Tubulointerstitial Nephritis and Uveitis Syndrome: A Report of 6 Cases with Renal Biopsy and Electron Microscopy Evaluation.

Tubulointerstitial nephritis with uveitis syndrome is a rare, immune-mediated entity, characterized by oculo-renal inflammation. Diagnosis requires the exclusion of all other causes of tubulointerstitial nephritis (TIN). We present 6 patients with clinical, laboratory, and renal biopsy findings denotative of tubulointerstitial nephritis with uveitis syndrome. All our patients experienced ocular and renal manifestations, defined by bilateral uveitis and photosensitivity, along with a decline of renal function. In some patients, increased serum creatinine was accompanied by non-nephrotic range proteinuria, glucosuria or "full-blown" Fanconi syndrome. The rest of the laboratory evaluation was normal apart from the presence of elevated erythrocyte sedimentation rate and increased urine ß2-microglobulin, as well as normochromic, normocytic anemia in some cases. All patients underwent renal biopsy. Histochemical (PAS, Masson, silver, Congo-red) and immunohistochemical stains for immune cell populations (CD3, CD20, CD4, CD8, PGM1, CD138) and for the assessment of ß2-microglobulin were conducted. Electron microscopy examination of the biopsies was also performed. Follow-up, ranging from 18 months to 10 years, was available for 4 patients. Histological evaluation revealed interstitial inflammatory infiltration consisting mainly of lymphocytes, with a T-cell predominance, along with several macrophages. Inflammation severity varied among different patients, with some showing scarce foci of immune cell clusters, while others demonstrated a dense, diffuse interstitial infiltration. Interestingly, in 2 cases, a granulomatous pattern, characterized by non-necrotic, ill-defined granulomas was detected. Tubulitis was also encountered in some patients. A divergence was noted regarding the chronicity index, with different levels of tubular atrophy, interstitial fibrosis, and global glomerulosclerosis among different cases. ß2-Microglobulin immunohistochemical evaluation revealed a substantial diminishment of cytoplasmic staining in tubular epithelial cells compared to control kidneys. The most notable finding derived from electron microscopy examination was the presence, in 1 patient, of scattered granular electron-dense deposits along some tubular basement membranes. First-line treatment included steroids, supplemented in some cases by additional immunosuppressive agents. Three patients experienced a partial or complete response, while progressive renal damage was observed in a case with severe chronic lesions and persistence of inflammation-triggering factor. Our cases seem to represent progressive stages within the continuum of disease evolution. Patients with more prominent inflammation might represent a more initial state, while those with a more severe chronicity index, probably depict more advanced stages. While the predominance of T-cells predicates a cell-mediated autoimmune mechanism, as the driving force of the disease occurrence, the presence of immune complexes in more advanced stages might indicate the involvement of humoral immunity as a late event during the disease course.

An analysis of seroprevalence and risk factors for parasitic infections of economic importance in small ruminants in Greece.

A cross-sectional serological survey was carried out to screen the small ruminants of Thessaly, Greece, for infection with Haemonchus contortus, lungworms (i.e. Cystocaulus ocreatus, Muellerius capillaris, Protostrongylus rufescens and Neostrongylus linearis) as a group, and for Cysticercus tenuicolis, Linguatula serrata and Oestrus ovis. A second objective was to determine the risk factors related to herd characteristics, management practices, farmer status and bioclimatic variables associated with these parasitic infections. A total of 361 sheep and 179 goat serum samples were examined. The seroprevalences were 33.9%, 41.5%, 14.1%, 4.6% and 1.4% for H. contortus, lungworms, L. serrata, C. tenuicolis and O. ovis, respectively. The final logistic regression model showed that farm location and temperature were associated with H. contortus, lungworm and L. serrata infections. Anthelmintic treatment, class of anthelmintic and rotation of grazing were associated with H. contortus and lungworm infections, while grazing with other herds was associated with lungworm and L. serrata infections; rain was associated with H. contortus and L. serrata infections. Farm type and age of farmer were associated with H. contortus infections and elevation was associated with lungworm infection. The results may help to formulate appropriate control strategies in Greece and other areas with similar climatic conditions in order to channel limited resources to mitigate only those risk factors which are significant to protect the profitability of the livestock industry.

Seroprevalence and risk factors associated with zoonotic parasitic infections in small ruminants in the Greek temperate environment.

A cross-sectional serological study was carried out to screen the sheep and goat population of Thessaly, Greece for evidence of infection with Toxoplasma, Toxocara, Leishmania, and Echinococcus and to determine the risk factors related to herd characteristics, herd management practices, farmer status, and the bioclimatic variables associated with these zoonotic parasitic infections. A total of 540 sheep and goat serum samples were examined. The seroprevalence of infection in all examined animals was 24.5% for Toxoplasma, 32% for Toxocara, 0% for Leishmania and 85.9% for Echinococcus. The final logistic regression model showed that the species of small ruminant, herd size, anthelmintic treatment, class of anthelmintic treatment, grazing with other herds, educational level of farmer, elevation of farm location, and generalized land cover were associated with Toxoplasma gondii infections, while the species of small ruminant, farm type, anthelmintic treatment, class of anthelmintic treatment, rotation of grazing, age of farmer, elevation of farm location, and generalized land cover were associated with Toxocara canis infections. Antibodies to T. gondii were detected in 102 (28.3%) of 360 sheep and in 30 (16.8%) of 179 goats. Animals in small flocks (150-300 animals) had an approximately 0.42-fold lower risk of having positive cases of T. gondii among animals compared with large flocks (>300 animals). Antibodies to T. canis were found in 155 (42.9%) of 361 sheep and 18 (10.1%) of 179 goats. The later finding constitutes the first report of seropositive goats to Toxocara. The risk of positivity for T. canis was 7.71-fold higher in sheep than in goats. Geographically, animals from plain areas had 2.9 and 2.01-fold higher risk of having positive cases of T. gondii and T. canis respectively. The significant bioclimatic variables (p<0.05) associated with the occurrence locations of T. gondii infection were related to higher temperature, lower precipitation, and lower elevation compared to the absence locations of T. gondii. The significant bioclimatic variables (p<0.05) associated with occurrence locations of T. canis infection were related to lower temperature and higher precipitation compared to absence locations of T. canis. These findings are useful to formulate appropriate control strategies for zoonotic parasites of sheep and goats in Greece and other areas with similar climatic conditions.

Survey of gastrointestinal parasitic infections of beef cattle in regions under Mediterranean weather in Greece.

Gastrointestinal (GI) parasitic infections of beef cattle were investigated in 15 farms from 3 different regions of Greece, characterized by temperate Mediterranean climate, during two years. A total of 262 faecal samples were collected. Helminth eggs were detected in 42 (16%) samples. Strongyle-type eggs were found in 28 (10.7%) samples, Strongyloides spp. and Toxocara spp. eggs in 8 (3.1%) samples each, and Capillaria spp. and Moniezia spp. eggs in 1 (0.4%) sample each. Coccidian oocysts were found in 123 (46.9%) samples. A logistic regression model showed that the age of animals, the number of employees, and the region of animals were associated with coccidian infections. There was almost a four-fold increase in the risk of coccidian infections in calves less than 12 months old compared with animals that were more than 36 months old (p<0.05). The risk of coccidian infections was 0.07, 0.18 and 0.27-fold lower for farms with 1, 2 and 3 employees respectively compared to farms with 4 employees; farms with less than 4 employees had a protective effect (p<0.05 in all cases). Almost a four-fold increased risk of coccidian infections was shown for animals from Epirus compared with those from Thessaly (p<0.05). These findings are useful to formulate appropriate control strategies for coccidian parasites of beef cattle in Greece and other areas with similar climatic conditions.

Assessment of swine farms in Greece in relation to the risk of exposure of pigs to Trichinella.

Commission Regulation (EC) No. 2075/2005 of 5 December 2005 lays down detailed conditions for Trichinella-free farms. The objectives of the present study were: (1) to assess the current state of swine farms in Greece in relation to the risk of exposure of pigs to Trichinella as a first step towards certification of Trichinella-free farms in Greece and (2) to identify a profile and characteristics of swine farms and farmers which can be used to formulate appropriate measures to promote good production practices for reducing risk of exposure of pigs to Trichinella. A total of 70 swine farms were inspected using audit components similar to those used by the U.S. Trichinae Certification Programme. Only four farms (6%) complied with all the criteria used for assessing the good production practices for reducing risk of exposure of pigs to Trichinella. A common characteristic of these four farms was that they had a large size (>300 sows) and produced their own feed. The most common issues among the farms that did not meet audit criteria in the present study were related to proper rodent control and accessibility of other animals in the feed storage area and the facility. In addition, the predominant significant differentiating characteristic for the farms not meeting the criteria was their small (<150 sows) size, while for the farmers it was their low educational level. These characteristics, which are linked to poor infrastructure and reluctance for improvements, respectively, will be difficulties that must be dealt with in the promotion of good production practices for Trichinella-free farms in Greece.