IL-33/ST2 contributes to severe symptoms in Plasmodium chabaudi-infected BALB/c mice.

It has been reported that IL-33 contributes to potentiation of Th2 inflammatory diseases and protection against helminth infection. Increased plasma IL-33 levels have been observed in patients with severe falciparum malaria, however, the role of IL-33 in malaria remains unclear. Here we report that IL-33 enhances inflammatory responses in malaria infection. ST2-deficiency altered severity of inflammation in the liver and serum levels of pro-inflammatory cytokines such as TNF-α and IL-6, and IL-13 that is a Th2 cytokine during Plasmodium chabaudi infection. IL-13-deficient mice have similar phenotype with ST2-deficient mice during P. chabaudi infection. Furthermore, ST2- and IL-13-deficiency reduced mortality from P. chabaudi infection. These results indicate that IL-33/ST2 can induce production of proinflammatory cytokines, such as TNF-α and IL-6, through production of IL-13 in P. chabaudi-infected BALB/c mice, suggesting that IL-33/ST2 play a critical role in inflammatory responses to malaria infection. Thus, these findings may define a novel therapeutic target for patients with severe malaria.

Loiasis in a Japanese Traveler Returning from Central Africa.

We encountered a probable case of loiasis in a returned traveler from Central Africa. A 52-year-old Japanese woman presented to our hospital complaining of discomfort in her eyes and skin. She reported having frequently visited Central Africa over many years and having been extensively exposed to the rainforest climate and ecosystem. Although no microfilariae were found in her blood, there was an elevated level of IgG antibodies against the crude antigens of Brugia pahangi, which have cross-reactivity with Loa loa. She was treated with albendazole for 21 days, after which the antigen-specific IgG level decreased and no relapse occurred.

Molecular identification of Anisakis and Hysterothylacium larvae in marine fishes from the East China Sea and the Pacific coast of central Japan.

Anisakiasis is a human disease caused by the accidental ingestion of larvae belonging to the family Anisakidae. Three fish species, the small yellow croaker Pseudosciaena polyactis, the mackerel Pneumatophorus japonicus and the hairtail Trichiurus haumela are important source for food products in the East China Sea. The prevalence and the identification of Anisakidae larvae in these fishes will benefit the prevention and control of anisakiasis. In this study, fish samples were obtained from fish markers in the East China Sea and the Pacific coast of central Japan during April 2011 and July 2013. For species identification, the PCR-based restriction fragment length polymorphism (PCR-RFLP) analysis of the entire ITS region (ITS1, 5.8 S and ITS2) of nuclear ribosomal DNA (rDNA) was performed. In total, 2004 larvae were collected from 80 hairtail fish, 20 small yellow croaker, and 27 mackerel from the East China Sea and the Pacific coast of central Japan. High prevalence of Anisakidae larvae infection (116/122, 95.1%) was detected in the East China Sea. Seven species were identified belonging to the genera Anisakis (Nematoda: Anisakidae) and Hysterothylacium (Nematoda: Anisakidae). Anisakis pegreffii was the predominant species accounting for 84.8% of all larvae examined in East China Sea, while all Anisakidae larvae isolated from Japan were identified as Anisakis simplex sensu stricto (s.s.). In the East China Sea, A. simplex s.s. and Anisakis typica were 0.6% (4/619) and 1.5% (9/619) of the identified nematodes, respectively. Interestingly, one larva was identified as a recombinant genotype of A. simplex s.s. and A. pegreffii. In addition, four species of the genus Hysterothylacium, namely, Hysterothylacium amoyense (31/619, 5.0%), Hysterothylacium aduncum (10/619, 1.6%), Hysterothylacium fabri (21/619, 3.4%) and Hysterothylacium spp. (18/619, 2.9%) were also identified in the present study. This is a comprehensive epidemiological dataset for the family Anisakidae in the East China Sea. The identification of A. typica, recombinant genotype of A. simplex s.s. and A. pegreffii, H. amoyense and H. fabri is first reported in this area. The wide diversity and substantial geographical distributions of these nematodes will provide a foundation for future studies of Anisakidae family. The high prevalence of these nematodes in marine fishes off the East China Sea may pose considerable food safety problems, which is a potential cause of human anisakiasis.

Molecular genotyping of anisakis larvae in Middle Eastern Japan and endoscopic evidence for preferential penetration of normal over atrophic mucosa.

BACKGROUND: Anisakiasis is a parasitic disease caused primarily by Anisakis spp. larvae in Asia and in Western countries. The aim of this study was to investigate the genotype of Anisakis larvae endoscopically removed from Middle Eastern Japanese patients and to determine whether mucosal atrophy affects the risk of penetration in gastric anisakiasis. METHODS: In this study, 57 larvae collected from 44 patients with anisakiasis (42 gastric and 2 colonic anisakiasis) were analyzed retrospectively. Genotyping was confirmed by restriction fragment length polymorphism (RFLP) analysis of ITS regions and by sequencing the mitochondrial small subunit (SSU) region. In the cases of gastric anisakiasis, correlation analyses were conducted between the frequency of larval penetration in normal/atrophic area and the manifestation of clinical symptoms. RESULTS: Nearly all larvae were A. simplex seusu stricto (s.s.) (99%), and one larva displayed a hybrid genotype. The A. simplex larvae penetrated normal mucosa more frequently than atrophic area (p = 0.005). Finally, patients with normal mucosa infection were more likely to exhibit clinical symptoms than those with atrophic mucosa infection (odds ratio, 6.96; 95% confidence interval, 1.52-31.8). CONCLUSIONS: In Japan, A. simplex s.s. is the main etiological agent of human anisakiasis and tends to penetrate normal gastric mucosa. Careful endoscopic examination of normal gastric mucosa, particularly in the greater curvature of the stomach will improve the detection of Anisakis larvae.

The first genetically confirmed case of Dioctophyme renale (Nematoda: Dioctophymatida) in a patient with a subcutaneous nodule.

We describe a nematode larva in a subcutaneous nodule excised from a 44-year-old Chinese male who had been living in Japan for 15 years. Morphological features suggested that the worm was a dioctophimatid nematode. PCR amplification and sequencing of small subunit ribosomal DNA and mitochondrial cytochrome subunit c oxidase genes allowed us to identify the larva as the giant kidney worm, Dioctophyme renale (Goeze, 1972). This is the first molecularly confirmed human case of a dermal D. renale infection.

First report of Angiostrongylus cantonensis (Nematoda: Angiostrongylidae) infections in invasive rodents from five islands of the Ogasawara Archipelago, Japan.

BACKGROUND: Angiostrongylus cantonensis (Chen, 1935) is a parasite of murid rodents and causative agent of human neuro-angiostrongyliasis. In 2011, the Ogasawara Islands in the western North Pacific were assigned a World Natural Heritage site status. The occurrence of A. cantonensis is well documented in the Chichijima, Hahajima, and Anijima Islands. However, the occurrence of A. cantonensis in the other islands of the Ogasawara Islands has not been reported. METHODOLOGY/PRINCIPAL FINDINGS: Between March 2010 and July 2011, 57 Rattus norvegicus and 79 R. rattus were collected from 9 islands (the Hahajima group: Anejima, Imoutojima, Meijima, Mukohjima, and Hirajima; Chichijima group: Minamijima; Mukojima group: Nakoudojima and Yomejima; and Iwojima group: Iwojima). Adult nematodes were found in the pulmonary artery of 46 R. norvegicus collected in the 5 islands of the Hahajima group (Anejima, Meijima, Imoutojima, Hrajima, and Mukohjima Islands). These nematodes were identified by molecular analysis as A. cantonensis. Comparison of the mitochondrial DNA sequences confirmed that all the samples from the Ogasawara Islands shared only a single lineage of A. cantonensis, which has been previously detected in the Okinawa, Hawaii, and Brazil. CONCLUSIONS/SIGNIFICANCE: We describe new endemic foci of rat angiostrongyliasis in the Hahajima group (Anejima, Meijima, Imoutojima, Hirajima, and Mukohjima Islands) of the Ogasawara Islands. These findings indicate that the endemic foci of A. cantonensis are widely distributed in the Ogasawara Islands. Although human cases have not yet been reported in the Ogasawara Islands, the widespread detection of A. cantonensis could be of importance from the perspective of public health.

Basophil depletion downregulates Schistosoma mansoni egg-induced granuloma formation.

Granuloma formation around parasite eggs during schistosomal infection is considered to be controlled by Th2 cytokines. However, it is still controversial which cell populations are responsible for the host Th2 cytokine-dependent granuloma formation. Basophils have recently attracted attention because of their ability to produce large amounts of IL-4. Therefore, we investigated whether basophils play an essential role in the induction of granuloma formation induced by Schistosoma mansoni eggs. Together with our previous observation that basophil numbers increased markedly in the spleen at 7 weeks postinfection, immunohistochemical staining using anti-mMCP8 monoclonal antibody (mAb) showed basophil infiltration in the granulomatous lesions formed around parasite eggs. To examine the roles of basophils more directly, we treated mice with anti-CD200R3 mAb to deplete basophils. Depletion of basophils resulted in a reduction of basophil number with concomitant downregulation of egg granuloma formation at 7 weeks postinfection. Moreover, we observed a significant reduction in the size of egg granulomas formed in basophil-depleted mice in the pulmonary granuloma model. Taken together, these findings indicated that basophils are essential for S. mansoni egg-induced granuloma formation, and this may serve as a novel therapeutic target in ameliorating the pathology of schistosomiasis.

Phylogenetic relationships of rat lungworm, Angiostrongylus cantonensis, isolated from different geographical regions revealed widespread multiple lineages.

We conducted a pilot survey of genetic variation of A. cantonensis using small subunit (SSU) ribosomal (r) RNA and mitochondrial cytochrome c oxidase subunit I (coxI) gene sequences. Two distinct SSU genotypes (G1 and G2) were identified among 17 individual A. cantonensis worms from 17 different geographical localities in Japan, Mainland China, Taiwan, and Thailand. The partial coxI sequences were determined for 83 worms from 18 different geographical localities from Japan, Mainland China, Taiwan, and Thailand. Phylogenetic analysis showed eight distinct coxI haplotypes (ac1 to ac8). In 16 out of 18 localities, only a single coxI haplotype was found. However, in two localities, two coxI haplotypes coexisted. The common haplotypes found were: haplotype ac1 (Tokyo, Chiba, Kanagawa, Amamioshima Island, and Taichung), haplotype ac2 (Ishikawa, Shenzhen, and Lianjiang), haplotype ac5 (the Okinawa and the Ogasawara Islands), and haplotype ac7 (Miyagi, Aichi, and Kanagawa). Each of these regions is separated from the others by high mountain ranges or oceans. In addition, the lower genetic variation and particular geographical distribution of A. cantonensis in each location could indicate a founder effect, which may have resulted from multiple independent origins, and suggests that haplotypes migrated from endemic areas via human-related transportation.

Administrative practices of health professionals and use of artesunate-amodiaquine by community members for treating uncomplicated malaria in southern Ghana: implications for artemisinin-based combination therapy deployment.

OBJECTIVE: To investigate the use of artemisinin-based combination and monotherapy by community members and the administrative practices of health professionals in treating malaria in Ghana. METHOD: This study is a community-based cross-sectional survey in 11 rural and urban areas in southern Ghana. Using the interviewer method, close-ended questionnaires were administered to community members. Similar questionnaires were also administered in health facilities, community pharmacies and licensed chemical shops. RESULTS: A total of 1085 individuals comprising 959 non-health professionals and 126 health professionals were interviewed. Fifty-seven per cent of the community members visit pharmacies/drug stores as the first point of call when they suspect malaria. According to the participating drug sellers, artemether-lumefantrine (AL) is the most prescribed/sold anti-malarial drug (59.2%), followed by dihydroartemisinin (35%), sulfadoxine-pyrimethamine (33.0%) and artesunate-amodiaquine (AS-AQ) (27.2%). The majority of customers who visit pharmacies or drug stores without prescription have their anti-malarial drug selected by the shop attendant; in situations like that, dihydroartemisinin and artesunate monotherapies are sold just as AS-AQ and AL. Chloroquine is still sold by some drug vendors, 5 years after its proscription. CONCLUSION: Whereas the use of AS-AQ and AL are acceptable, the frequent use of dihydroartemisinin and artesunate monotherapy threatens the future of ACTs.

Plasmodium falciparum isolates from southern Ghana exhibit polymorphisms in the SERCA-type PfATPase6 though sensitive to artesunate in vitro.

BACKGROUND: In 2005, Ghana replaced chloroquine with artemisinin-based combination therapy as the first-line treatment for uncomplicated malaria. The aim of this work was to determine for the first time, polymorphisms in the putative pfATPase6 and pftctp, pfmdr1, pfcrt genes in Ghanaian isolates, particularly at a time when there is no report on artemisinin resistance in malaria parasites from Ghana. The sensitivity of parasite isolates to anti-malaria drugs were also evaluated for a possible association with polymorphisms in these genes. METHODS: The prevalence of point mutations in the above Plasmodium falciparum genes were assessed from filter-paper blood blot samples by DNA sequencing. In vitro drug sensitivity test was carried out on some of the blood samples from volunteers visiting hospitals/clinics in southern Ghana using a modified version of the standard WHO Mark III micro-test. RESULTS: All successfully tested parasite isolates were sensitive to artesunate; while 19.4%, 29.0% and 51.6% were resistant to quinine, amodiaquine and chloroquine respectively. The geometric mean of IC50 value for artesunate was 0.73 nM (95% CI, 0.38-1.08), amodiaquine 30.69 nM (95% CI, 14.18-47.20) and chloroquine 58.73 nM (95% CI, 38.08-79.38). Twenty point mutations were observed in pfATPase6 gene, with no L263E and S769N. All mutations found were low in frequency, except D639G which was observed in about half of the isolates but was not associated with artesunate response (p = 0.42). The pftctp gene is highly conserved as no mutation was observed, while CVIET which is chloroquine-resistant genotype at codon 72-76 of the pfcrt gene was identified in about half of the isolates; this was consistent with chloroquine IC50 values (p = 0.001). Mutations were present in pfmdr1 gene but were not associated with artemisinin response (p = 1.00). CONCLUSION: The pfATPase6 gene is highly polymorphic with D639G appearing to be fixed in Ghanaian isolates. These may just be spontaneous mutations as all parasite isolates that were tested displayed satisfactory in vitro response to artesunate. However, there is no improvement in susceptibility of the parasites to chloroquine five years after its proscription.

Dioctophyme renale (Nematoda: Dioctophymatoidea) in the abdominal cavity of Rattus norvegicus in Japan.

We collected 24 brown rats, Rattus norvegicus, in Kanagawa Prefecture in Japan and found one rat harboring a dioctophymatid nematode. A single male and a female worm were recovered from the abdominal cavity and were identified as Dioctophyme renale based on morphologic features and a BLAST DNA sequence analysis. We describe the morphological features of the adult worms and eggs from this extremely rare case of D. renale infection in a brown rat.

Parasitic infections in foreigners living in Japan: estimation of parasitic infection history by serum antibody screening.

We recently surveyed parasitic infections in 334 foreigners living as permanent residents in Japan. The survey results are presented herein. Our results highlight open issues in Japan, with reference to measures taken in Western countries where immigrants have long been accepted. In addition, we present our epidemiological method for investigating parasitic infection, making use of simple and valid large-scale screening. Among the foreigners participating in this survey, parasitic infections other than those in toxoplasmosis antibody positive individuals were rare. However, in view of the recent trend for increased total numbers of foreigners living in Japan, the onset of parasitic infections is anticipated to increase in Japan henceforth.

Human leptospirosis cases and the prevalence of rats harbouring Leptospira interrogans in urban areas of Tokyo, Japan.

Thirteen patients with leptospirosis were identified, as confirmed by laboratory analysis during the last 5 years in our laboratory, who came from urban areas of Tokyo, Japan. All of the patients came into contact with rats before the onset of illness. Seventeen per cent of Norway rats captured in the inner cities of Tokyo carried leptospires in their kidneys. Most of these rat isolates were Leptospira interrogans serovar Copenhageni/Icterohaemorrhagiae. Antibodies against these serovars and their DNA were detected in the patients. This suggests that rats are important reservoirs of leptospirosis, and that rat-borne leptospires occur in urban areas of Tokyo.

A familial case of visceral toxocariasis due to consumption of raw bovine liver.

We present 3 adult cases of visceral toxocariasis from the same family, who each consumed thin slices of raw bovine liver weekly, and developed eosinophilia and multiple small lesions in their livers and lungs. Serological examinations using the larval excretory-secretory product of Toxocara canis strongly indicated infection with Toxocara species larvae. The patients responded well to treatment with albendazole. Ingestion of raw liver from paratenic animals is considered to be a common transmission route of human toxocariasis, especially in adults.

Prolactin evokes lactational transmission of larvae in mice infected with Toxocara canis.

We investigated the trans-lactational maternal-neonatal transmission of Toxocara canis larvae in mice, with particular interest in the role of prolactin in their migration to the mammary gland. Two female mice were infected with 300 T. canis eggs soon after delivery of 27 offspring. After 1 week of breast-feeding, seven larvae were recovered from 4 of 13 offspring. After 2 weeks of lactation, 101 larvae were recovered from all the remaining offspring. Daily prolactin administration (5 microg) was performed 2 weeks before T. canis infection and continued until 2 weeks after infection in six non-pregnant female mice, which resulted in larval accumulation in the mammary gland. Furthermore, prolactin administration in female mice that had been infected with T. canis 4 weeks prior to prolactin treatment induced migration of larvae into the mammary gland. These findings suggest that prolactin is a promoting factor contributing to lactational transmission of T. canis larvae in mice.

Unusual radiological findings of Fasciola hepatica infection with huge cystic and multilocular lesions.

This report describes a case of hepatic phase Fasciola hepatica infection presenting huge and multilocular lesions. The unique radiological findings mimicked hydatid diseases and also cystic liver neoplasm. Fascioliasis should be included in the differential diagnosis for cystic liver diseases.