Epididymal Dirofilariasis in a Child: First Case Report from Bulgaria.

OBJECTIVE: To present case of a child with epididymal dirofil-ariasis. CLINICAL PRESENTATION AND INTERVENTION: An 11-year-old boy was admitted to the Clinic of Pediatric Urology for elective surgery treatment of epididymal cyst on the left side. After removal, the cyst was sent for histological examination. Microscopic examination of the histological slides revealed cross-sections of a nematode belonging to Dirofilaria spp., differentiated morphologically as D. repens. After surgery, the patient recovered completely. CONCLUSIONS: In most parts around the world, dirofilariasis is a rare and neglected infection. Nevertheless, the clinicians and pathologists must be informed about it.

Candidatus Dirofilaria hongkongensis as Causative Agent of Human Ocular Filariosis after Travel to India.

We report a human case of ocular Dirofilaria infection in a traveler returning to Austria from India. Analysis of mitochondrial sequences identified the worm as Candidatus Dirofilaria hongkongensis, a close relative of Dirofilaria repens, which was only recently described in Hong Kong and proposed as a new species.

[Orbital case of ocular dirofilariasis]. / Sluchaĭ orbital'nogo dirofiliarioza.

AIM: to report a clinical case of orbital dirofilariasis with attention to peculiarities of disease presentation, diagnostic measures, and treatment results. MATERIAL AND METHODS: A patient with a history of spontaneously subsiding recurrent oedema of the lower eyelid suspicious of parasitic cyst formation. The diagnosis was confirmed preoperatively by orbital ultrasound. Surgical intervention included orbitotomy with microsurgical excision of the parasitic cyst via a percutaneous approach through the lower eyelid skin crease. RESULTS: Ultrasonography of the orbits appeared to be the most informative diagnostic method in this case. Thorough surgical planning allowed us to avoid complications in the postoperative period and to achieve good cosmetic results. CONCLUSION: A painless solid mass lesion with recurrent perifocal oedema and hyperaemia without inflammatory infiltration of surrounding tissues is characteristic of parasitic cysts of the orbit. Amond other infectious diseases, a parasitic cyst stands out for symptomatic relapses and spontaneous regression, irrespective of the treatment received. The use of ultrasound allowed preoperative identification of the sac and the living helminth.

Current surveys on the prevalence and distribution of Dirofilaria spp. and Acanthocheilonema reconditum infections in dogs in Romania.

During the last decades, Dirofilaria spp. infection in European dogs has rapidly spread from historically endemic areas towards eastern and northeastern countries, but little or no information is available from these geographical regions. The present study provides a picture of filarial infections in dogs from Romania and compares two tests for the diagnosis of Dirofilaria immitis. From July 2010 to March 2011, blood samples were collected from 390 dogs from nine counties of Romania and serological SNAP tests were performed for the detection of D. immitis antigen. The remaining blood clots were subsequently used for DNA extraction followed by multiplex PCR for assessing filarioid species diversity (i.e. D. immitis, Dirofilaria repens and Acanthocheilonema reconditum). Based on molecular detection, an overall prevalence of 6.92 % (n = 27; 95 % confidence interval (CI) 4.70-10.03 %) for D. repens, 6.15 % (n = 24; 95 % CI 4.07-9.14 %) for D. immitis and 2.05 % (n = 8; 95 % CI 0.96-4.16 %) for A. reconditum was recorded, with significant variations according to sampling areas. Coinfections of D. immitis and D. repens were recorded in 23.91 % (n = 11) positive dogs. A slightly higher prevalence for D. immitis was detected at the SNAP test (n = 28, 7.17 %; 95 % CI 4.91-10.33 %), but this difference was not statistically significant (p = 0.66). However, only 53.57 % (n = 15) of antigen-positive dogs were confirmed by PCR, while other dogs (n = 9) PCR positive for D. immitis were negative at the serology. The present study shows that Dirofilaria species are endemic in the southern and southeastern areas of Romania, This article also provides, for the first time, an epidemiological picture of the distribution of A. reconditum in Romania.

Subconjunctival Dirofilaria masquerading as nodular scleritis.

A man in his late 50s presented with a gradually enlarging, painless, reddish mass on the white portion of his left eye for 2 weeks. His best-corrected visual acuity was 20/20 in both eyes. Slit-lamp examination showed a congested, nodular, elevated lesion on the temporal bulbar conjunctiva with two pustule-like elevations. Anterior segment optical coherence tomography showed a subconjunctival solid mass rather than an abscess or a cyst. Scleral deroofing was performed and a long thread-like object resembling a dead worm was identified. The worm was removed intact, and its histopathology confirmed the diagnosis of Dirofilaria Peripheral blood smear did not show any microfilariae. No recurrences or new lesions were observed during the follow-up examinations at 1 and 5 months post-surgery. This case highlights the importance of considering a parasitic aetiology in cases of nodular or infectious scleritis.

Evidences of increasing risk of dirofilarioses in southern Italy.

Given the spread of Aedes albopictus from northern to southern Italy, and the lack of updated data on Dirofilaria infections, this study was carried out to assess the infection risk for dogs and cats in Apulia region. During a 2-year study, 175 A. albopictus female specimens and samples of blood from 427 dogs (309 privately owned dogs and 118 shelter dogs) and 12 cats were collected. All blood samples were subjected to a modified Knott method, to a test for the detection of circulating Dirofilaria immitis antigen, and to a Dirofilaria species-specific real-time PCR for the simultaneous detection of D. immitis and Dirofilaria repens, targeting on partial cytochrome oxidase subunit 1 and internal transcribed spacer-2, respectively. Two abdomen and one thorax pools from A. albopictus were positive for D. immitis, with minimum infection rates of 1.14 and 0.51, respectively, and a probability of a single positive specimen to be infected of P = 0.6 % (95 % confidence interval (CI) = 0.12-1.73). Out of 439 examined subjects, 22 (5.0 %) tested positive for Dirofilaria spp. in at least one diagnostic test. A specific D. immitis infestation rate of 3.5 % was found among the privately owned dogs, while shelter dogs tested positive only for D. repens with a prevalence of 3.4 %; one cat tested molecularly positive for D. immitis. There was a significantly higher rate of positivity among guard dogs for D. immitis (odds ratio, 6.24, 95 % CI, 1.26-25.28; P < 0.05). The increasing risk of D. immitis infection in southern Italy is supported by the noteworthy positivity of A. albopictus populations and the cat. Our data highlight the usefulness to include filarioid infestation in routine diagnosis.

A novel Dirofilaria species causing human and canine infections in Hong Kong.

Dirofilariasis is globally the commonest manifestation of zoonotic filariasis. We report the detection of a novel canine species causing human and canine dirofilariasis in Hong Kong. Three human cases occurring over 10 months were identified, one presenting with cervical lymphadenopathy, one with an abdominal subcutaneous mass, and one with a subconjunctival nodule. Transected worms recovered from the resected abdominal subcutaneous mass were morphologically compatible with Dirofilaria. The cox1 gene sequences of the three human isolates were identical; however, they were only 96.2% and 89.3% identical to the cox1 gene of Dirofilaria repens and Dirofilaria immitis, respectively. Sequencing of the 18S-ITS1-5.8S gene cluster was successful in the intact worm, and the nucleotide sequences were 94.0% and 94.9% identical to those of D. repens and D. immitis, respectively. Screening of the blood samples from 200 dogs and 100 cats showed the presence of the novel Dirofilaria species in 3% (6/200) of the dogs' but none of the cats' blood samples. Nucleotide sequences of the cox1 gene and 18S-ITS1-5.8S gene clusters of the dogs' samples were identical to those in the human samples. The sera of canines infected by this novel Dirofilaria species were negative when tested with the SNAP 4Dx D. immitis detection kit, except in the case of dogs with a mixed infection with D. immitis as detected by PCR. The results from this study suggest that this novel Dirofilaria species is a cause of filarial infection in humans and dogs in Hong Kong. We propose to name this Dirofilaria species "Candidatus Dirofilaria hongkongensis."

Canine and feline infections by cardiopulmonary nematodes in central and southern Italy.

Capillaria aerophila, Aelurostrongylus abstrusus, Angiostrongylus vasorum and Dirofilaria immitis are cardiopulmonary nematodes affecting dogs and cats and presently emerging in several countries. The results obtained in 2009 - 2010 during a study aiming to investigate the occurrence of these nematodes in regions from Central (Marche and Abruzzo regions--Sites A and B, respectively) and southern (Apulia--Site C) Italy are here reported. A total of 534 and 436 individual faecal samples collected from dogs and cats were examined, together with 471 and 34 faecal environmental samples taken from dog shelters and catteries. One hundred and ninety-two individual blood samples were also collected from dogs. Faeces were examined using copromicroscopical flotations and Baermann technique, whereas blood samples were tested by Knott's method. Eggs of C. aerophila were detected in 1.48 % and 20 % (Site A), 8.67 % and 2.71 % (Site B), and 16.67 % and 0 % (Site C) of individual and environmental canine samples. C. aerophila was found in 2.90 % (Site A), 3.03 % (Site B) and 14.29 % (Site C) of individual cats. Larvae of A. vasorum were found in 0.96 % and 2.48 % of individual and environmental samples from Site B, respectively, while those of A. abstrusus in 1.82 % (Site A) and 9.96 % (Site B) of individual faeces. Microfilariae of Dirofilaria immitis, identified on the basis of key morphological and morphometric features, were detected in 2.56 % of samples collected from Site B. Despite the small sample size, these results indicate that cardiopulmonary nematodes occur in Central and southern Italy, thus they should be included in the differential diagnosis of pet cardiorespiratory diseases. Larger surveys are necessary to gain more information on the diffusion of these parasites, especially for C. aerophila and A. vasorum, for which the actual distribution is poorly known.

A human case of subcutaneous dirofilariasis caused by Dirofilaria repens in Vietnam: histologic and molecular confirmation.

Human dirofilariasis caused by infection with Dirofilaria worms has been frequently reported. The symptoms associated with infection by these filarial parasites, which are transmitted to humans by zooanthropophilic mosquitoes, are characterized by mainly pulmonary and subcutaneous nodules. Here, we report the first case in Vietnam of a subcutaneous dirofilariasis with a painful nodule in the right eyelid. An immature female worm was removed by excisional biopsy and identified as Dirofilaria repens by histology and DNA analysis.

Elimination of Dirofilaria (syn. Nochtiella) repens microfilariae in dogs with monthly treatments of moxidectin 2.5%/imidacloprid 10% (Advocate, Bayer) spot-on.

Elimination of microfilaria in dogs infected with zoonotic Dirofilaria repens would be desirable to reduce further spread. Moxidectin has demonstrated efficacy against microfilariae and safety in dogs infected with Dirofilaria immitis and could be an option for controlling D. repens microfilariae. A field study with 64 dogs previously confirmed positive for D. repens microfilaria was conducted in Hungary, in which a spot-on product (Advocate, Bayer) was tested. Treatments were applied to 44 dogs once a month for 3 months (five dogs) or 6 months (22 dogs), alternatively every 2 weeks for 6 months (17 dogs). Twenty dogs remained untreated. Microfilaria counts were performed once a month and for a further 6 months following the last treatment. Two weeks after the first treatment, 38 of 44 dogs were microfilaria negative. Four weeks after the initial treatment, one dog still showed a low microfilaria count. Following the second treatment, all treated dogs were negative. This status was maintained during the 6-month observation period after the last treatment. These data demonstrate the successful long-lasting elimination of microfilariae. Moreover, it may be supposed that adult D. repens were killed based on the observation that no further microfilariae were seen up to 6 months after the end of the treatment period.

A technique for capturing migratory periocular worms: a case series and review of literature.

PURPOSE: To describe the clinical presentation of migratory nematodes and to outline a simple strategy to ensure capture. METHODS: Retrospective case series. RESULTS: Two consecutive patients with suspected migratory nematodes were treated promptly by strategic placement of a pharmacological barrier in the forniceal conjunctiva using 1% lidocaine with epinephrine to block the routes of retreat and to immobilize the worms for controlled retrieval. Two live nematode worms, one subcutaneous dirofilaria and one subconjunctival Loa loa, were successfully removed. CONCLUSIONS: A sense of urgency is conveyed to isolate the migratory worm while it is still visible and residing in a location for easy surgical removal. The retreat of the worm to the deeper, inaccessible orbit is prevented by strategic placement of a perimeter of anesthetic.

[Procedures for species identification of the nematodes belonging to Dirofilaria genus present in the clinical material isolated from humans]. / Rozpoznawanie izolowanych od ludzi nicieni z rodzaju dirofilaria przy zastosowaniu technik biologii molekularnej.

Procedures for DNA extraction and amplification were modified to allow identification of Dirofilaria nematodes surgically removed from human tissues. Worm samples stored in: ethanol (24 weeks), formalin (46 weeks) or paraffin blocks (25weeks) were examined. Fragments of two ribosomal DNA regions (5.8S-ITS2-28S, 5SrRNA) and mitochondrial cytochrome oxidase subunit I gene were used as diagnostic markers. The highest PCR sensitivity was observed for DNA obtained from the worm preserved in ethanol, while the nucleic acid extracted form the parasite stored in formalin yielded the lowest PCR sensitivity. DNA extraction from the parasite preserved in formalin was more time consuming than DNA extraction from the remaining samples. Furthermore, the amplification of DNA isolated from the formaldehyde preserved worm allowed for identification of the parasite species only when the mitochondrial marker was used in Real Time PCR, and the amount of the obtained product was close to the detection limit. Species identification of the worms stored in the paraffin block and in ethanol was possible with both traditional and Real Time PCR. All analyzed worms were identified as D. repens which confirmed the species identification based on morphological features. The results show that molecular methods are relatively simple to use and suitable for identification ofDirofilaria sp. nematodes present in clinical material. Formalin is not suitable for storing material intended for molecular tests.

[Subcutaneous dirofilariasis of the upper lip in Tunisia]. / Dirofilariose sous-cutanée en Tunisie : une observation à localisation labiale.

INTRODUCTION: Dirofilariasis is a rare anthroponotic disease caused by Dirofilaria, the principal reservoir of which is the dog. The first case of subcutaneous dirofilariasis in Tunisia was reported in 1990. CASE REPORT: We report a case involving a 40-year-old woman living in northeastern Tunisia who presented with a subcutaneous lesion of the upper lip resembling a sebaceous cyst. Excisional biopsy released a worm identified on morphologic examination as Dirofilaria repens. Only excision allows simultaneous diagnosis and treatment. CONCLUSION: This is the 14th case of dirofilariasis reported in Tunisia. This parasitic disease is probably underestimated in our country. It should be considered for all subcutaneous nodules, regardless of localisation.

[Human dirofilariasis in the Tula region].

The paper describes cases of dirofilariasis in the residents of Tula and the Tula Region. One of the cases does not fit into the traditional concepts. On excising a tumor in an adolescent, two live actively moving nonencapsulated helminths: a male and a female Dirofilaria repens worms were removed, which were identified at the parasitology laboratory, Center of Hygiene and Epidemiology in the Tula Region.

On the validity of "Candidatus Dirofilaria hongkongensis" and on the use of the provisional status Candidatus in zoological nomenclature.

The fast development of molecular taxonomy is impacting our knowledge of the world parasite diversity at an unprecedented level. A number of operational taxonomic units have been uncovered and new species described. However, it is not always that new parasite species are being described in compliance with the International Code of Zoological Nomenclature. This is the case of "Candidatus Dirofilaria hongkongensis", a nematode found in dogs, jackals and humans in Hong Kong and parts of India. This name has been proposed without a formal description and without the designation of a holotype, and therefore is an unavailable name. Finally, we argue that using the provisional status Candidatus in zoological nomenclature is inappropriate, considering this term is not considered in the International Code of Zoological Nomenclature.

Dirofilaria hongkongensis infection presenting as recurrent shoulder mass.

In 2012, a novel canine Dirofilaria species, D. hongkongensis was identified in Hong Kong that caused human diseases and subsequently reported in an Austrian traveller returning from the Indian subcontinent. Here we present a case of human infection by D. hongkongensis manifested as recurrent shoulder mass. Diagnosis was achieved by cox1 gene sequencing of the excised specimen. The case illustrated that parasitic infection represents an important differential diagnosis for musculoskeletal lesions.

Canine vector-borne pathogens from dogs and ticks from Tamil Nadu, India.

Canine vector-borne diseases (CVBDs) pose a major health problem in dogs globally, with the potential to cause zoonoses, in particular in developing countries where scientific knowledge on the topic is minimal. Blood samples and ticks were collected from stray dogs in Tamil Nadu, South India to assess the prevalence of CVBD-causing pathogens (Anaplasma spp., Babesia spp., Ehrlichia spp., Hepatozoon spp., filarioids and Leishmania spp.). Of the 230 dogs examined, 229 (99.6%) were infested by ticks (mean intensity, 5.65) with Rhipicephalus sanguineus sensu lato and Rhipicephalus haemaphysaloides being morphologically identified in the 98.3% and 1.7% of the infested dogs, respectively. Overall, the 67.8% (n = 156) of dogs was positive for at least one pathogen with Hepatozoon canis being the most prevalent (37.8%) followed by Anaplasma platys (22.6%), Ehrlichia canis (16.1%) Babesia vogeli (10%), Anaplasma phagocytophilum (0.4%) and Babesia gibsoni (0.4%). Two filarioids (Dirofilaria sp. "hongkongensis" and Brugia malayi, 0.4%) were diagnosed in sampled animals. Co-infection with H. canis and A. platys was the most prevalent (8.3%, P = 0.00001), whilst all animals scored negative for Leishmania spp.. Out of 295 ticks analysed, 215 R. sanguineus s.l. (75.4%) and 8 R. haemaphysaloides (88.9%) were positive for at least one pathogen with H. canis as the predominant species (42.5%), followed by A. platys (33.8%), E. canis (16.9%), B. vogeli (3.8%) and A. phagocytophilum (0.3%). Fifty-six dogs (35.9%) harboured the same pathogen as the respective tick specimens, while 29 dogs (18.6%) had a different pathogen. Thirteen sequence types (STs) were identified for H. canis, with ST2 (49.4%) as the most representative in dogs and ST1 (73.5%) in ticks. Similarly, seven STs were found for Anaplasma spp. (i.e., five for A. platys, one for A. phagocytophilum and one for Anaplasma sp.), with ST2 as the most representative in dogs (70.6%) and ST3 (52.5%) in ticks for A. platys. Only one ST was identified for B. vogeli, B. gibsoni, E. canis, D. sp. "hongkongensis" and B. malayi. Regular surveillance and adoption of adequate treatment and control measures are needed to reduce the risk of disease-causing pathogens in stray dogs and of pathogens with zoonotic potential.

Dirofilaria repens infection and concomitant meningoencephalitis.

Dirofilaria repens, a filarial nematode of dogs and other carnivores, can accidentally infect humans. Clinical symptoms are usually restricted to a subcutaneous nodule containing a single infertile parasite. Here, we report a case of D. repens infection with a subcutaneous gravid worm and the patient's concomitant meningoencephalitis and aphasia.

Parasites on paper--The use of FTA Elute((R)) for the detection of Dirofilaria repens microfilariae in canine blood.

Storage of blood samples for subsequent DNA extraction without loss of integrity can be difficult under field conditions. Filter-based technologies are known to deliver good results for viral, bacterial and protozoan material but have not been tested for blood-dwelling stages of nematodes. In this study Whatman FTA Elute (Whatman plc, Middlesex, UK) filter technology was tested for its ability to stabilise DNA from blood samples of dogs naturally infected with Dirofilaria repens for storage prior to PCR. The concentration of microfilariae per 100microl of blood was evaluated and the blood was diluted to determine the lowest detectable number of parasites by real-time PCR (qPCR). In parallel, negative dog blood was prepared in the same way. A parasitaemia of 6+/-0.43 larvae per 100microl of blood containing EDTA could be detected using the FTA Elute filter cards, although quantification of the larvae by using the qPCR was not possible. Inasmuch as the average microfilaremia in a pool of positive dogs was 311+/-21.72 larvae per 100microl, these cards provide an effective tool for parasitological field studies because blood samples are stable for extended periods of time at room temperature without loss of DNA integrity.