Opisthorchis felineus, an emerging infection in Italy and its implication for the European Union.

The liver fluke Opisthorchis felineus is one of the few zoonotic trematodes that circulates in the European Union (EU). It is transmitted from freshwater snails to fish and then to fish-eating mammals, including humans, in which it causes opisthorchiasis. In the 20th century, the majority of infections in humans have been reported in Eastern Europe (e.g., Belarus, Russia, and Ukraine) and Asia (Siberia). In EU in the last fifty years, the parasite has been detected in humans of Germany and Greece, and in red foxes, polecats, cats, dogs, fish and mollusks of Germany, Italy, Poland, Portugal and Spain. In Italy, four individual cases and eight outbreaks of opisthorchiasis were reported from 2003 to 2011, for a total of 211 confirmed infections in humans. All infected persons had consumed raw fillets of tench (Tinca tinca) fished from two lakes in central Italy, but some of infected people were tourists who developed the disease in their respective home-countries. In the past decade, it has become increasingly popular to consume raw marinated fillets of fish. The objective of this review is to show how a change in human food habits have caused and increased the transmission of O. felineus, which has probably been circulating in the EU yet in a silent form for many years.

Cryptic and asymptomatic Opisthorchis felineus infections.

We describe the diagnostic difficulties experienced during an opisthorchiasis outbreak. Of 31 infected individuals, 61.3% were asymptomatic, and in the 12 symptomatic individuals, the duration of non-pathognomonic symptoms was shorter than 4 weeks. Serology by enzyme-linked immunosorbent assay and polymerase chain reaction fecal analysis were shown to be the most sensitive diagnostic tools.

Human illnesses caused by Opisthorchis felineus flukes, Italy.

We report 2 outbreaks of Opisthorchis felineus infection caused by the consumption of tench filets (Tinca tinca) from a lake in Italy. Of the 22 infected persons, 10 (45.4%) were asymptomatic. When present, symptoms (fever, nausea, abdominal pain, and myalgias) were mild. Eosinophilia occurred in all infected persons.

Adefovir and lamivudine in combination compared with adefovir monotherapy in HBeAg-negative adults with chronic hepatitis B virus infection and clinical or virologic resistance to lamivudine: a retrospective, multicenter, nonrandomized, open-label study.

OBJECTIVES: The aim of this study was to assess the therapeutic effectiveness of adefovir dipivoxil (ADV), administered in combination with lamivudine (LAM) or as monotherapy, and the rate of resistance to ADV, in hepatitis B e antigen (HBeAg)-negative adult patients with chronic hepatitis B virus (HBV) infection and clinical or virologic resistance to LAM. Furthermore, we evaluated in these selected patients the clinical co-variates associated with a sustained virologic response. METHODS: Data from adult outpatients aged >18 years with chronic HBV infection and clinical or virologic resistance to LAM were used in this retrospective, multicenter, nonrandomized, open-label study. Patients were selected if they received ADV 10 mg PO QD + LAM 100 mg QD PO or ADV 10 mg PO QD as monotherapy for 24 to 32 months between June 2003 and July 2006. End points were the proportions of patients who achieved virologic response (undetectable HBV-DNA [<3.3 log(10) copies/mL]) and biochemical response (normalization [<40 IU/L] of alanine aminotransferase [ALT]), and the proportions in whom resistance to ADV (rebound serum HBV-DNA >1 log(10) copies/mL compared with on-treatment nadir, as confirmed on molecular analysis) was found. HBV-DNA and ALT levels were checked every month during the first 3 months of treatment and every 3 months thereafter until 28 months. Data from each center were stored in a centralized database and analyzed by a blinded independent investigator. RESULTS: Data from 70 patients were included (48 men, 22 women; median age, 51 years; ADV + LAM, 36 patients; ADV monotherapy, 34). The median duration of the pharmacologic treatment in the 2 groups of patients was 28 months (range, 24-32 months). By month 3, virologic response was achieved in 30 patients (83%) in the ADV + LAM group and in 26 patients (76%) in the ADV monotherapy group. At 12 months, virologic response was achieved in 5 additional patients in the ADV + LAM group and 2 additional patients in the ADV monotherapy group. Biochemical response was found to be time dependent: in the 2 groups, the rates of biochemical response were, respectively, 56% and 54% at month 3, 80% and 71% at month 6, and 96% and 79% at month 12, persisting up to the end of the study period. The rates of clinical resistance to ADV were 3% with ADV + LAM and 18% with ADV monotherapy (with a 6% rate of resistance due to rtA181 mutation in the monotherapy group). Logistic regression analysis found that pre-treatment levels of HBV-DNA <5 log(10) copies/mL, ALT levels >150 IU/L, an inflammation score >7, and a fibrosis score <2 were the strongest covariates independently associated with a sustained virologic response in both groups of patients. No adverse events were reported in any of the patients. CONCLUSION: ADV, administered in combination with LAM or as monotherapy, appeared to be effective in this small, selected group of HBeAg-negative patients with clinical or virologic resistance to LAM, especially in those with low pretreatment HBV-DNA levels, high ALT levels, and low fibrosis scores.

Characterization of denatured proteins by hydrophobic interaction chromatography: a preliminary study.

In this preliminary study hydrophobic interaction chromatography (HIC) is proposed as a good tool in order to detect conformational changes induced by chemical denaturants in two globular proteins, cytochrome C (Cyt C) and myoglobin (MYO). Alterations in protein structure were manifested chromatographically by reproducible changes in peak heights, retention time, and appearance of multiple peaks. The HIC behavior of the two model proteins denatured by guanidinium thyocyanate (GdmSCN) was investigated, keeping constant various concentrations of urea in the mobile phase in a TSK-Gel Phenyl-5PW column (TosoBiosep). Suitable elution conditions provide evidence of the simultaneous presence of two denatured forms in the case of MYO, and sequential different denatured states of Cyt C.