Initial assessment of the economic burden of major parasitic helminth infections to the ruminant livestock industry in Europe.

We report a European wide assessment of the economic burden of gastrointestinal nematodes, Fasciola hepatica (common liver fluke) and Dictyocaulus viviparus (bovine lungworm) infections to the ruminant livestock industry. The economic impact of these parasitic helminth infections was estimated by a deterministic spreadsheet model as a function of the proportion of the ruminant population exposed to grazing, the infection frequency and intensity, the effect of the infection on animal productivity and mortality and anthelmintic treatment costs. In addition, we estimated the costs of anthelmintic resistant nematode infections and collected information on public research budgets addressing helminth infections in ruminant livestock. The epidemiologic and economic input data were collected from international databases and via expert opinion of the Working Group members of the European Co-operation in Science and Technology (COST) action COMbatting Anthelmintic Resistance in ruminants (COMBAR). In order to reflect the effects of uncertainty in the input data, low and high cost estimates were obtained by varying uncertain input data arbitrarily in both directions by 20 %. The combined annual cost [low estimate-high estimate] of the three helminth infections in 18 participating countries was estimated at € 1.8 billion [€ 1.0-2.7 billion]. Eighty-one percent of this cost was due to lost production and 19 % was attributed to treatment costs. The cost of gastrointestinal nematode infections with resistance against macrocyclic lactones was estimated to be € 38 million [€ 11-87 million] annually. The annual estimated costs of helminth infections per sector were € 941 million [€ 488 - 1442 million] in dairy cattle, € 423 million [€ 205-663 million] in beef cattle, € 151million [€ 90-213 million] in dairy sheep, € 206 million [€ 132-248 million] in meat sheep and € 86 million [€ 67-107 million] in dairy goats. Important data gaps were present in all phases of the calculations which lead to large uncertainties around the estimates. Accessibility of more granular animal population datasets at EU level, deeper knowledge of the effects of infection on production, levels of infection and livestock grazing exposure across Europe would make the largest contribution to improved burden assessments. The known current public investment in research on helminth control was 0.15 % of the estimated annual costs for the considered parasitic diseases. Our data suggest that the costs of enzootic helminth infections which usually occur at high prevalence annually in ruminants, are similar or higher than reported costs of epizootic diseases. Our data can support decision making in research and policy to mitigate the negative impacts of helminth infections and anthelmintic resistance in Europe, and provide a baseline against which to measure future changes.

Comparative in vitro efficacy of kefir produced from camel, goat, ewe and cow milk on Haemonchus contortus.

One of the great challenges of veterinary parasitology is the search for alternative methods for controlling gastrointestinal parasites in small ruminants. Milk kefir is a traditional source of probiotic, with great therapeutic potential. The objective of this study was to investigate the anthelmintic effects of kefir on the abomasal nematode Haemonchus contortus from sheep. The study used camel, goat, ewe and cow milk as a starting material, to produce camel, goat, cow and ewe milk kefir. All kefirs showed a significant concentration-dependent effect on H. contortus egg hatching at all tested concentrations. The highest inhibition (100%) of eggs was observed with camel milk kefir at a concentration 0.125 mg/ml. In relation to the effect of kefirs on the survival of adult parasites, all kefirs induced concentration-dependent mortality in adults, with variable results. The complete mortality (100%) of adults of H. contortus occurred at concentrations in the range 0.25-2 mg/ml. The highest inhibition of motility (100%) of worms was observed after 8 h post exposure with camel milk kefir at 0.25 mg/ml. These findings indicate that kefir can be considered a potential tool to control haemonchosis in sheep. Further investigations are needed to assess the active molecules in kefir responsible for its anthelmintic properties and to investigate similar in vivo effects.

Anthelmintic activity of Tunisian chamomile (Matricaria recutita L.) against Haemonchus contortus.

The chemical treatment of gastrointestinal parasitic diseases has been undermined by increasing resistance and high toxicity. There is an urgent need to search for alternative natural sources for the treatment of such parasites. In this respect, the present study aims to quantify phenolic compounds of chamomile (Matricaria recutita L.) and to study their in vitro anti-oxidant and anthelmintic activities in solvents with increasing polarity. In vitro determination of anti-oxidant capacity was carried out using 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2-azino-bis-(3-ethylbenzthiazoline-6-sulphonic acid) (ABTS) radical cation methods. In vitro anthelmintic activity was investigated on egg-hatching inhibition and loss of motility of adult worms of Haemonchus contortus from sheep. The results showed that methanolic and aqueous extracts contain more total polyphenols, total flavonoids and condensed tannins than chloroformic and hexanic extracts. ABTS and DPPH assays showed that methanolic extracts had the highest anti-oxidant potency (IC50 = 1.19 µg/ml and 1.18 µg/ml, respectively). In vitro anthelmintic activity showed that both methanolic (IC50 = 1.559 mg/ml) and aqueous (IC50 = 2.559 mg/ml) extracts had the greatest effect on egg hatching and motility of worms (100% after 8 h post exposure at 8 mg/ml). A significant and positive correlation between DPPH and ABTS tests was observed for all tested extracts. Therefore, total phenolic, total flavonoid and condensed tannin values were correlated with IC50 from both ABTS and DPPH, and with inhibition of egg hatching. To our knowledge, this report is the first of its kind to deal with in vitro anthelmintic activities of chamomile extracts.

In Vivo Nematicidal Potential of Camel Milk on Heligmosomoides Polygyrus Gastro-intestinal Nematode of Rodents.

Following our previous findings on the in vitro anthelmintic effect of camel milk on Haemonchus contortus, the current study aimed at investigating its in vivo effect. Investigations were carried out using mice infected with Heligmosomoides polygyrus which is a parasite commonly used to test the efficacy of anthelmintics. Thirty six Swiss white mice of both sexes aged 5 - 6 weeks old, and weighing between 20 and 25 g were orally infected with 0.5 ml dose of 100, 1-week-old H. polygyrus infective larvae (L3). After the pre-patent period, infected animals were randomly divided into 6 groups of 6 animals each. The nematicidal efficacy of camel milk was monitored through faecal egg count reduction (FECR) and total worm count reduction (TWCR). Four doses (8.25; 16.5; 33.0; 66.0 ml/kg body weight (bw)) for fresh camel milk and 22 mg/kg bw for albendazole were studied using a bioassay. Albendazole and 4 % dimethylsulfoxide were included in the protocol as reference drug and placebo, respectively. For all tested doses except 8.25 ml/kg bw, camel milk was effective in vivo against H. polygyrus reducing both faecal egg count and worm count (p < 0.05). The dose 66 ml/kg bw showed the highest nematicidal activity causing a 76.75 % FECR and a 69.62 % TWCR 7 day after initiating the treatment. These results support the possible use of camel milk in the control of gastro-intestinal helminthiasis.

[Allopurinol-induced DRESS complicated by hemophagocytic lymphohistiocytosis]. / DRESS à l'allopurinol compliqué d'un syndrome d'activation macrophagique.

BACKGROUND: Drug hypersensitivity syndrome is among the most severe drug hypersensitivity reactions and in rare cases it may progress to hemophagocytic lymphohistiocytosis. Herein, we report a case of allopurinol-induced drug reaction with eosinophilia and systemic symptoms complicated by hemophagocytic lymphohistiocytosis. CASE REPORT: An 18-year-old girl presented with maculopapular rash associated with cervical lymphadenopahy appearing 3 weeks after treatment with allopurinol. Her hemodynamic status at admission was unstable. Cutaneous examination revealed an itchy maculopapular rash, which was purpuric at certain sites, together with facial edema. The diagnosis of drug hypersensitivity was suggested and was confirmed by histological examination of a skin biopsy. Allopurinol was stopped. Two weeks later, however, eosinophilia was noted. Further, four days after discontinuation of allopurinol, in view of the laboratory signs of bicytopenia, hyponatremia, hypertriglyceridemia and hyperferritinaemia, as well as the presence of hemophagocytosis in bone marrow, a diagnosis was made of lymphohistiocytosis hemophagocytic syndrome complicating a drug reaction with eosinophilia and systemic symptoms. Moreover, viral serology tests were negative. The patient was given intravenous immunoglobulin and the outcome was good. DISCUSSION: The literature contains only very few reports of drug reaction with eosinophilia and systemic symptoms complicated by hemophagocytic lymphohistiocytosis. The incriminated drugs were vancomycin, lamotrigine and phenobarbital. To our knowledge, there has only been one report of allopurinol-induced drug reaction with eosinophilia and systemic symptoms complicated by hemophagocytic lymphohistiocytosis.

[Acute localized exanthematous pustulosis on the face: 6 cases in Tunisia]. / Pustulose exanthématique aiguë localisée de la face : six cas tunisiens.

BACKGROUND: Acute localized exanthematous pustulosis (ALEP) is a rare and localized variant of acute generalized exanthematous pustulosis (AGEP). Only 15 cases of ALEP have been reported to date in the literature, with all cases following drug administration. We report 6 paediatric cases of ALEP occurring in springtime, with no associated drug administration in any case. PATIENTS AND METHODS: Over the last three years (2011, 2012 and 2013), we observed 6 cases of ALEP in 6 Tunisian children aged between 9 and 14 years. All cases were observed during the spring months. Diagnosis of ALEP was based in all cases on the EuroSCAR criteria and on the definition of ALEP proposed by Prange et al. A drug-related aetiology was ruled out in all cases, with exposure to a specific planned plant (Thapsia garganica) being retained as an aetiological factor in one case. DISCUSSION: Drug administration is the most frequent though not the sole cause of ALEP. The seasonal nature of this dermatosis may suggest other causes, mainly viral infection, plant contact or airborne allergens.

Dynamics of infestation of tracers lambs by gastrointestinal helminths under a traditional management system in the North of Tunisia.

The authors present a survey of gastrointestinal helminths of sheep on permanent pastures in the extreme north region of Tunisia (Mediterranean climate). Dynamic infestation of animals has been monitored by using batches of three tracer lambs introduced each two months during 2004 and 2005. These lambs were kept in the pens of veterinary school of Sidi Thabet (Tunisia) during three months and then necropsied. Faecal and blood samples were took from tracer lambs each two months during the whole period, and from animal flock only during 2004. The main helminth genera encountered were Trichostrongylus spp., Teladorsagia spp., Strongyloides papillosus and Anoplocephalidea; occasionaly were found Nematodirus, Oesophagostomum, Chabertia, Cooperia, Trichuris and Paramphistomum. The egg count of the ewes and lambs in the flock showed two peaks. For both ewes and lambs there is a gradual increase from January with a peak in May-June. This first peak is considered to be due to acquisition of infective larvae during the rainy and cold season, as evident from the worm burdens of tracer lambs. The second peak was exclusively observed in ewes during late autumn-early winter (November-December); it has two origins: infestation by third larvae stage and the periparturient rise. The worm burdens of tracer lambs showed that there was a gradual accumulation of nematodes from September-October, reaching a peak in March-April; a very low or naught infection is reported during the dry period (July-August). Infection by Anoplocephalidea was higher during the dry season. This study is primordial for a comprehensive control programme implementation against gastrointestinal helminths.

Primary cutaneous aggressive epidermotropic CD4/CD8 double-negative cytotoxic T-cell lymphoma.

The classification of cutaneous T-cell lymphomas (CTCL) is based on clinical, histological and immunohistochemical findings. Diagnosis may be difficult given the significant heterogeneity of these tumours. We describe herein an original case of primary cutaneous aggressive epidermotropic CD4/CD8 double-negative cytotoxic T-cell lymphoma that illustrates the difficulty in classification.

Bilateral idiopathic hyperkeratosis of the nipple and areola.

Hyperkeratosis of the nipple and areola (HNA) is an unusual dermatosis that Levy-Franckel classified into three variants (1). This rare condition occurs primarily in young women and represents a cosmetic problem. Furthermore, its management is a therapeutic challenge. We report on the rare case of a 32-year-old woman with idiopathic bilateral HNA, which belongs to the third Levy-Franckel classification.

Infestation of tracer lambs by Fasciola hepatica in Tunisia: determining periods for strategic anthelmintic treatments.

Ovine fasciolosis causes high morbidity and mortality rates, resulting in large economic losses to the sheep industry in northern Tunisia. The authors surveyed ovine fasciolosis (Fasciola hepatica infestation) in a Barbarine sheep flock in the humid region of Tunisia (Sejnane, Governorate of Bizerte) over two consecutive years, 2004 to 2005. To assess the dynamics of fluke infestation, a total of 36 tracer lambs were introduced into the flock successively, in groups of three, every two months, and their infestations were monitored by coproscopy and necropsy. Coproscopic analysis revealed high mean percentages of infestation of 60% and 65% for flock lambs and ewes, respectively. Similarly, a high percentage of infestations was recorded in the tracer lambs (more than 70%) post mortem. Significant fluctuations in infestation dynamics were observed in the tracer lambs, and three distinct infestation periods were identified: a period of very low, non-constant infestation risk during the warm period (from July to October); a high-risk period from March to June, and a third period with a variable but constant infestation risk (from November to February). Based on these results, the authors propose strategic flukicide treatments with triclabendazole, aimed at reducing mollusc infestation and subsequent pasture contamination by metacercariae, during two main periods: in September and in February, just before the reactivation of the molluscs from aestivation and hibernation, respectively.