Human Taeniases in Slovakia (2010-2019): Genetic Analysis of Taenia saginata Isolates.

Taenia saginata and Taenia solium, known as beef and pork tapeworm, are foodborne pathogens of global importance having a substantial impact on human health and economy. The study aimed to summarize the occurrence of human Taenia spp. infection in past 10 years in Slovakia based on reports of clinicians and diagnostic laboratories to Public Health Authority of the Slovak Republic. Altogether, 19 human cases were reported in Slovakia in 2010-2019, with the incidence of infection ranging from 0.00 to 0.12/100,000 inhabitants per year. In two patients T. saginata infection was confirmed molecularly. Nucleotide sequences of the analyzed nad1 gene fragments derived from both patients were identical and in a phylogenetic tree clustered together with T. saginata Tsa isolate (AM503345), as well as with a homologous sequence of the completely sequenced mitochondrial genome of T. saginata. Similarly, cox1 nucleotide sequences derived from one of the patients and isolates from Asia and/or Europe were identical. A cluster for cox1 partial gene sequence was placed separately from closely related Taenia asiatica and/or T. solium isolates in the phylogenetic tree.

Ocular Dirofilariasis after Clinically Manifested Subcutaneous Migration of the Parasite: A Case Report.

Dirofilaria repens is the causative agent of human subcutaneous or, less often, ocular dirofilariasis. The work presents a rare case of ocular dirofilariasis manifested by previous subcutaneous migration accompanied by severe headache symptoms. In February 2017, a 58-yr-old man from Trnava region, western Slovakia, noticed red and itchy stripes on his left leg. Inflamed but painless stripes disappeared and showed up again every 5-7 days, migrating gradually towards the head. Approximately one month after the first skin's alterations, strong pain in the left temple, with the swelling of the left face and the enlargement of mandibular lymph nodes appeared. Several days later, the patient felt excruciating pain of the right eyeball accompanied by strong nausea and subsequent vomiting. Ocular examination revealed the presence of a live worm in the subconjunctival space and morphological and molecular analyses of extracted helminth confirmed D. repens as etiological agent of the infection. According to clinical manifestation of the infection, it could be supposed that ocular form of the disease was the result of the migration of a parasite through the subcutaneous tissues. Moreover, a rare phenomenon of lymphadenitis of underlying lymph nodes and the swelling of left face accompanied the migration.

Pseudo-Tumor of the Epididymis, a Rare Clinical Presentation of Human Dirofilaria repens Infection: a Report of Autochthonous Case of Dirofilariasis in Southwestern Slovakia.

PURPOSE: Dirofilariasis caused by the filarial nematode Dirofilaria repens is mainly a disease of dogs and other carnivores. Also, humans can be accidentally infected with this parasite. The infective third-stage filariform larvae are transmitted by various species of mosquitoes. Until this day, a total of 17 human cases caused by D. repens have been diagnosed in Slovakia, 11 subcutaneous, 4 ocular, 1 pulmonary and 1 in the epididymis. The aim of this report was to describe an unusual clinical case of dirofilariasis of the scrotum. METHODS: Extirpated worm was subjected to the molecular and histological identification. PCR for the amplification of cytochrome oxidase subunit 1 (CO1) was performed using specific D. repens primer pair. RESULTS: Here we document the 13th case of human dirofilariasis in a 46-year-old man from southwestern Slovakia. Very rare in humans, genital involvement manifests itself as pseudotumor nodule affecting the epididymis. The patient consulted a general practitioner due to a palpable subcutaneous lump in the scrotum. Routine laboratory analysis revealed blood eosinophilia (16.6%). The ultrasound examination was indicated, and subsequently, surgical excision of the right epididymal nodule was performed. On the basis of histological microscopic examination and PCR-based detection, the helminth was identified as Dirofilaria repens. This represents the ninth case of autochthonous dirofilariasis in Slovakia. CONCLUSIONS: The majority of D. repens infections were recorded in southwestern regions of Slovak Republic, which are considered to be endemic areas for canine dirofilariasis. Our described patient also comes from southwestern part of Slovakia (Topolníky, Dunajská Streda region).

The first report of animal genotypes of Cryptosporidium parvum in immunosuppressed and immunocompetent humans in Slovakia.

The aim of our study was to determine species and genotypes of Cryptosporidium in patients suffering from immunosuppressive illnesses, but also in immunocompetent patients suffering from diarrhoea. A total of 80 samples of faeces were collected from both immunosuppressed and immunocompetent patients. The immunosuppressed patients (65 samples) - 35 adult patients (group A) and 30 children (group B) were hospitalized at the Clinic of Oncohemathology. Samples from immunocompetent humans (15 samples, group C) were taken from patients with clinical signs of acute diarrhoea. With the use of molecular methods targeting the 60 kDa glycoprotein (GP60) gene region, we have identified multiple genotypes of Cryptosporidium. parvum and Cryptosporidium. hominis in immunocompromised, but also in immunocompetent individuals (C. hominis IbA10G2, IeA12G3T3; C. parvum IIaA10G1R1, IIaA11G2R1, IIaA12G2R1, IIaA13G1R1, IIaA14G1R1, IIaA14G2R1, IIaA17G1R1 and IIaA18G1R1). This is the first report of the occurrence of genotypes IIaA10G1R1, IIa12G2R1 and IIaA18G1R1 in human hosts.

Assessment of the diagnostic value of specific anti-Toxocara IgA in Slovakian patients suspected to have toxocarosis.

Human toxocarosis is one of the most widespread and prevalent helminthic zoonosis in many countries, including Slovakia. The aim was to evaluate the usefulness of IgA anti-Toxocara antibody detection in the serodiagnosis of toxocarosis. The levels of specific IgA antibodies were determined by excretory-secretory (ES)-enzyme-linked immunosorbent assay (ELISA). The IgA seropositivity in IgG anti-Toxocara seropositive patients (n = 52) was 32.7% and found to be highest in the oldest age groups (P = 0.026). The presence of IgA in suspected patients for toxocarosis were evaluated in respect to some characteristics of examined persons. Substantially higher IgA seropositivity was detected in patients with increased total IgE (44.8%) than in subjects with a normal level of IgE (17.4%; P = 0.036). No associations (P > 0.05) were found between IgA seropositivity and sex, level of specific IgG antibodies, avidity of IgG, eosinophilia, domicile, geophagia, traveling abroad, dog/cat ownership, or clinical symptoms. The IgA-ELISA showed sensitivity of 57.1% and specificity of 100%. Mild correlations (r = 0.302, r = 0.305, r = - 0.409) were observed between the levels of anti-Toxocara IgA antibodies and age, the amounts of eosinophils and IgA antibody levels, the amounts of eosinophils, and the values of IgG avidity, respectively. The presence of anti-Toxocara IgA may facilitate the diagnosis of toxocarosis and may well be useful for the determination of acute Toxocara infection. Moreover, this test should be accompanied by other immunological markers of examined patients (e.g., increased total IgE, eosinophilia, and low-avidity IgG antibodies).

Human Dirofilaria repens infections diagnosed in Slovakia in the last 10 years (2007-2017).

Human dirofilariosis is currently considered to be an emerging zoonosis of Central Europe with climate change and globalization playing a key role in its spreading. Additionally, the occurrence of Dirofilaria spp. is strongly subject to a certain number of microfilaremic dogs and the presence of the mosquito vectors. Both conditions are fulfilled in Slovakia. The first human case of autochthonous dirofilariosis in Slovakia was diagnosed in 2007, 2 years after the infection had been observed in the Slovak dog population. Since then, a total of 12 human cases caused by Dirofilaria repens have been registered at the Institute of Parasitology, Slovak Academy of Sciences, 7 subcutaneous, 4 ocular and 1 pulmonary; however, it is likely that some cases remain undiagnosed, seeing that this infection is still missed by physicians. Of the patients 9 were male and 3 were female and their age varied between 15 and 72 years (mean 49 years). The majority of those affected came from the southern regions of the country, bordering Austria and Hungary, which are considered to be endemic areas for canine dirofilariosis. In this paper all published and unpublished cases are reviewed, with a special emphasis on the rare pulmonary form of D. repens infection.

Immunodiagnostic approaches for the detection of human toxocarosis.

Human toxocarosis is an important zoonosis caused by larvae of Toxocara canis/cati. The objective was to evaluate the role of IgG anti-Toxocara antibody detection and the specific IgG avidity in diagnostics of human toxocarosis. Anti-Toxocara IgG antibodies and IgG avidity were evaluated by excretory-secretory (ES)-enzyme-linked immunosorbent assay (ELISA). The IgG anti-Toxocara seroprevalence in people (n = 7678) from western Slovakia was 15.3% and found to be highest in the oldest age groups. The presence of low- IgG avidity in 179 suspected patients for toxocarosis was evaluated in relation to sex, age, IgG antibody levels, eosinophilia, increased total IgE, domicile, geophagia, dog/cat ownership, anamnesis. Low- IgG avidity index was found in 30.7% of the patients. The low- IgG avidity in eosinophilic group (42.1%) was significantly higher than in non-eosinophilic group (22.0%; P = 0.043). Substantially higher eosinophilia was detected in children (under 10 years old; 55.6%) than in adults (aged ≥ 41 years; 17.6%; P = 0.009). Significant difference between seroprevalence of total IgE in patients coming from towns (48.8%) and patients from villages (21.3%) was established (P = 0.007). Mild negative correlation (r = -0.477, P = 0.043) was observed between the amounts of eosinophils and the values of IgG avidity. The sensitivity and specificity of IgG avidity assay were 43.8% and 83.3%, respectively. Our results suggest that besides anti-Toxocara IgG, measurement of IgG avidity may be useful for the determination of acute toxocarosis. Moreover, these tests should be accompanied by other immunological markers and determinants of examined patients such as eosinophilia, increased total IgE and age.

Molecular characterization and first report of Cryptosporidium genotypes in human population in the Slovak Republic.

In our study, we examined 91 fecal samples from five different groups of people containing HIV patients, hemodialysis patients, kidney transplant recipients, immunocompetent humans without clinical signs, and humans with suspected cryptosporidiosis. The purpose of our study was to determine species and genotype composition of representatives of Cryptosporidium spp. using PCR analysis of small subunit ribosomal RNA gene and 60-kDa glycoprotein gene and examine their phylogenetic relationship. In HIV-positive/AIDS-infected group of patients and in hemodialysis patients, no presence of Cryptosporidium species was detected. In two kidney transplant recipients, we detected species/genotypes Cryptosporidium parvum IIaA13G1T1R1 (KT355488) and Cryptosporidium hominis IaA11G2R8 (KT355489) and in two immunocompetent patients with clinical symptoms, we identified Cryptosporidium muris and C. hominis IbA10G2T1 (KT355490). In the group of healthy immunocompetent individuals without clinical signs, we identified species/genotype C. hominis IbA11G2 (KT355491) in one sample.

Synthesis of structural analogues of hexadecylphosphocholine and their antineoplastic, antimicrobial and amoebicidal activity.

Twelve derivatives of hexadecylphosphocholine (miltefosine) were synthesized to determine how the position and length of the alkyl chain within the molecule influence their biological activities. The prepared alkylphosphocholines have the same molecular formula as miltefosine. Activity of the compounds was studied against a spectrum of tumour cells, two species of protozoans, bacteria and yeast. Antitumour efficacy of some alkylphosphocholines measured up on MCF-7, A2780, HUT-78 and THP-1 cell lines was higher than that of miltefosine. The compounds showed antiprotozoal activity against Acanthamoeba lugdunensis and Acanthamoeba quina. Some of them also possess fungicidal activity against Candida albicans equal to miltefosine. No antibacterial activity was observed against Staphylococcus aureus and Escherichia coli. A difference in position of a long hydrocarbon chain within the structure with maximum efficacy was observed for antitumour, antiprotozoal and antifungal activity.

Cytomorphological changes and susceptibility of clinical isolates of Acanthamoeba spp. to heterocyclic alkylphosphocholines.

The treatment of diseases caused by pathogenic strains of Acanthamoeba spp. is to date limited and frequently unsuccessful. Alkylphosphocholines (APCs) are promising agents with interesting results of antiparasitic activity in experimental and clinical conditions. In the present study susceptibilities of two clinical isolates of Acanthamoeba spp. to four heterocyclic APCs were investigated. The isolates showed high degrees of susceptibility to studied APCs and all the tested concentrations inhibited the growth with the highest concentrations of 500-1000µM causing 100% eradication of the trophozoites and cysts. The highest susceptibility was noted in IF16-P-4-Pip with EC50 values of 28.62-43.73µM, and EC90 values of 30.70-63.16µM after 48h of incubation. The cytomorphological changes of trophozoites after the exposure to APCs included rounding up of cells, resorption of acanthopodia and subsequent lysis. The remains of cells were typical with oval shape and identifiable nucleus. After the application of IF16-P-4-Pip, IF16-P-2-MetPip, and IF16-P-Azep, at concentrations of 62.5-125µM to trophozoite suspension, a formation of pseudocysts was detected. The single-layered coat covering the surface of pseudocyst stained positively with a fluorescence brightener, Rylux. Destroyed cysts were characteristic with shrinkage of the cytoplasm and separation of the cytoplasmic membrane from the endocyst. IF16-P-2-MetPip at the highest concentration formed large spherical vesicles which frequently enclosed inactivated cysts. Heterocyclic APCs used in the study demonstrated strong amoebicidal activity and the cytotoxic effect of IF16-P-4-Pip similar to that of miltefosine indicates its possible therapeutic potential.

Synthesis, self-aggregation and biological properties of alkylphosphocholine and alkylphosphohomocholine derivatives of cetyltrimethylammonium bromide, cetylpyridinium bromide, benzalkonium bromide (C16) and benzethonium chloride.

A series of alkylphosphocholine and alkylphosphohomocholine derivatives of cetyltrimethylammonium bromide, cetylpyridinium bromide, benzalkonium bromide (C16) and benzethonium chloride have been synthesized. Their physicochemical properties were also investigated. The critical micelle concentration (cmc), the surface tension value at the cmc (γcmc), and the surface area at the surface saturation per head group (Acmc) were determined by means of surface tension measurements. The prepared compounds exhibit significant cytotoxic, antifungal and antiprotozoal activities. Alkylphosphocholines and alkylphosphohomocholines possess higher antifungal activity against Candida albicans in comparison with quaternary ammonium compounds in general. However, quaternary ammonium compounds exhibit significantly higher activity against human tumor cells and pathogenic free-living amoebae Acanthamoeba lugdunensis and Acanthamoeba quina compared to alkylphosphocholines. The relationship between structure, physicochemical properties and biological activity of the tested compounds is discussed.

The first reported cases of human cryptosporidiosis caused by Cryptosporidium hominis in Slovak Republic.

Cryptosporidiosis belongs to the important parasitic infections with zoonotic potential and the occurrence in European countries is rare. The first cases of cryptosporidiosis caused by Cryptosporidium hominis detected in the Slovak republic were described here. Collection of examined humans consisted of five family members. Faecal specimens were examined by formalin sedimentation, by the Sheather's sugar flotation and by immunochromatography and visualised by the Ziehl-Neelsen acid fast stain. A fragment of the Cryptosporidium small subunit ribosomal RNA gene was amplified by nested polymerase chain reaction and species was determined by restriction fragment length polymorphism analysis with the endonucleases SspI and VspI. C. hominis was found in faeces of two immunocompetent siblings (a 7-year-old boy and a 2-year-old girl). The symptoms occurred only in the boy as gastrointestinal disorders lasting 5 days, and manifested by abdominal pain, an elevated body temperature (37.2 °C), mild diarrhoea, accompanied by lassitude, depression and anorexia. Ultrasonic scan revealed enlarged spleen and mezenteric lymph nodes. Microscopic examination of the stool sample revealed numerous Cryptosporidium oocysts. The DNA typing identified C. hominis subtype IbA10G2. Cryptosporidium was also detected in the boy's sister without any complications and symptoms. Their father, mother and grandmother were parasitologically negative. The source of infection remained unknown. Human cases in present study reflect necessity of systematic attention on intestinal parasites diagnostic inclusive of cryptosporidia.

Relationship between aggregation properties and antimicrobial activities of alkylphosphocholines with branched alkyl chains.

Synthesis of five alkylphosphocholines with branched alkyl chains (Isophol-PCs) with different length of alkyl chains was described. Isophol(8)-PC and Isophol(12)-PC represent new compounds. The physico-chemical properties of Isophol-PCs were determined, critical micelle concentration and types of formed aggregates in aqueous solutions were investigated. The biological activities of Isophol-PCs have been studied for the first time in the present study. Antimicrobial activities of alkylphosphocholines were studied against bacteria (Staphylococcus aureus, Escherichia coli), yeast (Candida albicans) and pathogenic free-living amoebae (Acanthamoeba lugdunensis and Acanthamoeba quina). A. lugdunensis and A. quina are relatively insusceptible to action of miltefosine (standard compound of alkylphosphocholines) and therefore they are good models for studies of amoebicidal action of the investigated compounds. Relationship between structure, physico-chemical and biological activities of Isophol-PCs was discussed. S. aureus and C. albicans were sensitive to action of Isophol(16)-PC, Isophol(20)-PC. E. coli was not sensitive to action of all studied alkylphosphocholines in the concentrations equal to, or less than 10mM. Among all the synthesized compounds, Isophol(16)-PC had the highest level of activity against both strains of Acanthamoeba. The minimum trophocidal concentrations of Isophol(16)-PC against A. lugdunensis and A. quina are about four times lower than the minimum trophocidal concentrations of miltefosine against both strains.

Human dirofilariosis in the Slovak Republic - a case report.

The spread of dirofilariosis, as a newly emerging zoonosis, due to global changes has been documented in several Central European countries. In Slovakia, the first autochthonous case of dirofilariosis was recorded in dogs in 2005. The first case of human subcutaneous dirofilariosis caused by Dirofilaria repens was diagnosed in a 60- year-old patient from an area of western Slovakia. We report another case of dirofilariosis in a 37-year-old woman living in the same area of south-western Slovakia. The infection manifested as a painful, inflamed nodule on the back of the left hand, containing an adult parasite. Morphological analysis aroused suspicion of the presence of a filarial worm belonging to the genus Dirofilaria. Subsequent PCR analysis of the DNA identified the parasite as Dirofilaria repens. After removal of the parasite, the subcutaneous nodule completely resolved and the patient was successfully cured.

Synthesis and biological activity of dialkylphosphocholines.

A series of dialkylphosphocholines were prepared and evaluated for their biological activity. The antiprotozoal activity was determined against Acanthamoeba lugdunensis. Compound 15 exhibited excellent trophocidal activity. None of the tested dialkylphosphocholines exhibited better fungicidal activity against Candida albicans than miltefosine. The antineoplastic activity was determined against HeLa. The most cytotoxic was compound 10, which was more active against tumor cells as against normal cells.

Dialkylamino and nitrogen heterocyclic analogues of hexadecylphosphocholine and cetyltrimetylammonium bromide: effect of phosphate group and environment of the ammonium cation on their biological activity.

A series of dialkylamino and nitrogen heterocyclic analogues of hexadecylphosphocholine and cetyltrimethylammonium bromide have been synthesized. The prepared compounds exhibit significant cytotoxic, antifungal and antiprotozoal activities. Alkylphosphocholines possess higher antifungal activity against Candida albicans in comparison with quaternary ammonium compounds. However, quaternary ammonium compounds exhibit significant higher activity against human tumor cells and Acanthamoeba lugdunensis compared to alkylphosphocholines. In addition, their haemolytic toxicity has been investigated. The relationship between structure and biological activity of the tested compounds is discussed.

First cases of Acanthamoeba keratitis in Slovakia.

We present the case report of the first identification of Acanthamoeba as a causative agent of keratitis in the Slovak Republic. For the first time, Acanthamoeba sp. Group III was isolated from a 53-year-old patient with keratitis, which was manifested after an injury of the right eye. A delayed visit to a physician as well as a late diagnosis of the illness led to the advanced stage of eye disease. As the treatment with itraconazol and cornea transplantation showed no result, enucleation of the eye was decided. Acanthamoeba ludgunensis was also the causative agent of keratitis in a 39-year-old patient wearing contact lenses. His complaints occurred a month after bathing in a thermal swimming pool. The symptoms presented in the left eye were those of herpetic keratitis, and led to a cloudy cornea with circular infliltrate and poor vision. A prompt clinical and laboratory diagnosis, along with treatment with propamidine-isetionate resulted in a significant improvement of the eye condition. Contact lenses were probably related to another case of Acanthamoeba keratitis. The patient, a 15-year-old girl, kept wearing contact lenses during bathing in various swimming pools and in the sea; her contact lenses were also regularly washed under tap water. Due to the fact that cysts of Acanthamoeba sp. group II were found in the contact lens solution, this is presumed to be the source of the eye infection.