.

Host-parasite kinship in a female-philopatric bird population: evidence from relatedness trend analysis.

Conspecific brood parasitism (CBP), an alternative reproductive tactic where some females lay eggs in the nests of other females of the same species, occurs in many animals with egg care. It is particularly common in waterfowl, for reasons that are debated. Many waterfowl females nest near their birthplace, making it likely that some local females are relatives. We analyse brood parasitism in a Hudson Bay population of common eiders, testing predictions from two alternative hypotheses on the role of relatedness in CBP. Some models predict host-parasite relatedness, others predict that parasites avoid close relatives as hosts. To distinguish between the alternatives, we use a novel approach, where the relatedness of host-parasite pairs is tested against the spatial population trend in pairwise relatedness. We estimate parasitism, nest take-over and relatedness with protein fingerprinting and bandsharing analysis of egg albumen, nondestructively sampled from each new egg in the nest throughout the laying period. The results refute the hypothesis that parasites avoid laying eggs in the nests of related hosts, and corroborate the alternative of host-parasite relatedness. With an estimated r of 0.12-0.14, females laying eggs in the same nest are on average closer kin than nesting neighbour females. Absence of a population trend in female pairwise relatedness vs. distance implies that host-parasite relatedness is not only an effect of strong natal philopatry: some additional form of kin bias is also involved.

The impact on database searching arising from inconsistency in the nomenclature of parasitic diseases.

The existing usage of disease names formed from the name of the parasite taxon is characterised by marked heterogeneity. This is largely due to the fact that, for coining disease names, four different suffixes, '-osis', '-iosis', '-asis' and '-iasis', are being used inconsistently. The result is that alternative terms are in use for naming the same disease, e.g. trypanosomosis and trypanosomiasis, fasciolosis and fascioliasis, ascariosis and ascariasis. Inspite of the SNOAPAD/SNOPAD guideline (1988) which proposed the principles of a uniform and standard disease nomenclature, the actual usage depends largely on tradition, educational imprinting and personal preferences, showing great variation. By using alternative disease names as search terms the author investigates in four databases the impact of nomenclatural heterogeneity on information storage and retrieval. It is evident that the existence of alternative disease names in parasitology markedly interferes with the efficacy of online data retrieval. The value of a disease name as a search term was shown to be greatly different in various databases. Until we have to coexist with an inconsistent disease terminology we need to adopt specially structured database-search techniques to ensure a proper level of precision in searching. Such possible techniques are considered.

Nomenclature for parasitic diseases: cohabitation with inconsistency for how long and why?

The author surveys the early history of nomenclature for parasitic diseases or infections which led to the existing usage of synonymous names with diverse spellings for denominating the same disease entities. In order to diminish heterogeneity in nomenclatural usage, principles of the standardized nomenclature of parasitic diseases (SNOPAD) have been put forward by the World Association for the Advancement of Veterinary Parasitology. Pros and cons regarding the SNOPAD concept are discussed in seeking consensus terminology. The need for a standard nomenclature may be judged differently. SNOPAD is just a guideline based on carefully reasoned and clearly defined principles for those authors and editors dissatisfied with the existing heterogeneous and inconsistent nomenclatural usage and wish to rely on a uniform and standard disease nomenclature. The major suggestion of SNOPAD is the use solely of suffix -osis when disease name is coined from the name of a parasite taxon. Meanwhile, the proposed principles were found sensible and accepted more in the field of veterinary, less in medical parasitology. In a recent survey it has been revealed that the majority (73.8%) of 126 national language parasitological textbooks or compendia from 21 countries of Europe published since 1990 adopted consistent '-osis' disease terminology and the rest (26.2%) used a mixture of disease names ending in '-osis' and '-iasis' inconsistently. For achieving substantial shift towards the use of more consistent disease terminology, the interest and support of the parasitologists' community is required. Editorials and database producers hold the key to further progress provided they see the advantages of the use of a single name of worldwide currency for each disease entity.

Effect of asymptomatic natural infections due to common mouse pathogens on the metastatic progression of B16 murine melanoma in C57BL/6 mice.

To investigate whether the presence of infections in C57BL/6 mice influences the metastatic ability of B16 melanoma (B16M) cells, we compared the susceptibility to metastasis development of pathogen-free mice with that of mice from a colony endemically infected with several mouse pathogens. We found that, compared to seronegative controls, mice that were seropositive at least to Mouse Hepatitis Virus (MHV) and Mycoplasma pulmonis: (i) exhibited a higher interindividual variability in all the parameters quantifying metastatic progression; (ii) had elevated serum levels of proinflammatory cytokines both before and at the end of the experiment; (iii) were more susceptible to hepatic metastasis. Interestingly, final levels of tumor necrosis factor (TNF)-alpha and interleukin (IL)-18 correlated with the extent of hepatic colonization by the melanoma cells. To confirm the metastasis-enhancing effect of MHV and M. pulmonis we measured the ability of B16M cells to metastasize in pathogen-free animals housed for increasing time-intervals in the vicinity of MHV(+) animals. Notably, susceptibility to metastasis was lower in animals seronegative to MHV than in MHV(+) mice, whereas the latter were less susceptible to metastasis than MHV(+) M. pulmonis(+) mice. Seropositive animals had increased levels of TNF-alpha and IL-18 suggesting that MHV and M. pulmonis enhance the metastatic ability of melanoma cells by inducing the release of proinflammatory cytokines. While our results highlight the importance of using pathogen-free animals in metastasis studies, they emphasize the need for a comprehensive health monitoring of the mice used in such studies, particularly in case of using facilities lacking appropriate containment measures.