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Garnaud C, Fricker-Hidalgo H, Evengård B, Álvarez-Martínez MJ, Petersen E, Kortbeek LM, Robert-Gangneux F, Villena I, Costache C, Paul M, Meroni V, Guy E, Chiodini PL, Brenier-Pinchart MP, Pelloux H. Toxoplasma gondii-specific IgG avidity testing in pregnant women. Clin Microbiol Infect 2020; 26:1155-1160. [PMID: 32334096 DOI: 10.1016/j.cmi.2020.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The parasite Toxoplasma gondii can cause congenital toxoplasmosis following primary infection in a pregnant woman. It is therefore important to distinguish between recent and past infection when both T. gondii-specific IgM and IgG are detected in a single serum in pregnant women. Toxoplasma gondii-specific IgG avidity testing is an essential tool to help to date the infection. However, interpretation of its results can be complex. OBJECTIVES To review the benefits and limitations of T. gondii-specific avidity testing in pregnant women, to help practitioners to interpret the results and adapt the patient management. SOURCES PubMed search with the keywords avidity, toxoplasmosis and Toxoplasma gondii for articles published from 1989 to 2019. CONTENT Toxoplasma gondii-specific IgG avidity testing remains a key tool for dating a T. gondii infection in immunocompetent pregnant women. Several commercial assays are available and display comparable performances. A high avidity result obtained on a first-trimester serum sample is indicative of a past infection, which occurred before pregnancy. To date, a low avidity result must still be considered as non-informative to date the infection, although some authors suggest that very low avidity results are highly suggestive of recent infections depending on the assay. Interpretation of low or grey zone avidity results on a first-trimester serum sample, as well as any avidity result on a second-trimester or third-trimester serum sample, is more complex and requires recourse to expert toxoplasmosis laboratories. IMPLICATIONS Although used for about 30 years, T. gondii-specific avidity testing has scarcely evolved. The same difficulties in interpretation have persisted over the years. Some authors have proposed additional thresholds to exclude an infection of <9 months, or in contrast to confirm a recent infection. Such thresholds would be of great interest to adapt management of pregnant women and avoid unnecessary treatment; however, they need confirmation and further studies.
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Affiliation(s)
- C Garnaud
- Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France; Parasitology-Mycology, CHU Grenoble Alpes, Grenoble, France.
| | | | - B Evengård
- Department Clinical Microbiology, Umea University, Umea, Sweden
| | - M J Álvarez-Martínez
- Microbiology Department, Hospital Clínic-ISGLOBAL, University of Barcelona, Barcelona, Spain
| | - E Petersen
- Directorate General for Disease Surveillance and Control, Ministry of Health, Oman; Institute for Clinical Medicine, Faculty of Health Science, University of Aarhus, Denmark; ESCMID Emerging Infections Task Force, ESCMID, Basel, Switzerland
| | - L M Kortbeek
- National Institute for Public Health and the Environment; Centre for Infectious Disease Control (CIb) Bilthoven, the Netherlands
| | - F Robert-Gangneux
- Université Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé Environnement et Travail)-UMR_S 1085, Rennes, France
| | - I Villena
- Université Reims Champagne-Ardenne EA 7510, CHU Reims, Centre National de Référence de La Toxoplasmose, CRB Toxoplasma, Reims, France
| | - C Costache
- Microbiology Department 'Iuliu Hatieganu', University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - M Paul
- Department and Clinic of Tropical and Parasitic Diseases, University of Medical Sciences, Poznan, Poland
| | - V Meroni
- University Pavia Internal Medicine and Medical Therapy Department, Microbiology and Virology Department IRCCS, Foundation San Matteo Polyclinic, Pavia Italy
| | - E Guy
- Toxoplasma Reference Unit, Public Health Wales Microbiology, Swansea, UK
| | - P L Chiodini
- Hospital for Tropical Diseases and the London School of Hygiene and Tropical Medicine, London, UK
| | - M-P Brenier-Pinchart
- Parasitology-Mycology, CHU Grenoble Alpes, Grenoble, France; Université Grenoble Alpes, INSERM-CNRS, Institute for Advanced Biosciences, Grenoble, France
| | - H Pelloux
- Parasitology-Mycology, CHU Grenoble Alpes, Grenoble, France; Université Grenoble Alpes, INSERM-CNRS, Institute for Advanced Biosciences, Grenoble, France
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Suijkerbuijk AWM, van Gils PF, Bonačić Marinović AA, Feenstra TL, Kortbeek LM, Mangen MJJ, Opsteegh M, de Wit GA, van der Giessen JWB. The design of a Social Cost-Benefit Analysis of preventive interventions for toxoplasmosis: An example of the One Health approach. Zoonoses Public Health 2017; 65:185-194. [PMID: 29131528 DOI: 10.1111/zph.12417] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Indexed: 01/01/2023]
Abstract
Toxoplasma gondii infections cause a large disease burden in the Netherlands, with an estimated health loss of 1,900 Disability Adjusted Life Years and a cost-of-illness estimated at €44 million annually. Infections in humans occur via exposure to oocysts in the environment and after eating undercooked meat containing tissue cysts, leading to asymptomatic or mild symptoms, but potentially leading to the development of ocular toxoplasmosis. Infection in pregnant women can lead to stillbirth and disorders in newborns. At present, prevention is only targeted at pregnant women. Cat vaccination, freezing of meat destined for undercooked consumption and enhancing biosecurity in pig husbandries are possible interventions to prevent toxoplasmosis. As these interventions bear costs for sectors in society that differ from those profiting from the benefits, we perform a social cost-benefit analysis (SCBA). In an SCBA, costs and benefits of societal domains affected by the interventions are identified, making explicit which stakeholder pays and who benefits. Using an epidemiological model, we consider transmission of T. gondii after vaccination of all owned cats or cats at livestock farms. To identify relevant high-risk meat products that will be eaten undercooked, a quantitative microbial risk assessment model developed to attribute predicted T. gondii infections to specific meat products will be used. In addition, we evaluate serological monitoring of pigs at slaughter followed by an audit and tailor made advice for farmers in case positive results were found. The benefits will be modelled stochastically as reduction in DALYs and monetized in Euro's following reference prices for DALYs. If the balance of total costs and benefits is positive, this will lend support to implementation of these preventive interventions at the societal level. Ultimately, the SCBA will provide guidance to policy makers on the most optimal intervention measures to reduce the disease burden of T. gondii in the Netherlands.
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Affiliation(s)
- A W M Suijkerbuijk
- Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - P F van Gils
- Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - A A Bonačić Marinović
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - T L Feenstra
- Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Department of Epidemiology, University of Groningen, Groningen, The Netherlands
| | - L M Kortbeek
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - M-J J Mangen
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - M Opsteegh
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - G A de Wit
- Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J W B van der Giessen
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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3
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van der Snoek EM, Couwenberg SM, Stijnis C, Kortbeek LM, Schadd EM. Two cases of cutaneous leishmaniasis in Dutch military personnel treated with oral miltefosine. J ROY ARMY MED CORPS 2015; 163:68-70. [PMID: 26661280 DOI: 10.1136/jramc-2015-000530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/10/2015] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In the Netherlands, cutaneous leishmaniasis is most commonly seen in military personnel deployed on a mission or training abroad. The treatment of two Dutch soldiers who acquired cutaneous leishmaniasis with oral miltefosine was evaluated. Adverse effects were monitored and the improvement of skin lesions was assessed. CASE REPORTS A military nurse with a painless Chiclero's ulcer due to Leishmania (Viannia) braziliensis acquired in Belize and a military physical training instructor with itchy swelling and small ulcer of the back of his left elbow due to L. donovani/infantum complex acquired in Ibiza were treated with oral miltefosine 50 mg three times a day for 28 days. DISCUSSION Both patients responded well to oral miltefosine. Adverse effects were mild. Increase of creatinine levels was seen while liver transaminase levels were unremarkable. CONCLUSIONS Miltefosine proved to be a convenient, effective and well-tolerated treatment option in the treatment of cutaneous leishmaniasis in Dutch military personnel.
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Affiliation(s)
| | - S M Couwenberg
- Department of Dermatology, Central Military Hospital, Utrecht, The Netherlands
| | - C Stijnis
- Center for Tropical and Travel Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - L M Kortbeek
- Laboratory for Infectious Diseases and Perinatal Screening, RIVM, Bilthoven, The Netherlands
| | - E M Schadd
- Department of Internal Medicine, Central Military Hospital, Utrecht, The Netherlands
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Fournet N, Deege MP, Urbanus AT, Nichols G, Rosner BM, Chalmers RM, Gorton R, Pollock KG, van der Giessen JW, Wever PC, Dorigo-Zetsma JW, Mulder B, Mank TG, Overdevest I, Kusters JG, van Pelt W, Kortbeek LM. Simultaneous increase of Cryptosporidium infections in the Netherlands, the United Kingdom and Germany in late summer season, 2012. Euro Surveill 2013. [DOI: 10.2807/ese.18.02.20348-en] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- N Fournet
- These authors contributed equally to this work
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - M P Deege
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, the Netherlands
- Saltro Diagnostic Centre, Utrecht, the Netherlands
- These authors contributed equally to this work
| | - A T Urbanus
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - G Nichols
- Gastrointestinal, Emerging and Zoonotic Infections Department, Health Protection Agency Colindale, London, United Kingdom
| | - B M Rosner
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | - R M Chalmers
- Cryptosporidium Reference Unit, Public Health Wales, Swansea, United Kingdom
| | - R Gorton
- Health Protection Agency, North East Region, Newcastle, United Kingdom
| | - K G Pollock
- Health Protection Scotland, Glasgow, United Kingdom
| | - J W van der Giessen
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - P C Wever
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, ’s-Hertogenbosch, the Netherlands
| | - J W Dorigo-Zetsma
- Central Laboratory for Bacteriology and Serology, Tergooi ziekenhuizen, Hilversum/Almere, the Netherlands
| | - B Mulder
- Laboratory of Medical Microbiology and Public Health, Enschede, the Netherlands
| | - T G Mank
- Regional Laboratory for Medical Microbiology and Public Health, Haarlem, the Netherlands
| | - I Overdevest
- Laboratory for Medical Microbiology and Immunology, St Elisabeth Hospital, Tilburg, the Netherlands
| | - J G Kusters
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - W van Pelt
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - L M Kortbeek
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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5
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Fournet N, Deege MP, Urbanus AT, Nichols G, Rosner BM, Chalmers RM, Gorton R, Pollock KG, van der Giessen JW, Wever PC, Dorigo-Zetsma JW, Mulder B, Mank TG, Overdevest I, Kusters JG, van Pelt W, Kortbeek LM. Simultaneous increase of Cryptosporidium infections in the Netherlands, the United Kingdom and Germany in late summer season, 2012. Euro Surveill 2013; 18:20348. [PMID: 23324424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Starting August 2012, an increase in Cryptosporidium infections was reported in the Netherlands, the United Kingdom and Germany. It represented a 1.8 to 4.9-fold increase compared to previous years. Most samples were C. hominis IbA10G2. A case–control study was performed in the Netherlands but did not identify an endemic source. A case–case study in the north of England found travel abroad to be the most common risk factor.
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Affiliation(s)
- N Fournet
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Friesema IHM, Boer RF, Duizer E, Kortbeek LM, Notermans DW, Norbruis OF, Bezemer DDL, Heerbeek H, Andel RNJ, Enk JG, Fraaij PLA, Koopmans MPG, Kooistra-Smid AMD, Duynhoven YTHP. Etiology of acute gastroenteritis in children requiring hospitalization in the Netherlands. Eur J Clin Microbiol Infect Dis 2011; 31:405-15. [DOI: 10.1007/s10096-011-1320-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 06/08/2011] [Indexed: 12/01/2022]
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Pinelli E, Herremans T, Harms MG, Hoek D, Kortbeek LM. Toxocara and Ascaris seropositivity among patients suspected of visceral and ocular larva migrans in the Netherlands: trends from 1998 to 2009. Eur J Clin Microbiol Infect Dis 2011; 30:873-9. [PMID: 21365288 DOI: 10.1007/s10096-011-1170-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 01/07/2011] [Indexed: 10/18/2022]
Abstract
Toxocara canis, Toxocara cati and Ascaris suum are roundworms of dogs, cats and pigs, respectively, that can also infect humans. These zoonotic helminths have a worldwide distribution and are also endemic in the Netherlands. Infection with Toxocara sp. may result in visceral larva migrans (VLM) or ocular larva migrans (OLM) caused by the migrating larvae. Although A. suum has been reported to occasionally mature to the adult stage in humans, clinical cases of VLM suspected to be caused by A. suum have been described. Diagnosis of these helminth infections relies mainly on serology. Here we analyse the results from the Toxocara and Ascaris IgG-ELISA from a total of 2,838 serum samples from VLM and OLM suspected patients that were sent to our institution from 1998 to 2009. Results indicate that for each year the Ascaris seropositivity is significantly higher compared to the Toxocara seropositivity. Furthermore, while Toxocara seropositivity has decreased over time, the Ascaris seropositivity has not significantly changed for the past 12 years. The Ascaris and Toxocara seropositivity was also shown to increases with age and, while gender has no influence on the Ascaris seropositivity, males showed higher Toxocara seropositivity.
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Affiliation(s)
- E Pinelli
- National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control Netherlands, P.O. Box 1, 3720, BA Bilthoven, The Netherlands.
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Kortbeek LM, Hofhuis A, Nijhuis CDM, Havelaar AH. Congenital toxoplasmosis and DALYs in the Netherlands. Mem Inst Oswaldo Cruz 2010; 104:370-3. [PMID: 19430666 DOI: 10.1590/s0074-02762009000200034] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Accepted: 03/11/2009] [Indexed: 11/21/2022] Open
Abstract
The calculation of disability-adjusted life years (DALYs) enables public health policy makers to compare the burden of disease of a specific disease with that of other (infectious) diseases. The incidence of a disease is important for the calculation of DALYs. To estimate the incidence of congenital toxoplasmosis (CT), a random sample of 10,008 dried blood spot filter paper cards from babies born in 2006 in the Netherlands were tested for Toxoplasma gondii-specific IgM antibodies. Eighteen samples were confirmed as positive for IgM, resulting in an observed birth incidence of CT of 1.8 cases per 1,000 live-born children in 2006 and an adjusted incidence of 2.0 cases per 1,000. This means that 388 infected children were born in 2006. The most likely burden of disease is estimated to be 2,300 DALYs (range 820-6,710 DALYs). In the previous calculations, using data from a regional study from 1987, this estimate was 620 DALYs (range 220-1,900 DALYs). The incidence of CT in the Netherlands is much higher than previously reported; it is 10 times higher than in Denmark and 20 times higher than in Ireland, based on estimates obtained using the same methods. There is no screening program in the Netherlands; most children will be born asymptomatic and therefore will not be detected or treated.
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Affiliation(s)
- L M Kortbeek
- Laboratory for Infectious Diseases and Perinatal Screening, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and Environment, BA Bilthoven, the Netherlands.
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van der Snoek EM, Lammers AM, Kortbeek LM, Roelfsema JH, Bart A, Jaspers CAJJ. Spontaneous cure of American cutaneous leishmaniasis due toLeishmania naiffiin two Dutch infantry soldiers. Clin Exp Dermatol 2009; 34:e889-91. [DOI: 10.1111/j.1365-2230.2009.03658.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pinelli E, Willers SM, Hoek D, Smit HA, Kortbeek LM, Hoekstra M, de Jongste J, van Knapen F, Postma D, Kerkhof M, Aalberse R, van der Giessen JWB, Brunekreef B. Prevalence of antibodies against Ascaris suum and its association with allergic manifestations in 4-year-old children in The Netherlands: the PIAMA birth cohort study. Eur J Clin Microbiol Infect Dis 2009; 28:1327-34. [PMID: 19644714 DOI: 10.1007/s10096-009-0785-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 07/11/2009] [Indexed: 11/28/2022]
Abstract
The association between helminth infections and childhood atopic diseases remains controversial. The majority of studies have been carried out in tropical areas, whereas less information is available from western countries with low intensity of helminth infections. In the Netherlands, the infection of pigs with Ascaris suum is very common, particularly on pig farms with outdoor facilities. This helminth can also infect humans, causing visceral larva migrans. This study aims at determining the prevalence of antibodies against A. suum and its association with allergic symptoms and sensitisation in a population of 4-year-old children living in The Netherlands. Blood samples from 629 children from the prospective birth cohort Prevention and Incidence of Asthma and Mite Allergy (PIAMA) study were examined for Ascaris antibodies. Data on allergic symptoms and sensitisation were collected using questionnaires and radioallergosorbent tests (RAST). A total of 45 out of 629 (7%) were found to be Ascaris-seropositive. In addition, a positive association between Ascaris seropositivity and wheeze in the last year, doctor-diagnosed asthma and food and aero-allergen sensitisation was found. These results support the hypothesis that low-level or transient infection with helminths enhances allergic reactivity.
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Affiliation(s)
- E Pinelli
- Department of Parasitology and Mycology, Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, Centre for Infectious Disease Control Netherlands, National Institute of Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.
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Bowles EC, Hillenius JM, Biesma DH, Kortbeek LM, de Jongh BM. [Postnatal ocular toxoplasmosis in a grown woman]. Ned Tijdschr Geneeskd 2009; 153:292-296. [PMID: 19291946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Edmée C Bowles
- Afd. Medische Microbiologie en Immunologie, St. Antonius Ziekenhuis, Nieuwegein.
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Pinelli E, Mommers M, Kortbeek LM, Castagna B, Piergili-Fioretti D, Bruschi F. Specific IgG4 response directed against the 45-kDa glycoprotein in trichinellosis: a re-evaluation of patients 15 years after infection. Eur J Clin Microbiol Infect Dis 2007; 26:641-5. [PMID: 17610096 DOI: 10.1007/s10096-007-0349-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate the humoral immune response in late human trichinellosis with particular attention to the presence of IgG4 antibodies directed against the Trichinella-45-kDa glycoprotein (gp). This study re-evaluates subjects 15 years after they were involved in a trichinellosis outbreak that occurred in Central Italy following the consumption of raw boar meat infected with Trichinella britovi. The results show that ELISA tests using the E/S antigen identified five IgM- and eight IgG-positive patients and no IgA-positive patients. Tests using immunoblot (IB) with E/S antigens identified three IgM-, five IgA-, seven- IgG1- and three IgG4-positive sera. When the purified 45-kDa gp was used as an antigen, the IB revealed that six of the ten sera tested were positive for IgG4. Sera were also evaluated with a commercial kit, revealing that 11 of 12 patients had a highly sensitive reactivity against Trichinella proteins (64 and 44-43 kDa). In conclusion, humoral immune response against Trichinella is still present in these patients 15 years after the initial infection, including an IgG4 response directed to the 45-kDa gp.
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Affiliation(s)
- E Pinelli
- Department of Parasitology, Diagnostic Laboratory for Infectious Diseases and Perinatal Screening (LIS), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Abstract
Although the outcomes of toxoplasmosis have been well documented, an integrated estimate of the impact of this infection on the health status of the population is not available. "Disability-adjusted life years" are the sum of years of life lost and years lived with disability, weighted for the severity of the illness. The estimated disease burden of congenital toxoplasmosis in The Netherlands is 620 (range, 220-1900) disability-adjusted life years per year, which is similar to that for salmonellosis and is mainly caused by fetal loss and chorioretinitis. However, there is considerable uncertainty in this estimate. Scenario analysis indicates that the true burden may be underestimated. In other countries, the disease burden is expected to vary with the incidence of congenital infection, but it may also depend on the health care system. In countries that actively screen for toxoplasmosis, such as France, there may be a lower burden of morbidity but a higher burden of mortality.
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Affiliation(s)
- A H Havelaar
- National Institute for Public Health and the Environment, Netherlands Center for Infectious Disease Control, Bilthoven, The Netherlands.
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14
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van der Giessen JWB, de Vries A, Roos M, Wielinga P, Kortbeek LM, Mank TG. Genotyping of Giardia in Dutch patients and animals: a phylogenetic analysis of human and animal isolates. Int J Parasitol 2006; 36:849-58. [PMID: 16701663 DOI: 10.1016/j.ijpara.2006.03.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 02/26/2006] [Accepted: 03/02/2006] [Indexed: 11/30/2022]
Abstract
Giardia duodenalis (syn. Giardia lamblia, Giardia intestinalis) is a protozoan organism that can infect the intestinal tract of many animal species including mammals. Genetic heterogeneity of G. duodenalis is well described but the zoonotic potential is still not clear. In this study, we analysed 100 Giardia DNA samples directly isolated from human stool specimens, to get more insight in the different G. duodenalis assemblages present in the Dutch human population. Results showed that these human isolates could be divided into two main Assemblages A and B within the G. duodenalis group on the basis of PCR assays specific for the Assemblages A and B and the DNA sequences of 18S ribosomal RNA and the glutamate dehydrogenase (gdh) genes. Genotyping results showed that G. duodenalis isolates originating from Dutch human patients belonged in 35% of the cases to Assemblage A (34/98) and in 65% of the cases to Assemblage B (64/98) whereas two human cases remained negative in all assays tested. In addition, we compared these human samples with animal samples from the Netherlands and human and animal samples from other countries. A phylogenetic analysis was carried out on the DNA sequences obtained from these Giardia and those available in GenBank. Using gdh DNA sequence analysis, human and animal Assemblage A and B Giardia isolates could be identified. However, phylogenetic analysis revealed different sub-clustering for human and animal isolates where host-species-specific assemblages (C, D, E, F and G) could be identified. The geographic origin of the human and animal samples was not a discriminating factor.
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Affiliation(s)
- J W B van der Giessen
- National Institute for Public Health and the Environment (RIVM), Microbiological Laboratory for Health Protection, Antonie van Leeuwenhoeklaan 9, P.O. Box 1, Bilthoven, The Netherlands.
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Abstract
A male patient developed acute pulmonary histoplasmosis 2 weeks after bathing in the water falls of Wli, Ghana. Exposure to Histoplasma capsulatum was probably mediated through inhalation of an aerosol of water and guano from the large colony of fruit bats of the falls. More cases of acute pulmonary histoplasmosis can be expected.
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Affiliation(s)
- P J de Vries
- Division of Infectious Diseases, Tropical Medicine and AIDS, Department of Internal Medicine, Academic Medical Center, 1100 DE Amsterdam, The Netherlands.
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van Duynhoven YTHP, de Jager CM, Kortbeek LM, Vennema H, Koopmans MPG, van Leusden F, van der Poel WHM, van den Broek MJM. A one-year intensified study of outbreaks of gastroenteritis in The Netherlands. Epidemiol Infect 2005; 133:9-21. [PMID: 15724705 PMCID: PMC2870216 DOI: 10.1017/s0950268804002936] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In 2002, in The Netherlands a national study of gastroenteritis outbreaks was performed. Epidemiological information was collected by the Public Health Services (PHS) and the Food Inspection Services (FIS) using standardized questionnaires. Stool samples were collected for diagnostic testing. For foodborne outbreaks, food samples were taken. In total, 281 gastroenteritis outbreaks were included, mainly from nursing homes and homes for the elderly (57%), restaurants (11%), hospitals (9%) and day-care centres (7%). Direct person-to-person spread was the predominant transmission route in all settings (overall 78%), except for restaurant outbreaks where food was suspected in almost 90% (overall in 21% of outbreaks). The most common pathogen was norovirus (54%), followed by Salmonella spp. (4%), rotavirus group A (2%), Campylobacter spp. (1%) and only incidentally others. In conclusion, most outbreaks were reported from health and residential institutions, with norovirus as the dominant agent. Control should aim at reducing person-to-person spread. In foodborne outbreaks norovirus was common, due to contamination of food by food handlers. Salmonella, as the second foodborne pathogen, was mainly associated with raw shell eggs. These results stress the continuous need for food safety education, complementary to governmental regulation.
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Affiliation(s)
- Y T H P van Duynhoven
- Centre for Infectious Disease Epidemiology, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
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17
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Abstract
During 1995--1996 a population-based seroprevalence study was conducted in The Netherlands. Risk factors were established for postnatally acquired toxoplasmosis. The results were compared with a study conducted during 1987-1988 in pregnant women in the Southwest of The Netherlands in order to estimate the change in seroprevalence. In total, 7521 sera were tested and the national seroprevalence was 40.5 % (95 % CI 37.5-43.4). Living in the Northwest, having professional contact with animals, living in a moderately urbanized area, being divorced or widowed, being born outside The Netherlands, frequent gardening and owning a cat were independently associated with Toxoplasma seropositivity. Risk factors like eating undercooked meat could not be studied. The seroprevalence among women aged 15-49 years was 10 % lower (35.2 %, 95 % CI 32.9-38.6) in the study of 1995-1996, compared to the Toxoplasma study of 1987--1988 (45.8 %, 95 % CI 45.2-46.3). The steepest rise in seroprevalence still occurred among the subjects aged 25-44 years.
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Affiliation(s)
- L M Kortbeek
- Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, National Institute of Public Health and the Environment, 3720 BA Bilthoven, The Netherlands.
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Pinelli E, Mommers M, Homan W, van Maanen T, Kortbeek LM. Imported Human Trichinellosis: Sequential IgG4 Antibody Response to Trichinella spiralis. Eur J Clin Microbiol Infect Dis 2004; 23:57-60. [PMID: 14608495 DOI: 10.1007/s10096-003-1039-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Two out of five members of one household presented with clinical signs of trichinellosis after their return to the Netherlands. The family had consumed Trichinella-infected pork in Montenegro, formerly Yugoslavia. Serological tests were performed at 1, 2, 6, and 18 months after ingestion of the infected meat. Trichinella-specific IgM, IgG, and IgA antibodies measured in sera from symptomatic and asymptomatic patients remained positive up to 18 months after ingestion. The measured IgG4 antibody response directed to a 45 kDa Trichinella spiralis antigen also persisted 18 months after ingestion for three of the family members.
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Affiliation(s)
- E Pinelli
- Department of Parasitology and Mycology, National Institute of Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands.
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de Wit MA, Kortbeek LM, Koopmans MP, de Jager CJ, Wannet WJ, Bartelds AI, van Duynhoven YT. A comparison of gastroenteritis in a general practice-based study and a community-based study. Epidemiol Infect 2001; 127:389-97. [PMID: 11811870 PMCID: PMC2869762 DOI: 10.1017/s0950268801006082] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We compared gastroenteritis cases that consulted a general practitioner (GP) with those who did not in a community-based study and also with those in a GP-based study. We aimed to identify factors associated with consultation, and with inclusion of cases by GPs, and secondly to study the effects on the frequency of detection of pathogens. Furthermore, we estimated the under-ascertainment by GPs. Both studies were performed in The Netherlands in the same population in an overlapping time-period. Overall, 5% of community cases consulted a GP. Cases who consulted suffered from more severe episodes than non-consulting cases. Inclusion of cases by GPs, instead of a study team, caused a selection of more severe cases with more chronic symptoms. When extrapolating data from GP-based studies, it should be taken into account that, in general practice, gastroenteritis due to bacteria and Giardia lamblia is a relatively large proportion of that in the community and gastroenteritis due to Norwalk-like viruses is a relatively small proportion. The incidence of gastroenteritis in general practices was estimated between 14 and 35 per 1000 person years.
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Affiliation(s)
- M A de Wit
- Department of Infectious Diseases Epidemiology, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
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de Wit MA, Koopmans MP, Kortbeek LM, Wannet WJ, Vinjé J, van Leusden F, Bartelds AI, van Duynhoven YT. Sensor, a population-based cohort study on gastroenteritis in the Netherlands: incidence and etiology. Am J Epidemiol 2001; 154:666-74. [PMID: 11581101 DOI: 10.1093/aje/154.7.666] [Citation(s) in RCA: 384] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A prospective population-based cohort study with a nested case-control study was conducted to estimate the incidence of gastroenteritis and the associated pathogens in the general Dutch population. Follow-up of two consecutive cohorts was performed by weekly reporting cards from December 1998 to December 1999. Cases and controls in the case-control study supplied a questionnaire and stool samples. The standardized gastroenteritis incidence was 283 per 1,000 person-years. The incidence rose with increasing level of education and was higher for persons with a history of diarrhea and for young children. Bacterial pathogens accounted for 5% of cases, bacterial toxins for 9%, parasites for 6%, and viral pathogens for 21%, with Norwalk-like virus (NLV) as the leading pathogen in 11% of cases. The gastroenteritis incidence was higher than that reported for England, but lower than for the United States. In community cases, viral pathogens are the leading cause of gastroenteritis, with NLV being the number one cause of illness in all age groups but one. In many countries, preventive measures are implemented to decrease bacterial infections. However, additional prevention of viral infections, especially NLV, might significantly decrease the number of gastroenteritis cases in the community.
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Affiliation(s)
- M A de Wit
- Department of Infectious Diseases Epidemiology, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
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21
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Straathof CS, Kortbeek LM, Roerdink H, Sillevis Smitt PA, van den Bent MJ. A solitary spinal cord toxoplasma lesion after peripheral stem-cell transplantation. J Neurol 2001; 248:814-5. [PMID: 11596790 DOI: 10.1007/s004150170101] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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de Wit MA, Koopmans MP, Kortbeek LM, van Leeuwen NJ, Vinjé J, van Duynhoven YT. Etiology of gastroenteritis in sentinel general practices in the netherlands. Clin Infect Dis 2001; 33:280-8. [PMID: 11438890 DOI: 10.1086/321875] [Citation(s) in RCA: 167] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2000] [Revised: 11/14/2000] [Indexed: 11/03/2022] Open
Abstract
Data from a general practice-based, case-control study on gastroenteritis and the pathogens related to this disease were used to study the association between specific pathogens and the infected patients' ages and symptoms. For comparison, the occurrence of these pathogens in control patients, stratified by age, also is presented. In children with gastroenteritis who were <5 years of age, rotavirus (in 21% of patients) and Norwalk-like virus (NLV; in 15%) were the most common pathogens. Among patients who were 5-14 years of age, Campylobacter species (in 16% of patients) and Giardia lamblia (in 10%) were the most common pathogens. In the older patients, Campylobacter species was also the most common pathogen (8% to 15% of patients). In addition, several symptoms in case patients were associated with specific pathogens. Blood in the stool was associated with infection with Campylobacter species. In patients with fever, Salmonella species, Campylobacter species, and rotavirus were detected relatively often. Vomiting was associated with NLV and rotavirus. This is the first study in The Netherlands and one of the first studies in the world that has investigated a broad range of pathogens recovered from an unselected population of patients who had consulted general practitioners because of gastroenteritis.
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Affiliation(s)
- M A de Wit
- Department of Infectious Diseases Epidemiology, National Institute of Public Health and the Environment, 3720 BA Bilthoven, The Netherlands.
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23
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Abstract
The antibody isotype response to Trichinella spiralis excretory/secretory (ES) products of muscle larva was examined using sera from patients with confirmed trichinellosis. Using Western blots we identify components of the ES antigen that are recognized by IgM and IgG antibodies. A 45 kDa component was strongly recognized by different antibody classes and subclasses. We observed a 45 kDa-specific IgG4 response that was detected exclusively using sera of patients with trichinellosis and not of patients with echinococcosis, filariasis, cysticercosis, ascariasis, strongyloidiasis or toxocariasis. These results are relevant for the diagnosis of human trichinellosis.
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Affiliation(s)
- E Pinelli
- Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, National Institute of Public Health and the Environment (RIVM), Bilthaven, The Netherlands.
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de Vries PJ, Kerst JM, Kortbeek LM. [Migrating swellings from Asia: gnathostomiasis]. Ned Tijdschr Geneeskd 2001; 145:322-5. [PMID: 11234296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Two patients suffered from intermittent subcutaneous swellings of the face. A 41-year-old man recalled a recent episode with severe thoracic pain and at that time pleurisy was documented. In this patient there was pronounced eosinophilia. The other was a 32-year-old woman. Both patients had traveled to southeast Asia. Antibodies against Gnathostoma spinigerum were detectable in both patients. The first patient was treated with albendazole 200 b.i.d. for three weeks, but because of recurrent facial swelling, he was treated again with albendazole at a higher dose: 400 b.i.d. for eight weeks, which the swellings did not recur. The second patient was not treated because the frequency of the swellings had already decreased spontaneously. Gnathostomiasis is an infection by the nematode G. spinigerum. The main route of human infection is by eating insufficiently not well-cooked fish or frog. The initial infection is often not recognised, but severe symptoms can occur. In humans, the larva of the nematode does not develop further but may wander through the subcutaneous tissues. Untreated, the infection usually runs a mild, self limiting course, but complications such as invasion of the central nervous system or of the eye have been described. Treatment with albendazole reduces recurrence of swellings.
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Affiliation(s)
- P J de Vries
- Afd. Inwendige Geneeskunde, onderafd. Infectieziekten, Tropische Geneeskunde & Aids, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ Amsterdam.
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25
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Abstract
From 1996 to 1999, the incidence of gastroenteritis in general practices and the role of a broad range of pathogens in the Netherlands were studied. All patients with gastroenteritis who had visited a general practitioner were reported. All patients who had visited a general practitioner for gastroenteritis (cases) and an equal number of patients visiting for nongastrointestinal symptoms (controls) were invited to participate in a case-control study. The incidence of gastroenteritis was 79.7 per 10,000 person years. Campylobacter was detected most frequently (10% of cases), followed by Giardia lamblia (5%), rotavirus (5%), Norwalk-like viruses (5%) and Salmonella (4%). Our study found that in the Netherlands (population 15.6 million), an estimated 128,000 persons each year consult their general practitioner for gastroenteritis, slightly less than in a comparable study in 1992 to 1993. A pathogen could be detected in almost 40% of patients (bacteria 16%, viruses 15%, parasites 8%).
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Affiliation(s)
- M A de Wit
- National Institute of Public Health and the Environment, Department of Infectious Diseases Epidemiology, PO Box 1, 3720 BA Bilthoven, The Netherlands.
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26
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Ongkosuwito JV, Kortbeek LM, Van der Lelij A, Molicka E, Kijlstra A, de Smet MD, Suttorp-Schulten MS. Aetiological study of the presumed ocular histoplasmosis syndrome in the Netherlands. Br J Ophthalmol 1999; 83:535-9. [PMID: 10216050 PMCID: PMC1723054 DOI: 10.1136/bjo.83.5.535] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To investigate whether presumed ocular histoplasmosis syndrome in the Netherlands is caused by Histoplasma capsulatum and whether other risk factors might play a role in the pathogenesis of this syndrome. METHODS 23 patients were clinically diagnosed as having presumed ocular histoplasmosis syndrome based on the following criteria: peripapillary atrophy, punched out lesions, a macular disciform lesion or scar in one eye without vitritis. As controls, 66 sex and age matched healthy volunteers were used. Serum samples from both patients and controls were tested for the presence of antibodies against H capsulatum, Toxoplasma gondii, Toxocara canis et cati, Ascaris sp, and for the presence of antigens of Cryptococcus neoformans. Serum samples were also tested for the presence of autoantibodies against retinal or choroidal proteins. To investigate other risk factors, patients and controls were asked to fill in a health and travel related questionnaire. Ten patients with ocular toxoplasmosis were used as a disease control group. RESULTS None of the patients with presumed ocular histoplasmosis syndrome or controls had circulating antibodies directed against H capsulatum. No risk factors could be identified and no indications for autoimmunity and no evidence for the role of the other infectious agents could be demonstrated. CONCLUSIONS In a Dutch group of patients fulfilling the criteria of a disease currently named presumed ocular histoplasmosis syndrome, no risk factors or relation with the fungus H capsulatum could be detected.
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Affiliation(s)
- J V Ongkosuwito
- Department of Ophthalmo-Immunology, Netherlands Ophthalmic Research Institute, Amsterdam, Netherlands
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Abstract
The incidence of patent Toxocara canis infection as result of reactivation of somatic larvae with subsequent tracheal migration was investigated by faecal examination during 23 oestrous cycles of 15 bitches. Blood samples were collected for determination of total and differential leukocyte counts, prolactin concentration, and Toxocara titre. Five pregnant dogs were used as controls. In the cyclic dogs there were no alterations in white blood cell counts or prolactin concentration, in contrast with the pregnant dogs, in which both variables increased, starting 10 days after onset of the luteal phase. The difference was significant at day 40 and day 60 (both p < 0.005). No significant differences were observed in the number of eosinophils or in the Toxocara antibody titre. T. canis eggs were only found in the faeces of three 1-year-old, cyclic dogs at 1, 60, and 140 days, respectively, after the onset of the luteal phase. It is concluded that cyclic beagle bitches, in which prolactin levels increase in the second half of the luteal phase, are unlikely to be at higher risk for patent T. canis infection than in other phases.
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28
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Brouwer RE, Kortbeek LM, van Knapen F, Overbosch D. [Neurocysticercosis]. Ned Tijdschr Geneeskd 1995; 139:2721-5. [PMID: 8569885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- R E Brouwer
- Rode Kruis Ziekenhuis, afd. Interne Geneeskunde, Den Haag
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Schneeberger PM, Kortbeek LM, Schneider MM, Geelen SP, van Leeuwen MS, Hoepelman IM. [Poor results of treatment of echinococcosis with albendazole in 7 patients]. Ned Tijdschr Geneeskd 1994; 138:460-3. [PMID: 8133947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To assess the effect of treatment of echinococcal disease with albendazole, a drug recently licensed in the Netherlands for this treatment. SETTING The University Hospital Utrecht and the Wilhelmina Children's Hospital, Utrecht. DESIGN Follow-up study. METHOD Clinical symptoms, serology and size and morphology of cysts of all patients (n = 7) treated with albendazole with a therapeutical dose (10 mg/kg for adults and 6 mg/kg for children in two daily doses during three cycles of 28 days) were monitored for at least one year. RESULTS Two patients improved, two patients did not show any change, and the condition of three patients deteriorated. CONCLUSION The efficacy of albendazole treatment with this regimen for hydatid disease is disappointing. If patients are treated with albendazole, the total dose administered to adults should be more than 80 g.
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Affiliation(s)
- P M Schneeberger
- Academisch Ziekenhuis, Eijkman-Winkler Laboratorium voor Medische Microbiologie, Utrecht
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Kortbeek LM, van Knapen F, Polderman AM, Verwey JJ. [Echinococcosis in The Netherlands, 1987-1991]. Ned Tijdschr Geneeskd 1993; 137:2715-6. [PMID: 8289945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- L M Kortbeek
- Rijksinstituut voor Volksgezondheid en Milieuhygiëne, Laboratorium voor Parasitologie en Mycologie, Bilthoven
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Abstract
Six fresh Giardia lamblia strains were isolated by in vitro excystation and subsequent culturing of excysted parasites in bile-supplemented BI-S-33 medium. The cysts passed in faeces appeared to differ in structure when observed using differential interference contrast microscopy. Sometimes the enclosed organisms were closely applied to the cyst wall; in most stool specimens, however, the parasites were separated from the cyst wall by a space. Cysts with parasites closely applied to the wall were the most viable type, with excystation rates up to 90%. Cysts with organisms detached from the wall displayed low excystation rates, 0-15%. During exposure to the induction solution of hydrochloric acid (pH 2), parasites initially closely applied to the cyst walls completely detached, and after transfer into culture medium vigorous flexing movements of the organisms were observed. Stool samples from 42 symptomatic and asymptomatic giardiasis patients were examined; in 26 of the samples parasites hatched, and 6 new strains were established in axenic culture.
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Affiliation(s)
- M A Hautus
- Laboratory of Parasitology, University of Amsterdam, The Netherlands
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