Parasitic infections among patients hospitalized in the Tropical and Parasitic Clinic of Poznan University of Medical Sciences, Poland between 2015 and 2018. Is there a relationship between protozoa infection and gastrointestinal symptoms?

Introduction: Diarrhoea is a common reason for hospitalization among travellers returning from the tropics. The aetiology is predominantly bacterial, but it can also be caused by parasites such as Giardia intestinalis, Cryptosporidium spp., and Blastocystis spp. Aim: We analysed patients from the Poznan Tropical and Parasitic Clinic to evaluate the presence of parasitic infections and to find correlations between infections, journeys, and gastrointestinal symptoms. Material and methods: In our study we examined 2561 stool samples obtained from patients hospitalized in the Tropical and Parasitic Department of Poznan Medical University, Poland. Microscopic examinations of samples were performed based on a direct thin smear in 0.9% NaCl, which allowed the assessment of the presence of protozoa life stages. Results: In 106 (4.14%) of the 2561 examined samples we detected parasites, mainly from people coming back from tropical areas (61.32%). Mostly we detected Blastocystis sp. and Giardia intestinalis. Fifty percent of patients suffered from gastrointestinal symptoms, so careful microscopic stool examination should be performed in every case in which intestinal pathology occurs, and certainly in travelling individuals. Conclusions: Traveling is a real risk factor for protozoa infection. The most common parasites detected in the stool are Blastocystis sp. and Giardia intestinalis. Parasitic coinfection should be taken into consideration as a pathologic agent in patients suffering from abdominal signs and persistent diarrhoea. Prolonged protozoa infection and its role in microbiota alterations requires further investigation.

Cryptosporidium spp. and Blastocystis spp. coinfection as a reason of an acute diarrhea in a young healthy veterinary Polish student - Case report.

OBJECTIVES: Cryptosporidium belongs to enteric parasites responsible for prolonged symptoms in the gastrointestinal tract, both in immunocompetent and immunocompromised individuals. One of the risk factors of infection is contact with an infected person or animals (cattle). The case is described of a young man admitted to the Department of Tropical and Parasitic Diseases of the Medical University in Poznan, Poland, because of watery diarrhea with high fever and in whom symptomatic treatment did not produce any improvement. MATERIAL AND METHODS: A 21-year -old male was examined and his epidemiologic history obtained. Primary blood test, anti- Toxocara IgG (ELISA) and anti-Toxoplasma gondii IgG and IgM (ELISA) were performed. PCR detected 16 enteropathogens in a stool sample. Microscopic parasitic stool examination was also performed based on Ziehl-Neelsen method, which allowed the assessment of the presence of cryptosporidium life stages. RESULTS: Epidemiology data provided information that the patient was a veterinary student who therefore had many contacts with domestic animals. Multiplex PCR detected a genetic material of Cryptosporidium. The result was confirmed with repeated positive direct stool examinations which gave the evidence of Cryptosporidium spp. oocysts and vacuolar forms of Blastocystis spp.. CONCLUSIONS: 1) Cryptosporidium is responsible for watery diarrhea in healthy individuals. 2) Contact with animals (cattle) is a potential risk factor for infection. 3) Protozoan co-infection should be treated to shorten the symptomatic period and to avoid post-infection complications. 4) Different diagnostic methods increase the possibility to establish appropriate diagnosis.

Carbapenemase-producing Enterobacteriaceae in a group of Polish travelers returning from South and South-East Asia, June 2017 - June 2018. Environment- or healthcare-associated?

INTRODUCTION: Carbapenemase-producing Enterobacteriaceae have spread rapidly through the countries and continents to become a global concern. One of the main reservoirs of NDM-1 positive strains from the Enterobacteriaceae family is the Indian subcontinent (Bangladesh, Pakistan, India). MATERIAL AND METHODS: During June 2017 - June 2018, rectal swab samples were collected routinely in all patients returning to Poland from South and South-East Asia. During molecular examinations gene blaNDM-1 encoding NDM-1 carbapenemase was detected. RESULTS: 31 patients were examined after returning to Poland from a trip to South and South-East Asia. The presence of New Delhi Metallo-ß-lactamase-1 producing Escherichia coli and Klebsiella pneumoniae was confirmed in three patients (9.7%) returning to Poland from travels to India. All the positive patients were hospitalized during the trip in a New Delhi hospital. CONCLUSIONS: Digestive tract carriage of NDM in a group of Polish travelers is a significant health and epidemiological problem. The study confirms the necessity for screening for carbapenemase-producing Enterobacteriaceae (CPE), particularly among travellers. Rectal swabs should be collected in every case of patients returning from international trips, and the possibility of environment-associated infections should be emphasized.

Case of Plasmodium knowlesi Malaria in Poland Linked to Travel in Southeast Asia.

We report a case of Plasmodium knowlesi malaria imported to central Europe from Southeast Asia. Laboratory suspicion of P. knowlesi infection was based on the presence of atypical developmental forms of the parasite in Giemsa-stained microscopic smears. We confirmed and documented the clinical diagnosis by molecular biology techniques.

Disseminated skin rash and blood eosinophilia in a Polish traveler diagnosed Strongyloides stercoralis, Trichuris trichiura, Schistosoma sp. and Blastocystis sp. coinfection

Traveling to tropical countries make very often for travelers a danger of illnesses, which do not exist or exist very rarely in temperate climate. Imported parasitic disease cases are inevitable and have been reported increasingly as a result of enhanced globalization. The most common infections in endemic areas are caused by soil transmitted helminths. Symptoms of many invasions occurred even several weeks after returning from endemic areas (schistosomatosis, strongyloidosis, leishmaniosis). In this work we described a case of a young Polish traveler, who came back to Poland, from two months touristic journey in Democratic Republic of the Congo, Africa, who was diagnosed Schistosoma sp., Trichuris trichiura, Strongyloides stercoralis and Blastocystis sp. coinfection. Parasitic infections should be taken under consideration in differential diagnosis in patients suffering from disseminated skinvchanges and eosinophilia syndrome specially in individuals returning from endemic areas.

Massive Cryptosporidium infections and chronic diarrhea in HIV-negative patients.

Protozoa of the genus Cryptosporidium are common parasites of domestic and wild animals-mammals, birds, reptiles, and fishes. The invasive forms are thick-walled oocysts, which can be present in water supplies, on fruits, vegetables, or in the soil contaminated with feces. In this work, we describe three cases of middle-aged persons with massive Cryptosporidium hominis infection and chronic diarrhea with no immunological abnormalities and no history of previous travels to tropical countries. The lesions discovered during colonoscopy within the large intestine-cryptitis and the histopathological changes were related to massive cryptosporidiosis. All these statements indicate necessity of parasitological stool examination in cases with chronic diarrhea in which no etiological agents are detected, but not only in HIV positive individuals. Parasite's eradication leads to symptom disappearance as well as improvement of histopathological mucosa alterations.

Cerebral malaria and multi-organ dysfunction in an adult woman with Plasmodium falciparum infection imported from Cameroon: a case report

Malaria is one of the most life-threatening parasitic diseases caused by the protozoa of the genus Plasmodium, occurring in the tropical and subtropical regions. Misdiagnosed infection can progress to a wide range of life-threatening pathologies, including severe anemia and cerebral malaria which can lead to death even few days after first symptoms appearance. Cerebral malaria is rare in adults and most cases are connected to children under 5 years old living in malaria endemic areas. In this article we describe cerebral malaria caused by the Plasmodium falciparum in a 45-year-old Polish patient, who traveled to Cameroon without any malaria prophylaxis. The patient had been treated in an intensive care unit because of multi-organ dysfunction as a result of the delayed malaria diagnosis. The presence of thrombocytopenia, anemia, metabolic acidosis, acute respiratory distress syndrome and multi-organ dysfunction involving liver, kidneys, and brain created an image of advanced severe malaria. Loss of consciousness, GCS 6, and the presence of asexual Plasmodium falciparum forms in blood films are the evidence of cerebral malaria. To avoid development of cerebral malaria, the illness should be diagnosed immediately. The cerebral malaria can occur also in adult healthy individuals. Appropriate treatment with intravenous artemisine can protect the patient from lifethreatening complications. Prolonged anemia after treatment can be a consequence of artemisine usage as well as a severe malaria sequel.

Dirofilaria repens infection as a cause of intensive peripheral microfilariemia in a Polish patient: process description and cases review.

Dirofilariasis is a parasitic disease of dogs and other carnivores transmitted mainly by the mosquitoes of the genera Culex, Aedes, Anopheles. Full life cycle of the Dirofilaria nematodes in humans is extremely rarely observed, usually lacking species determination at the molecular level. We report fully documented unusual clinical manifestation of subcutaneous dirofilariasis with intensive microfilariemia in peripheral blood revealed by the Knott's concentration technique. The identification of the Dirofilaria repens nematode was based on typical morphological findings for adult gravid female nematode found in the histopathological preparations. The morphology of microfilariae obtained from patient's peripheral blood was also typical for D. repens. The final identification was confirmed by the molecular analysis of microfilariae collected from the blood.

Intestinal coccidian parasites as an underestimated cause of travellers' diarrhoea in Polish immunocompetent patients.

Intestinal coccidian parasites are intracellular protozoa most frequently transmitted during food-borne and water-borne infections. This group of parasites is responsible for acute diarrhoeal illnesses especially among immunocompromised patients. However, they are more frequently detected in immunocompetent individuals including travellers, and they should also be considered as important etiologic factors of travellers' diarrhoea. We examined 221 immunocompetent patients hospitalized due to acute or chronic diarrhoea and other gastrointestinal symptoms after returning from international journeys to hot climates. A basic microscopical examination and acid - fast staining of stool samples was performed. Each patient was also a part of the epidemiological investigation to define potential risk factors of tropical gastrointestinal infections. Intestinal coccidiosis was confirmed in 12 out of 221 successively hospitalized patients (5.4%). The most common coccidian parasite was Cryptosporidium spp., detected in nine Polish travellers (4.1%). Cyclospora spp. was diagnosed in three cases (1.4%), including two mixed infections with Cryptosporidium spp., and Cystoisospora spp. in two other cases (0.9%). The study has revealed that intestinal coccidian parasites are a significant threat to immunocompetent travellers and should be always considered in the differential diagnosis of gastrointestinal disorders. Therefore, it is necessary to perform specialized diagnostic methods for the detection of Cryptosporidium spp., Cystoisospora spp., and Cyclospora spp. oocysts in reference parasitology laboratories. Clinical observations demonstrated simultaneously an insufficient level of knowledge in Polish tourists concerning the main risk factors of intestinal parasitic diseases during international travels, particularly to developing countries with lower economic and sanitary conditions.