A T-cell diagnostic test for cystic echinococcosis based on Antigen B peptides.

Cystic echinococcosis (CE) immunodiagnosis is still imperfect. We recently set-up a whole-blood test based on the interleukin (IL)-4 response to the native Antigen B (AgB) of Echinococcus granulosus. However, AgB is encoded by a multigene family coding for five putative subunits. Therefore, the aims of this study were to analyse the IL-4 response to peptides spanning the immunodominant regions of the five AgB subunits and to evaluate the accuracy of this assay for CE diagnosis. Peptides corresponding to each subunit were combined into five pools. A pool containing all peptides was also used (total pool). IL-4 evaluated by enzyme-linked immunosorbent assay was significantly higher in patients with CE compared to those without (NO-CE subjects) when whole-blood was stimulated with AgB1 and with the total pool. Moreover, IL-4 levels in response to the total pool were significantly increased in patients with active cysts. Receiver Operator Curve analysis identified a cut-off point of 0.59 pg/mL predicting active cysts diagnosis with 71% sensitivity and 82% specificity in serology-positive CE patients. These data, if confirmed in a larger cohort, offer the opportunity to develop new diagnostic tools for CE based on a standardized source of AgB as the peptides.

Present status of laboratory diagnosis of human taeniosis/cysticercosis in Europe.

Human cysticercosis (CC) is a parasitic zoonosis caused by the larval stage (cyst) of the Taenia solium. Cysts can establish in the human central nervous system (neurocysticercosis, NCC) and other organs and tissues; they also develop in pigs, the natural intermediate host. Human taeniosis may be caused by T. solium, Taenia saginata and Taenia asiatica tapeworms; these infections are usually asymptomatic, but show a significant relevance as they perpetuate the parasites' life cycle, and, in the case of T. solium, they are the origin of (N)CC. In European Union (EU) member states and associated countries, the occurrence of autochthonous T. solium cases is debated, and imported cases have significantly increased lately; the status of T. asiatica has been never reported, whereas T. saginata is prevalent and causes an economic impact due to condemned carcasses. Based on their effects on the EU society, the specific diagnosis of these pathologies is relevant for their prevention and control. The aims of this study were to know the diagnostic tests used in European laboratories for human taeniosis/cysticercosis by means of a questionnaire, to determine potential gaps in their detection, and to obtain preliminary data on the number of diagnosed taeniosis/CC cases.

T-cell clones in human trichinellosis: Evidence for a mixed Th1/Th2 response.

In humans, studies on the cellular immune response against Trichinella are scarce. Aim of this study was to characterize the cytokine profile of T cells specific for Trichinella britovi in trichinellosis patients. Peripheral blood mononuclear cells (PBMC) were obtained from five patients involved in a trichinellosis outbreak caused by T. britovi, which occurred in 2013 in Tuscany (Italy). All the patients resulted positive for Trichinella-specific IgG, IgE and presented eosinophilia. T cells were investigated for their proliferation to excretory/secretory antigens from Trichinella spiralis muscle larvae (TsES) and for their cytokine profile. A total of 284 CD4+ and 42 CD8+ T-cell clones were obtained from the TsES-specific T-cell lines from PBMC. All T-cell clones proliferated in response to mitogen. Of the 284 CD4+ T-cell clones generated from TsES-specific T-cell lines, 135 (47%) proliferated significantly to TsES; 26% CD8+ T-cell clones showed proliferation to TsES. In the series of the 135 TsES-specific CD4+ clones, 51% expressed a Th2 profile, 30% a Th0 and 19% Th1. In the series of the 11 TsES-specific CD8+ T-cell clones, 18% were Tc2, 45% Tc0 and 36% Tc1. In human trichinellosis, the cellular immune response is, during the chronic phase, mixed Th1/Th2.

Proficiency testing to detect Trichinella larvae in meat in the European Union.

According to the Commission Implementing Regulation (EU) 2015/1375 (replacing the Commission Regulation (EC) No 2075/2005), all animals, which are potential carriers of Trichinella spp. larvae, should be tested at the slaughterhouse or game-handling establishments according to one of the approved tests. One of the core duties of the European Union Reference Laboratory for Parasites is to organize proficiency testing (PT), as stated in the Commission Regulation (EC) No. 882/2004 of the European Parliament and of the Council. The aim of this work was to evaluate the results of PTs of the digestion method carried out by the National Reference Laboratories for Parasites (NRLPs) over a nine year period (2007-2015). Participating laboratories received a panel of samples consisting in 35g or 100g of minced pork or horse meat spiked with Trichinella spiralis live larvae. The number of spiked samples varied from 2 to 9 over the years. A negative control was also included in the panel, except during the 2015 PT, when only positive samples were used. The percentage of NRLPs, which passed the PT, increased from 83.3% in 2007 to 100% in 2014. Considering the number of recovered larvae, the heterogeneity in participant's results reduced overtime. The values of the overall mean difference between spiked and recovered larvae decreased during the study period, witnessing a general improvement of NRLPs performance and confirming the effectiveness of PT for a good performance of this test.

Spatial distribution of Trichinella britovi, T. spiralis and T. pseudospiralis of domestic pigs and wild boars (Sus scrofa) in Hungary.

Trichinellosis is a foodborne disease caused by the consumption of raw meat and raw meat-derived products from swine, horse and some game animals infected with nematode worms of the genus Trichinella. Between June 2006 and February 2011, 16 million domestic pigs and 0.22 million wild boars (Sus scrofa) were tested for Trichinella sp. in Hungary. Trichinella infection was not found in any pigs slaughtered for public consumption. Nevertheless, Trichinella spiralis was detected in four backyard pigs when trace back was done following a family outbreak. Trichinella infection was demonstrated in 17 wild boars (0.0077%). Larvae from wild boars were identified as Trichinella britovi (64.7%), T. spiralis (29.4%) and Trichinella pseudospiralis (5.9%). Although the prevalence of Trichinella sp. infection in wild boars and domestic pigs is very low, the spatial analysis reveals that the level of risk differs by region in Hungary. Most of the T. britovi infected wild boars (63.6%) were shot in the north-eastern mountain area of Hungary; whereas domestic pigs and wild boars infected with T. spiralis were detected only in the southern counties bordering Croatia and Romania. In the north-western and central counties, the prevalence of Trichinella infection seems to be negligible.

The loading of labelled antibody-engineered nanoparticles with Indinavir increases its in vitro efficacy against Cryptosporidium parvum.

There is much evidence to indicate the ability of Indinavir (IND) to reduce Cryptosporidium parvum infection in both in vitro and in vivo models. However, there are limitations to the administration of IND as such, due to its renal toxicity and the high rate of metabolism and degradation. We aimed to encapsulate IND in biodegradable poly (D,L-lactide-co-glycolide) nanoparticles (Np) and to engineer their surface by conjugation with an anti-Cryptosporidium IgG polyclonal antibody (Ab). Tetramethylrhodamine-labelled Np were loaded with IND and modified by conjugation with an Ab. The IND-loaded modified Np (Ab-TMR-IND-Np) did not show any change, as demonstrated by chemical analysis studies. Simultaneous addition of 50µM Ab-TMR-IND-Np and excysted oocysts to the cell culture resulted in complete inhibition of the infection. In C. parvum-infected cells, the extent to which the infection decreased depended on the duration of treatment with the Ab-TMR-IND-Np. The antibody-engineered Np loaded with IND were able to target C. parvum in infected cells and therefore might represent a novel therapeutic strategy against Cryptosporidium sp. infection. Moreover, the use of Np as an IND delivery device, allows the development of a more appropriate dose formulation thereby reducing the IND side effects.

Trichinella britovi and Trichinella spiralis mixed infection in a horse from Poland.

Trichinella infections in horses continue to represent a health problem and, despite the rarity of infection, it is necessary to continue to control properly horse meat. In 2008, a 10-year-old horse imported from Poland to Italy for consumption found to have been positive at the digestion test. Both Trichinella britovi and Trichinella spiralis larvae in a proportion of 4:1 were detected in the horse muscles. This is the first report of a mixed Trichinella species infection in a horse. The epidemiological investigation revealed that the infected horse originated from a small farm about 120km from Warsaw and the horse owner had bought the horse at a horse market. The findings suggest that the horse was fed more than once with infected meat.

The isolation of Leishmania tropica and L. aethiopica from Phlebotomus (Paraphlebotomus) species (Diptera: Psychodidae) in the Awash Valley, northeastern Ethiopia.

In a survey of Leishmania infections in phlebotomine sandflies in a highly suspected focus of leishmaniasis in the Awash Valley (northeastern Ethiopia) between January 1994 and August 1997, a total of 3307 females of 11 Phlebotomus species (P. orientalis, P. fantalensis, P. saevus, P. sergenti, P. gemetchi, P. alexandri, P. bergeroti, P. duboscqi, P. arabicus, P. martini, and P. rodhaini) were dissected. Promastigotes were detected in 17 females of three species (11 P. saevus, 4 P. sergenti and 2 P. arabicus). Of these, only two P. saevus (one from Upper Awash and one from Middle Awash) and three P. sergenti (from Upper Awash) positives were successfully isolated in culture and were typed by isoenzyme analysis. Four isolates (two each from P. saevus and P. sergenti) were identified as new zymodemes (Z) of L. tropica and one isolate from P. sergenti was typed as a new zymodeme of L. aethiopica. This is the first finding of natural infections of P. saevus and P. arabicus and the first evidence for the former to be a vector of L. tropica. This is also the first time P. sergenti has been implicated in L. tropica transmission in Ethiopia; the isolation of L. aethiopica from a Paraphlebotomus species (P. sergenti) is also a new record. The possible presence of human cutaneous leishmaniasis (L. tropica and L. aethiopica), and wild reservoir host(s) of the parasites, especially rock hyrax (Procavia capensis) in the Upper and Middle Awash Valley remain to be determined.

[A Pediatric case of lupoid leishmaniasis diagnosed by PCR]. / Un caso di leishmaniosi lupoide in età pediatrica diagnostica mediante PCR.

The purpose of this paper is to describe the clinical features of lupoid leishmaniasis in a child and to underline the use of PRC as a necessary and reliable tool in controversial diagnosis. Lupoid leishmaniasis, also known as chronic or relapsing leishmaniasis, is mainly widespread in the Middle East, where it represents up to 5% of all cutaneous Leishmaniasis. It strongly resembles Lupus Vulgaris, both clinically and histologically, and is therefore not usually diagnosed immediately but after a certain period of time. The amastigotic forms are rare or absent. The cutaneous nodules or plaques can slowly enlarge over the years. The case of an eleven-year-old albanian child living in Durazzo (Albania), suffering since three years with a plaque formed by apple-jelly nodules and scars on his right cheek, is presented. Using PCR, the presence of Leishmania infantum DNA led to a diagnosis of lupoid leishmaniasis. The therapeutic strategy of a combination of oral itraconazole and infiltration of metilglucamina antimoniate has been carried out, with good result, as checked through "telemedicine".

Role of PCR in diagnosis and prognosis of visceral leishmaniasis in patients coinfected with human immunodeficiency virus type 1.

A group of 76 consecutive human immunodeficiency virus (HIV)-positive patients with fever of unknown origin (n = 52) or fever associated with pulmonary diseases was evaluated in order to assess the usefulness of PCR with peripheral blood in the diagnosis and follow-up of visceral leishmaniasis. We identified 10 cases of visceral leishmaniasis among the 52 patients with fever of unknown origin. At the time of diagnosis, all were parasitemic by PCR with peripheral blood. During follow-up, a progressive decline in parasitemia was observed under therapy, and all patients became PCR negative after a median of 5 weeks (range, 6 to 21 weeks). However, in eight of nine patients monitored for a median period of 88 weeks (range, 33 to 110 weeks), visceral leishmaniasis relapsed, with positive results by PCR with peripheral blood reappearing 1 to 2 weeks before the clinical onset of disease. Eight Leishmania infantum and two Leishmania donovani infections were identified by PCR-restriction fragment length polymorphism analysis. PCR with peripheral blood is a reliable method for diagnosis of visceral leishmaniasis in HIV-infected patients. During follow-up, it substantially reduces the need for traditional invasive tests to assess parasitological response, while a positive PCR result is predictive of clinical relapse.

[Phlebotomine sandflies (Diptera-Psychodidae) of the isle of Cyprus. II--Isolation and typing of Leishmania (Leishmania infantum Nicolle, 1908 (zymodeme MON 1) from Phlebotomus (Larroussius) tobbi Adler and Theodor, 1930]. / Les phlébotomes (Diptera-Psychodidae) de l'île de Chypre. II--Présence de Leishmania (Leishmania) infantum Nicolle, 1908 (zymodeme MON1) chez Phlebotomus (Larroussius) tobbi Adler et Theodor, 1930.

During two surveys conducted in Cyprus (August 1998 and September 1999), 2,910 phlebotomine sandflies females were caught by CDC miniature light traps then dissected under binocular and examined on microscope. Eleven species were identified: Phlebotomus papatasi, P. sergenti, P. jacusieli, P. alexandri, P. tobbi, P. galilaeus, P. mascittii, P. economidesi, Sergentomyia fallax, S. minuta et S. azizi. The Larroussius species (P. galilaeus and P. tobbi) are the most abundant (more than 60% of our captures). Promastigotes were isolated from one specimen identified as P. tobbi. A Leishmania stock was successfully cultured and identified by isoenzyme characterisation as belonging to L. infantum zymodeme MON 1. The same zymodeme was isolated and identified from four dogs too. Because of the absence of usual vectors of L. infantum in the eastern part of the Mediterranean basin (P. neglectus and P. syriacus), and according to its distribution in Cyprus, P. tobbi constitute certainly a good local vector. It seems to be not very anthropophilic, that could explain the very few human cases.

Cytokine profile induced by Cryptosporidium antigen in peripheral blood mononuclear cells from immunocompetent and immunosuppressed persons with cryptosporidiosis.

The proliferative response of peripheral blood mononuclear cells (PBMC) to a crude extract from Cryptosporidium parvum (CCE) was studied in persons who acquired cryptosporidiosis in the same outbreak (15 immunocompetent subjects with prior cryptosporidiosis and 22 human immunodeficiency virus [HIV]-positive persons with various levels of immunosuppression and active cryptosporidiosis) and in individual patients (8 HIV-positive patients with active cryptosporidiosis and 15 HIV-positive persons without history of cryptosporidiosis). PBMC from HIV-positive persons showed less proliferation to CCE and mitogens than did PBMC from immunocompetent subjects with prior cryptosporidiosis, independent of CD4 cell count. In immunocompetent subjects, cytokine gene expression was consistent with cytokine production, whereas in HIV-positive subjects it was not. The production of interferon-gamma in CCE-stimulated PBMC from both immunocompetent and HIV-positive subjects with cryptosporidiosis and the lack of interferon-gamma in CCE-stimulated PBMC from HIV-positive subjects without cryptosporidiosis indicate that C. parvum mainly induces a Th1 response.

Identification of a human isolate of Encephalitozoon cuniculi type I from Italy.

A microsporidial strain, obtained from a person with AIDS living in Italy was isolated and cultivated on RK13 (rabbit kidney) cell monolayers. Identification at the species level was performed by immunological and molecular methods. Western blot analysis showed that the human isolate and the Encephalitozoon cuniculi reference strain had similar banding patterns. The small subunit rRNA sequence analysis confirmed the identification of the isolate as E. cuniculi, which is a widespread microsporidian species infecting a wide range of natural hosts, including humans. Moreover, based on the sequence of the rDNA internal transcribed spacer region, this isolate was classified as E. cuniculi type I (rabbit strain), previously reported in six persons with AIDS living in Switzerland. These results provide further information on the geographical distribution of E. cuniculi types.

Intestinal microsporidiosis in Italian individuals with AIDS.

A survey on microsporidiosis in individuals with AIDS presenting chronic diarrhoea was carried out in Italy, over a four-year period (1992-1995). Three out of 72 (4.2%) individuals were found positive, on intestinal biopsies, for Enterocytozoon bieneusi by light microscopy and transmission electron microscopy (TEM). Sixteen individuals with AIDS, from a second group of subjects, were confirmed positive, by TEM, for intestinal microsporidiosis due to Enterocytozoon bieneusi. Of these 19 cases, 10 (52.6%) were homosexual men. Two of these individuals, under albendazole treatment, showed also spores with unusual features. The prevalence of intestinal microsporidiosis (12-50%) reported in European countries, Australia and North America, where homosexuality is the major HIV risk factor (63-77%), is higher than in Italy, where homosexual men represent only 16% of the total number of AIDS cases.

Opportunistic and non-opportunistic parasites in HIV-positive and negative patients with diarrhoea in Tanzania.

A survey on intestinal parasites in a rural area of Tanzania revealed the presence of eight protozoa and seven helminths in 287 subjects (81.8%). The prevalence of Entamoeba histolytica and Ascaris lumbricoides was higher in HIV-negative than in HIV-positive patients (P < 0.01; P < 0.04) (25.1% and 12.5% for E. histolytica; 10.5% and 3.7% for A. lumbricoides). On the other hand, Cryptosporidium parvum, Isospora belli and Strongyloides stercoralis prevalence was higher in HIV-positive than in HIV-negative patients (P < 0.01). The prevalence of these two opportunistic protozoa was also higher in AIDS patients than in HIV-positive patients without AIDS. Specific anti-C. parvum IgG were detected by ELISA in 18% and 56% of HIV-negative and positive patients, respectively, confirming the high number of contacts between this parasite and humans. Specific anti-Encephalitozoon cuniculi and anti-Encephalitozoon hellem IgG were detected by IFA in 18% and 19% of subjects, respectively, without any correlation with HIV and malaria infections.