Haematological and biochemical abnormalities in hunting dogs infected with Acanthocheilonema reconditum, associated risk factors, and a European overview.

Acanthocheilonema reconditum is a filarial parasite transmitted by arthropods (fleas, lice, and ticks) that infect dogs. There is minimal published data available to date on potential haematological and biochemical changes associated with this parasitic infection. Study aims were (i) provide an overview of A. reconditum in Europe, (ii) define A. reconditum prevalence and risk factors in a specific dog population (hunting) from southern Italy, and (iii) assess the frequency of haemato-biochemical abnormalities associated with infection. Blood samples collected from 3020 dogs were tested by a modified Knott's technique to count and identify microfilariae. Eighty-four dogs were infected by A. reconditum (2.78%; 95% CI 2.19-3.37%). Microfilariae ranged from 1 to 212/ml. Based on clinical examination, all but six dogs with non-specific symptoms were healthy. Haematological abnormalities included leucocytosis (n = 15), with eosinophilia (n = 14) and monocytosis (n = 13). Serum biochemical abnormalities included increased total serum proteins (n = 19), albumins (n = 7), total globulins (n = 14), ALT (n = 1), and ALP (n = 1); one dog was hypoalbuminemic, and BUN was mildly increased in 2 dogs. Risk factors included the province origin (Napoli, OR=5.4, 95%CI: 2.1-14.0; Caserta, OR=5.1, 95%CI: 2.5-10.6), hunting wild mammals (OR=2.8, 95% 95%CI: 1.6-4.8), and ectoparasite infestation (OR=1.9, 95%CI: 1.1-3.1). There was a negative correlation between microfilaraemic load and decreased albumin level (-0.37; p=0.021). Our results showed that A. reconditum circulates within the hunting dog population of southern Italy, with seemingly low pathogenic potential.

Microfilaria-dependent thoracic pathology associated with eosinophilic and fibrotic polyps in filaria-infected rodents.

BACKGROUND: Pulmonary manifestations are regularly reported in both human and animal filariasis. In human filariasis, the main known lung manifestations are the tropical pulmonary eosinophilia syndrome. Its duration and severity are correlated with the presence of microfilariae. Litomosoides sigmodontis is a filarial parasite residing in the pleural cavity of rodents. This model is widely used to understand the immune mechanisms that are established during infection and for the screening of therapeutic molecules. Some pulmonary manifestations during the patent phase of infection with L. sigmodontis have been described in different rodent hosts more or less permissive to infection. METHODS: Here, the permissive Mongolian gerbil (Meriones unguiculatus) was infected with L. sigmodontis. Prevalence and density of microfilariae and adult parasites were evaluated. Lungs were analyzed for pathological signatures using immunohistochemistry and 3D imaging techniques (two-photon and light sheet microscopy). RESULTS: Microfilaremia in gerbils was correlated with parasite load, as amicrofilaremic individuals had fewer parasites in their pleural cavities. Fibrotic polypoid structures were observed on both pleurae of infected gerbils. Polyps were of variable size and developed from the visceral mesothelium over the entire pleura. The larger polyps were vascularized and strongly infiltrated by immune cells such as eosinophils, macrophages or lymphocytes. The formation of these structures was induced by the presence of adult filariae since small and rare polyps were observed before patency, but they were exacerbated by the presence of gravid females and microfilariae. CONCLUSIONS: Altogether, these data emphasize the role of host-specific factors in the pathogenesis of filarial infections.

Persons with onchocerciasis-associated epilepsy and nodding seizures have a more severe form of epilepsy with more cognitive impairment and higher levels of Onchocerca volvulus infection.

Following previous reports of very high epilepsy prevalence in the onchocerciasis-endemic villages in Maridi County, South Sudan, a study was conducted to investigate the association between the level of Onchocerca volvulus infection, epilepsy, and related outcomes. In December 2018, persons with epilepsy (PWE) were recruited from villages where an epilepsy prevalence of 4.4% (range: 3.5-11.9%) was documented. We enrolled 318 participants from whom two skin snips were taken for microscopic detection of O. volvulus microfilariae (mf). Seizure history was obtained for all PWE and their degree of disability assessed using the modified Rankin scale. Almost all (84.9%) PWE had detectable mf in their skin snips. Onchocerciasis-infected PWE experienced nodding seizures more often than uninfected PWE (p=0.034). Moreover, persons with nodding seizures had more frequent seizures (p<0.001) and higher disability scores (p<0.001), and were more often cognitively impaired and younger at the time of their first epileptic seizure (nine years vs 12 years, p<0.001) compared to PWE without nodding seizures. Based on multivariate models, nodding seizures were associated with higher mf densities (aOR: 1.022; 95% CI: 1.005-1.041). Epilepsy onset at a younger age was associated with a worse outcome. Higher frequency of seizures, longer duration of epilepsy and younger age were associated with increased disability. Regular antiepileptic drug use was associated with better cognitive and disability outcomes. PWE with nodding seizures have a more severe form of onchocerciasis-associated epilepsy, with earlier seizure onset and higher levels of O. volvulus infection. Younger PWE were prone to worse epilepsy outcomes, which would be prevented with regular antiepileptic treatment.

Progress towards lymphatic filariasis elimination in Ghana from 2000-2016: Analysis of microfilaria prevalence data from 430 communities.

BACKGROUND: Ghana started its national programme to eliminate lymphatic filariasis (LF) in 2000, with mass drug administration (MDA) with ivermectin and albendazole as main strategy. We review the progress towards elimination that was made by 2016 for all endemic districts of Ghana and analyze microfilaria (mf) prevalence from sentinel and spot-check sites in endemic districts. METHODS: We reviewed district level data on the history of MDA and outcomes of transmission assessment surveys (TAS). We further collated and analyzed mf prevalence data from sentinel and spot-check sites. RESULTS: MDA was initiated in 2001-2006 in all 98 endemic districts; by the end of 2016, 81 had stopped MDA after passing TAS and after an average of 11 rounds of treatment (range 8-14 rounds). The median reported coverage for the communities was 77-80%. Mf prevalence survey data were available for 430 communities from 78/98 endemic districts. Baseline mf prevalence data were available for 53 communities, with an average mf prevalence of 8.7% (0-45.7%). Repeated measurements were available for 78 communities, showing a steep decrease in mean mf prevalence in the first few years of MDA, followed by a gradual further decline. In the 2013 and 2014 surveys, 7 and 10 communities respectively were identified with mf prevalence still above 1% (maximum 5.6%). Fifteen of the communities above threshold are all within districts where MDA was still ongoing by 2016. CONCLUSIONS: The MDA programme of the Ghana Health Services has reduced mf prevalence in sentinel sites below the 1% threshold in 81/98 endemic districts in Ghana, yet 15 communities within 13 districts (MDA ongoing by 2016) had higher prevalence than this threshold during the surveys in 2013 and 2014. These districts may need to intensify interventions to achieve the WHO 2020 target.

Wuchereria bancrofti filaria activates human dendritic cells and polarizes T helper 1 and regulatory T cells via toll-like receptor 4.

Interaction between innate immune cells and parasite plays a key role in the immunopathogenesis of lymphatic filariasis. Despite being professional antigen presenting cells critical for the pathogen recognition, processing and presenting the antigens for mounting T cell responses, the dendritic cell response and its role in initiating CD4+ T cell response to filaria, in particular Wuchereria bancrofti, the most prevalent microfilaria is still not clear. Herein, we demonstrate that a 70 kDa phosphorylcholine-binding W. bancrofti sheath antigen induces human dendritic cell maturation and secretion of several pro-inflammatory cytokines. Further, microfilarial sheath antigen-stimulated dendritic cells drive predominantly Th1 and regulatory T cell responses while Th17 and Th2 responses are marginal. Mechanistically, sheath antigen-induced dendritic cell maturation, and Th1 and regulatory T cell responses are mediated via toll-like receptor 4 signaling. Our data suggest that W. bancrofti sheath antigen exploits dendritic cells to mediate distinct CD4+ T cell responses and immunopathogenesis of lymphatic filariasis.

Dirofilaria immitis infestation in imported police (K-9) dogs in Iraq: clinicopathological and molecular investigations study / Infecção por Dirofilaria immitis em cães policiais importados no Iraque: estudo clínico-patológico e de investigações moleculares

Dirofilaria immitis, the cause of heartworm infestation (HWI) or dirofilariasis, affects members of the Canidae and remains a worldwide clinical problem. In Iraq, dirofilariasis was believed absent until 2009, when the Karbala Governorate was reported as an endemic area for canine dirofilariasis. Consequently, this study intended to investigate the occurrence of Dirofilaria immitis in police dogs in one police academy in Iraq and to study the gross and histopathological changes in 5 dead dogs, as well as to identify the species of the causative parasite using PCR technique. Thirty-nine police dogs, aged between 6 months and 12 years were included in this study. For the microfilariae investigation, 5 ml blood samples were collected from all dogs in EDTA tubes and examined by Knott's method. The systemic necropsy performed in five dead dogs showed severe clinical signs of dirofilariasis and tissue specimens were sent for routine histopathological processing. For the molecular analysis, adult worms of the detected Dirofilaria spp. were used for DNA extraction and amplification of the cox1 gene. Fifteen of 39 (38.46%) dogs were diagnosed with moderate to severe microfilariasis. The dead dogs revealed typical severe clinical signs of dirofilariasis. Moreover, typical gross and histopathological changes were also seen, accompanied by generalized thromboembolic lesions, suggesting the occurrence of the caval syndrome. The PCR investigation confirmed that D. immitis was the species present in Iraq. In conclusion, this study establishes that Iraq is a newly reported endemic area for dirofilariasis. Moreover, the infestation occurring in these cases most probably happened inside Iraq. The authors recommend doing further epidemiological studies concerning the occurrence of D. immitis in local dogs as well as in the imported dogs in all Iraqi governorates to better understand the epidemiological map of this disease and to introduce an active treatment and preventive program. Awareness and education regarding this disease should be provided to the veterinarians, dog guiders and people in direct contact with dogs, as this disease is one of the important zoonotic diseases.(AU)

A Dirofilaria immitis, causadora da infestação pelo verme do coração (IVC) ou dirofilariose afeta os membros da família Canidae e ainda é um problema clínico mundial. Até o ano de 2009, acreditava-se que o Iraque fosse livre da dirofilariose, porém nessa ocasião a governadoria de Kerbala foi relatada como uma área endêmica de dirofilariose. Assim, o presente trabalho foi realizado para investigar a ocorrência da Dirofilaria immitis em cães policiais em uma academia de polícia do Iraque, estudar as alterações macroscópicas e histopatológicas em cinco cães mortos, bem como, identificar as espécies do parasita causador com o emprego da técnida de PCR. Trinta e nove cães policiais com 6 meses a 12 anos de idade foram incluídos no estudo. Amostras de sangue de cinco mililitros foram colhidas por animal, em tubos com EDTA e foram examinadas pelo método de Knott. A necropsia sistêmica foi realizada em cinco cães que haviam apresentado sinais clínicos severos de dirofilariose e espécimens dos seus tecidos foram enviados para o processamento histopatológico de rotina. Para a análise molecular dos vermes adultos de Dirofilaria spp, foi empregada a extração do DNA e a amplificação do gene cox1. Quinze de 39(38,46%) cães foram diagnosticados com uma microfilariase variável de moderada para severa. As alterações macroscópicas e histopatológicas foram acompanhadas por lesões generalizadas tromboembólicas sugestivas da ocorrência da síndrome da veia cava. A investigação de PCR confirmou que a D.immitisera a espécie presente no Iraque. A conclusão do estudo estabeleceu que o Iraque deve passar a ser considerado como uma nova área endêmica da dirofilariose. Além da infestação registrada nos casos descritos é provável que ela também esteja presente em outras regiões do Iraque. Os autores recomendam a realização de estudos epidemiológicos para investigar a ocorrência de D.immitis tanto nos cães locais bem como em cães importados em todas as governadorias do Iraque, para ser construído o mapa epidemiológico da distribuição da doença e implantadas as ações de tratamento e de um progrma preventivo. Ações de educação em saúde sobre a doença deverão ser dirigidas para os veterinários, tratadores de cães e para pessoas em geral que tenham contato com os cães, pois esta doença é uma importante zoonose.(AU)

Thioredoxin reductase from the bovine filarial parasite Setaria cervi: Studies on its localization and optimization of the extraction.

Exploration of novel drug targets has been the major thrust area in filarial research. In this regard, identification and characterization of oxidative enzymes that play pivotal role in the survival of filarial parasite inside host are of immense importance. In this study, we are reporting the presence of an important redox regulatory enzyme, thioredoxin reductase (TrxR) in the bovine filarial parasite Setaria cervi. TrxR was found to be exists throughout the developmental stages viz. oocyte, microfilaria and adult of the parasite. Since further studies on this enzyme require adequate quantity, influential extraction parameters were optimized statistically using response surface methodology (RSM) employing a seven factors based Box-Behnken design matrix. ANOVA analysis revealed the relative importance of each parameter and a regression equation was eventually developed that could predict the specific activity (SA) of TrxR. Finally the optimized extraction conditions predicted by RSM was 6.1ml of 61.86mM buffer, pH 6.0, with extraction temperature 39.96°C for 180min in addition to 450rpm agitation and 20µl/ml of protease inhibitor. Therefore this study is going to be the maiden report depicting the identity of TrxR in filarial parasite and the optimized extraction conditions for its isolation with better kinetic efficiency.

Exsheathment and midgut invasion of nocturnally subperiodic Brugia malayi microfilariae in a refractory vector, Aedes aegypti (Thailand strain).

Exsheathment and midgut invasion of nocturnally subperiodic Brugia malayi microfilariae were analyzed using light and scanning electron microscopy in a refractory vector, Aedes aegypti (Thailand strain). Results showed that exsheathed microfilariae represented only approximately 1% of the total microfilaria midguts dissected at 5-min post-infected blood meal (PIBM). The percentage of exsheathed microfilariae found in midguts progressively increased to about 20, 60, 80, 90, and 100% at 1-, 2-5-, 6-12-, 18-36-, and 48-h PIBM, respectively. Importantly, all the microfilariae penetrating the mosquito midguts were exsheathed. Midgut invasion by the exsheathed microfilariae was observed between 2- and 48-h PIBM. SEM analysis revealed sheathed microfilariae surrounded by small particles and maceration of the microfilarial sheath in the midguts, suggesting that the midguts of the refractory mosquitoes might have protein(s) and/or enzyme(s) and/or factor(s) that induce and/or accelerate exsheathment. The microfilariae penetrated the internal face of the peritrophic matrix (PM) by their anterior part and then the midgut epithelium, before entering the hemocoel suggesting that PM was not a barrier against the microfilariae migrating towards the midgut. Melanized microfilariae were discovered in the hemocoel examined at 96-h PIBM suggesting that the refractory mosquitoes used melanization reactions against this parasite. This study provided evidence that A. aegypti (Thailand strain) has refractory mechanisms against B. malayi in both midgut and hemocoel.

New insights into the ecology and biology of Acanthocheilonema reconditum (Grassi, 1889) causing canine subcutaneous filariosis.

In spite of its wide distribution among dogs and the evidence of its implication as a zoonotic agent, scant information is available on the biology of Acanthocheilonema reconditum (Spirurida, Onchocercidae). In this study, blood samples from 152 Sicilian dogs were examined for A. reconditum microfilariae at the beginning of the study and 1 year later. The periodicity of microfilaraemia was investigated by bleeding 2 highly microfilaraemic dogs twice a day for 10 days and, later on, every 2 weeks for 1 year and a third animal every 3 h for 96 h. Fleas and ticks infesting dogs were collected and dissected for the detection of A. reconditum larvae. The prevalence of infestation was 11·2% (17/152) and 13·3% (16/120) at the beginning and at the end of the study, with a 1 year cumulative incidence of 5·9%. Although dogs bled twice a day showed a higher number of microfilariae in most of the morning samples, the absence of any circadian rhythm was suggested by data of the third experiment conducted by bleeding a dog every 3 h for 4 days. A. reconditum developing forms were detected in 5·1% (4/78) of dissected fleas, but not in any of the 272 ticks. The study provides new insights into the biology and ecology of this dog filarioid in its definitive and intermediate hosts.

Filariasis presenting as multiple subcutaneous nodules: a rare case report.

Filariasis presenting as multiple subcutaneous nodules is very rare and only a very few cases are reported in the literature. Microfilaria bancrofti is known to occur in different sites like breast, thyroid, lymph nodes, liver, lungs and body fluids, however, in contrast to the other filarial species, its occurrence in soft tissues is rarely reported. Conventional method of diagnosis of filariasis is by demonstration of microfilaria in peripheral blood smear which may be diurnal or nocturnal. The various species are differentiated by the morphological features like presence or absence of sheath, granules and nuclear arrangement in the tail end. We hereby report an unusual case of Wuchereria bancrofti infestation diagnosed on biopsy of subcutaneous nodule in a patient whose initial clinical presentation was of urticarial rashes over the upper extremities. In differential diagnosis of various subcutaneous nodular masses the possibility of filarial granuloma must be kept and a careful search should be done for adult worm or microfilaria in the serial tissue sections.

Effects of doxycycline on early infections of Dirofilaria immitis in dogs.

The antifilarial effects of tetracycline drugs were first demonstrated when they were found to be highly effective against L(3) and L(4) of Brugia pahangi and Litomosoides sigmodontis in rodent models. Tetracyclines are also now known to have activity against microfilariae and adult Dirofilaria immitis, but assessment of their activity against larval and juvenile heartworms has not been reported previously. This study assessed the effects of doxycycline administered orally at 10mg/kg twice daily for 30-day periods at selected times during the early part of the life cycle of D. immitis in dogs with dual infections of D. immitis and B. pahangi. Twenty beagles were randomly allocated by weight to four groups of five dogs each. On Day 0, each dog was given 50 D. immitis L(3) and 200 B. pahangi L(3) by SC injection. Dogs received doxycycline on Days 0-29 (Group 1); Days 40-69 (Group 2); or Days 65-94 (Group 3). Group 4 served as untreated controls. Blood samples were collected for microfilariae counting and antigen testing. Necropsy for collection of adult heartworms and selected tissues were performed Days 218-222. Heartworms recovered were examined by immunohistology, conventional microscopy/transmission electron microscopy, and molecular biology techniques. No live heartworms were recovered from dogs in Group 1; dogs in Group 2 had 0 to 2 live worms (98.4% efficacy), and dogs in Group 3 had 0-36 live worms (69.6% efficacy). All control dogs had live adult heartworms (25-41). The live worms recovered from dogs in Groups 2 and 3 were less developed and smaller that worms from control dogs. Microfilariae were not detected in any dogs in Groups 1 and 2; one dog in Group 3 had 1 microfilariae/ml at necropsy. All control dogs had microfilariae at necropsy. One dog in Group 1 was antigen positive at one sampling (Day 166). One dog in Group 2 was antigen positive Days 196 and 218-222 and three dogs in Group 3 were antigen positive at one or more samplings All five control dogs were antigen positive at all three sampling times. These findings suggest that doxycycline at 10mg/kg orally twice daily for 30 days has efficacy against migrating tissue-phase larvae and juvenile worms and will delay or restrict microfilarial production.

Evaluation of endocytic capacity and NADPH-oxidase activity from armadillo (Dasypus novemcinctus) eosinophils infected with microfilariae.

Endocytic activity of phagocytic cells from armadillos infected with viruses, parasites or bacteria is unknown. This report shows that eosinophils from armadillos infected with microfilaria act against these helmintic parasites but have deficiencies in their oxygen-dependent bacteriocidal mechanisms and also in endocytic capacity against yeast.

A role for Mansonia uniformis mosquitoes in the transmission of lymphatic filariasis in Uganda?

The possible role of Mansonia uniformis mosquitoes in the transmission of lymphatic filariasis was assessed in an endemic area of Uganda, by examining their diurnal biting cycle, host preference and ability to support the development of experimental and natural Wuchereria bancrofti infections. Anopheles gambiae s.l. served as controls. Human landing catches revealed that outdoor biting peaked early in the evening (19:00-20:00h), while indoor biting peaked around midnight (23:00-24:00h). By far the majority of indoor collected M. uniformis had derived their blood meals from humans. Both biting and feeding behaviour were therefore compatible with a potential for transmission. In experimentally fed M. uniformis (total of 1915), the microfilariae were seen to ex-sheath and to start migration, but the L1s accumulated in the thorax and only few developed further. In dissections from Day 11 onwards, 4.6% (43/932) of M. uniformis had L2 larvae and 0.7% (7/932) had L3 larvae of W. bancrofti. The corresponding figures for An. gambiae s.l. were 13.4% and 4.6%, respectively. Dissection of wild caught M. uniformis (total of 6823) did not reveal any natural infections with W. bancrofti infective larvae, whereas wild caught An. gambiae s.l. had an infective rate of 1.3%. Other filarial species, and mermithids, were common in M. uniformis. It is concluded that M. uniformis has a limited potential to support development of W. bancrofti to the infective stage, and it does not appear to play a role as a vector under natural conditions.

The invasion of the midgut of the mosquito Culex (Culex) quinquefasciatus Say, 1823 by the helminth Litomosoides chagasfilhoi Moraes Neto, Lanfredi and De Souza, 1997.

The Litomosoides chagasfilhoi helminth was studied as a model for microfilaria invasion of the midgut of Culex quinquefasciatus mosquito, vector of Wuchereria bancrofti helminth, causative agent of the human filariasis. Histology and transmission and scanning electron microscopy were utilized to show the topography of mosquito midgut invasion by the helminth. An analysis of midguts dissected at different time points after a blood meal demonstrated that the microfilariae interacted and crossed the peritrophic matrix and the midgut epithelium of C. quinquefasciatus. The microfilariae invaded preferentially the mosquito abdominal midgut and the invasion process occurred between 2 and 3h after the blood feeding. In some cases, microfilariae caused an opening in the midgut that separated the epithelial cells, while in others cases, the worms caused the detachment of cells from the epithelium. Ultimately, L. chagasfilhoi crossing activity appeared to damage the midgut. It was also observed that the microfilariae lost their sheaths during their passage through the fibrous material of the peritrophic matrix, before they reached the midgut epithelium. Since the exsheathment process is necessary for the continuity of larvae development, it seems that the passage through the peritrophic matrix is an important step for the parasite's life cycle. This experimental model revealed details of the interaction process of helminthes within the vector midgut, contributing to the knowledge of factors involved in the vector competence of C. quinquefasciatus as a vector of filariasis.

Poorer NF-kappa B signaling by microfilariae in macrophages from BALB/c mice affects their ability to produce cytotoxic levels of nitric oxide to kill microfilariae.

Upon activation with microfilariae (mf), macrophages from C57Bl/6 mice showed higher nuclear factor-kappa B (NF-kappa B) but lower activating protein 1 DNA-binding activity as compared to BALB/c macrophages. The C57Bl/6 macrophages produced cytotoxic levels of nitric oxide (NO) to kill Setaria cervi mf as compared to BALB/c macrophages. Inhibition of the NF-kappa B signal by pyrrolidine dithiocarbamate (PDTC) blocked NO production and microfilaricidal activity of C57Bl/6 macrophages and inclusion of the exogenous NO generator (SNP) in the PDTC treated C57Bl/6 macrophage cultures induced mf cytotoxicity. These results underscore that the NF-kappa B signal (induced in response to mf) is important for the NO-mediated microfilaricidal activity of macrophages.

Transmission intensity and the patterns of Onchocerca volvulus infection in human communities.

We focus on possible constraints upon Onchocerca volvulus establishment in humans in relation to exposure rates to infective larvae (L3) as measured by the annual transmission potential (ATP). We use mathematical and statistical modeling of pre-control west African (savanna), Mexican, and Guatemalan data to explore two hypotheses relating human infection to transmission intensity: microfilarial (mf) loads either saturate with increasing ATP or become (asymptotically) proportional to the ATP. The estimated proportion of L3 developing into adult worms ranged from 7% to 0.3% (low and high intensity areas, respectively). Relationships between mf prevalence and both mf and transmission intensity were nonlinear and statistically similar between west Africa (Simulium damnosum s.l.) and Meso America (S. ochraceum s.l.). This similarity extended to the relationship between mf intensity and ATP. The critical biting rates for onchocerciasis introduction and persistence (which depended on vector competence and host preference), were approximately 10-fold higher in settings where onchocerciasis is transmitted by S. ochraceum than in those where the vector is S. damnosum. A role for focal vector control in Mexico and Guatemala, in addition to nodulectomy and ivermectin, is suggested.

An unexpected guest in follicular fluid.

Parasitic infection as the only or concomitant cause of infertility in Caucasian women is rare. A parasitic infection may also present itself quite unexpectedly as a coincidental finding as shown with this case report. Moving microfilariae of Mansonella perstans were found in the aspirated follicular fluid of a patient who underwent in-vitro fertilization (IVF) with embryo transfer because of tubal pathology due to Chlamydia trachomatis. The patient also appeared to have a Schistosoma infection. To our knowledge, the presence of parasites in follicular fluid has never been reported before. We expect that infertility physicians may be confronted with parasitic infections more often, not only in patients originating from tropical countries but also in Western women as a result of a tendency to travel more frequently to exotic and (sub)tropical countries.