Systematic examination of the cardiopulmonary, urogenital, muscular and gastrointestinal parasites of the Eurasian otters (Lutra lutra) in Denmark, a protected species recovering from a dramatic decline.

The Eurasian otter (Lutra lutra) is a protected species in Denmark and at present, the population is recovering due to conservation efforts. The Danish otters are mainly found in the continental part of Denmark (Jutland), but establishment in the main islands (Fyn and Zealand) has been observed. While there is a lack of systematic studies on the parasite fauna of otters in Denmark, this study aims to screen otters for their parasite fauna, especially those of zoonotic and/or veterinary importance. Thirty-three otter carcasses, road-killed (n = 30), found dead (n = 2) and shot (n = 1), were collected between June 2013 and May 2014 and examined for cardiopulmonary, urogenital, gastrointestinal, and muscle helminths by post mortem examination. Faecal samples were analysed by modified concentration McMaster technique and direct immunofluorescence test for Giardia and Cryptosporidium. At least one parasite was found in 75.8% of animals. The parasite fauna included 13 species, consisting of five nematodes: Molineus patens (30.3%), Aonchotheca putorii (27.3%), Strongyloides sp. (24.2%), Physaloptera sp. (12.1%), Eucoleus aerophilus (10.0%); one cestode: Schistocephalus solidius (6.1%); four trematodes: Metorchis bilis (33.3%), Isthimiophora melis (15.2%), Cryptocotyle sp. (3.0%), Plagiorchis sp. (3.0%); one acanthocephalan: Acanthocephalus ranae (18.2%); and two protozoans: Giardia spp. (3.1%), and Eimeria spp. (3.1%). The study showed that otters carry parasites of zoonotic and veterinary importance. Many of these parasites can also infect native carnivores and birds, and the distribution of these parasites may be affected if the otter population continue to increase in Denmark.

Synanthropic Clogmia albipunctata Causing Urogenital and Gastrointestinal Myiasis

Being a synanthropic cosmopolitan fly of tropical origin, Clogmia albipunctata is an aquatic species that is commonly found in moisture-rich places such as inside a house, sewage treatment plants, and hospitals. C. albipunctata can cause urogenital, intestinal, and even nasopharyngeal accidental myiasis under non-hygienic conditions or if a person consumes substandard food. Its larvae enter the human body via bodily cavities such as rectum, genitalia, or urinary canal, thereby leading to the development of infestation. This can in turn cause haematuria, bloody stool, vomiting and fever, with the appearance of larvae in urine and faeces. Here, we present the case of a 43-year-old woman with infection in the urogenital and gastrointestinal systems by the fourth instar larvae of C. albipunctata. To the best of our knowledge, this is the first report of myiasis caused by this species in Turkey. This study will provide general information about the biology of this species and methods to recognize it.

[Urogenital Myiasis Caused by Psychoda spp. in Female Patient with No Risk Factor for Myiasis]. / Miyaz Için Risk Faktörü Bulundurmayan Bir Kadin Hastada Psychoda spp. Kaynakli Ürogenital Miyaz Olgusu.

Myiasis is defined as follows; some flies lay their eggs and larvae on live organs and tissues or on cavities of nose, eye, ear and etc of humans or animals and the larvae develop there and cause pathological disorders. One of the rare types of myiasis is the urogenital myiasis. This condition has been associated with covering urogenital area with clothes in almost all populations and therefore, less chance for flies to reach this site and lay their eggs. Low socio-cultural level and poor hygiene conditions are stated as the most important risk factors of myiasis. On the other hand, toilets within the human living spaces are ideal environments for fly larvae that are fed on bacteria as they contain moisture and a microbial environment. It is stated that especially in case of the presence of an underlying infection, flies are more prone to lay their eggs or larvae on this area due to the bad smell. In this case report, a patient with a moderate sociocultural level with no underlying chronic disease, no open wound in the genital area and no urinary tract infection was presented. A 53-year-old female patient living with her family in an apartment flat in the city center of Konya admitted to the outpatient clinic of infectious diseases with the complaint of moving worms in her urine. The patient stated that she had seen maggots while urinating for two weeks and that she passed her urine into a container to be sure that the maggots were coming from her urine, upon seeing the maggots there she has admitted to the hospital. The Larvae were defined as the fourth stage larvae of Psychoda spp. No open lesions or wounds were seen in genitourinary area of the patient who had no complaints other than mild urinary burning. Complete blood count test results of the patient were normal and there was no growth in her urine culture. It was stated that other family members whom she lived with did not have similar complaints. The patient was diagnosed as genitourinary myiasis caused byPsychoda spp. and informed about the relationship between hygiene and the disease. And urinary antiseptics were initiated as the treatment for the patient. After the treatment, no larvae were seen in the urine of the patient. In conclusion, many regions are suitable for Psychoda type of adult flies to live in our country due to the climate conditions. It is considered that infestation may develop in patients with less risk factors in terms of urogenital myiasis, that larvae may increase in number of patients who are not treated or followed up and that the infestation may become chronic and results in more serious clinical conditions. The necessary treatment and follow-up must be performed in such cases and the patients should be educated about the relationship between infestation and hygiene.

Estrogen receptors in urogenital schistosomiasis and bladder cancer: Estrogen receptor alpha-mediated cell proliferation.

Estrogen-like metabolites have been identified in S. haematobium, the helminth parasite that causes urogenital schistosomiasis (UGS) and in patients´ blood and urine during UGS. Estrogen receptor (ER) activation is enriched in the luminal molecular subtype bladder cancer (BlaCa). To date, the significance of ER to these diseases remains elusive. We evaluated ERα and ERß expression in UGS-related BlaCa (n = 27), UGS-related non-malignant lesions (n = 35), and noninfected BlaCa (n = 80). We investigated the potential of ERα to recognize S. haematobium-derived metabolites by docking and molecular dynamics simulations and studied ERα modulation in vitro using 3 BlaCa cell lines, T24, 5637 and HT1376. ERα was expressed in tumor and stromal cells in approximately 20% noninfected cases and in 30% of UGS-related BlaCa, predominantly in the epithelial cells. Overall, ERα expression was associated with features of tumor aggressiveness such as high proliferation and p53 positive expression. ERα expression correlated with presence of schistosome eggs. ERß was widely expressed in both cohorts but weaker in UGS-related cases. molecular dynamics simulations of the 4 most abundant S. haematobium-derived metabolites revealed that smaller metabolites have comparable affinity for the ERα active state than 17ß-estradiol, while the larger metabolites present higher affinity. Our in vitro findings suggested that ERα activation promotes proliferation in ERα expressing BlaCa cells and that this can be reverted with anti-estrogenic therapy. In summary, we report differential ER expression between UGS-related BlaCa and noninfected BlaCa and provide evidence supporting a role of active ERα during UGS and UGS-induced carcinogenesis.

Connecting Female Genital Schistosomiasis and Menstrual Hygiene Initiatives.

Effective future control of female genital schistosomiasis (FGS) requires an integrated and multisectoral approach, bringing together HIV, sexual and reproductive health, and reproductive rights sectors. In this article, an underappreciated but important connection between FGS and menstrual hygiene initiatives in Africa is highlighted.

Urogenital myiasis caused by Lucilia sericata (Diptera: Calliphoridae) in a domestic rabbit in Italy.

The report describes a case of urogenital myiasis in a domestic rabbit Oryctolagus cuniculus L. (Lagomorpha: Leporidae) caused by Lucilia sericata (Meigen; Diptera: Calliphoridae) in region Emilia-Romagna (Northern Italy). The case, occurring in June 2018, is the first one involving L. sericata as an agent of myiasis in a domestic rabbit in Italy. Species identification was based on morphological investigations of males through identification keys. The rabbit developed the urogenital myiasis as a consequence of chronic enteritis causing an accumulation of faeces in the perianal and perineal region.

Elevation of C-reactive protein, P-selectin and Resistin as potential inflammatory biomarkers of urogenital Schistosomiasis exposure in preschool children.

BACKGROUND: Schistosomiasis is known to induce inflammatory immune responses. C-reactive protein (CRP), resistin and P-selectin are serological inflammatory markers that rise during the acute stages of infection. Here, we propose such inflammatory biomarkers have a potential for use in urogenital schistosomiasis diagnostic screening for exposure and infection in preschool-aged children. METHODS: As part of a larger study on urogenital schistosomiasis, 299 preschool children aged 1-5 years were included in this cross-sectional study. Parasitological diagnosis was conducted using urine filtration for Schistosoma haemtobium infection, and Kato Katz for S. mansoni infection. Serum levels of P-selectin, resistin, CRP, and antibodies against S. haematobium cercarial antigen preparation (CAP) and soluble worm antigen preparation (SWAP) were measured by ELISA. RESULTS: Of the 299 participants, 14% were egg positive for S. haematobium. Serology showed 46 and 9% of the participants to have been exposed to S. haematobium cercarial antigens and adult worm antigens, respectively. Levels of P-selectin were significantly higher in participants infected with S. haematobium (egg-positive) than in uninfected participants (p = 0.001). Levels of P-selectin were also higher in those exposed to cercarial antigen than in unexposed participants (p = 0.019). There was a positive correlation between P-selectin and infection intensity (r = 0.172; p = 0.002), as well as with IgM responses to CAP and SWAP (r = 0.183; p = 0.001); (r = 0.333; p < 0.0001) respectively. CRP significantly correlated with IgM responses to CAP (r = 0.133; p = 0.029) while resistin correlated with IgM responses to CAP and SWAP (r = 0.127; p = 0.016); (r = 0.197; p = 0.0004). CRP levels were higher in those exposed to cercarial and adult worm antigens than unexposed participants (p = 0.035); (p = 0.002) respectively, while resistin was higher in participants exposed to cercarial antigen than unexposed participants (p = 0.024). CONCLUSION: In this preschool population, P-selectin is significantly associated with urogenital schistosome infection and intensity; hence a potential biomarker for infection diagnosis and disease monitoring. The inflammatory biomarkers (P-selectin, Resistin and CRP) were significantly higher in participants exposed to cercarial antigens than unexposed individuals indicating an underlying inflammatory environment.

Urogenital Myiasis Caused by Psychoda albipennis in a Female Child in Libya

Urogenital myiasis is a parasitic infestation caused by larvae of Psychoda spp. and it is very rare in humans. A 10- year old female was presented with urogenital myiasis and 4th stage Larvae of Psychoda albipennis (Diptera: Psychodidae) were found in urine. The patient was complained of painful sensation, discomfort and burning while urination. Urinary tract antiseptics were prescribed for the patient and advised to drink plenty of water for hydration. Local health authorities should take proper measures to maintain hygienic conditions for the people under risk.

Human urogenital myiasis: A systematic review of reported cases from 1975 to 2017.

The public health importance of myiasis [infestation with dipterous (fly) larvae] remains unknown. This disease is spread worldwide in animals and humans, but baseline data on its prevalence are limited. In particular, knowledge on human urogenital myiasis (UGM) is scattered. As such, a systematic search was undertaken of five English and five Persian databases for publications describing UGM cases in English or Persian published between 1975 and 2017. In total, 45 papers reporting 59 UGM cases from various regions of the world are included in this review. All included papers were from the English databases. The age of patients ranged from 5 to 89 years, and the mean age was 40.6 years. Thirty-six of the patients were female and 19 were male. The highest number of cases (n = 12) was reported from Brazil. The most common genera causing UGM were Psychoda spp. (23.7%) and Cochliomyia spp. (11.8%). The vagina was the most commonly reported anatomical location of UGM for women, and the urogenital tract was the most commonly reported location for men. Thirteen cases were reported from rural areas and eight cases from urban areas; the location of other cases was not specified. The incidence of UGM is likely to be substantially underestimated when evaluated based on published case reports. Epidemiological studies, such as questionnaires to medical doctors, could help to gather the necessary baseline data on the occurrence of UGM.

A pilot study using wearable global positioning system data loggers to compare water contact levels: Schistosoma haematobium infection in pre-school-age children (PSAC) and their mothers at Barombi Kotto, Cameroon.

Background: Barombi Kotto, Cameroon serves as a reference location for assessing intervention strategies against Schistosoma haematobium. Methods: As part of a pilot study, the whole community was treated with praziquantel, inclusive of pre-school-age children (PSAC) and their mothers. One year later, egg-patent infections were reassessed and water contact patterns of 12 pairs of PSAC and their mothers were measured with global positioning system (GPS) data loggers. Results: A substantial reduction in general infection prevalence, from 44.8% to 12.2%, was observed but certain PSAC and mothers continued to have egg-patent infections. Analysis of GPS data demonstrated similar water contact levels between the child and mother groups, although certain individuals were numerical outliers. Conclusions: This study shows the potential of GPS data loggers to clarify the at-risk status of PSAC and mothers.

Urogenital Myiasis Caused by Psychoda albipennis.

Myiasis is one of the reasons for urogenital parasitosis in our country. Psychoda albipennis is a fly that leads to urogenital myiasis. In this case, a 28-year-old female with complaints of dysuria, nausea, vomiting, abdominal pain, and dropping larvae with urine was referred to our hospital. Larvae in the urine sample were macroscopically and microscopically examined. Subsequently, the patient was diagnosed with urogenital myiasis due to P. albipennis fourth phase larvae. The symptoms were relieved with antibiotic and urinal antiseptic treatments. A diagnosis of urogenital myiasis should be considered in patients with urogenital complaints.

Urinogenital Myiasis From Blow Fly in a Pakistani Child.

Herein is reported the first case of urogenital myiasis from Peshawar, Pakistan. Third instar blow fly larvae were recovered from the urinogenital tract of a 5-year old female child. The larvae were identified as Chrysomya bezziana(Villeneuve), using Light and Scanning Electron microscopic techniques. The study brings into focus the subject of human myiasis, about which little is known in Pakistan.

Urogenital schistosomiasis in women of reproductive age and pregnant mothers in Kwale County, Kenya.

Generally, women residing in areas endemic for urinary schistosomiasis may suffer from female genital schistosomiasis which is acquired during childhood. The objective of this cross-sectional study was to estimate the prevalence and intensity of infection of Schistosoma haematobium in women of reproductive age (16-45 years) and to investigate whether S. haematobium had any effect on kidney function. A total of 394 women of known pregnancy status (158 pregnant and 236 non-pregnant) were recruited from five villages (known for their high prevalence of infection of S. haematobium) in Kwale County. Serum samples were analysed to determine levels of urea and creatinine as proxy indicators of kidney function. Data revealed that pregnant women did not, on average, have a higher prevalence or intensity of infection of urinary schistosomiasis than non-pregnant women. During pregnancy, the level of prevalence and intensity of infection of S. haematobium was highest in the first trimester (0-13 weeks), dropped in the second trimester (14-26 weeks) and rose again in the third trimester (27-40 weeks). In addition, 24.8% of women were infected with hookworm, while none were diagnosed with malaria parasites. Of 250 samples analysed for serum urea and creatinine, none had significant levels of pathology, either in pregnant or non-pregnant women. Despite World Health Organization (WHO) recommendations that pregnant women should be treated with praziquantel after the first trimester, in practice this has not been the case in many countries, including Kenya. In view of this, healthcare providers should be informed to consider treatment of pregnant women infected with schistosomiasis during antenatal visits and whenever there is mass drug administration as recommended by the WHO.

[Urogenital Myiasis Caused by Psychoda albipennis (Diptera: Psychodidae) in a Woman in Siirt]. / Siirt'te Bir Kadin Hastada Psychoda albipennis (Diptera: Psychodidae)Kaynakli Ürogenital Miyaz.

Urogenital myiasis cases occurring with the settlement of larvae of flies belonging to the order Diptera are facultative and are rarely encountered in humans. In this study, urogenital myiasis caused by Psychoda albipennis in a 20-year-old female patient was presented. The patient was admitted to our hospital with complaints of nausea, vomiting, and dysuria and claimed that she saw motile larvae in her urine. Five larvae collected from the patient's urine were microscopically examined, and they were identified as fourth-stage larvae of Psychoda albipennis. Complaints of the patient ceased after the application of an antibiotic and urinary antiseptic. It was concluded that myiasis should be considered in patients with urogenital complaints.

Immunity in urogenital protozoa.

Innate and adaptive immunity play a significant role in urogenital infections. Innate immunity is provided by the epithelial cells and mucus lining along with acidic pH, which forms a strong physical barrier against the pathogens in female reproductive tract. Cells of innate immune system, antimicrobial peptides, cytokines, chemokines and adaptive immunity in the reproductive tract are evolved during infection, and a pro-inflammatory response is generated to fight against the invading pathogen Trichomonas vaginalis, a primary urogenital protozoa, the etiological agent of human trichomoniasis, a curable sexually transmitted infection. The involvement of the urogenital tract by other protozoal infections such as P. falciparum, Trypanosoma, Leishmania, Toxoplasma, Entamoeba histolytica and Acanthamoeba infection is rarely reported. Trichomonas induce pro-inflammatory and immunosuppressive responses in infected subjects. Multifactorial pathogenic mechanisms including parasite adherence, cysteine proteases, lipophosphoglycan, free radical, cytokine generation and Toll-like receptors appear to interplay with the induction of local and systemic immune responses that ultimately determine the outcome of the infection. However, the involvement of urogenital pathogen-specific immune mechanisms and effect of normal local resident flora on the outcome (symptomatic vs. asymptomatic) of infection are poorly understood. Moreover, immune interactions in trichomoniasis subjects co-infected with bacterial and viral pathogens need to be elucidated.

Eosinophil granule proteins ECP and EPX as markers for a potential early-stage inflammatory lesion in female genital schistosomiasis (FGS).

BACKGROUND: Genital granulomas induced by Schistosoma haematobium eggs can manifest as different lesion types visible by colposcopy; rubbery papules (RP), homogenous sandy patches (HSP) and grainy sandy patches (GSP). Pronounced tissue eosinophilia is a candidate marker for active S. haematobium pathology, as viable schistosome egg granulomas often are eosinophil rich. Here it was investigated whether eosinophil granule proteins ECP (eosinophil cationic protein) and EPX (eosinophil protein-X) in urine and genital lavage can be used as markers for active FGS lesions. METHODS: Uro-genital samples from 118 Malagasy women were analysed for ECP and EPX by standard sandwich avidin/biotin amplified ELISA. PRINCIPAL FINDINGS: The women with RP lesions had significantly higher levels of ECP and EPX in both lavage and urine. Furthermore, women with RP lesions were significantly younger than those with GSP. This could indicate that RP lesions might be more recently established and thus represent an earlier inflammatory lesion stage. CONCLUSION: ECP in genital lavage might be a future tool aiding the identification of FGS pathology at a stage where reversibility remains a possibility following praziquantel treatment.

Genitourinary schistosomiasis: life cycle and radiologic-pathologic findings.

Genitourinary schistosomiasis is produced by Schistosoma haematobium, a species of fluke that is endemic to Africa and the Middle East, and causes substantial morbidity and mortality in those regions. It also may be seen elsewhere, as a result of travel or immigration. S haematobium, one of the five fluke species that account for most human cases of schistosomiasis, is the only species that infects the genitourinary system, where it may lead to a wide spectrum of clinical symptoms and signs. In the early stages, it primarily involves the bladder and ureters; later, the kidneys and genital organs are involved. It rarely infects the colon or lungs. A definitive diagnosis of genitourinary schistosomiasis is based on findings of parasite ova at microscopic urinalysis. Clinical manifestations and radiologic imaging features also may be suggestive of the disease, even at an early stage: Hematuria, dysuria, and hemospermia, early clinical signs of an established S haematobium infection, appear within 3 months after infection. At imaging, fine ureteral calcifications that appear as a line or parallel lines on abdominopelvic radiographs and as a circular pattern on axial images from computed tomography (CT) are considered pathognomonic of early-stage schistosomiasis. Ureteritis, pyelitis, and cystitis cystica, conditions that are characterized by air bubble-like filling defects representing ova deposited in the ureter, kidney, and bladder, respectively, may be seen at intravenous urography, intravenous ureteropyelography, and CT urography. Coarse calcification, fibrosis, and strictures are signs of chronic or late-stage schistosomiasis. Such changes may be especially severe in the bladder, creating a predisposition to squamous cell carcinoma. Genital involvement, which occurs more often in men than in women, predominantly affects the prostate and seminal vesicles.

[Treatment of patients with resistant urogenital infection].

In our trial 43 patients with urogenital infections resistant to standard therapy received the same basic therapy (4 tablets of safocid a day for 5 days) which, on demand, was combined with pathogenetic and symptomatic treatment. The effect was achieved by both subjective and objective parameters: pathogenic microflora was not detected after 10 days in 39 (90.7%) patients; none of the patients discharged protozoa, fungi. Tests for chlamidia were negative in all the carriers in 2 months, for ureaplasma--in 94.1% males and 83.3% females, respectively. A significant response was observed in 38 of 43 (88.4%) patients, improvement was seen in 5 (11.6%) patients. The above results persisted for 2 months of follow-up.

Modified Field's staining--a rapid stain for Trichomonas vaginalis.

Trichomonas vaginalis, a flagellate protozoan parasite commonly found in the human genitourinary tract, is transmitted primarily by sexual intercourse. Diagnosis is usually by in vitro culture method and staining with Giemsa stain. There are laboratories that use Gram stain as well. We compared the use of modified Field's (MF), Giemsa, and Gram stains on 2 axenic and xenic isolates of T. vaginalis, respectively. Three smears from every sediment of spun cultures of all 4 isolates were stained, respectively, with each of the stains. We showed that MF staining, apart from being a rapid stain (20 s), confers sharper staining contrast, which differentiates the nucleus and the cytoplasm of the organism when compared to Giemsa and Gram staining especially on parasites from spiked urine samples. The alternative staining procedure offers in a diagnostic setting a rapid stain that can easily visualize the parasite with sharp contrasting characteristics between organelles especially the nucleus and cytoplasm. Vacuoles are more clearly visible in parasites stained with MF than when stained with Giemsa.

[Descriptive epidemiology of extrapulmonary hydatid cysts: a report of 265 Tunisian cases]. / Profil epidémiologique descriptif des kystes hydatiques extra pulmonaires: a propos d'une série tunisienne de 265 cas.

BACKGROUND: Hydatidosis is a parasitic endemic disease in Tunisia. The liver and lung are the most common sites of involvement; however, it can develop anywhere in the body. AIM: The aim of the present study was to analyse the epidemiological features of extrapulmonary hydatid cysts and compare our results with those reported in literature. METHODS: A retrospective study of 265 extrapulmonary hydatid cysts collected over the 18-year period from 1990 to 2007 was undertaken. RESULTS: There were 101 male and 164 female patients (sex ratio M/F = 0.61) ranging in age from 2 to 84 years (mean age = 38.7). In our series, hydatid cysts involved mainly the kidney (24.1%), the central nervous system (22.6%), the liver (19.6%) and the spleen (11.3%). The other less frequent sites included the peritoneum (n = 9), heart (n = 9), bone (n = 6), adrenal gland (n = 4), epiploon (n = 4), orbit (n = 4), ovary (n = 3), prostate (n = 2), bladder (n = 2), breast (n = 2), Douglas' cul-de-sac (n = 2), diaphragm (n = 1), testis (n = 1), broad ligament (n = 1), mediastinum (n = 1), nasal cavity (n = 1), soft tissue (n = 1), abdominal wall (n = 1), parotid gland (n = 1), psoas muscle (n = 1), synovia (n = 1), thymus (n = 1) et le pancreas (n = 1). CONCLUSION: In contrast to literature, our results show that hydatid cysts of the kidney and of the central nervous system are more frequent than hepatic location which occupies the 3rd rank.