Case Report: Atypical Presentation of Visceral Leishmaniasis: Two Cases from Northwest Ethiopia.

Human visceral leishmaniasis (VL) is a life-threatening disease caused by protozoan parasites belonging to the Leishmania donovani complex. Atypical cases of leishmaniasis and HIV coinfection have been documented in case reports, mostly associated with gastrointestinal tract, kidney, and skin involvement. We report two VL cases with atypical localizations not reported from east Africa before, both diagnosed and treated at the Leishmaniasis Research and Treatment Center, Gondar, Ethiopia. The first case was an HIV-infected patient with scrotal and penile involvement. Leishmania parasites were detected in the spleen and the scrotum. The second case was an immunocompetent individual with esophageal, laryngeal, and pharyngeal involvement and facial lesions. Leishmania parasites were detected in the spleen, skin, and esophageal biopsies. Current evidence suggests atypical presentation can occur in patients irrespective of their HIV status. Therefore, we suggest a high index of suspicion for VL among clinicians working in endemic areas of Ethiopia.

Molecular and light microscopy evidence for the transfer of Myxobolus honghuensis from Carassius auratus gibelio broodfish to progeny.

Myxozoans usually have a complex life cycle involving indirect transmission between vertebrate and invertebrate hosts. The vertical transmission of these parasites in vertebrate hosts has not been documented so far. Here, we assessed whether the myxozoan parasite Myxobolus honghuensis is vertically transmitted in naturally infected allogynogenetic gibel carp Carassius auratus gibelio (Bloch). M. honghuensis infection of broodfish, fertilized eggs and laboratory-cultured progeny was monitored in 2018 and 2019. The presporogonic stage was microscopically observed in the pharynx of broodfish and their progeny. In situ hybridization confirmed the presence of M. honghuensis presporogonic stage in the pharynx of broodfish and progeny. Nested PCR results showed that M. honghuensis was present in tissues and eggs of broodfish, fertilized eggs and their corresponding progeny. The sequences obtained from broodfish and progeny showed 98.0-99.8% similarity with ITS-5.8S rDNA of M. honghuensis. This study provides molecular and light microscopy evidence for the transfer of M. honghuensis from broodfish to progeny via the eggs, but it is insufficient to assert that M. honghuensis can transmit vertically in naturally infected allogynogenetic gibel carp. This is the first record about vertical transfer of myxozoan in the vertebrate host.

First report of Kudoa sp. in the palate and pharyngeal musculature of Gobioides grahamae Palmer and Wheeler, 1955 (Perciformes, Gobiidae) from Marajó Island, Brazil / Primeiro registro de Kudoa sp. na musculatura do palato e faringeal de Gobioides grahamae Palmer e Wheeler, 1955 (Perciformes, Gobiidae) da Ilha do Marajó, Brasil

The aim of this study was to describe the first occurrence ofKudoasp. inGobioides grahamae, contributing to the understanding of this group of parasites in the Amazonian ichthyofauna. Forty specimens ofG. grahamaecollected from the natural environment were analyzed. Cysts ofKudoasp. were diffusely distributed through the striated skeletal muscle fibers with severe edema and inflammatory infiltrate composed of lymphocytes were observed in 30% of the specimens. Edema and marked coagulation necrosis of the muscle fibers was associated with infection byKudoasp. spores, which had accumulated inside the skeletal muscle fibers. Although there are no records of foodborne outbreaks caused by Kudoa spp. in Brazil, it is of paramount importance that we evaluate its occurrence, since the consumption of fish, especially raw fish, has increased because of the adoption of Japanese cuisine. To minimize the economic impacts on the fisheries market and the risk of this parasite to public health, it is necessary to initiate a program to monitor the presence of this likely underdiagnosed, emerging parasite.(AU)

O objetivo deste estudo foi descrever a primeira ocorrência de Kudoa sp. em Gobioides grahamae, contribuindo, assim, para a compreensão desse grupo de parasitas na ictiofauna amazônica. Foram analisados 40 espécimes de G. grahamae coletados de ambiente natural. Cistos de Kudoa sp. foram distribuídos difusamente através das fibras musculares esqueléticas estriadas com presença de edema grave e infiltrado inflamatório composto de linfócitos, que foram observados em 30% dos espécimes. Edema e necrose de coagulação acentuada das fibras musculares foram associados com a infecção por esporos de Kudoa sp., acumulados no interior das fibras musculares da faringe. Apesar de não haver registros de surtos de origem alimentar causada por Kudoa spp. no Brasil, é de suma importância a avaliação de sua ocorrência, uma vez que o consumo de peixe, especialmente peixe cru, aumentou por causa da adoção da culinária japonesa. Para minimizar os impactos econômicos no mercado da pesca e o risco desse parasita para a saúde pública, é necessário iniciar um programa para monitorar a presença desse parasita emergente, possivelmente subdiagnosticada.(AU)

RNA-seq analysis of local tissue of Carassius auratus gibelio with pharyngeal myxobolosis: Insights into the pharyngeal mucosal immune response in a fish-parasite dialogue.

The lack of practical control measures for pharyngeal myxobolosis is becoming an important limiting factor for the sustainable development of the gibel carp (Carassius auratus gibelio) culture industry in China. Myxobolus honghuensis has been identified as the causative agent of this pandemic disease, which exclusively infects the pharynx of gibel carp, a potential important mucosal lymphoid-associated tissue (MLAT). Myxozoa generally initiate invasion through the mucosal tissues of fish, where some of them also complete their sporogonial stages. However, the pharynx-associated immune responses of teleost against myxosporeans infection remain unknown. Here, a de novo transcriptome assembly of the pharynx of gibel carp naturally infected with M. honghuensis was performed for the first time, using RNA-seq. Comparative analysis of severely infected and mildly infected pharyngeal tissues (SI group and MI group) from the same fish individuals and control pharyngeal tissues (C group) from the uninfected fish was carried out to investigate the potential mucosal immune function of the fish pharynx, and characterize the panoramic picture of pharynx local mucosal immune responses of gibel carp against the M. honghuensis infection. A total of 242,341 unigenes were obtained and pairwise comparison resulted in 13,009 differentially-expressed genes (DEGs) in the SI/C group comparison, 6014 DEGs in the MI/C group comparison, and 9031 DEGs in the SI/MI group comparison. Comprehensive analysis showed that M. honghuensis infection elicited a significant parasite load-dependent alteration of the expression of numerous innate and adaptive immune-related genes in the local lesion tissue. Innate immune molecules, including mucins, toll-like receptors, C-type lectin, serum amyloid A, cathepsins and complement components were significantly up-regulated in the SI group compared with the C group. Up-regulation of genes involved in apoptosis signaling pathway and the IFN-mediated immune system were found in the SI group, suggesting these two pathways played a crucial role in innate immune response to M. honghuensis infection. Up-regulation of chemokines and chemokine receptors and the induction of the leukocyte trans-endothelial migration pathways in the severely and mildly infected pharynx suggested that many leucocytes were recruited to the local infected sites to mount a strong mucosal immune responses against the myxosporean infection. Up-regulation of CD3D, CD22, CD276, IL4/13A, GATA3, arginase 2, IgM, IgT and pIgR transcripts provided strong evidences for the presence of T/B cells and specific mucosal immune responses at local sites with M. honghuensis infection. Our results firstly demonstrated the mucosal function of the teleost pharynx and provided evidences of intensive local immune defense responses against this mucosa-infecting myxosporean in the gibel carp pharynx. Pharyngeal myxobolosis was shaped by a prevailing anti-inflammatory response pattern during the advanced infection stages. Further understanding of the functional roles of fish immune molecules involved in the initial invasion and/or final sporogony site may facilitate future development of control strategies for this myxobolosis.

A Case of Unexpected Clinostomum complanatum Infection Initially Presenting as Foreign Body in Pharynx.

A 46-year old man visited our outpatient clinic with complaint of foreign body sensation in throat after consuming raw freshwater fish 5 days ago. Laryngoscopic examination revealed a motile worm attached on posterior pharyngeal wall. The worm was removed using biopsy forceps under transnasal endoscopy and evidently identified as Clinostomum complanatum after microscopic examination. Patient's subjective foreign body sensation of throat and hyperemia of laryngeal mucosa remained for approximately 2 weeks post-removal, which were eventually resolved after administration of non-steroidal anti-inflammatory drug and anti-refluxant drug for 2 weeks. Treatment was ended at three weeks since the first visit. C. complanatum infections in humans are rare, and only four cases have been reported in Korea. Symptoms resembling pharyngitis or laryngitis occurs by consumption of raw, infected freshwater fish and treatment is done by mechanically removing the parasite.

Morphological and molecular characterization of a new species Myxobolus gutturocola n. sp. (Myxozoa: Myxobolidae) from the throat of Hypophthalmichthys molitrix in China.

Myxobolus gutturocola n. sp. was isolated from the throat of silver carp, Hypophthalmichthys molitrix, in Chongqing, China. Myxospore valves are unsymmetrical and smooth. Mature spores are ellipsoidal in frontal view, measuring 12.5 ± 0.2 µm (n = 25) in length, 8.4 ± 0.2 µm (n = 25) in width and 7.1 ± 0.2 µm (n = 25) in thickness. Each spore has two pyriform and unequal sizes polar capsules, the large one with 5.7 ± 0.2 µm in length × 3.6 ± 0.2 µm in width and the small one with 4.6 ± 0.2 µm in length × 2.6 ± 0.1 µm in width. Polar filaments are coiled seven or eight turns in the large polar capsule and four or five turns in the small polar capsule. The coils are arranged almost perpendicularly to the longitudinal axis of the polar capsule. Morphological analysis revealed that M. gutturocola n. sp. is distinct from related species of Myxobolus Bütschli, 1882. Molecular analysis has demonstrated that its SSU rDNA sequences do not match with any available sequences in GenBank. Phylogenetic analysis of the SSU rDNA sequences indicated this species clustered in a clade composed exclusively of parasites infecting the fishes of the Leucisini lineage and most closely related to Myxobolus pavlovskii isolated from the gill filaments of silver carp in Hungary.

Description of a new species of the genus Anguillonema Fuchs, 1938 (Nematoda: Sphaerularioidea) with an identification key to the species.

Anguillonema iranicum n. sp. is described and illustrated as the second species of this genus from Iran, based on morphological, morphometric and molecular characteristics. It is identified by a short, thin body, a continuous lip region, six lines on the lateral field, a short, thin stylet, a posteriorly located pharyngo-intestinal junction to excretory pore, the presence of a post-vulval uterine sac, vulval position at 89% (87.4-89.9%) of body length, an elongate conoid tail with a rounded to pointed tip and not dorsally bent, and common functional males with short spicules and lacking a bursa. Morphological differences between the new species and the three known species of the genus, namely A. amolensis, A. crenati and A. poligraphi, are discussed. Molecular phylogenetic studies of the new species using partial 18S rDNA sequence revealed that it formed a sister clade with three species of Howardula, one species of Anguillonema and one unidentified isolate. In phylogenetic analyses using partial sequences of 28S rDNA D2-D3 segment, the new species formed a clade with two isolates of Parasitylenchus. A key to identification of Anguillonema species is also presented.

Nondisseminated rhinosporidiosis with multisite involvement in the head and neck.

Rhinosporidiosis is a communicable disease prevalent in tropical countries that affects one or more mucocutaneous sites such as the nasal cavity, pharynx, skin, bronchus, genitals, and bone, in isolation or together. We report a case of multicentric rhinosporidiosis involving the nasal cavity, oropharynx, larynx, and cheek skin without disseminated disease outside the head and neck. Although the appearance of mucocutaneous lesions in our patient was similar to that of papilloma or neoplasm, the distinct clinicopathologic characteristics of the rhinosporidiosis guided us in managing the case successfully. In our own experience with 11 patients with rhinosporidiosis on whom we operated over the past 5 years, the nasal cavity and pharynx were the most commonly involved sites in the head and neck. Surgical excision of all lesions along with cauterization of the base and long-term dapsone therapy is the current standard of care for multicentric rhinosporidiosis.

The discovery of Caligus macrurus Heller, 1865 (Copepoda: Caligidae) in the Mediterranean Sea, and the recognition of Sciaenophilus van Beneden, 1852 as a junior synonym of Caligus Müller, 1785.

The siphonostomatoid parasitic copepod Caligus macrurus Heller, 1865 is redescribed based on new material collected from the gill filaments and pharynx of tripletail Lobotes surinamensis Bloch (Lobotidae) caught in Iskenderun Bay, Turkey. Key diagnostic characters and newly observed taxonomic features are reported, supported by light and scanning electron microscopy observations. This is the first report of C. macrurus from Mediterranean waters. Caligus macrurus is also recognised as conspecific with the better known Caligus bennetti Causey, 1953, found on the same host, which becomes a junior subjective synonym of C. macrurus. Caligus O.F. Müller, 1785 and Sciaenophilus van Beneden, 1852 have both been treated as valid genera within the family Caligidae although numerous doubts have been expressed over the validity of the latter. The morphological evidence does not support generic level distinction and we recommend the transfer of all species currently placed in Sciaenophilus into Caligus as C. tenuis (van Beneden, 1852), C. pharaonis von Nordmann, 1832, C. nibeae Shen, 1957 and C. macrurus.

Expansion of Comprehensive Screening of Male Sexually Transmitted Infection Clinic Attendees with Mycoplasma genitalium and Trichomonas vaginalis Molecular Assessment: a Retrospective Analysis.

Of 1,493 encounters of males at a sexually transmitted infection (STI) clinic in a community with a high prevalence of STI, Chlamydia trachomatis was detected in 8.7% and Neisseria gonorrhoeae was detected in 6.6%. Additional Trichomonas vaginalis and Mycoplasma genitalium screening found 17.4% and 23.9% of the encounters, respectively, to be positive for STI. STI agents were detected in 13.7% of urine specimens; addition of pharyngeal and rectal collections to the analysis resulted in detection of STI agents in 19.0% and 23.9% of encounters, respectively. A total of 101 (23.8%) encounters of identified STI involved sole detection of M. genitalium Expansion of the STI analyte panel (including M. genitalium) and additional specimen source sampling within a comprehensive STI screening program increase identification of male STI carriers.

Accacoelium contortum (Trematoda: Accacoeliidae) a trematode living as a monogenean: morphological and pathological implications.

BACKGROUND: Accacoelium contortum (Rudolphi, 1819) Monticelli, 1893 is a frequent but poorly known trematode found on gills, pharynx and digestive tract of the ocean sunfish Mola mola (L.). Although the morphology of A. contortum agrees with that of a typical endoparasitic trematode, with two relatively small suckers and no large holdfasts, this parasite is normally ectoparasitic. The main objective of this paper is to explore this peculiar host-parasite relationship. METHODS: A total of 106 ocean sunfish were examined for the presence of A. contortum. The oropharyngeal chamber (gills and pharynx) and the digestive tract were analysed. As the previous descriptions of this species seem to be based on contracted specimens, for the morphological study the parasites were killed using two methods: with hot 70% ethanol (with relaxed bodies) and with 70% ethanol at room temperature (with contracted bodies). For histological studies, samples from fresh fish with parasitised left gills, pharynx and digestive tract were fixed in buffered 10% formalin. For molecular studies the 18S, 28S and ITS-2 sequences were provided and compared with the available data in GenBank®. RESULTS: New information on the morphology of A. contortum and on the parasite-related response and pathological alterations in the host are given. New diagnostic traits for some structures are provided: e.g. tegumental papillae of the forebody with apical digitiform swellings and mouth surrounded by a circum-oral crown of simple papillae. The length of the ventral sucker peduncle and the position of the vitellarium were found to be associated with the contraction degree of the specimen. Immature individuals of this species are described for the first time. An intense proliferative inflammatory response of host gill and pharynx epithelium at the host-parasite interface was detected and parasites became partially covered by overgrowths of host tissues. CONCLUSIONS: The induction of prominent histological alterations associated with A. contortum seems to be an adaptation to the external environment, an unusual location for trematodes.

Oral manifestations in the American tegumentary leishmaniasis.

INTRODUCTION: American tegumentary leishmaniasis (ATL) can affect the skin or mucosa (mucocutaneous leishmaniasis - MCL) including the oral cavity. MCL oral lesions are often confused with other oral diseases, delaying diagnosis and specific treatment, and increasing the likelihood of sequelae. Thus, increasing the knowledge of the evolution of ATL oral lesions can facilitate its early diagnosis improving the prognosis of healing. OBJECTIVES: Evaluate the frequency of ATL oral lesion and describe its clinical, laboratory and therapeutic peculiarities. METHODS: A descriptive transversal study was carried out, using data from medical records of 206 patients with MCL examined at the outpatient clinics-IPEC-Fiocruz between 1989 and 2013. Proportions were calculated for the categorical variables and the association among them was assessed by the Pearson's chi-square test. Measures of central tendency and dispersion were used for the continuous variables and their differences were assessed by both parametric (t test) and non parametric (Mann-Whitney) tests. P-values <0.05 were considered as significant. RESULTS: The most affected site was the nose, followed by the mouth, pharynx and larynx. Seventy eight (37.9%) have oral lesions and the disease presented a lower median of the evolution time than in other mucous sites as well as an increased time to heal. The presence of oral lesion was associated with: the presence of lesions in the other three mucosal sites; a smaller median of the leishmanin skin test values; a longer healing time of the mucosal lesions; a higher recurrence frequency; and a smaller frequency of treatment finishing and healing. When the oral lesion was isolated, it was associated with an age 20 years lower than when the oral lesion was associated with other mucosal sites. CONCLUSION: Considering the worst therapy results associated with the presence of oral lesions, we suggest that lesions in this location represent a factor of worse prognosis for MCL.

A new species of chondracanthid copepod parasitic in the pharynx of hagfishes (Myxiniformes: Myxinidae) from off Taiwan.

A new species of Acanthochondria Oakley, 1927 (Copepoda, Poecilostomatoida, Chondracanthidae), parasitic in the pharynx of hagfishes Eptatretus burgeri (Girard), E. sheni (Kuo, Huang & Mok) and E. yangi (Teng), from off Taiwan is described and illustrated. The new species can be distinguished from its congeners by having the neck region longer than wide (about 2-3 times as long as wide), the moderately long protopod of leg 2 (Type E), the endopod of leg 2 as large as exopod, the cephalosome wider than long, the armature formula of antennule (1, 1, 2, 2, 9), the relatively long trunk (6.7 mm) and egg-sacs (14.4 mm). This is the first record of a parasitic chondracanthid from hagfishes. The findings may provide insights into the phylogenetic relationships and interactions among chondracanthids, hagfishes and demersal fishes, but call for further molecular studies.

Retrospective assessment of transcription-mediated amplification-based screening for Trichomonas vaginalis in male sexually transmitted infection clinic patients.

Transcription-mediated amplification (TMA) enhances detection of Neisseria gonorrhoeae and Chlamydia trachomatis from rectal and pharyngeal sources. The utility of TMA for detection of Trichomonas vaginalis has recently been described. We report on the performance of TMA for detection of sexually transmitted infection (STI) agents from extraurogenital sources, with a focus on T. vaginalis. Within a 21-month interval, 1,314 consecutive male patient encounters at an STI clinic resulted in collection of 2,408 specimens for C. trachomatis, N. gonorrhoeae, and T. vaginalis TMA screening. A total of 471 encounters were managed with a single specimen collection (94.9% urine), with 12.7% positive for at least one STI agent. This detection percentage increased to 14.4% with collection of specimens from two sources and to 20.3% with collection from three sources (P = 0.03 versus single-source sampling). A total of 44.4% of encounters were managed by collection of urine and pharyngeal specimens and 19.1% by the addition of a third (rectal) collection. While procurement of urine and rectal specimens resulted in greater detection of C. trachomatis (6.1% and 11.3% rates, respectively) than of other STI agents, 858 pharyngeal specimens yielded a 2.9% T. vaginalis detection rate compared with 2.1% for N. gonorrhoeae and 1.6% for C. trachomatis. All T. vaginalis pharyngeal detections were confirmed by TMA-based alternative target testing. A total of 38.1% of T. vaginalis-positive pharyngeal specimens were derived from symptomatic patient encounters. A total of 85.7% of males with T. vaginalis-positive pharyngeal collections indicated strictly heterosexual preference. Additional specimen source sampling is necessary to make STI screening comprehensive. Incorporation of extraurogenital sources into assessment for T. vaginalis detection may identify additional symptomatic and asymptomatic male STI carriers.

Myxobolus honghuensis n. sp. (Myxosporea: Bivalvulida) parasitizing the pharynx of allogynogenetic gibel carp Carassius auratus gibelio (Bloch) from Honghu Lake, China.

Myxobolus honghuensis n. sp. is described from allogynogenetic gibel carp Carassius auratus gibelio (Bloch), during a survey of myxosporean parasites in Honghu Lake, Hubei Province, China. It is characterized by the presence of round plasmodia of 5-12 mm in diameter in the pharynx of host. Mature spores of M. honghuensis were pyriform in frontal view and anterior pointed with bluntly round posterior, they measured 16.9 ± 0.5 (15.1-19.5) µm long, 10.4 ± 0.4 (9.0-11.3) µm wide, and 8.4 ± 0.4 (7.9-9.1) µm thick. Two polar capsules were pyriform and slightly unequal with larger polar capsule 8.4 ± 0.4 (7.6-10.2) µm × 3.9 ± 0.2 (3.0-4.5) µm and smaller capsule 7.9 ± 0.2 (7.0-9.3) µm × 3.7 ± 0.3 (2.8-4.1) µm. Polar filaments coiled with seven to eight turns. Both morphology and DNA sequence data revealed that M. honghuensis n. sp. was distinct from other described Myxobolus species. Phylogenetic analysis placed M. honghuensis n. sp. in a clade of gill-infecting myxobolids.

[A case of leech infestation mimicking upper respiratory tract infection]. / Üst Solunum Yolu Enfeksiyonunu Taklit Eden Bir Sülük Enfestasyonu Olgusu.

Urban life and industrialization leads to a decrease in the incidence of many parasitic diseases. Especially, using the supervised water supplies in urban areas decreases the chance of such infestations and limits it in rural areas. However, the people who live in urban areas and have diseases such as kidney stones think that mountain waters may be beneficial for their illness. These types of water supplies are generally unsafe, uncontrolled and septic. That is why usage of them can cause some elusive parasitic infestations in people who live in urban areas. It is meaningful to submit the case described below to illustrate the possibility of parasitic infestations in patients who have upper respiratory tract infection symptoms who are admitted to the physician.

Unusual location of primary hydatid cyst: soft tissue mass in the parapharyngeal region.

Hydatid cyst is a cyclozoonotic infection caused by the cestode Echinococcus granulosus. Hydatid cyst in the head and neck region is very rare, even in countries where echinococcus infestation is endemic. We report the case of a 17-year-old male patient presenting with a hydatid cyst in the parapharyngeal and neck region. There was no pulmonary or hepatic involvement. The definitive therapy comprised excision of the cystic mass and postoperative medical treatment.