First Case of Human Anisakiosis in Greece: Acute Invasive Infection Mimicking Peritoneal Malignancy.

Consumption of raw and mildly processed seafood, in the context of modern Western world eating trends, is recognized as a major driver for human fish-borne infections. However, these zoonoses and their unfamiliar risks remain neglected and underappreciated among European diagnosticians. In contemporary Europe anisakidosis is one of the most important fish-borne zoonoses. It is caused by ingesting the third-stage infective larvae of the nematode parasites that belong to the family Anisakidae. The case described herein, is an intestinal and ectopic form of anisakiosis (Anisakis spp.), causing symptoms of subacute abdomen and masquerading as an intraperitoneal malignancy. It is the first anisakidosis case reported in Greece, affecting a young patient who had been repeatedly exposed to the parasite by consuming homemade raw fish. Right hemicolectomy, omentectomy and excision of a descending colon nodule were uneventfully performed. The pathology report confirmed granulomatous tissue with eosinophilic infiltration and parasites that were morphologically and molecularly identified as Anisakis spp. Although challenging, acquiring an accurate diagnosis of anisakidosis can prevent unnecessary surgery, as the infection typically is self-resolving, and if treatment is deemed necessary, it can be limited to antiparasitic medication. However, in rare cases, extra-gastrointestinal migration of larvae can cause severe damage with practically unknown risks, posing a diagnostic and therapeutic dilemma. In such a clinical case scenario, surgical exploration can decisively contribute to a definitive diagnosis and early identification of intraabdominal complications necessitating surgical intervention.

Endoparasites in wild populations of Cyprus mouflon (Ovis gmelini ophion).

The Cyprus mouflon (Ovis gmelini ophion) is a subspecies of wild sheep, endemic to Cyprus and strictly protected by national and international legislation. In the present study, 107 Cyprus mouflon faecal samples were collected from locations within the species geographical range and examined by standard parasitological methods, i.e. flotation, sedimentation and Ziehl-Neelsen stained smears. Parasites were found in 104 (97.39%) samples. First stage larvae of the lungworms Muellerius capillaris and Cystocaulus ocreatus were found in 93 (86.9%) and in 65 (60.7%) of the samples, respectively, strongylid eggs in 46 (43%), Eimeria spp. oocysts in 44 (41.1%) and Nematodirus spp. Trichuris spp. and Moniezia spp. eggs in 10 (9.3%), 7 (6.5%) and 1 (0.9%) sample, respectively. To the best of the authors' knowledge, this is the first survey on the endoparasites of Cyprus mouflon. The possible role of the parasites found on the health status of the animals and the risk of endoparasite transmission from domestic ruminants to Cyprus mouflon are discussed.

Multicenter randomized, and blinded European field study evaluating the efficacy and safety of Felpreva®, a novel spot-on formulation containing tigolaner, emodepside and praziquantel, in treating cats with mixed infection with intestinal nematodes, cestodes and/or lungworms.

This paper describes a multicentric field study which has evaluated the safety and efficacy of a novel spot on formulation containing emodepside 2.04% w/v, praziquantel 8.14% w/v and tigolaner 9.79% w/v (Felpreva®, Vetoquinol) when administered at the intended commercial dose of 0.15 ml/kg body weight to privately owned cats infected with major intestinal nematodes (Toxocara cati, Toxascaris leonina, Ancylostoma tubaeforme, Uncinaria stenocephala) and/or cestodes (Dipylidium caninum, Taenia taeniaeformis) and/or lungworms (Aelurostrongylus abstrusus, Troglostrongylus brevior). A total of 219 cats from 26 veterinary clinics located in Albania, Greece, Hungary, Italy and Portugal were included in the study. Feces from the cats were examined on a single occasion between Study Day -7 and Day 0 (baseline) and post-treatment (i) twice between Day 7 and Day 14 (± 2) (for intestinal helminths) or (ii) twice between Day 21 (± 2) and Day 28 (± 2) (for lungworms). Cats were allocated into two groups at a ratio of 2:1 (Felpreva®: Profender®, i.e. a commercial control product containing emodepside and praziquantel). Cats infected with intestinal helminths were treated once on Day 0 (i) with Felpreva® (Group 1) or (ii) with Profender® (Group 2). Animals infected with lungworms received a second treatment with Profender® on Day 14 (± 2) regardless of group allocation. Faecal egg or larval count reduction for Felpreva® was 97.47% for intestinal nematodes and 96.80% for lungworms. No cats infected with cestodes at baseline resulted positive after treatment with Felpreva®. However, the low number of cats (n = 10) did not allow for a statistical analysis to be performed. Non-inferiority of Felpreva® compared to Profender® was statistically demonstrated for all target intestinal and respiratory parasites. No adverse events nor application site reactions were observed. These results show that the new topical combination product Felpreva® is highly safe and efficacious in treating infections caused by major species of feline intestinal nematodes, cestodes and lungworms under field conditions.

Clinical investigations and treatment outcome in a European wildcat (Felis silvestris silvestris) infected by cardio-pulmonary nematodes.

Recently, feline cardio-pulmonary nematodes have attracted high scientific interest, as they are increasingly reported from various areas. Most of these parasites have similar transmission patterns and/or host reservoirs, thus they may affect domestic and wild felids living in sympatry. In the present study, a case of multiple cardio-pulmonary parasitism in co-infection with other parasites in a European wildcat is presented. The animal, found exhausted, was hospitalised for recovery and parasitological, haematological, clinical and imaging examinations were performed. The parasitological examinations revealed 4 cardio-pulmonary nematodes, i.e. Aelurostrongylus abstrusus, Troglostrongylus brevior, Eucoleus aerophilus, Angiostrongylus chabaudi, 3 intestinal parasites, i.e. Toxocara cati, ancylostomatids, Cystoisospora felis, 2 haemoparasites, i.e. Hepatozoon felis and elements morphologically compatible with small Babesia/Cytauxzoon spp., and Ixodes ricinus and Haemaphysalis erinacei ticks. Treatment with a spot-on formulation containing imidacloprid 10% and moxidectin 1% (Advocate® spot-on solution for cats, Bayer) was decided and follow-up faecal examinations were performed until the release of the animal. By the end of the hospitalisation, all metazoan endoparasites were no longer detectable in faecal examinations, with the exception of a low number of A. abstrusus larvae. Thus, the animal was released after a second treatment with the same product. This is the first description of an apparently successful treatment of multiple cardio-respiratory parasitosis in a naturally infected wildcat showing compatible clinical signs. The evidence that Advocate® may be effective against A. chabaudi could be useful for treating infected, hospitalised, wildcats and it is promising in the case A. chabaudi infection will spread to domestic cats in a near future.

Endoparasitism of Greek ostriches: First report of Entamoeba struthionis and Balantioides coli.

Ostrich farming is a worldwide practice and an internationally developing industry. Among challenges in livestock production are the parasitic infections. The present study aimed to the investigation of the gastrointestinal parasites biota and prevalence in ostriches raised in different areas of Greece. A total of 141 clinically healthy ostriches originating from four different localities of Greece were coprologically examined for parasites of the gastrointestinal tract. Coprological examination revealed a considerably high rate of infection (65.9%) with protozoa; however, no helminths (trematodes, cestodes and nematodes) were detected. In detail, cysts of Entamoeba struthionis have been found in 57.4% of the examined birds. Moreover, 39.0% of sampled ostriches harboured cysts of Balantioides coli (syn. Balantidium coli), while oocysts of Cryptosporidium sp. were detected at a low percentage (2.1%). Partial sequences of the small subunit rRNA (16S rRNA) gene and the ITS region were amplified from pooled Entamoeba and Balantioides positive samples, respectively, confirming for the first time the presence of Entamoeba struthionis and Balantioides coli in ostriches in Greece. Some of these parasitoses require attention as they may affect productivity performance of the animals in commercial ostrich farming and possibly pose disease risk for livestock and humans.

Severe Verminous Pneumonia Caused by Natural Mixed Infection with Aelurostrongylus abstrusus and Angiostrongylus chabaudi in a European Wildcat from Western Balkan Area.

AIMS: Aelurostrongylus abstrusus (Railliet, 1898) and Angiostrongylus chabaudi (Biocca, 1957) are important cardiopulmonary metastrongyloids in felids. This case report describes, for the first time, a natural and patent mixed infection caused by A. abstrusus and A. chabaudi in a European wildcat (Felis silvestris silvestris) from Bosnia and Herzegovina. Most important, this is a rare report of fatal parasitism in wildlife, involving a severe verminous bronchopneumonia and gastrointestinal nematode and cestode infection with Toxocara cati, Taenia taeniaeformis, Aonchotheca putorii, and Ancylostoma spp. RESULTS: Emphasis is set to detailed description of granulomatous, interstitial verminous bronchopneumonia, morphological description of A. abstrusus and A. chabaudi, and molecular confirmation of diagnosis by triplex PCR. CONCLUSION: The data provided in this study contribute to the knowledge on the epizootiology and pathological effect of these neglected metastrongyloids in European wildcat.

Occurrence and zoonotic potential of endoparasites in cats of Cyprus and a new distribution area for Troglostrongylus brevior.

The present study investigated for the first time the occurrence of pulmonary and intestinal parasites of cats in Cyprus. Cats from five districts of Cyprus (Lefkosia, Lemesos, Larnaka, Pafos and Ammochostos) were examined by classical parasitological methods and the identity of lungworm larvae, whenever present, was confirmed by PCR-coupled sequencing. A total of 185 cats, 48 living exclusively indoors and 137 with outdoor access, were included in the study. Parasites were found in 66 (35.7%) of the examined cats, i.e. Toxocara cati (12%), Cystoisospora rivolta (12%), Joyeuxiella/Diplopylidium spp. (7%), Giardia spp. (6.5%), Troglostrongylus brevior (5%), Cystoisospora felis (2.5%), Aelurostrongylus abstrusus (2%), Taenia spp. (0.5%) and Dipylidium caninum (0.5%). Mixed infections were recorded in 18 cats. Cats that lived exclusively indoors or had received an antiparasitic treatment in the last 6 months were less likely to be infected (p < 0.05). Moreover, cats younger than 1 year old were more likely to shed first-stage larvae of T. brevior (p = 0.04). The present study shows that cats in Cyprus are infected at a high percentage by a variety of parasites that potentially affect their health and also, in some cases (i.e. T. cati, D. caninum, Giardia spp.), may have an impact on human health. Moreover, it was revealed that T. brevior, a lungworm of emerging significance, is present on the island, rendering Cyprus the easternmost distribution border of this parasite in Europe to date.

Extension of the Avian Host Range of Collyriclosis in Europe.

We describe cases of collyriclosis in apodiform and passeriform birds in Portugal, Switzerland, and Germany. We extend the host range of Collyriculm faba to include apodiform birds ( Apus apus , Apus melba , and Apus pallidus ) and the passerine Sitta europaea (Eurasian Nuthatch). Infections varied in severity from an incidental finding to severe debilitation and death. The infection route remains unclear with the apparent absence from Germany, Portugal, and Switzerland of the first intermediate host of C. faba, the aquatic gastropod Bythinella austriaca, implying that other organisms might be involved in the parasite's life cycle. Furthermore, the detection of C. faba cysts in very young passerine birds may indicate an infection during the nestling stage and a rapid development of parasite-containing subcutaneous cysts. This series of cases highlights an increased geographic range into Portugal and the potential debilitating nature of a parasite of migratory birds in Europe. However, given the rarity of cases, collyriclosis does not seem to present an important threat to migratory species preservation.

First evidence of the European wildcat (Felis silvestris silvestris) as definitive host of Angiostrongylus chabaudi.

Angiostrongylus chabaudi (Strongylida, Angiostrongylidae) is a parasitic nematode described for the first time last century from the pulmonary arteries of six European wildcats (Felis silvestris silvestris) in central Italy. Since then, this parasite remained practically unknown until recently, when immature A. chabaudi have been reported from one wildcat in Germany and two domestic cats (Felis silvestris catus) in Italy. The present report describes the first record of A. chabaudi in Greece and, most importantly, the first known case of patent infection by A. chabaudi. The necropsy of a road-killed F. s. silvestris found near the lake Kerkini, in the municipality of Serres (Macedonia, Greece), revealed the presence of nematodes of both sexes in the right ventricle and the pulmonary artery of the heart. All parasites were mature adults and numerous eggs were present in the uteruses of females. The morphological characteristics of the parasites were consistent with those of A. chabaudi. Moreover, Angiostrongylus-like first stage larvae (L1) were present in the faeces of the animal that was negative for any other cardio-pulmonary parasite. Genetic examination of adult parasites and L1 confirmed the morphological identification as A. chabaudi. Histopathological examination of the lungs showed severe, multifocal to coalescing, chronic, interstitial granulomatous pneumonia due to the presence of adult parasites, larvae and eggs. These findings demonstrate for the first unequivocal time that this nematode reproduces in the European wildcat which should be ultimately considered a definitive host of A. chabaudi. Finally, the L1 of A. chabaudi are described here for the first time, opening new prospects for further studies on this neglected parasite.

Regurgitations in a Lamb with Acute Coenurosis-A case Report.

Coenurosis is a disease of the central nervous system in sheep, caused by Coenurus cerebralis, the larval stage of Multiceps multiceps, which inhabits the small intestine of Canidae. A case of regurgitations in a 2.5 month old lamb with acute coenurosis is being reported. The lamb was presented with a sudden onset of ataxia and regurgitations for 10 days. The post-mortem examination revealed 4 immature C. cerebralis cysts between 0.5 and 1.5 cm in diameter located in the brainstem and cerebellum, and histopathological examination revealed multifocal pyogranulomatous meningoencephalitis, so a diagnosis of acute coenurosis was established. Thus, acute coenurosis should be included in the differential diagnosis of regurgitations in lambs.

An analysis of seroprevalence and risk factors for parasitic infections of economic importance in small ruminants in Greece.

A cross-sectional serological survey was carried out to screen the small ruminants of Thessaly, Greece, for infection with Haemonchus contortus, lungworms (i.e. Cystocaulus ocreatus, Muellerius capillaris, Protostrongylus rufescens and Neostrongylus linearis) as a group, and for Cysticercus tenuicolis, Linguatula serrata and Oestrus ovis. A second objective was to determine the risk factors related to herd characteristics, management practices, farmer status and bioclimatic variables associated with these parasitic infections. A total of 361 sheep and 179 goat serum samples were examined. The seroprevalences were 33.9%, 41.5%, 14.1%, 4.6% and 1.4% for H. contortus, lungworms, L. serrata, C. tenuicolis and O. ovis, respectively. The final logistic regression model showed that farm location and temperature were associated with H. contortus, lungworm and L. serrata infections. Anthelmintic treatment, class of anthelmintic and rotation of grazing were associated with H. contortus and lungworm infections, while grazing with other herds was associated with lungworm and L. serrata infections; rain was associated with H. contortus and L. serrata infections. Farm type and age of farmer were associated with H. contortus infections and elevation was associated with lungworm infection. The results may help to formulate appropriate control strategies in Greece and other areas with similar climatic conditions in order to channel limited resources to mitigate only those risk factors which are significant to protect the profitability of the livestock industry.

Seroprevalence and risk factors associated with zoonotic parasitic infections in small ruminants in the Greek temperate environment.

A cross-sectional serological study was carried out to screen the sheep and goat population of Thessaly, Greece for evidence of infection with Toxoplasma, Toxocara, Leishmania, and Echinococcus and to determine the risk factors related to herd characteristics, herd management practices, farmer status, and the bioclimatic variables associated with these zoonotic parasitic infections. A total of 540 sheep and goat serum samples were examined. The seroprevalence of infection in all examined animals was 24.5% for Toxoplasma, 32% for Toxocara, 0% for Leishmania and 85.9% for Echinococcus. The final logistic regression model showed that the species of small ruminant, herd size, anthelmintic treatment, class of anthelmintic treatment, grazing with other herds, educational level of farmer, elevation of farm location, and generalized land cover were associated with Toxoplasma gondii infections, while the species of small ruminant, farm type, anthelmintic treatment, class of anthelmintic treatment, rotation of grazing, age of farmer, elevation of farm location, and generalized land cover were associated with Toxocara canis infections. Antibodies to T. gondii were detected in 102 (28.3%) of 360 sheep and in 30 (16.8%) of 179 goats. Animals in small flocks (150-300 animals) had an approximately 0.42-fold lower risk of having positive cases of T. gondii among animals compared with large flocks (>300 animals). Antibodies to T. canis were found in 155 (42.9%) of 361 sheep and 18 (10.1%) of 179 goats. The later finding constitutes the first report of seropositive goats to Toxocara. The risk of positivity for T. canis was 7.71-fold higher in sheep than in goats. Geographically, animals from plain areas had 2.9 and 2.01-fold higher risk of having positive cases of T. gondii and T. canis respectively. The significant bioclimatic variables (p<0.05) associated with the occurrence locations of T. gondii infection were related to higher temperature, lower precipitation, and lower elevation compared to the absence locations of T. gondii. The significant bioclimatic variables (p<0.05) associated with occurrence locations of T. canis infection were related to lower temperature and higher precipitation compared to absence locations of T. canis. These findings are useful to formulate appropriate control strategies for zoonotic parasites of sheep and goats in Greece and other areas with similar climatic conditions.

Persistent Giardia spp. and Trichuris spp. infection in maras (Dolichotis patagonum) at a zoo in Greece.

The mara (Dolichotis patagonum) is a species classified as "Near Threatened" by the International Union for Conservation of Nature. In the wild, it inhabits only Argentina, but it is also kept in zoos around the world. In order to investigate the endoparasites of the maras kept in the Attica Zoological Park, Greece, four fecal examinations were performed in a period of 4 yr (2008-2011) by standard parasitologic methods. Cysts of the protozoan parasite Giardia spp. and eggs of the nematode Trichuris spp. were found in all four examinations. The possible routes of infection of the maras and the importance of these parasites to other animals and to humans are discussed.

Specific anti-Leishmania spp. antibodies in stray cats in Greece.

Greece is a highly endemic country for Leishmania species. Canine cases of leishmaniosis are recorded in different parts of the country. However, no case of feline leishmaniosis has been reported yet. In the present study, the seroprevalence in cats was investigated as a first approach to measuring Leishmania spp. infection of this animal species, in Greece. For this purpose, blood serum samples from 284 stray adult cats, living in the major area of Thessaloniki (Northern Greece), were examined by enzyme-linked immunosorbent assay for the detection of anti-Leishmania spp. IgG. Eleven (3.87%) of the examined animals were found positive. The prevalence was lower in cats than in dogs coming from the same area, based on previous studies. Despite the low seroprevalence for Leishmania spp. in cats, leishmaniosis may be taken into consideration concerning the differential diagnosis of the feline diseases, especially in endemic areas.

Periodic administration of allopurinol is not effective for the prevention of canine leishmaniosis (Leishmania infantum) in the endemic areas.

A total of 95 clinically healthy and seronegative for Leishmania infantum dogs, residing an area highly endemic for canine leishmaniosis (CL) and living an outdoor life-style, were split into positive and negative groups, and then were randomly assigned to receive allopurinol (n=51; 20 mg/kg once daily), or placebo (n=44) for 1 week per month, from April to November. Forty per cent (38/95) of these dogs were not reexamined and retested at the end of the trial for reasons unrelated to CL. None of the remaining 57 dogs exhibited the symptomatic form of the disease at the end of the 1-year follow-up period. Of the 15 allopurinol-treated dogs that were non-infected (negative PCR and tissue smear microscopy) at the beginning of the trial, 6 (40% P=0.03) became PCR-positive, of which 3 became also seropositive, at the end of the observation period. In contrast, only 1 of 7 (14.3%) placebo-treated non-infected dogs became PCR positive at the same time point. Of the 19 allopurinol-treated dogs that were infected (PCR-positive) at the beginning of the trial, 18 (94.7%) remained PCR-positive and one (5.3%) seroconverted, at the end of the observation period. Of the 16 initially infected and placebo-treated dogs, 14 (87.5%) remained PCR positive, of which one (6.7%) also turned positive by tissue smear microscopy. Therefore, it is concluded that the use of allopurinol, at the daily dose of 20mg/kg, for 1 week per month, during the period of sandfly activity, does not prevent the infection of non-infected dogs by L. infantum, and, also, does not help in the elimination of the parasite from dogs with asymptomatic infections.